Local and regional anaesthesia 119

anesthetic had been completed, patients were placed in prone position quickly. mage scale time to achieve level I, duration of analgesia and adverse effects
The characteristics of sensory and motor block, haemodynamic data, advers (AE) was done.
effects, patient and surgeon satisfaction were recorded. The sample size was Results and Discussion: Patients data are shown in the table 1.
calculated to provide 80% power to detect a 25% reduction in the incidence of
complete motor block in Group L compared with Group B. Descriptives were Table 1. Patients data by group (Median [25-75 percentages])
quoted as mean±SD, median (range), number (incidence) as appropriate. Sta- Group A Group B
tistical analyses were performed using Student’s t, Mann-Whitney U, Fischer’s (N=46) (N=14)
exact and Chi-Square tests.
VAS at positioning for spinal 3 [2-3] 0,5 [0-1]*
Results and Discussion: There were no significant differences between the Time to perform spinal anesthesia 3 [2-4] 3 [3-4]
two groups for patient demografic data, duration of operation, patient-surgeon Patient acceptance (yes/no) 35/11 14/0*
satisfaction, haemodynamic and side effects. The onset time, highest level, two Bupivacaine dose (mg) 17,5 [12,5-20] 17,5 [17,5-20]
segment regression, time to S2 regression of sensory block weren’t different in Onset of sensory block (min) 10 [9-10] 10 [9-10]
two groups (p=0.077, 0.057, 0.091 and 0.084 respectively). The incidence of Anesthesia level T4 – S5 T4 – S5
complete motor blok was 16% and 8% in Group B at the beginning and the Bromage scale time to achieve 12 [12-13] 12 [11-12,5]
end of the operation. There was not complete motor block in Group L (p=0.110 Duration of analgesia (min) 250 [240-260] 255 [240-260]
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Number of patients with clinically significant adverse effects 5 2

and 0.490 respectively).
Conclusion(s): We concluded that both regimes are effective and safe in spinal *p<0,05.
anaesthesia for pilonidal cyst-sinus operations in prone position.
References: Both the groups showed rapid onset, excellent analgesia and good quality mo-
1 Løvstad RZ. Acta Anaesthesiol Scand 2000; 44: 48–52. tor block. There were no significant differences in clinical effects after performing
SA in StP and SpP and number of clinically significant AE. Group B showed a
significantly less incidence of pain during LP and this position was more ac-
8AP6-2 ceptable for patients in compared to group A. Using SpP for LP decreases risk
Urinary retention after spinal anaesthesia: Unilateral vs. removal of loose fragments in patients with unstable fractures. SpP can be also
bilateral spinal anaesthesia with 0.5% bupivacain. use to performing SA in patients with pelvis fractures wich can’t be placed in
A prospective randomized study sitting or lateral position.
Conclusion(s): Spinal anesthesia performed in supine position in selected pa-
R. Ehrenberg, P. Lemberger, C. Wiesenack
tients is more advantageous than performed in sitting position in patients with
Anaesthesiology, University of Regensburg, Regensburg, Germany unstable Femoral Fractures.
Background and Goal of Study: Urinary retention is one of the most com-
mon complications next to haemodynamic effects following spinal anaesthesia.
The aim of this prospective randomized study was to compare the time to first 8AP6-4
voiding and the incidence of urinary retention after two different techniques of
Does unilateral hypobaric spinal anaesthesia (U.h.S.A.)
spinal anaesthesia.
prevents from post-operative urinary retention in case of
Materials and Methods: 251 patients (ASA I-III) were randomly allocated in 2
using intrathecal morphine?
groups to receive either hyperbaric for unilateral (Group 1) or isobaric bupiva-
caine for bilateral (Group 2)spinal anaesthesia. Bladder volume was measured D. Asselineau
perioperative via ultrasound. Sensory and motor block was assessed by loss of Anaesthesiology, Clinique du Colombier, Limoges, France
cold sensation and modified Bromage scale. Time from spinal injection to first Background and Goal of Study: Post-Operative Urinary Retention incidence
voiding and necessity to catheterisation was recorded. is reported between 7% & 52%. With age, sex, post-operative morphine titra-
Results and Discussion: There were no differences between the two groups tion, large infusion volumes, & long-lasting surgery, Spinal Anaesthesia is a main
regarding demographic data. Postoperative measurements of bladder volume risk factor [2], with incidence around 25%, & more if intrathecal morphine is
were similar in both groups: Group 1: 282ml ±159; Group 2: 282ml±154). used. In such a case, we want to know if Unilateral hypobaric Spinal Anaesthesia
Unilateral block was recorded in 87% patients. Sensory level on the operated (U.h.S.A.) may lead to fewer Post-Operative Bladder Catheterization (P.O.B.C.).
