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December 14, 2022Malaysian Journal of AnaesthesiologyOpen Access

Continuous spinal anaesthesia, an underutilised neuraxial technique in current anaesthesia practice: a timely reminder

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Key result

Continuous spinal anaesthesia provided adequate anaesthesia with haemodynamic stability and no reported complications in two high-risk elderly patients undergoing orthopaedic surgery.

Why the study?

Continuous spinal anaesthesia is a cardio-stable technique in high-risk surgical patients, but its use has declined over recent decades due to concerns regarding complications such as post-dural puncture headaches and neurological deficits.

Design

Case series

Authors

EOE Theen OngSultan Haji Ahmad Shah HospitalHNHui Ping NgSultan Haji Ahmad Shah HospitalMGMuhamad Rasydan Abdul GhaniInternational Islamic University Malaysia

Discussion

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Implication

CSA feasible without complications in high-risk elderly cases; leaves open need for prospective trials before wider use.

Study Design

Type

Case Report (n=2)

Multicenter

No

Structured PICO

P
Population
Two elderly patients (aged 85 and 87) with multiple comorbidities and high cardiac risk undergoing proximal femoral nailing under continuous spinal anaesthesia.
I
Intervention
Continuous spinal anaesthesia (CSA) using the Pajunk IntraLong set, with an initial bolus of 1 ml heavy bupivacaine 0.5% followed by 0.5 ml top-up doses at 10-minute intervals to achieve T10 dermatome.
O
Outcome
Haemodynamic stability and successful anaesthesia without complicationssafety

Continuous spinal anaesthesia is a feasible and haemodynamically stable technique for high-risk elderly patients with multiple comorbidities undergoing orthopaedic surgery.

Limitations

  • Only two cases reported
  • Lack of a control group

Cite This Study

Ong et al. (2022) conducted a case report in Intertrochanteric fractures requiring orthopaedic surgery (n=2). Continuous spinal anaesthesia was evaluated on Haemodynamic stability and complications. Continuous spinal anaesthesia provided adequate anaesthesia with haemodynamic stability and no reported complications in two high-risk elderly patients undergoing orthopaedic surgery.

synapsesocial.com/papers/6a86ecfaddd5671cb07cbe89https://doi.org/10.35119/myja.v1i2.7
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Also Consider

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  1. 1Thoracic continuous spinal anesthesia for high-risk comorbid older patients undergoing major abdominal surgery: one-year experience of an Italian geriatric hospital2020 · 40 citations
  2. 2Effect of Continuous Spinal Anesthesia and Single Shot Spinal Anesthesia on Hemodynamics for Lower Abdominal and Hip Surgeries in Adults: An Observational Study2019 · 3 citations
  3. 3Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective <scp>UK</scp> Anaesthesia Sprint Audit of Practice ( <scp>ASAP</scp> ‐2)2016 · 185 citations
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