THORACIC SEGMENTAL SPINAL ANAESTHESIA IN UPPER ABDOMINAL SURGERIES AND SIMPLE MASTECTOMY-A CASE SERIES

Madhuchanda Borah, Kaveri Das, Bijoy Ahir, ANJALI VERMA, Pydimalla Venkata Gowtham, Karuna Kumar Das, Pritanu Deb Baruah
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Abstract

Objective: To observe safety and efficacy of Segmental thoracic spinal anesthesia (STSA) in upper abdominal and breast surgeries. Methods: 14 cases were selected, out of which 6 laparoscopic cholecystectomy (LC), 4 open cholecystectomy (OC), 3 emergency exploratory laparotomy and 1 simple mastectomy. Under full aseptic precaution, segmental thoracic spinal anesthesia was administered through midline approach in T8-9 space for upper abdominal surgeries and T5-6 space in a simple mastectomy. Using 25G Quincke spinal needle 1.5 ml [7.5 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl was given in abdominal surgeries and 1.2 ml [6 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl in simple mastectomy. Results: Age group of patients ranged from 25 to 65 y, Male: Female ratio of 4:10, Body Mass Index (BMI) range of 22 to 24.9 with physiological status of ASA I to ASA III. Hemodynamically, hypotension was observed in every patient after 5-10 min of STSA well managed with fluid and vasopressors with no bradycardia. Average width of sensory block was T3 to L1-2 in upper abdominal surgeries and T1 to T8 in a simple mastectomy. Motor block was Modified Bromage Scale (MBS) of 0 to 1 during and postoperatively. Regarding analgesia, Visual Analogue Scale (VAS) score was 0 intraoperatively and 0-1 postoperatively. Sedation score was 2 both intraoperatively and postoperatively with no significant complications and good patient and surgeon satisfaction. Conclusion: Segmental thoracic spinal anaesthesia is a safe and effective procedure with good patient and surgeon satisfaction.
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上腹部手术和单纯乳房切除术中的胸椎节段脊髓麻醉--病例系列
目的观察分段胸椎麻醉(STSA)在上腹部和乳房手术中的安全性和有效性。方法:选取 14 个病例,其中 6 例腹腔镜胆囊切除术(LC)、4 例开腹胆囊切除术(OC)、3 例急诊探查性开腹手术和 1 例单纯乳房切除术。在完全无菌预防措施下,上腹部手术通过中线T8-9间隙进行胸椎分段麻醉,简单乳房切除术通过T5-6间隙进行胸椎分段麻醉。在腹部手术中使用 25G Quincke 脊柱针头注射 1.5 毫升 [7.5 毫克] 0.5% 异丙基左旋布比卡因混合 0.4 毫升(20 微克)芬太尼,在单纯乳房切除术中注射 1.2 毫升 [6 毫克] 0.5% 异丙基左旋布比卡因混合 0.4 毫升(20 微克)芬太尼。结果:患者年龄介于 25 至 65 岁之间,男女比例为 4:10:男女比例为 4:10,体重指数(BMI)介于 22 至 24.9 之间,生理状态为 ASA I 至 ASA III。血流动力学方面,每位患者在 STSA 5-10 分钟后都会出现低血压,通过输液和使用血管加压剂得到了很好的控制,但没有出现心动过缓。在上腹部手术中,感觉阻滞的平均宽度为 T3 至 L1-2,在单纯乳房切除术中为 T1 至 T8。术中和术后的运动阻滞为改良布罗马格量表(MBS)的 0 至 1。关于镇痛,术中视觉模拟量表(VAS)评分为 0,术后评分为 0-1。术中和术后镇静评分均为 2 分,无明显并发症,患者和外科医生满意度良好。结论分段胸椎麻醉是一种安全有效的手术,患者和外科医生都非常满意。
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