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Combined spinal-epidural anaesthesia for large orthopaedic surgery

Dariusz Piotrowski, Krzysztof Ulbrich, Zbigniew Kaszyński, Wojciech Gaszyński, Piotr Skiba

Med Sci Monit 1999; 5(5): CR934-939 :: ID: 503418

Abstract

The study is a presentation of our own experience with the use of combined spinal-epidural anaesthesia (CSEA) in patients subjected to surgery in the Department of Traumatic, Field Surgery and Orthopaedics, Military Medical University in ü—d. Anaesthesia was performed in 292 patients aged 30-84 years, who were subjected to the grafting of hip joint endoprosthesis and to bloody repositioning of femoral diaphysis fracture. CSEA anaesthesia was induced with Espocan set manufactured by B. BRAUN using a 'needle through needle' method. 3-4 ml 0.5% bupivacaine (Marcain spinal, ASTRA) was administered to subarachnoid space, after which an extradural catheter was introduced cephalad. The following were evaluated: time during which sensory blockade was obtained, the scope of anaesthesia, the degree of motor blockade, HR, SAP, DAP, SpO2. In 38 patients (13%), anaesthesia had to be prolonged with 12 ml 0.5% bupivacaine administered to subarachnoid space. After the procedure, extradural catheter was used for analgesia with morphine or fentanyl. Minor headache of short duration was observed in 18 patients (6.1%), while 42 patients (14.4%) complained of back aches. On the basis of the results obtained, it was found that CSEA is a safe and easy method of anaesthesia to be performed by experienced anaesthetist. Fast and reliable blockade results in sufficient muscle relaxation. It allows to extend the scope and duration of anaesthesia as well as to use post-operative analgesia with opioids administered to extradural space.

Keywords: Fentanyl, Morphine, post-operative analgesia, combined spinal-epidural anaesthesia, orthopaedic surgery

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750