OPTIMIZED METHOD OF UNILATERAL SPINAL ANESTHESIA, PRELIMINARY RESULTS
Introduction: Unilateral, or otherwise, monolateral spinal anesthesia (USA /MSA), is one of the methods of spinal anesthesia in one side operations on the lower limbs. However, this kind of anesthesia is not without flaws. One of the main criteria for evaluating this type of anesthesia is the frequency of successful monolateral blocks, which, according to different authors, varies from 13% to 94%. Such a spread is, without any doubts, is not the criterion of a "reliable" method of anesthesia and in many cases is explained by the technique of its implementation. In recent years, by Mamyrov D.U. et al., a new original technique of monolateral spinal anesthesia with the use of electroneurostimulation (MCA + ENS) has been proposed, reg №26023 ((19) KZ(13)A4(11)26023), but its effectiveness and safety have not been studied enough. The aim of the study: To conduct the comparative evaluation of the efficacy and safety of the methods of conventional monolateral spinal anesthesia (MSA) and monolateral spinal anesthesia using electroneurostimulation (MSA + ENS). Materials and methods: This work was carried out within the frames of the PhD doctoral education program. On the basis of Pavlodar city hospital №1, in the period from July to September 2018, 18 patients operated on for varicose disease of the lower limbs, deep vein thrombosis of the lower extremities, as well as amputations of one of the extremities were examined. 7 patients underwent MSA + ENS (main group), 11 patients had traditional MSA (comparison group). The study design is a blind, randomized, clinically-controlled study. During the processing of statistical data, the following criteria were applied: the Shapiro – Wilk criterion, the Levene criterion, Student's t-test for independent samples, the U-Mann Whitney test with the Moses amendment and the Chi-square test was used to analyze dichotomous variables. Results: Both study groups were comparable to gender M = 1.56 (SD = 0.5), age M = 50.7 (SD = 8.7), BMI = 25 (SD = 5.2) and ASA status M = 2.4 (SD = 0.5). In both groups there were no statistically significant differences in hemodynamic parameters, so in main group MSAP = 103 (SD = 4.6), t = 1.43 df = 16 p> 0.05; in comparison group MSAP = 99 (SD = 6.6), t = 1.55 df = 15.7 p> 0.05. At the same time, the parameters of the sensor and motor block are different. Thus, the adequacy of anesthesia in the main group was observed in all patients, in the comparison group, 4 (36%) patients required additional administration of analgesics. Bilateral anesthesia was in 2 (18.1%) patients in the comparison group. Also, 2 (18.1%) patients of the comparison group had nausea, without vomiting. In the postoperative period 2 (18.1%) patients of the comparison group there were post-puncture headaches, that had been treated after 2 days, in patients of the main group headaches were not observed Conclusions: The obtained results, despite the small amount of observations, confirm the expediency of applying the MSA + ENS method, since this technique gives an objective control of the puncture of the dura mater process by obtaining a motor response. The MSA + ENS technique allows to stop pushing the spinal needle into the subarachnoid space, thereby reducing the incidence of injury of the spinal cord roots and cauda equina with a needle, also significantly increases the chance of obtaining an adequate one-sided spinal block. Thus, this method seems to us more effective and safe in comparison with the usual monolateral spinal anesthesia.
