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Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
Spinal anesthesia is a reliable form of anesthesia that is technically easier to perform and produces adequate anesthesia significantly faster than epidural anesthesia [66]. Other advantages are its simplicity, lower drug doses, and superior abdominal muscle relaxation. Compared with epidural, spinal technique is associated with similar failure rate, need for additional intraoperative analgesia, need for conversion to general anesthesia intraoperatively, maternal satisfaction, need for postoperative pain relief, and neonatal intervention [66]. Compared with epidural, spinal anesthesia for cesarean section is associated with reduced time, by about 8 minutes, from start of the anesthetic to start of the operation.
Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Hypotension is the most common side effect of spinal anesthesia and can be limited but not completely prevented by prehydration with 1000 to 1500mL of crystalloid administered immediately prior to induction. The use of colloid may be more effective (136). When fluid administration is insufficient to prevent or treat hypotension, vasopressors are often required. In the past, ephedrine had been the drug of choice. Ephedrine has both alpha and beta agonist properties. Phenylephrine, however, is a pure alpha vasoconstrictor and was once considered to be potentially harmful as it was shown in sheep models that potent vasoconstrictors decrease uterine blood flow (137). More recently, it has been determined that, clinically, phenylephrine does not have deleterious fetal/neonatal effects when administered judiciously. Indeed, infants born to mothers receiving phenylephrine have higher umbilical cord arterial blood pH levels than those treated with ephedrine (138). Another troublesome side effect from spinal anesthesia is post-dural puncture headache. The use of small-gauge pencil-point needles, however, has reduced the incidence of post-dural puncture headache to an acceptable rate of 0.5% to 1% (139). In a 2001 survey, spinal anesthesia was the most commonly used anesthetic technique for elective cesarean delivery. Even for emergent cesarean deliveries, spinal anesthesia was used 45% to 59% of the time (128).
Spinal Anesthesia
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The main alternate regional procedure to spinal anesthesia in pediatrics is caudal anesthesia. The decision between the two techniques for minor surgery on the pelvis usually depends more upon the experience of the anesthesiologist than upon specific surgical indications, as both techniques can be performed in patients who are awake. The doses for spinal anesthesia are smaller than those for caudal blocks, and this may be of importance in high-risk patients. Conversely, spinal anesthesia requires more precautionary measures and provides less postoperative pain relief than epidural blocks via the caudal route.
Pre-anaesthetic ultrasonographic assessment of neck vessels as predictors of spinal anaesthesia induced hypotension in the elderly: A prospective observational study
Published in Egyptian Journal of Anaesthesia, 2022
Bassant M. Abdelhamid, Abeer Ahmed, Mai Ramzy, Ashraf Rady, Haitham Hassan
Spinal anaesthesia was performed while the patient was in a sitting position. The patient was co-loaded with 10–12 ml/kg ringer acetate over 10–15 minutes. A 25-gauge spinal needle was introduced at either the level of L3–4 or L4–5 interspaces, 10 mg of 0.5% hyperbaric bupivacaine plus 25 µg of fentanyl were injected, the patient was then turned and maintained in a supine position. A cold test using an alcohol gauze was conducted to assess the degree of sensory block, with a desired T8 dermatomal level block. Maintenance fluid 2 ml/kg/hour of ringer acetate was then commenced. MAP was measured every 2 minutes after administering the anaesthesia for a total of 20 minutes. Any episode of hypotension, defined as a decline in MAP to less than 75% of the preoperative baseline reading, was recorded and managed by administering five µg of norepinephrine. If the hypotensive episode persisted for two minutes, another bolus of norepinephrine was administered. Any episodes of bradycardia were managed by administering 0.01 mg/kg of atropine.
Surgical options for meralgia paresthetica: long-term outcomes in 13 cases
Published in British Journal of Neurosurgery, 2019
Zeki Serdar Ataizi, Kemal Ertilav, Serdar Ercan
Surgery was performed under spinal anesthesia. An incision was made 1 cm below the anterior superior iliac spine and parallel to skin folds. The incision was deepened through the subcutaneous tissue and fascia lata. Particular attention was paid to the anatomical variations of the nerve tracing. The site at which the LFCN exits the fascia under the inguinal ligament was exposed. The lower leaf of the inguinal ligament was opened, and thus the nerve was decompressed anteromedially. The nerve was mobilized. The fascial edge between the ASIS and the initial part of the sartorius muscle was opened, and thus the nerve was decompressed anteromedially (Figure 1). The nerve was lifted and suspended to separate the LCFN from fascia adhesions. Isotonic saline was injected into the perineum of the LCFN which was observed to be completely free in the inguinal canal.
Comparison of Two Methods: Spinal Anesthesia and Ischiorectal Block on Post Hemorrhoidectomy Pain and Hospital Stay: A Randomized Control Trial
Published in Journal of Investigative Surgery, 2018
Sedigheh Nadri, Hormoz Mahmoudvand, Shirin Rokrok, Mohammad Javad Tarrahi
In this study, 46 patients were male, and 24 others were female. Demographic data such as age 45.10 ± 5.02 years and average weight of 75 ± 16 kg was noted for all groups. Out of the 35 patients with spinal anesthesia, 28 patients (80%) were hospitalized in the first 6 hr, 13 (37.1%) in the second 6 hr, and 3 patients (8.6%) in the second 12 hr of the post-operative hospitalization. The number of patients that received hospitalization under ischiorectal block were 13 patients (37.1%) in the first 6 hr, 4 patients (11.4%) in the second 6 hr, and 1 patient (2.9%) in the second 12 hours showing a significance difference between the two groups (p < 0.05). The patients hospitalized received 1 mg/kg intravenous pethidine. These results suggest that postoperative pain in ischiorectal blocks patients, that necessitate hospitalization was lower as compared to spinal anesthesia.