Syed Khurrom Ahmed1, M A Jalil Barbhuiya2, Mohd. Abdus Samad Azad3,
Mahmudul Hasan4, Rajnarayan Chowdhury5, Md. Abul Hasnat6
Mahmudul Hasan4, Rajnarayan Chowdhury5, Md. Abul Hasnat6
1. Assistant Professor, Department of Anesthesiology, Jalalabad Ragib Rabeya Medical College, Sylhet.
2. Professor and Head, Department of Anesthesiology and ICU, North East Medical College, Sylhet.
3. Associate Professor(cc), Department of Surgery, MAG Osmani Medical College, Sylhet.
4. Assistant Professor, Department of Anesthesiology, Jalalabad Ragib Rabeya Medical College, Sylhet.
5. Assistant Professor, Department of Anesthesiology, Jalalabad Ragib Rabeya Medical College, Sylhet.
6. Anesthesiologist, Department of Anesthesiology, Jalalabad Ragib Rabeya Medical College, Sylhet.
Abstract
The most common adverse effect of spinal anaesthesia is the hemodynamic instability; eg. Hypotension and Bradycardia. The incidence of hypotension and bradycardia has been reported to be 33% and 13% respectively. These effects are caused by unavoidable sympathetic blockade following spinal anaesthesia. The use of unilateral spinal anesthesia may restrict sympathetic block and avoid the undesired cardiovascular effects. The aim of this prospective, randomized study was to compare unilateral with bilateral spinal anesthesia in patients undergoing surgery for varicose veins according to hemodynamic change. Forty ASA I and ASA II patients scheduled for surgical repair of varicose veins were randomly allocated into two groups to receive bilateral (Group A,n=20) and unilateral (Group B, n=20) spinal anesthesia. Group A patients received bilateral spinal anesthesia with 3 ml hyperobaric 0.5% bupivacaine (15 mg) and group B patients received unilateral spinal anesthesia with hyperbaric spinal solution (0.5% bupivacaine 5mg plus fentanyl 50 mcg and 1ml of 10% glucose). We measured non invasive mean arterial blood pressure and heart rate before spinal blockade and then after 5, 15, 30. and 45minutes. We also recorded the onset of motor and sensory blockade and side-effects. There were no significant differences between two groups with respect to age, gender, weight, height and duration of surgery. In group A, 15 minutes after the initiation of the spinal block a statistically significant drop in the systolic and diastolic blood pressure from the baseline value was observed (p<0.05). Comparing systolic and diastolic blood pressure among groups, a statistically significant difference was also found 15 minutes after spinal injections (p<0.05). There were no statistically significant differences in heart rate between groups. In patients undergoing surgery for varicose veins, unilateral spinal anesthesia is associated with minimal hemodynamic changes. We conclude that unilateral spinal anesthesia is an attractive alternative to bilateral spinal anesthesia in this group of patients.
Key Words: Unilateral spinal anesthesia, Spinal anesthesia, Varicose vein surgery.