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    Fiaz medico
    The document discusses comparing the hemodynamic effects of unilateral versus bilateral spinal anesthesia for inguinal hernia repair. It outlines the background, objectives, hypotheses, materials and methods for a proposed study to collect data on rates of hypotension and bradycardia between the two groups to determine if unilateral spinal anesthesia results in fewer hemodynamic complications.

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    Synopsis DR ABC

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    Fiaz medico
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    The document discusses comparing the hemodynamic effects of unilateral versus bilateral spinal anesthesia for inguinal hernia repair. It outlines the background, objectives, hypotheses, materials and methods for a proposed study to collect data on rates of hypotension and bradycardia between the two groups to determine if unilateral spinal anesthesia results in fewer hemodynamic complications.

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    The document discusses comparing the hemodynamic effects of unilateral versus bilateral spinal anesthesia for inguinal hernia repair. It outlines the background, objectives, hypotheses, materials and methods for a proposed study to collect data on rates of hypotension and bradycardia between the two groups to determine if unilateral spinal anesthesia results in fewer hemodynamic complications.

    Copyright:

    © All Rights Reserved
    66 views8 pages

    Synopsis DR ABC

    Uploaded by

    Fiaz medico
    The document discusses comparing the hemodynamic effects of unilateral versus bilateral spinal anesthesia for inguinal hernia repair. It outlines the background, objectives, hypotheses, materials and methods for a proposed study to collect data on rates of hypotension and bradycardia between the two groups to determine if unilateral spinal anesthesia results in fewer hemodynamic complications.

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    The Controller

    Research Training and Monitoring Cell,

    College of Physicians and Surgeons, Pakistan,

    7th street Phase-II DHA, Karachi 75500

    Respected Sir:
    Please find enclosed a copy of synopsis titled

    “Comparison of Haemodynamic Effects of Unilateral versus Bilateral Spinal Anaesthesia in

    Inguinal Hernia Repair”

    Prepared by:
    Dr. Muhammad Nazir

    Postgraduate Trainee

    FCPS II Anesthesiology

    Submitted on:
    RTMC No.: ANS-2017-126-1773

    FCPS-I Roll No.: 95017

    Name of Supervisor:
    Dr. JAWAD ZAHIR

    MBBS, FCPS

    Professor of Anesthesiology

    Head of Department Anesthesiology

    Intensive Care & Pain Medicine

    Name of Institute:
    Holy Family Hospital Rawalpindi

    Sign of Head of department:

    Supervisor Sign:
    Comparison of Haemodynamic Effects of Unilateral versus Bilateral Spinal Anaesthesia
    in Inguinal Hernia Repair.

    SUPERVISOR:

    DR. JAWAD ZAHIR


    MBBS, FCPS

    Professor

    Head of Department Anesthesiology

    Intensive Care & Pain Medicine

    Holy Family Hospital

    Rawalpindi

    Dr. Muhammad Nazir


    Postgraduate Trainee

    FCPS Anesthesiology

    Comparison of Haemodynamic Effects of Unilateral versus Bilateral Spinal Anaesthesia


