Walking spinal anesthesia in day-case inguinal herniorraphy: impact of different local anesthetics on discharge criteria

Iulia Cîndea, Alina Balcan, Gh. Nicolae, V. Gherghina

Clinica A.T.I., Spitalul Clinic Judeţean de Urgenţă, Constanţa

Abstract

Background and objectives. Walking spinal is a term defining a new technique of regional anesthesia that is preferred because it gives satisfactory conditions for day-case abdominal surgery, patient satisfaction and it allows the subject to leave the operating room on foot. The purpose of our study was to evaluate comparatively the influence on discharge criteria of spinal anesthesia with commonly used local anesthetics for day-case inguinal herniorraphy.

Patients and methods. Following institutional approval and after written informed consent, 92 ASA I-II subjects, scheduled for day-case herniorraphy have been enrolled in a prospective observational study performed in the Constanta County Hospital. The patients have been randomly allocated in three groups to receive spinal anesthesia with 5 mg bupivacaine 0.5% (group B, n = 31), 5 mg levobupivacaine 0.5% (group L, n = 31) and respectively 7.5 mg ropivacaine 0.75% (group R, n = 30). Each study solution diluted to 3 ml with distiled water has been injected at L2-L3 interspaces in sitting position over 2 minutes. Then the patients have been placed in dorsal decubitus for the surgical procedure. The following parameters were evaluated and recorded: spinal block resolution time (SRT), time to micturition (TM), incidence of analgesia requirements (AR) and ability to stand and walk (ASW) in recovery room, patient satisfaction and discharge time. Statistical analysis was performed using t-student and chi-square test.

Results. Intergroup demographics were similar. All spinal anesthesia procedures were adequate for planned surgery. Hemodynamics was comparable among the studied groups. Data regarding SRT (138 ± 53 vs 156 ± 63 vs 105 ± 45 min), TM (230 ± 68 vs 198 ± 62 vs 250 ± 58 min), AR (26/31 vs 28/31 vs 25/30 patients) and ASW (13/31 vs 15/31 vs 18/30 patients) did not statistically differ among the groups.
Patients have considered anesthesia conditions to be excellent in proportion of 83.87% (26/31) in group B, whereas patient satisfaction was of 90.32% (28/31) in group L, respectively 93.33% (28/30) in group R, differences that did not reach statistical significance (p = 0.28). Criteria for home discharge were fulfilled after 270 ± 74 min in group B, 235 ± 97 min in group L and 290 ± 87 min in group R (p = 0.28).

Conclusions. Equipotent doses of bupivacaine, levobupivacaine and ropivacaine used in walking spinal anesthesia for inguinal hernia repair have similar influences in walk-out criteria.

Keywords: local anaesthetics, walking spinal, herniorraphy

Tehnica anestezică “walking spinal” în herniorafia inghinală de zi: impactul diferitelor anestezice locale asupra criteriilor de externare