A COMPARATIVE STUDY OF CARDIOVASCULAR STABILITY IN UNILATERAL AND BILATERAL SPINAL BLOCK IN LOWER LIMB SURGERY (FRACTURE TIBIA).

Corresponding Author:
Dr. Gurpreet Kaur Atwal,
Senior Resident,
SGRD, Amritsar, 44-B, New Kangra Colony,
Near Partap School, Amritsar, Punjab, India.
E-mail: preetatwal14@gmail.com

ABSTRACT

BACKGROUND

Spinal anaesthesia is an effective alternative to general anaesthesia when the surgical site is located on the lower extremities, perineum or lower body wall. It is easy to perform and results in sympathetic block, sensory analgesia and motor block. There are several disadvantages of spinal anaesthesia, among which are bradycardia and hypotension. Unilateral spinal anaesthesia limits the motor, sensory and sympathetic block to one side and thus have fewer haemodynamic complications.

The aim of our study was to compare cardiovascular stability in unilateral versus bilateral spinal block in lower limb surgery (Fracture Tibia) using 3 mL of 0.5% heavy bupivacaine.

MATERIALS AND METHODS

This non-randomised controlled trial was performed in 100 patients who were assigned to two groups. Both groups received 3 mL (15 mg) of 0.5% hyperbaric bupivacaine intrathecally in lateral decubitus position at L4-L5 lumbar interspace with operating limb down. In Group I (Bilateral group), patients were immediately turned supine. In Group II (Unilateral group) patients were kept in lateral position for 10 minutes. Onset of sensory and motor block, haemodynamic changes, regression of motor block and incidence of complications were recorded. The sample size estimation was also done at conveniences.

RESULTS

By giving 3 mL of 0.5% hyperbaric bupivacaine, haemodynamic parameters (Heart rate, blood pressure, peripheral saturation of oxygen, respiratory rate) were statistically comparable in both groups. The mean onset of sensory blockade was faster in Group II (Unilateral Group) as compared to Group I (Bilateral Group). The results showed statistically significant increase in the duration of postoperative analgesia and requirement of postoperative analgesics was significantly less in Group II (Unilateral Group) as compared to Group I (Bilateral Group). So, the effect is more profound and longer lasting in the unilateral group.

CONCLUSION

Using 3 mL of 0.5% hyperbaric bupivacaine, unilateral spinal block when compared with bilateral spinal block, the haemodynamic changes were found to be statistically insignificant. Unilateral spinal block provides early onset of sensory and motor block, dense motor block with increase in duration of postoperative analgesia.

KEY WORDS

Unilateral Spinal Block, Bilateral Spinal Block, Bupivacaine, Fracture Tibia.