Key result
Unilateral spinal anesthesia provided greater hemodynamic stability with significantly higher systolic blood pressure and a lower incidence of ephedrine use (5.1% vs 75%) compared to epidural anesthesia.
Why the study?
Does unilateral spinal anesthesia improve hemodynamic stability and reduce complications compared to epidural anesthesia in patients undergoing unilateral surgeries?
RCT (n=115)
Double-blind
Random number table
No
Does unilateral spinal anesthesia improve hemodynamic stability and reduce complications compared to epidural anesthesia in patients undergoing unilateral surgeries?
p-value: p=<0.001
Unilateral spinal anesthesia provides superior hemodynamic stability and significantly reduces the need for ephedrine compared to epidural anesthesia in unilateral surgeries.
Unilateral spinal anesthesia may be preferred over epidural for unilateral surgeries; extends RCT evidence on regional anesthesia hemodynamics.
BACKGROUND: Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries. MATERIALS AND METHODS: In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery. RESULTS: SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively). CONCLUSION: Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia.
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Kiasari et al. (2017) conducted an RCT in Unilateral surgeries below the T10 sensory level (n=115). Unilateral spinal anesthesia vs. Epidural anesthesia was evaluated on Trend in changes in systolic blood pressure (SBP) over 30 minutes (p=<0.001). Unilateral spinal anesthesia provided greater hemodynamic stability with significantly higher systolic blood pressure and a lower incidence of ephedrine use (5.1% vs 75%) compared to epidural anesthesia.
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