A COMPARATIVE STUDY OF THE EFFICACY AND HEMODYNAMIC CHANGES OF COMBINED SPINAL EPIDURAL ANESTHESIA AND SPINAL ANESTHESIA FOR TOTAL VAGINAL HYSTERECTOMY
Introduction. The choice of the best anaesthesiologic method for total vaginal hysterectomy surgeries must be based on the results of the assessment of patient’s preoperative condition, specifi c risks of anaesthesia as well as the magnitude of local functional and structural changes, their compensation, technical peculiarities of this surgery, and the need for adequate perioperative anaesthesia while preserving vital functions within an acceptable, safe range. The use of block anaesthesia methods in total vaginal hysterectomy surgeries has several advantages due to reliable protection against surgical stress with minimum systemic impact on the body.
Aim. To compare the eff ectiveness and safety of spinal – and combined spinal-epidural anaesthesia methods during total vaginal hysterectomy in patients with incomplete uterine prolapse based on the comparative analysis of hemodynamic profi les, quality of intraoperative anaesthesia, and the duration of postoperative analgesia.
Methods. 40 female patients were examined in the gynaecological department of «Lviv emergency hospital» who underwent a planned total vaginal hysterectomy due to incomplete uterine prolapse of II and III degrees. Group 1 (n = 18) included patients who received a combined spinal-epidural anaesthesia (CSE), while group 2 (n = 22) – received classical spinal anaesthesia.
Cardiac output (CO) and cardiac index (CI) were monitored using an esCCO module (Life Scope Monitor by Nihon Kohden, Japan). In addition, blood pressure (BP), mean blood pressure (MAP), and heart rate (HR) were measured. The postoperative pain intensity was evaluated using the VAS-scale.
Results. In contrast to group 1, we observed a signifi cant decrease in CO and CI after 30 minutes as well as a decreased MAP – after 60 minutes from the onset of anaesthesia in group 2. A tendency towards hypotension and bradycardia was observed until the end of surgery in both groups. The total volume of infusion for the prevention of hypotension in group 1 was 1.543.75 ± 55.45 ml, which equalled 21.36 ± 1.12 ml / kg of body weight; in group 2, it amounted to 1.835.0 ± 70.7 ml, i.e. 26.17 ± 1.51 ml / kg (p = 0.006); the diff erence was 18.4%. Immediately after surgery, pain levels in both groups were equal (VAS 0), but after 2 hours of the postoperative period, the pain level of the second group was twice as high - with VAS 4, whereas in the fi rst group it was VAS 2. This diff erence remained even after 4 following the surgery.
Conclusions. The CSE group needed a signifi cantly smaller volume of infusion compared to the group that received spinal anaesthesia, which indicates a more stable and safe hemodynamic response. This is also confi rmed in the study of indicators, such as BP, MAP, CO, CI, and HR during the surgery. During CSE, postoperative analgesia was more eff ective due to prolonged epidural analgesia.
Disclosures. No conflicts of interest, financial or otherwise, are declared by the authors.
The personal contribution of the authors. The authors of this publication personally conducted all levels of research and literature review, as well as meta-analysis. The authors established the purpose of the study, analysed, and formulated the results upon the study of the topic relevance. The authors have also conducted a comprehensive clinical, laboratory, and instrumental examination and personally treated patients.
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