Journal of
eISSN: 2373-6437
Submit manuscript...
Short Communication Volume 10 Issue 2
Subarachnoid anaesthesia plus general anaesthesia in abdominal surgery
Caiazzo S, Cangianiello M, Donadio G, Internicola P, Romano M, Forte M
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Department of Anaesthesia, Italy
Correspondence: Forte M, Department of Anaesthesia, H. S. Maria della Pietà, Casoria, Napoli, Italy
Received: March 06, 2018 | Published: March 28, 2018
Citation: Caiazzo S, Cangianiello M, Donadio G, et al. Subarachnoid anaesthesia plus general anaesthesia in abdominal surgery. J Anesth Crit Care Open Access. 2018;10(2):76 DOI: 10.15406/jaccoa.2018.10.00363
Short communication
The aim of this study is to assess the effects of pain therapy with morphine plus bupivacaine in subarachnoid anaesthesia in those patients who must be subjected to general anaesthesia.
Criterion of inclusion: Patients ASA2; between 40 and 80 years, suffering from neoplasm of colon, stomach or of bladder.
Criterion of exclusion: Patients ASA ¾; with contraindication to subarachnoid anaesthesia and with severe cardiac pathology.
We have examined 30 patients with the criterion indicated for a year. The average time of surgery is 3 – 4 hours.
After an infusion start of 500 cc of saline solution, every patient was subjected to subarachnoid anaesthesia (pencan needle g 27) with morphine hydrochloride 0,1 mg and bupivacaine 0,5 % 12 mg. Then general anaesthesia was induced with propofol; fentanyl 0,1 mg; vecuronium bromide.
General anaesthesia was administered with sevoflurane 2% plus fentanyl 0,1 mg (only one dose at the beginning of surgery). In all cases we administered three additional bolus of vecuronium during surgery.
In only three cases there were complications during surgery and a laparotomy was performed, so we administered an additional dose of vecuronium.
Complications
During surgery there were some cases of hypotension and four cases of significant bradycardia (45 bpm). Such cases didn’t require any supportive therapy since they resolved after few minutes. No other serious problems required an emergency treatment.
After waking up, all patients were alert, oriented and without pain, completely able to put themselves on a gurney without help. In the following 24 hours after surgery, no patient needed a pain treatment. Both diuresis and perfusion were good. Nausea and vomit were absent.
After 24 hours we have always given intravenous pain therapy with paracetamol and/with ketorolac at low dose in only two administrations. As a result, the association between locoregional anaesthesia and general anaesthesia in major surgery proved to be very successful. The patient has always had a perfect pain and hemodynamic compliance with a reduced use of intravenous medicines. The patient waking up was perfect.
Reflections
In both laparoscopic and laparotomic cancer surgery is essential to keep patients in total analgesia during and post surgery. This ensures a faster recovery of the patient’s physiological functions. Epidural anaesthesia is certainly the ideal solution, even better than subarachnoid anaesthesia. This kind of anaesthesia is indeed mentioned in ERAS protocol.
ERAS protocol is aimed to prepare the patient very well before surgery and to ensure an excellent analgesic coverage during and after surgery so that the patient can be autonomous in 24 hours’ time both in motor functions and in active enteral feeding.
This protocol requires not to use major opioids. Epidural anaesthesia is considered the ‘gold standard’ for this aim. However, subarachnoid anaesthesia successfully achieves the same results, such as a better compliance of the patient, who is subjected to a less invasive procedure than epidural anaesthesia. The patient doesn’t wear the epidural catheter after surgery: this is safer as the management of a medical device after surgery presents more problems in postoperative nursing in hospitals where postoperative intensive care is not present, such as placing of the epidural catheter in patient movement and frequent difficulties in the correct management of the epidural catheter, of medicines and of hemodynamics.1‒5
Conclusion
The data we have obtained encourage this procedure and represent a good compromise for the management of patients who must be subjected to oncological abdominal surgery even according to ERAS protocol.
Acknowledgment
None
Conflict of interest
Authors don’t have any conflict of interest.
References
- Culebras X, Savoldelli GL, Van Gessel E, et al. Low dose sufentanil does not potentiate intrathecal morphine for perioperative analgesia after major colorectal surgery. Can J Anaesth. 2007;54(10):811‒7.
- Jacobsohn E, Lee TW, Amadeo RJ, et al. Low dose intrathecal morphine does not delay early extubation after cardiac surgery. Can J Anaesth. 2005;52(8):848‒57.
- Koning MV, Teunissen AJW, van der Harst E, et al. Intrathecal morphine for laparoscopic segmental colon resection as part of an enhanced recovery protocol: a randomized controlled trial. Reg Anesth Pain Med. 2018;43(2):166‒173.
- Wongyngsinn M, Baldini G, Stein B, et al. Spinal analgesia for laparoscopic colon resection using an enhanced recovery after surgery programme: better analgesia, but no benefits on postoperative recovery: arandomized controlled trial. Br J Anaesth. 2012;108(5):850‒6.
- Adler JA, Lotz NM. Intrathecal pain management in cardiac surgery a systematic review. J Pain Res. 2017;10:2565‒2575.
©2018 Caiazzo, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.