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Kaudalinė ir mažų hiperbarinio bupivakaino dozių spinalinė anestezijos darant anorektalines operacijas (klinikinis atsitiktinių imčių tyrimas)

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dc.contributor.author Gudaitytė, Jūratė
dc.date.accessioned 2017-08-21T08:06:55Z
dc.date.available 2017-08-21T08:06:55Z
dc.date.issued 2005
dc.identifier.uri http://repository.lsmuni.lt/handle/1/60017
dc.description.abstract The aim of the randomized controlled trial was to test the hypothesis that caudal and minimal effective spinal hyperbaric bupivacaine anaesthesia produce similar level of blockade and can be recommended as alternative methods for adult anorectal surgery. The objectives of the study were as follows: 1. To assess caudal blockade in terms of the rate of success, level and duration of sensory and motor block, clinical profile, and quality of anaesthesia. 2. To determine minimal effective dose of spinal hyperbaric bupivacaine in a randomized, double-blinded controlled trial comparing the clinical effects and quality of sensory and motor block of 7.5 mg, 5 mg, and 4 mg doses of spinal hyperbaric bupivacaine. 3. To study the difference of effects of caudal and low-dose spinal hyperbaric bupivacaine blockade with respect to the rate of success, technical characteristics, level and duration of sensory and motor blockade in a randomized controlled trial. 4. To study the effect of caudal and low-dose spinal hyperbaric bupivacaine blockade on changes in mean arterial blood pressure (BP) and heart rate (HR), rate of postoperative complications and quality of anaesthesia according to the patient and medical staff. Methods. Three separate studies were carried out including 322 adult patients. (1) Caudal blockade for adult anorectal study, a pilot study (1 st study). During the period of 01.2001-06.2002 56 patients were involved, a single shot caudal block was made with 22G 40 mm needle and injection of 10 ml of 2% lidocaine and 10 ml of 0.5% bupivacaine. (2) The randomized controlled, double-blinded trial of minimal dose spinal hyperbaric bupivacaine (2nd study) 09.2003-12.2004 included 152 patients. The aim was to find minimal effective dose of spinal hyperbaric bupivacaine for anorectal surgery by injecting randomly 7.5, 5, and 4 mg doses of spinal hyperbaric bupivacaine and study their clinical profile and quality of anaesthesia. Patients had dural puncture with 25-26G spinal Tamanho needle (BBraun, Germany) and injection over 2 minutes of 0.5% spinal hyperbaric bupivacaine 1.5 ml (group S7.5, n=18), 1.0 ml (group S5, n=67) and 0.8 ml (group S4, n=67). Ten minutes after the dural puncture, patients were asked to lye down, and the dermatome level of sensory block was tested with alcohol swab. Motor block was tested with modified Bromage scale (score 0- no motor block, 1 – able to flex ankle and bend knees, 2 –able to flex ankle, 3- full motor block), and surgery was started. Groups were compared with respect to the rate of success, level and duration of sensory and motor block, time to ambulation and urination, changes in mean BP and HR, postoperative pain, complications, and quality of anaesthesia according to the patient and medical staff. (3) A randomized clinical trial of caudal and low-dose spinal hyperbaric bupivacaine blockade. The aim of the 3rd, randomized controlled study was to compare caudal and low-dose spinal hyperbaric bupivacaine anaesthesia with respect to the rate of success, supplementary analgesia, level and duration of sensory and motor blockade, changes in mean BP and HR, complications and quality of anaesthesia according to the patient and medical staff. The study was carried out in 09.2004-03.2005 and included 114 patients. Patients randomly got either spinal blockade with 1.0 ml of 0.5% hyperbaric bupivacaine (group S5, n=38) or 0.8 ml (group S4, n=38), or caudal blockade with 7.5 ml of 2% lidocaine+7.5 ml of 0.5% bupivacaine +epinephrine 5 μg/ml+saline to total volume of 20 ml (group K, n=38). Results (1) The rate of success of