    in Inguinal Hernia Repair.
    INTRODUCTION:
    A special technique of spinal anaesthesia named spinal hemi block was described for one limb
    surgeries, which was named as spinal hemianalgesia. This is also known as unilateral spinal
    anaesthesia.1 The distance between the left and right spinal roots is only 10-15 millimeter in
    the lumbar or lower thoracic level. Such a small distance should reasonably prevent from
    producing strictly unilateral block of the spinal nerve roots.2 However, various clinical reports
    3-5
    suggested that using small doses of either hypo or hyperbaric anesthetic solution injected at
    low speeds through directional needles in patients lying in the lateral decubitus position for 10-
    15 minutes results in preferential distribution of spinal anaesthesia towards the operated side,
    providing intense surgical block on that side. Even though the term unilateral spinal anaesthesia
    has been in vogue for a long time most of the research on this are recent. Even though
    performing spinal anaesthesia is technically easier, the complications which are usually
    expected like hypotension and bradycardia can be detrimental to the high risk group patients.
    The haemodynamic changes encountered in spinal anaesthesia are directly related to the extent
    of sympathetic block and can be decreased by restricting the block to unilateral sympathetic
    chain. Unilateral block is effective in restricting the extent of sympathetic block, hence shows
    minimal haemodynamic changes as compared to bilateral block.6 The lack of hypotension, in
    particular, makes unilateral spinal anesthesia suitable for patients with cardiovascular risk
    factors e. g. aortic valve stenosis or coronary artery disease. Increasing numbers of surgical
    procedures are now being performed on an outpatient basis. Until now, spinal anesthesia has
    been considered unsuitable for this, not only because of the high incidence of intraoperative
    hypotension and postoperative urinary retention but also because of the prolonged
    postoperative stay before home discharge. This is not the case with unilateral spinal anesthesia:
    motor function returns rapidly, the incidence of urinary retention is extremely low, and patients
    are usually eligible for home discharge sooner than after bilateral spinal anesthesia or general
    anesthesia. The success of the technique depends on a number of factors. In addition to the
    local anesthetic, its concentration and dose, and the baricity of the injected solution, the shape
    of the spinal needle, the injection speed, the patient’s position during injection, and the time
    the patient remains in this position after injection are equally important parameters.1 Few
    studies have been done in the recent past evaluating the hemodynamic stability amongst
    bilateral and unilateral subarachnoid block. Ijaz et al reported frequency of hypotension to be
    6.7% in unilateral group compared to 60% in bilateral subarachnoid block group . Another
    study by Ahmad et al7 reported frequency of hypotension to be 7.7% in unilateral group versus
    24.6% in the bilateral subarachnoid group. The difference reported by them was lower
    compared to that by Ijaz et al. These contrasting results and the limited number of studies on
    the subject led us to compare the hemodynamic stability of patients in patients undergoing
    unilateral versus Bilateral spinal anesthesia.
    OBJECTIVE:
    To Compare the haemodynamic effects of unilateral versus bilateral spinal anaesthesia
    in inguinal hernia repair.

    OPERATIONAL DEFINITIONS:
    Primary Outcome Variables:
    Bradycardia: Patients having heart rate < 60 beats per min anytime from the moment of
    administration of spinal anesthesia till end of the procedure
    Hypotension: A drop in Mean arterial pressure of more than 30% of baseline values anytime
    from the moment of administration of spinal anesthesia till the end of the procedure

    NULL HYPOTHESIS:
    There is no difference in the frequency of hypotension in patients undergoing unilateral spinal
    anesthesia as compared to Bilateral spinal anesthesia
    ALTERNATE HYPOTHESIS
    Frequency of hypotension in patients undergoing Unilateral spinal anesthesia is less as
    compared to those undergoing Bilateral anesthesia.
    MATERIALS AND METHODS:
    Setting: Holy Family Hospital, Rawalpindi.
    Study Design: Randomized Control trial.
    Sample size:
    Using OpenEPI Sample Size calculator with the following:
    Confidence level: 95%
    Power of test: 80%
    Anticipated population proportion 1 : 6.7%
    Anticipated population proportion 2 : 60%

    Sample size in each group comes to be 12 patients in each group.

    SAMPLING TECHNIQUE:Non Probability consecutive sampling.


    Duration:6 months after the approval of synopsis.
    SAMPLE SELECTION: -
    Inclusion criteria:
    ASA – I, II
    Age: Adults 30 -60 years.(both gender)
    Elective surgery (Inguinal Hernia Repair)
    Exclusion criteria:
    Patient refusal
    Haemodynamic instabilty
    Patients with Ischaemic herat disease
    Infection at the site of injection,
    Diseases / injuries of vertebral column
    Neurological deficits
    History of coagulopathy
    Known allergy to local anaesthetic.

