Continuous spinal anaesthesia and analgesia in high-risk patients undergoing abdominal surgery

Background: Continuous spinal anaesthesia has been used as a possibly safer technique than general anesthesia alone, in high-risk patients with a more predictable effect and lesser hemodynamic and respiratory repercussions.
Aim: To evaluate the consequences of continuous spinal anaesthesia and analgesia, in 52 high-risk patients undergoing major abdominal surgery.
Settings and Design: Operating room and postanaesthesia care unit of an oncology hospital; a prospective study.
Materials and Methods: After inserting the 22 gauge spinal catheter, plain 0.5% Bupivacaine 7.5 mg was administered through the catheter. Additional doses of Bupivacaine 2.5 mg were given, until a sensory T₄ level and total dose was noted. The postoperative analgesia involved a continuous intrathecal infusion of Sufentanil 1 mg h^-1 with Bupivacaine 1 mg h^-1. Pain scores and side effects were assessed at 1, 2, 4, 6, 12, 18 and 24 h after the surgery.
Results: The dose of Bupivacaine required to achieve the sensory T₄ level, was 13.1±4.5 mg. Forty percent of patients had hypotension and were easily controlled by the intermittent intravenous bolus of Ephedrine (22.2±16.8 mg). The technique provided effective analgesia with low dynamic and static pain scores and a low incidence of minor side effects such as nausea (14%), vomiting (6%) and pruritis (22%).
Statistical Analysis: Kolmogorov Smirnov test was used to analyze the distribution of the data. Data are presented as mean ± SD, median, range or percentages.
Conclusions: We concluded that continuous spinal anaesthesia and analgesia for the perioperative management could be performed effectively and safely, in high-risk patients with minimal adverse effects.

Keywords
Anaesthetic technique, continuous spinal anaesthesia, analgesia, postoperative, patients, high-risk, humans.