Yernar D. Mamyrov 1, https://orcid.org/0000-0003-4070-2165 Daulet U. Mamyrov 2, https://orcid.org/0000-0001-7887-1736 Marat K. Syzdykbayev 1, https://orcid.org/0000-0002-0561-4111 Yoshihiro Noso 3, https://orcid.org/0000-0003-3477-1260 1 Anesthesiology and intensive care department, Semey medical university, Semey city, Republic of Kazakhstan; 2 Anesthesiology and intensive care department, Pavlodar branch of Semey medical university, Pavlodar city, Republic of Kazakhstan; 3 Department of surgery, Faculty of Medicine, Shimane University, Izumo city, Shimane, Japan
1. Barbosa F.T., Jucá M.J., Castro A.A., Cavalcante J.C. Neuraxial anaesthesia for lower-limb revascularization. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD007083. DOI: 10.1002/14651858.C D007083.pub3. 2. Basurto Ona X. et al. Drug therapy for preventing post-dural puncture headache // Cochrane Database Syst. Rev. 2013. № 2. С. CD001792. 3. Bergmann I. et al. Selective unilateral spinal anaesthesia for outpatient knee arthroscopy using real-time monitoring of lower limb sympathetic tone // Anaesth. Intensive Care. 2015. Т. 43. № 3. pp. 351–356. 4. Büttner B. et al. Einseitige Spinalanästhesie // Anaesthesist. 2016. Т. 65. № 11. pp. 847–865. 5. Cappelleri G. et al. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study // Anesth. Analg. 2005. Т. 101. № 1. pp. 77–82, table of contents. 6. Casati A. et al. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. // Eur. J. Anaesthesiol. 2003. Т. 20. № 8. pp. 640–6. 7. Casati A. et al. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy // Anesth. Analg. 2004. Т. 99. № 5. pp. 1387–1392. 8. Chambers D.J., Bhatia K. Cranial nerve palsy following central neuraxial block in obstetrics – a review of the literature and analysis of 43 case reports // Int. J. Obstet. Anesth. 2017. Т. 31. pp. 13–26. 9. Cicekci F. et al. Is unilateral spinal anesthesia superior to bilateral spinal anesthesia in unilateral inguinal regional surgery? // Middle East J. Anaesthesiol. 2014. Т. 22. № 6. pp. 591–6. 10. Enk D. et al. Success rate of unilateral spinal anesthesia is dependent on injection flow // Reg. Anesth. Pain Med. 2001. Т. 26. № 5. pp. 420–427. 11. Esmaoglu A. et al. Bilateral vs. unilateral spinal anesthesia for outpatient knee arthroscopies. // Knee Surg. Sports Traumatol. Arthrosc. 2004. Т. 12. № 2. pp. 155–8. 12. Gao L. et al. Effects of prophylactic ondansetron on spinal anesthesia-induced hypotension: a meta-analysis // Int. J. Obstet. Anesth. 2015. Т. 24. № 4. pp. 335–343. 13. J. Brull M., Monica M., J. Brull S. Spinal anesthesia // Curr. Opin. Anaesthesiol. 2005. Т. 18. № 5. pp. 527–533. 14. Kosem B. An unusual complication of anesthesia: Unilateral spinal myoclonus // Ağrı - J. Turkish Soc. Algol. 2016. Т. 29. № April. pp. 90–91. 15. Kumar Singh T. et al. Unilateral Spinal Anaesthesia for Lower Limb Orthopaedic Surgery Using Low Dose Bupivacaine with Fentanyl or Clonidine: A Randomised Control Study // J. Anesth. Clin. Res. 2014. Т. 05. № 12. P. 5. 16. Magar J.S., Bawdane K.D., Patil R. Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery // 2017., pp. 17-20. 17. Moosavi Tekye S.M., Alipour M. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery // Brazilian J. Anesthesiol. (English Ed. 2013. Т. 110. 18. Potapov O.L. Unilateral spinal anesthesia in operations on the kidney and upper third of the ureter. // Klin. khirurhiia. 2009. № 10. pp. 36–9. 19. Ripollés Melchor J. et al. Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. A systematic review and meta-analysis. // Minerva Anestesiol. 2015. Т. 81. № 9. pp. 1019–30. 20. Tanasichuk M.A. et al. Spinal hemianalgesia: an evaluation of a method, its applicability, and influence on the incidence of hypotension // Anesthesiology. 1961. Т. 22. № 1. pp. 74–85. 21. Tomak Y. et al. Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery // J. Anesth. 2016. Т. 30. № 1. pp. 26–30. 