A comparative study of unilateral vs bilateral spinal anaesthesia using hyperbaric bupivacaine with buprenorphine in unilateral inguinal hernia surgery
Unilateral spinal anaesthesia can be used for inguinal hernia surgery. The advantage is that it provides a stronger block on the side of surgery and accelerated recovery of the nerve block, with better maintenance of cardiovascular stability. Hence it can be a valuable technique for high-risk patients.
The aim: This randomized controlled trial was designed to evaluate the onset and duration of Sensory and motor block in both unilateral and bilateral spinal anaesthesia and the adverse effects of buprenorphine given intrathecally with 0.5 % bupivacaine for Spinal anaesthesia in patients scheduled for unilateral inguinal hernia surgery.
Materials and methods: it is a сomparative two group randomized clinical study with 60 patients with 30 patients in Group U (UNILATERAL) and 30 patients in Group B (BILATERAL) is undertaken to study the changes in haemodynamics and side effects. Whereas, within the group (for the unilateral group) comparison of the time taken to reach L1, T12, T10 and the Bromage time between the surgical side and non-surgical side sides of surgery was done.
Results: T10 -T12 spinal anaesthesia was achieved in both groups; the average time to anaesthetic onset in the unilateral group was 5.27±1.2 min, and in the bilateral, it was 5.90±1.02 min (p-value=0.32). Sensory and motor block lasted longer in the bilateral group when compared to the unilateral group; the incidence of side effects was limited to the occurrence of hypotension and bradycardia in the unilateral group than in the bilateral group. The success rate of unilateral spinal anaesthesia in our study was 100 %.
Conclusion: Because of haemodynamic stability and faster recovery characteristics of unilateral spinal block, it can be used as a suitable technique in patients with a limited cardiovascular reserve and for outpatient anaesthesia.
Gouveia, M. (2014). Spinal Hemianesthesia: Unilateral and Posterior. Austin J Anesthesia and Analgesia, 1 (1), 1003.
Casati, A. (2004). Unilateral anaesthesia for inguinal hernia repair: A prospective, randomized, double blind, comparison of bupivacaine, levobupivacaine and ropivacaine. Minerva Anastesiol, 70, 542.
Hocking, G., Wildsmith, J. A. W. (2004). Intrathecal drug spread. British Journal of Anaesthesia, 93 (4), 568–578. doi: https://doi.org/10.1093/bja/aeh204
Moosavi Tekye, S. M., Alipour, M. (2014). Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery. Brazilian Journal of Anesthesiology, 64 (3), 173–176. doi: https://doi.org/10.1016/j.bjane.2013.06.014
Karaduman, I., Karasu, D., Yilmaz, C., Oner, S., Erdem Solak, H., Korfali, G. (2017). The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy. Pain Research and Management, 2017, 1–8. doi: https://doi.org/10.1155/2017/2454267
Büttner, B., Mansur, A., Bauer, M., Hinz, J., Bergmann, I. (2016). Einseitige Spinalanästhesie. Der Anaesthesist, 65 (11), 847–865. doi: https://doi.org/10.1007/s00101-016-0232-x
Ahmad, H., Sagheer, A., Aslam, S. (2015). Comparison of Haemodynamic effects of Unilateral versus Bilateral Spinal Anaesthesia in Inguinal Herniorrhaphy. Journal of University Medical & Dental College, 6 (4).
Akhtar, M. N., Tariq, S., Abbas, N., Murtaza, G., Nadeem Naqvi, S. M. (2012). Comparison of haemodynamic changes in patients undergo ingunilateral and bilateral spinal anaesthesia. Journal of College of Physicians and Surgeons Pakistan, 22 (12), 747–750.
Fanelli, G., Borghi, B., Casati, A., Bertini, L., Montebugnoli, M., Torri, G. (2000). Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Canadian Journal of Anesthesia/Journal Canadien d’anesthésie, 47 (8), 746–751. doi: https://doi.org/10.1007/bf03019476
Brown, D.; Miller, R. D. (Ed.) (2005). Spinal, epidural, and caudal anesthesia. Miller‘s Anesthesia. Philadelphia, 1653–1683.
Magar, J. S., Bawdane, K. D., Patil, R. (2017). Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery. Journal of Clinical and Diagnostic Research, 11 (7), UC17–UC20. doi: https://doi.org/10.7860/jcdr/2017/26235.10215
Sevim, C., Hadi, U. Y., Can, A., Alparslan, K. (2023). Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study. Brazilian Journal of Anesthesiology, 73 (1), 72–77. doi: https://doi.org/10.1016/j.bjane.2021.04.020
Zhang, D. Y., Anderson, A. S. (2014). The Sympathetic Nervous System and Heart Failure. Cardiology Clinics, 32 (1), 33–45. doi: https://doi.org/10.1016/j.ccl.2013.09.010
Cicekci, F., Yilmaz, H., Balasar, M., Sahin, M., Kara, F. (2014). Is unilateral spinal anesthesia superior to bilateral spinal anesthesia in unilateral inguinal regional surgery? Middle East Journal of Anesthesiology, 22 (6), 591–596.
Singh, T., Anabarsan, A., Srivastava, U., Kannaujia, A., Gupta, A., Pal, C. et al. (2014). Unilateral Spinal Anaesthesia for Lower Limb Orthopaedic Surgery Using Low Dose Bupivacaine with Fentanyl or Clonidine: A Randomised Control Study. Journal of Anesthesia & Clinical Research, 5 (12). doi: https://doi.org/10.4172/2155-6148.1000484
Frey, K., Holman, S., Mikat-Stevens, M., Vazquez, J., White, L., Pedicini, E. et al. (1998). The Recovery Profile of Hyperbaric Spinal Anesthesia With Lidocaine, Tetracaine, and Bupivacaine. Regional Anesthesia and Pain Medicine, 23 (2), 159–163. doi: https://doi.org/10.1097/00115550-199823020-00008
Kumar, R., Viswanath, O., Saadabadi, A. (2022). Buprenorphine. StatPearls. Treasure Island: StatPearls Publishing.
Stefanov, C., Tilkijan, M., Dimov, E. (2005). Unilateral Spinal Anesthesia in Knee Arthroscopy: Clinical and harmacoeconomic Effects of Application of Hyperbaric Bupivacaine. Internet Journal of Anesthesiology, 10 (2). doi: https://doi.org/10.5580/d22
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