doiSerbia

Advantageous usage combined spinal, epidural and general anesthesia versus general anesthesia in abdominal surgery

Malenković Vesna ('Bežanijska kosa', Klinika za hirurgiju, Odeljenje anestezije i reanimacije, Beograd)
Zorić Sava ('Bežanijska kosa', Klinika za hirurgiju, Odeljenje anestezije i reanimacije, Beograd)
Ranđelović Tomislav D. ('Bežanijska kosa', Klinika za hirurgiju, Odeljenje anestezije i reanimacije, Beograd)

Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavorable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n=34), was treated with CSEGA and second group of patients (n=33), was treated only with standard (GA). Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure central venous pressure, and dieresis. In the 24 hours postoperative period the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolysm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.

Keywords: spinal, epidural, general, combined anesthesia, analgesia, abdominal surgery, subarachnoidal space, epidural cateter (EDC)