Continuous spinal anesthesia/analgesia vs. single-shot spinal anesthesia with patient-controlled analgesia for elective hip arthroplasty

BACKGROUND: In total hip replacement surgery several anesthesiological techniques can be used. In this study we compared continuous spinal anesthesia (CSA) and postoperative analgesia vs. single-shot spinal anesthesia (SPA) and postoperative patient-controlled intravenous analgesia with morphine (SPA). METHODS: In a prospective randomized study, 68 patients, ASA I-III, between 50 and 85 years of age were allocated to these two groups. Quality of analgesia, hemodynamic stability and technical difficulties, as well as incidence of postoperative nausea and vomiting (PONV) and post dural puncture headache (PDPH), were recorded during a 24-h period. RESULTS: Visual analog scale (VAS) scores were significantly lower in the CSA group from 3 h post operation (P < 0.05). Mean arterial pressure dropped by 21 +/- 11 mmHg in the CSA group and 29 +/- 14 in the SPA group during induction (P < 0.05). Technical difficulties and incidence of PDPH were similar in both groups. Postoperative nausea and vomiting was lower in the CSA group (P < 0.05). CONCLUSIONS: Continuous spinal anesthesia/analgesia is a very practicable method providing better postoperative analgesia and better hemodynamic stability during anesthesia induction than SPA followed by morphine PCA analgesia after total hip replacement surgery.     

Continuous infusion epidural analgesia in obstetrics

The effects of 0.08% (Group A) and 0.25% (Group B) solutions of bupivacaine were compared in a random manner, to assess continuous pump infusion epidural analgesia in labour. Both solutions were infused at a dose rate of 20 mg bupivacaine/hour. The results in all the mothers who had received infusions lasting more than 4 hours were studied. There were 25 in Group A and 28 in Group B. Any treatment during the infusion epidural for inadequate analgesia, hypotension, etc., was recorded as an intervention. The mean of the intervention-free intervals was significantly greater in Group A than in Group B, and significantly fewer top-up injections were required in Group A. The results show that the administration of a 0.08% solution of bupivacaine into the epidural space by continuous pump infusion is more labour saving than the infusion of a 0.25% solution. The concept that a greater volume infusion rate maintains a more extended liquid sleeve of local anaesthetic in the epidural space is supported.     

Debate on use of spinal anesthesia in obstetrics: spinal anesthesia has definite indications in obstetrics

Spinal anesthesia has the advantages of speed of onset, reliability and lack of toxicity over lumbar epidural block. Against this must be offset several disadvantages, but these can be largely eliminated by careful choice of equipment and meticulous attention to details of technique. Only experienced obstetric anesthetists should perform spinal anesthesia, especially for Caesarean section. Given these conditions, spinal block has a most important part to play in obstetric anesthesia.