Key result
CSEA matches spinal anesthesia for pulmonary stability while reducing peri-operative side effects and post-operative pain.
Why the study?
Lower extremity surgeries in elderly patients have a high prevalence of peri-operative medical problems related to anaesthesia, necessitating evaluation of anaesthetic techniques to improve recovery and avoid functional decline.
Does combined spinal epidural anaesthesia improve peri-operative pulmonary status and reduce side effects compared to spinal anaesthesia in geriatric patients undergoing lower extremity surgery?
RCT (n=70)
Randomly allocated
No
Does combined spinal epidural anaesthesia improve peri-operative pulmonary status and reduce side effects compared to spinal anaesthesia in geriatric patients undergoing lower extremity surgery?
p-value: p=>0.05
Combined spinal epidural anaesthesia is effective and safe, producing stable peri-operative pulmonary status with prolonged analgesia and fewer side effects compared to spinal anaesthesia in geriatric patients.
Supports CSE over spinal anaesthesia in geriatric lower extremity surgery for fewer side effects and better analgesia; extends RCT evidence on regional techniques in the elderly.
Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups; 35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p 2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe; produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.
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Begum et al. (2020) conducted an RCT in Geriatric patients undergoing lower extremity surgery (n=70). Combined Spinal Epidural Anaesthesia (CSEA) vs. Spinal Anaesthesia (SA) was evaluated on Peri-operative pulmonary status (RR, SpO2, EtCO2, PEFR, BHT) (p=>0.05). Combined spinal epidural anaesthesia produced a stable peri-operative pulmonary status comparable to spinal anaesthesia, while significantly reducing peri-operative side effects and post-operative pain in geriatric patients undergoing lower extremity surgery.
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