Background: Sequential combined spinal epidural anesthesia (CSEA) is probably the greatest advancement in the central neuraxial block in this decade for geriatric patients due to the potential advantages of both spinal and epidural anesthesia. This study was designed to compare the clinical effects of sequential CSEA versus spinal and epidural anesthesia in geriatric patients undergoing transurethral resection of the prostate (TURP).
Methods: Ninety patients aged 65 to 80 years were randomly allocated into three groups of 30 each. Group A (n=30) patients were administered spinal anesthesia with 2.5 ml of 0.5% hyperbaric bupivacaine, group B (n=30) received epidural anesthesia with 15 ml of 0.5% isobaric bupivacaine, and group C (n=30) received sequential CSEA with 1 ml of 0.5% hyperbaric bupivacaine and 6 ml of 0.5% isobaric bupivacaine given through epidural route to extend the block up to T10. Patients were observed for hemodynamic parameters, sensory and motor block, total dose required to establish the desired level, and patient satisfaction score.
Results: None of the patients were excluded in the study. Group A patients reported rapid onset of sensory block (3.08±11.57 minutes) compared to group B (11.57±1.48 minutes), and group C (5.47±1.25 minutes). The onset of motor block was expeditious in group A (8.08±1.0 minutes) compared to group B (20.33±1.86 minutes) and group C (15.53±1.31 minutes). Patients in group B had maximum hemodynamic stability but with delayed onset and were technically more complex than group A. Patients in group C were hemodynamically more stable than group A. They had a faster onset of action with decreased doses of local anesthetic drug required compared to group B.
Conclusion: Sequential CSEA is a safe, effective, and reliable technique that combines the advantages of both spinal and epidural while minimizing their disadvantages. It has the advantage of stable hemodynamic parameters along with the provision of prolongation analgesia for geriatric patients undergoing TURP surgery.
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http://dx.doi.org/10.7759/cureus.58099 | DOI Listing |
Cureus
November 2024
Department of Internal Medicine, Aga Khan University Hospital, Nairobi, KEN.
Post-dural puncture headaches usually occur when the cerebrospinal fluid (CSF) leaks due to trauma to the dura mater. This often results in spontaneous intracranial hypotension characterized by orthostatic headaches, neck stiffness, and nausea. In this case report, we discuss a 20-year-old male patient who developed symptoms of intracranial hypotension one year following a lumbar puncture.
View Article and Find Full Text PDFNeuroSci
December 2024
Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
Background: Intraoperative neuromonitoring (IONM) is crucial for the safety of scoliosis surgery, providing real-time feedback on the spinal cord and nerve function, primarily through motor-evoked potentials (MEPs). The choice of anesthesia plays a crucial role in influencing the quality and reliability of these neuromonitoring signals. This systematic review evaluates how different anesthetic techniques-total intravenous anesthesia (TIVA), volatile anesthetics, and regional anesthesia approaches such as Erector Spinae Plane Block (ESPB), spinal, and epidural anesthesia-affect IONM during scoliosis surgery.
View Article and Find Full Text PDFVet Rec
December 2024
Division of Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
Background: The objective of this study was to analyse the potential benefit of the epidural application of steroids on time to ambulation in non-ambulatory dogs affected by intervertebral disc disease (IVDD) treated with decompressive surgery.
Methods: This prospective, randomised, blinded control trial involved 41 dogs with thoracolumbar disc extrusion, which were randomly allocated into two groups. In the control group, saline was locally applied after surgical decompression of the spinal cord (n = 23).
J Sex Med
December 2024
Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY 40202, United States.
Background: 95% of men with spinal cord injuries exhibit difficulties with sexual function, including erectile dysfunction, anejaculation, retrograde ejaculation, poor ejaculatory force, and poor sperm quality.
Aim: The primary goal is to determine if well-established interventions, such as spinal cord epidural stimulation, are a feasible treatment for sexual dysfunction and if locomotor recovery training can be used to improve ejaculatory function in a rodent model of spinal cord injury (SCI).
Methods: Male Wistar rats underwent thoracic laminectomies (shams), spinal cord transections, or moderate spinal cord contusion injuries.
Int Immunopharmacol
December 2024
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Antibody New Drug Research Center, National Cheng Kung University, Tainan, Taiwan. Electronic address:
Background: Post-laminectomy syndrome (PLS) manifests as recurrent chronic back pain, with or without radiating leg pain, affecting 10-40% of patients following laminectomy. While surgical interventions can alleviate recurrent disc herniation or joint instability, medical management of PLS remains challenging due to unsatisfactory outcomes. Epidural fibrosis is a frequent cause of PLS, leading to nerve root tethering and dural sac compression.
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