مقايسه نتايج بي حسي نخاعي با بي حسي توام نخاعي - اپيدورال در اعمال جراحي اورولوژي و شكمي با سوزن دو كاناله مخصوص

Comparison of Spinal Anesthesia and Combined Spinal-epidural Anesthesia in trems of Failure Rate and Post-dural Puncture Headache in Urologic and Lower Abdominal Procedures

Background and Objectives: Combined spinal-epidural (CSE) anesthesia, has gained increasing popularity since its introduction in 1937. The major advantages of this method, are the rapid onset, reliability of the spinal anesthesia, and possibility of extending anesthesia and analgesia into the postoperative period via the epidural catheter. Materials and Methods: In a prospective and double-blind study, 60 patients scheduled for elective urologic and pelvic surgeries, were allocated randomly in tow groups: in the control group, in 30 patients spinal anesthesia was performed with 25 G spinal needle and in the second group, also consisted of 30 patients, combined spinal-epidural anesthesia was used with a special needle. All patients were in ASA (American society of anesthesiologists) classes 1, II and III, without any contraindications for regional anesthesia. Results: In control group (spinal anesthesia), failure rate was 13.2% (p=0.04) and incidence of headache was 6.6% (p-0.05). In combined group (Spinal-epidural anesthesia), failure rate and incidence of headache were t)%. The mean time of onset in spinal group was 4 seconds and in combined group was 3.77 seconds. In combined group, epidural space measured 5.44 mm. Conclusion: This study showed the follwing advantages for combined group: rapid onset of effect, low incidence of failure and headache, enabling surgeon for prolonging the duration of anesthesia or extending the level of sensory block, and feasibility of post-operative analgesia through epidural catheter. Combined spinal and epidural anesthesia, has become the technique of choice for most procedures performed under regional anesthesia.