Comparative study of haemodynamic stability in continuous spinal anaesthesia (CSA) vs single dose spinal anaesthesia (SDSA) in lower limb orthopedic surgeries

After obtaining ethical committee’s approval and written informed consent patients undergoing lower

limb orthopedic surgeries under Continuous Spinal Anaesthesia and Single Dose Spinal Anaesthesia

will be recruited in this study.

Participants will be allotted in to two groups through balanced randomization. A computer software viz.

WINPEPI will be used for the randomization. The procedure allocation will be kept in a sealed opaque

envelops and they will be opened after written informed consent of eligible participants.

Pre-anaesthetic check-up will be carried out in all patients.

Using a sealed envelope technique, patients will be randomly assigned into two

groups

Group C: will receive Continuous Spinal Anaesthesia with Initial dose of 0.5% hyperbaric

BUPIVACAINE 10 mg (2 ml)

Group S: will receive Single Dose Spinal Anaesthesia with Total dose of 0.5% hyperbaric

BUPIVACAINE 18-19 mg (3.6-3.8 ml)

After arrival to procedure room, a peripheral I.V line, a blood pressure cuff and pulse oximetry probe

will be attached.

Pre-operative heart rate, systolic, diastolic, mean arterial pressure, and SpO2 will be recorded.

All patients will be co loaded with Ringer lactate solution 10ml/kg over 15 minutes.

Intraoperative monitoring, including continuous electrocardiogram, pulse oximetry, and Non-invasive

blood pressure, will be attached and baseline vitals noted

Following equipments will be required:

 A portable sterile tray containing:

 Sterile towel and gauze packs

 Sterile gloves

 Spirit

 Bowls containing povidone iodine

 Sterile syringes of 2ml, 5ml and 10 ml

 Sterile needle 18G, 20G and 24G

 Sterile 23G Quincke’s spinal needle

 Epidural catheter set (18 G Epidural Needle, 20 G Epidural Catheter)

 Local anaesthetic agent- Inj Bupivacaine 0.5% (Hyperbaric)

 Local anaesthetic agent- Inj Lignocaine 2 %

Under all aseptic precautions the skin was cleaned with an antiseptic solution.

After palpating a space at or below L3/L4, subcutaneous tissues and muscles are infiltrated with 2 ml of

LIGNOCAINE 2%.

The Tuohy needle (18 G) is then inserted until the resistance of the ligaments is felt. Thereafter the

needle is cautiously advanced, pausing every 0.5 cm to remove the stylet and check for CSF.

Once CSF is identified the needle should be occluded before inserting the catheter 3–4 cm into the

subarachnoid space.

To check the catheter, the end should be lowered below the level of insertion and a constant, steady

drip of CSF is observed. The catheter is then secured using an epidural dressing and the filter is

connected.

 Give 2 ml Hyperbaric Bupivacaine 0.5% (i.e; 10 mg)

with the patient in a supine position and check the block height after 5–10 min.

Further doses of 1 ml Hyperbaric Bupivacaine 0.5% can be injected every 5–10 min until the desired

block height is achieved.

Top up doses of Hyperbaric Bupivacaine 0.5% 0.8 ml can be given every hour to maintain the sensory

at T10.

Sensory and motor level will be evaluated by blind individual every 30 seconds for first 5 minutes, 1

minute till 10 minutes, every 5 minutes till 30 minutes and every 30 minutes till the end of surgery.

Sensory block will be checked bilaterally at mid-clavicular line using pinprick method.

 Intraoperative Hemodynamic Parameters

1. Mean Arterial Pressure (MAP)- measured every 2 minutes till first 10 minutes, Every 5 minutes

till first 10 minutes followed by every 15 minutes throughout the surgery.

2. Heart Rate (HR)- measured every 2 minutes till first 10 minutes, Every 5 minutes till first 10

minutes followed by every 15 minutes throughout the surgery.

3. Systolic Blood Pressure (SBP)- measured every 2 minutes till first 10 minutes, Every 5 minutes

till first 10 minutes followed by every 15 minutes throughout the surgery.

4. Diastolic Blood Pressure (DBP)-measured every 2 minutes till first 10 minutes, Every 5

minutes till first 10 minutes followed by every 15 minutes throughout the surgery.

5. Incidence of Hypotension- Decrease in MAP>20% from baseline

6. Incidence of Bradycardia- Decrease in HR >20% from baseline

7. Overall Incidence of Hemodynamic Instability- Decrease in MAP and HR >20% from baseline

8. Use of Vasopressors- Frequency and total dose

9. Use of Anticholinergics- Frequency and total dose