    DATA COLLECTION PROCEDURE:


    After approval from hospital ethical committee, written informed consent will be
    taken from the parents,24 patients will be recruited according to above mentioned selection
    criteria. All patients will be assessed a day before surgery for anesthesia fitness. Patients will
    be prepared by fasting (8 hours for solid foods, 4 hours for clear fluids). Patients will be
    randomly divided into two equal groups by computer-generated random numbers.
    Group A will receive unilateral spinal anaesthesia.
    Group B will receive bilateral spinal anaesthesia.
    After arrival in operation theatre, monitoring including echocardiography,
    pulse oximeter, non invasive blood pressure will be attached and baseline heart rate and blood
    pressure will be noted.Each group will be preloaded with Ringer lactate at the rate of 15 ml/kg
    over 10 min.Baseline vitals will be taken. Spinal anaesthesia will be induced in the lateral
    position with 25G, Quincke needle at L3-L4 level in group A patients. Under aseptic measures
    2 ml of 0.75% hyperbaric bupivacaine will be injected intrathecally after observing clear CSF
    flow. Patient will be lying lateral for 10 min and then supine position will be made.
    Spinal anaesthesia will be induced in the sitting position with 25G,Quincke needle at L3-L4 in
    group B patients.Under aseptic measures ml of 0.75% hyperbaric bupivacaine will be injected
    intrathecally after observing clear CSF flow.Patient will be positioned supine and 10 degree
    head down to achieve block for surgery.
    The level of sensory block in both groups will be assessed by pin prick method in a caudal to
    cephalic direction.Motor block will be recorded according to the Bromage scale. Fluid
    administration will be continued intraoperatively and a decrease in mean arterial pressure
    greater than 20 % below the pre-anaesthetic baseline will be treated with the dose of
    Phenylephrine 100 mcg IV. A decrease in heart rate below 50 beats/min will be treated with
    dose of atropine 0.01 mg /kg IV.

    DATA ANALYSIS:
    Data will be collected on a well-structured Proforma and SPSS 22 version will be used
    to analyze data.Frequency and percentage will be calculated for Gender, presence of
    hypotension,bradycardia . Quantitative variable like age, heart rate and blood pressure will be
    measured in terms of mean and standard deviation.Chi square test will be applied to compare
    the proportion of hypotension and bradycardia amongst the two groups . Effect modifiers such
    as ASA class, reducibility/irreducibility of hernia will be controlled through stratification and
    post stratification statistical tests applied.A p value of <0.05 will be taken as statistically
    significant.

    REFERENCES:
    1. Büttner B, Mansur A, Bauer M, Hinz J, Bergmann I. Unilateral spinal anesthesia:
    literature review and recommendations. Der Anaesthesist. 2016 Nov;65(11):847-65.
    2. Imbelloni LE. Spinal hemianesthesia: Unilateral and posterior. Anesthesia, essays and
    researches. 2014 Sep;8(3):270.
    3. .Gentili ME, Mamalle JC, Le Foll G. Combination of low dose bupivacaine and
    clonidine for unilateral spinal anesthesia in arthroscopy knee surgery. Reg Anesth,
    1995; 20: 169-70.
    4. Kuusniemi KS, Pihlajamaki KK, Irjala JK, Jaakkola PW, Pitkanen MT, Korkeila JE.
    Restricted spinal anaesthesia for ambulatory surgery: a pilot study. Eur J Anaesthesiol,
    1999; 16: 2-6.
    5. Karacalar S, Türe H, Sarihasan B. Unilateral spinal anesthesia in two centenarian
    patients. J Clin Anesth, 2008; 20: 452-4.
    6. IJAZ N, ALI K, AFZAL F, AHMAD S. COMPARISON OF HAEMODYNAMIC
    EFFECTS OF UNILATERAL VERSUS BILATERAL SPINAL ANAESTHESIA IN
    ADULT PATIENTS UNDERGOING INGUINAL HERNIA REPAIR. Biomedica.
    2013 Dec 31;29(4).
    7. Ahmad H, Sagheer A, Aslam S. Comparison of Haemodynamic effects of Unilateral
    versus Bilateral spinal anesthesia in inguinal herniorrhaphy. JUMDC VOL.6, Issue 4,
    2015

    Performa
    GROUP ____________
    Gender: ______

    Serial No.: ___________

    Name: ______________

    Hospital registration number: _________

    Date of Surgery: _____________


    Weight (kg): __________
    Age: ____________

    ASA Class:

    Hernia: Reducible / Irreducible

    Height: __________

    BMI: _______________

    Date of admission: _________

    Outcome Variable Yes/ No

    Hypotension

    Bradycardia

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