Key result
Unilateral and low-dose subarachnoid blocks significantly reduced the incidence of hypotension requiring treatment (20% vs 35%, p=0.013) compared to classical subarachnoid block in high-risk patients.
Why the study?
Does unilateral or low-dose subarachnoid block with fentanyl improve hemodynamic stability compared to classical subarachnoid block in ASA III and IV patients undergoing lower limb surgeries?
RCT (n=60)
Double-blind
Simple randomization using sealed envelope method
No
Does unilateral or low-dose subarachnoid block with fentanyl improve hemodynamic stability compared to classical subarachnoid block in ASA III and IV patients undergoing lower limb surgeries?
Absolute Event Rate: 20% vs 35%
p-value: p=0.013
Unilateral and low-dose subarachnoid block with fentanyl provide better hemodynamic stability than classical subarachnoid block in high-risk patients undergoing lower limb surgeries.
Supports unilateral/low-dose subarachnoid blocks with fentanyl in ASA III-IV patients; extends evidence for modified spinal techniques to improve hemodynamic stability.
Spinal anaesthesia is considered as a safe technique but can be detrimental to patients with hemodynamic instability. Safety improves if the block can be localized to the area of surgery. Patients with ASA3 and ASA4 grades are haemodynamically unstable. Hence an effective alternative may be unilateral subarachnoid block for lower extremity surgeries. Aim-to compare classical subarachnoid block(SAB) with unilateral SAB and low dose SAB. Method-60 patients were divided in three groups. Control Group received 2ml of 0.5% Bupivacaine and turned to supine position immediately. STUDY Group I received 2ml of 0.5 % Bupivacaine and kept in lateral position for 10 minutes and then turned supine. STUDY Group II received 1.5 ml of 0.5 % Bupivacaine with 25 g( 0.5 ml) Fentanyl and kept in lateral position for 10 minutes and then turned supine. Sensory blockade, motor blockade and haemodynamic parameters were studied.
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Srikanth et al. (2015) conducted an RCT in ASA III and IV patients undergoing emergency unilateral lower limb surgery (n=60). Unilateral subarachnoid block and low dose subarachnoid block with fentanyl vs. Classical subarachnoid block (2 ml 0.5% Bupivacaine) was evaluated on Hypotension requiring treatment (p=0.013). Unilateral and low-dose subarachnoid blocks significantly reduced the incidence of hypotension requiring treatment (20% vs 35%, p=0.013) compared to classical subarachnoid block in high-risk patients.
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