Comparison of thoracic vs lumbar spinal anaesthesia fo orthopaedic surgeries
Keywords:Lumbar spinal anaesthesia, Orthopaedic surgeries, Thoracic spinal anaesthesia
Background: Thoracic spinal anaesthesia has emerged as one of the most promising anaesthetic techniques in the recent times. On the other hand, lumbar approach has been the conventional choice for orthopaedic surgeries since the advent of spinal anaesthesia. This study aimed at determining which approach is better suited for orthopaedic surgeries.
Methods: Total 60 patients scheduled for orthopaedic surgeries were divided into two groups : group T and group L. Group T patients were given thoracic spinal anaesthesia at the T9-T10 / T10-T11 interspace using 1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25µg (0.5 ml) of fentanyl. Group L patients received 2.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25 µg (0.5 ml) of fentanyl at LI-L2/L2-L3 interspace. Authors evaluated the degree of analgesia and motor block, haemodynamics and neurological complications.
Results: Onset of analgesia was faster in thoracic group - 2min. The duration of sensory and motor block was shorter in thoracic group. There were no significant differences in haemodynamic variables and respiratory parameters between the two groups and no neurological complication in any patient.
Conclusions: Thoracic spinal anaesthesia is preferable to lumbar spinal anaesthesia for orthopaedic surgeries.
Jonnesco T. Remarks on general spinal analgesia. Br Med J. 1909;2:1396-401.
Orrison WW, Eldevik, Sackett JF. Lateral C1-2 puncture for cervical myelography. Part III: Historical, anatomic, and technical considerations. Radiol. 1983;146:401-8.
Imbelloni LE, Ferraz-Filho JR, Quirici MB, Cordeiro JA. Magnetic resonance imaging of the spinal column. Br J Anaesth. 2008;101:433-4.
Imbelloni LE, Quirici MB, Ferraz-Filho JR, Cordeiro JA, Ganem EM. The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging. Anesth Analg. 2010;110:1494-5.
Lee RA, van Zundert AA, Breedveld P, Wondergem JH, Peek D, Wieringa PA. The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI) Acta Anaesth Belg. 2007;58:163-7.
Imbelloni LE, Pitombo PF, Ganem EM. The incidence of paresthesia and neurologic complications after lower spinal thoracic puncture with cut needle compared to pencil point needle. Study in 300 patients. J Anesth Clin Res. 2010;1:106.
Imbelloni LE, Gouveia MA. A comparison of thoracic spinal anesthesia with low-dose isobaric and low-dose hyperbaric bupivacaine for orthopedic surgery: A randomized controlled trial. Anesthesia Essays Res. 2014 Jan;8(1):26.
Hogan QH, Prost R, Kulier A, Taylor ML, Liu S, Mark L. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesiology: J Ame Soc Anesthesiol. 1996;84(6):1341-9.
Hogan Q. Size of human lower thoracic and lumbosacral nerve roots. Anesthesiol. 1996;85:37-42.
Imbelloni LE, Grigorio R, Fialho JC, Fornasari M. Pitombo PF. Thoracic spinal anesthesia with low doses of local anesthetic decreases the latency time, motor block and cardiovascular changes. study in 636 Patients. J Anesthe Clin Res. 2011;S11:001.
Kour L, Gupta KC, Mehta N, Mehta KS. Laparoscopic Cholecystectomy Under Low Thoracic Combined Spinal Epidural Anaesthesia: A Comparative Study Between Isobaric and Hyperbaric Bupivacaine. IOSR-JDMS 2018;17(1):1-4.
Imbelloni LE, Sant’Anna R, Fornasari M, Fialho JC. Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine. Local Regional Anesth. 2011;4:41.
Imbelloni LE. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique. Saudi J Anaesth. 2014 Oct;8(4):477-83.
Solakovic N. Comparison of hemodynamic effects of hyperbaric and isobaric bupivacaine in spinal anesthesia. Med Arch. 2010;64(1):11.