caudal blockade was 87,5%. Changes of haemodynamics were clinically insignificant with reduction of arterial BP and HR over 20% registered in 8.16% of cases. Successful caudal blocks were uncomplicated in 65.31% of cases. Complications after caudal blockade were as follows: epidural vein puncture (6.12% of cases), paraesthesias during injection (6.12%), urinary retention (8.16%), and motor block in legs (14.29%). Mean duration of postoperative analgesia was 7.84±4.01 h. (2) Groups were comparable in demographics. Three patients were excluded due to unsuccessful block, the rate of successs being 98%. Mean level of sensory block was 10.4±1.7, 7.4±2.2 and 7.0±1.9 in group S7.5, S5 and S4, respectively (p<0.01; ANOVA, p<0.05 group S7,5 vs S5 and S7,5 vs S4, but p=1,0 group S5 vs S4, Bonferroni). Mean duration of sensory block was 310.5±42.6, 255.9±43.7 and 228.8±34.8 min in group S7.5, S5 and S4, respectively (p<0.01, ANOVA, p<0.01 group S7.5 vs S5, S7.5 vs S4 and S5 vs S4, Bonferroni). Mean level of motor block was 2-3 Bromage score in 70.5% of cases in group S7.5, compared to 0-1 score in 97.3 and 92.1% of cases in group S5 and S4, respectively. Median duration (range) of motor block was 90 (0-120), 0 (0-90) and 0(0-60) min in group S7.5, S5 and S4, respectively (p<001 ANOVA, p<001 group S7.5 vs S5 and S7.5 vs S4, but p=0,13 group S5 vs S4, Bonferroni). Time to ambulation was statistically different among groups: 183.2±39.3, 150.5±38.0 and 129.6±39.7 in group S7.5, S5 and S4, respectively (p<0.01 ANOVA, p<0.001 group S7.5 vs S5, S7.5 vs S5, and S5 vs S4, Bonferroni). Urinary retention developed in 18.1% of cases (p ns). Groups were comparable in morphine requirements, only oral diclofenac requesting in 64.5% of cases. Quality of anaesthesia was compareable among groups according to the anaesthesiologist and surgeon. Quality of anaesthesia was rated as excellent (score 2) by patient in OR postoperatively in 58.8, 94.7 and 86.8% day 1 in 76.5, 92.1 and 97.4% of cases in group S7.5, S5 and S4, respectively; by surgical ward nurse in 82.4, 100 and 97.4% of cases in group S7.5, S5 and S4, respectively (p<0.05). Lower rate of quality in group S7.5 was due to excessive motor blockade. (3) Groups were comparable in demographics. Spinal blockades were successful in 100% and caudal in 92.1% of cases (p ns).Patients in group K required more sedation with thiopentone (p<0.05). Groups were comparable in the level of sensory (mean 7.1±2.2, 6.7±1.9 and 7.2±1.9 dermatomes in group S5, S4 and K, respectively) and motor block (Bromage score 0 in 73.9% of cases). Duration of sensory block was 253.1±39.8, 231.1±42.3, 300.1±45.5 min. (p<0.01 ANOVA; p<0.05 group K vs S5, K vs S4 and S5 vs S4, Bonferroni). Time to ambulation was different among groups as follows: 136.6±32.2, 123.0±45.9 ir 184.3±41.3 min; p<0.001 ANOVA, p<0.001 group S5 vs K, S4 vs K, Bonferroni). Groups were comparable in duration of motor block, time to urination and rate of postoperative complications. Urinary retention developed in 13.5% of cases (p ns). More patients in group S5 and S4 requested i/v morfine compared to group K (p=0,03, χ2). Quality of anaesthesia was rated comparably similar among groups according to the patient, anaesthesiologist and surgical ward nurse. Quality of anaesthesia according to the surgeon was rated as excellent in 100, 97.4 and 88.6% of cases in group S5, S4 and K, shincter relaxation was rated as excellent in 100, 97.4 and 82.9% of cases in group S5, S4 and K, respectively (p<0.05).
dc.language.iso lit
dc.subject Kaudalinė anestezija
dc.subject Anorektalinės operacijos
dc.subject Regioninė anestezija
dc.subject Spinalinė anestezija
dc.subject Hiperbarinis bupivakainas
dc.title Kaudalinė ir mažų hiperbarinio bupivakaino dozių spinalinė anestezijos darant anorektalines operacijas (klinikinis atsitiktinių imčių tyrimas)
dc.title.alternative Caudal and low-dose hyperbaric bupivacaine spinal anaesthesia for adult anorectal sugery: a randomized clinical study
dc.type Daktaro disertacija


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