22. Zhang L. et al. Sciatic-femoral nerve block versus unilateral spinal anesthesia for outpatient knee arthroscopy: A meta-analysis // Minerva Anestesiol. 2015. Т. 81. № 12. pp. 1359–1368. 23. Kozyrev A.S. i dr. Monolateral'naya spinal'naya anesteziya u detei. [Monolateral spinal anesthesia in children.]; Federal'noe gosudarstvennoe byudzhetnoe uchrezhdenie «Rossiiskii orden Trudovogo Krasnogo Znameni nauchno-issledovatel'skii institut travmatologii i ortopedii im. R.R. Vredena» Ministerstva zdravookhraneniya Rossiiskoi Federatsii [Federal State Budgetary Institution "Russian Order of the Red Banner of Labor Research Institute of Traumatology and Orthopedics. R.R. Vreden" of the Ministry of Health of the Russian Federation], 2010. pp. 13-17. [in Russian] 24. Konstantinova G.D., Donskaya E.D., Epshtein S.L. Khirurgicheskoe lechenie varikoznoi bolezni nizhnikh konechnostei u lits starshe 60 let v statsionare kratkosrochnogo prebyvaniya [Surgical treatment of varicose disease of the lower extremities in persons older than 60 years in the hospital for short stays] // Novosti khirurgii [Surgery news.]. 2012. T. 16. № 4, pp. 50-58. [in Russian] 25. Lakhin R. i dr. Eksperimental'noe issledovanie gidrodinamiki giperbaricheskogo rastvora, vvodimogo cherez spinal'nye igly razlichnykh tipov i kalibrov [Experimental study of the hydrodynamics of a hyperbaric solution injected through spinal needles of various types and calibers] // Anesteziologicheskaya i reanimatologicheskaya pomoshch' bol'nym. [Anesthetic and resuscitation care for patients] 2013. T. 10. № 2. pp. 3–8. [in Russian] 26. Lakhin R.E. i dr. Gidrodinamika giperbaricheskogo rastvora na modeli “Steklyannaya spina”, vvodimogo cherez spinal'nye igly razlichnykh tipov i kalibrov [Hydrodynamics of a hyperbaric solution on the “Glass back” model introduced through spinal needles of various types and calibers] // Vestnik anesteziologii i reanimatologii [Bulletin of anesthesiology and resuscitation.]. 2013. T. 10. № 3. pp. 33–39. [in Russian] 27. Mamyrov D.U., Zhakupov R.K., Mamyrov E.D. Sposob monolateral'noi spinal'noi anestezii [The way of monolateral spinal anesthesia]// 2012. T. 9. № 19. pp. 1–6. [in Russian] 28. Soatov A.R., Semenikhin A.A. Puti snizheniya operatsionno-anesteziologicheskogo riska pri operatsiyakh na nizhnikh konechnostyakh u geriatricheskikh bol'nykh s nedostatochnost'yu krovoobrashcheniya [Ways to reduce operative-anesthetic risk in operations on the lower limbs in geriatric patients with circulatory failure] // Regionarnaya anesteziya i lechenie ostroi boli [Regional anesthesia and acute pain treatment]. 2013. T. 7. № 1, pp. 33–37. [in Russian] 29. Fisher B. Kak izbezhat' nevrologicheskikh oslozhnenii? Rekomendatsii ESRA dlya nadlezhashchei klinicheskoi praktiki [How to avoid neurological complications? ESRA guidelines for good clinical practice]// Regionarnaya anesteziya i lechenie ostroi boli [Regional anesthesia and acute pain treatment]. 2010. T. 4. № 2. pp. 54–59. [in Russian]. 30. Shadurskii N.N., Kuz'min V.V., Voshchinin A.V. Metodika odnostoronnei epidural'noi anestezii pri endoprotezirovanii kolennogo sustava [Methods of unilateral epidural anesthesia for knee arthroplasty]// Regionarnaya anesteziya i lechenie ostroi boli [Regional anesthesia and acute pain treatment]. 2012. T. 6. № 4. pp. 22–28. [in Russian]
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Мамыров Е.Д., Мамыров Д.У., Сыздыкбаев М.К., Йошихиро Носо. Усовершенствованный метод односторонней спинальной анестезии, предварительные результаты // Наука и Здравоохранение. 2019. 2 (Т.21). С. 67-75. Mamyrov Ye.D., Mamyrov D.U., Syzdykbayev M.K., Yoshihiro Noso Optimized method of unilateral spinal anesthesia, preliminary results. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 2, pp. 67-75. Мамыров Е.Д., Мамыров Д.У., Сыздыкбаев М.К., Йошихиро Носо. Бір жақты жұлын анестезия әдісін жетілдіру, алдын ала нәтижелері // Ғылым және Денсаулық сақтау. 2019. 2 (Т.21). Б. 67-75.

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