side was Th 8 in both groups. Time of first voiding after injection required Materials and Methods: From Oct.06 to Oct.07, 120 patients with short
273±61minutes in group 1 and 329±73 minutes in group 2. All patients in (<90’) lower limb surgery, were randomized in 2 groups, after informed con-
group 1 were able to void spontaneously and 16 Patients (12%) need catheter- sent: Group 1: 60 patients had U.h.S.A.with hypobaric L-bupivacaine 2mg/ml.
ization in group 2. This study demonstrated no significant influence of risk fac- Group 2: 60 patients had U.h.S.A.with hypobaric L-bupivacaine 2mg/ml & in-
tors for urinary retention (e. g. age, sex, dosage of local anaesthetics). Solely trathecal morphine. We used a same protocol in both groups: 25G Whitacre
the technique of unilateral spinal aneasthesia reduced the incidence of urinary needle, no preloading infusion, ephedrine delivered if !SAP &/or !H.R. was
retention. >-20%. No postoperative morphine P.C.A. Items noticed were: Age, Sex, ASA
Conclusion(s): Our findings suggest that unilateral spinal anaesthesia reduces score, L-bupivacaine dose, ephedrine doses & peri-operative infusion volume
the incidence of disturbances of micturation and time of first voiding and. Firm required, spontaneous urination or bladder catheterization.
haemodynamic circumstances cause also significant earlier meet criteria for dis- Results and Discussion: Both groups had same characteristics for sex,
charge home compared to bilateral spinal anaesthesia. age, ASA score, L-bupivacaine dose, & surgery. No differences were found
in ephedrine consumption & in infusion volume required. Unilateral Spinal
Anaesthesia provides better early post-operative comfort & less haemodynamic
8AP6-3 changes than conventional spinal anaesthesia [1,3]. This is confirmed here, by
Performing a spinal anesthesia in the supine position in low doses of ephedrine and low volumes of peri-operative infusion required.
patients with unstable femoral fractures
I. Kuchyn, F. Glumcher Male Female Age L-bupivacaine Ephedrine Infusion vol. P.O.B.C.
Anesthesiology and Intensive Therapy, National Medical University, Kyiv,
Group 1 31 29 59,13 8,487mg 0,824mg 167,5ml 0
Ukraine Standard deviation 16,13 1,395 3,845 187,27
Background and Goal of Study: Surgical operation on account of femoral Group 2 28 32 62,55 8,762mg 3,35mg 268,33ml 8 (=13,33%)
fractures can be successfully done with using spinal anesthesia (SA) but un- Standard deviation 14,35 1,208 6,286 244,42
stable fractures makes difficult and dangerous moving the patients in sitting χ2 & t Student N.S. N.S. N.S. N.S. N.S. N.S. χ2 =8,57
(t=2,66) (t=2,54) p<0,01
or lateral position. Use the Orthopedic Navigation Table permits performing a
spinal SA in supine position (SpP). This study is designed to compare the clini-
cal effects of SA performed in SpP versus Sitting Position (StP). P.O.B.C. incidence is among lowest levels reported (no P.O.B.C.in the “mor-
Materials and Methods: 60 ASA physical status I-III patients, scheduled for phineless group”). But, as in conventional spinal anaesthesia, P.O.B.C. inci-
surgery account of femoral fractures were allocated into two equable groups. dence was significantly higher (p< 0,01) in the “morphineless group”, with inci-
SA in patients of group A (N=46) was performed in StP. SA in patients of group dence reaching 13% of patients.
B (N=14) was performed in SpP on the Orthopedic Navigation Table. All pa- Conclusion(s): U.h.S.A doesn’t protect from P.O.B.C.when intrathecal mor-
tients received 10-20 mg of 0.5% plain bupivacaine through a 23 gauge spinal phine is used.
needle at L3-L4 level. The VAS at positioning for lumbar puncture (LP), time to References:
perform SA and patient acceptance were observed. To investigate the clinical 1 Low-dose hyperbaric bupivacaine for unilateral spinal anaesthesia: Casati A, Can J
effects of SA the analysis of onset of sensory block, level of anesthesia, Bro- Anaesth 1998.