Unilateral spinal anesthesia versus conventional spinal anesthesia in ambulatory lower abdominal surgery

Iulia Cîndea, Alina Balcan, V. Gherghina, Gh. Nicolae
Clinica Anestezie-Terapie Intensivă, Spitalul Clinic Judeţean de Urgenţă Constanţa

Abstract

Background and goal of study. Unilateral spinal anesthesia offers analgesia and operating conditions as good as standard spinal technique in outpatient scheduled for lower abdominal surgery. The objective of the prospective randomized current study is to evaluate the two spinal techniques with respect to recovery times, level of patient postoperative comfort and anesthetic-related costs.

Materials and method. One hundred ASA I-II, premedicated subjects scheduled for hernioplasty were randomly allocated into two groups to receive conventional (n = 50) and unilateral (n = 50) spinal anesthesia with 10 mg hyperbaric bupivacaine. In unilateral spinal anesthesia group a lateral decubitus position with the operative side down was maintained for 15 minutes, after spinal injection. For both groups recovery times, postoperative effects profile during a 5 days follow-up period, as well as costs were registered. 5 days after the procedure, the patients were interviewed by telephone about analgesia medication requirements after discharge, as well as the occurrence of headache and backache.

Results and discussions. Compared to bilateral spinal anesthesia, the subjects receiving unilateral spinal technique had shorter recovery times (120 ± 56 min versus 240 ± 70 min, p < 0.001) and lower pain scores at discharge (14 ± 13 mm versus 32 ± 30 mm, p < 0.001). These patients had less requirements for analgesic medication at home (22/50 versus 40/50, p < 0.05). Frequency of headache (2/50 versus 9/50) and backache (1/50 versus 6/50) registered lower values in unilateral spinal anesthesia group, too. The anesthetic-related costs were also less for unilateral spinal technique (102.14 ± 30.82 $ versus 134.93 ± 31.03 $, p = 0.001).

Conclusions. The unilateral spinal anesthesia technique is more cost-effective than traditional spinal anesthesia for lower abdominal procedures in ambulatory setting, as it is associated with an earlier recovery, high postoperative patient satisfaction and decreased costs.

Key words: spinal anesthesia, ambulatory surgery, hyperbaric bupivacaine