Details
Category: Volume 09 Issue 06 June 2021
Hits: 720

Title: Spinal Anaesthesia Using Taylors Lumbosacral Approach to Reduce the Incidence and Severity of Haemodynamic Side Effects in Patients Undergoing Transurethral Resection of Prostate

Authors: Dr Kamini Randhawa, Dr Shweta Mahajan, Dr Arti Sharma

 DOI: https://dx.doi.org/10.18535/jmscr/v9i6.41

Abstract

Hemodynamic side effect like bradycardia and hypotension are the most common undesired side effects during spinal anaesthesia. In1940 Taylor described a SPA technique by a lumbosacral approach which caused less haemodynamic disturbances. The purpose of the present study was to compare the incidence and severity of haemodynamic side effects between a lumbar approach at L4/5 or Taylor’s lumbosacral approach. 30 patients received SPA by a L4/5 approach and 30 patients by Taylor’s approach.

Bupivacaine dose did not differ between groups. Onset of MLSB was faster (3.17+1.020 min vs 7.20+1.215, p <0.001) in the lumbar group. Onset of motor block was faster (5.47+1.358 min vs 8.40+0.770) in lumbar group but duration of motor block did not differ between groups. The maximum decrease in heart rate was greater in lumbar group (27% vs 7%, p value 0.019). The maximum decrease in mean arterial pressure was also greater in the lumbar group (60% vs. 70%, p value 0.037). SPA with plain bupivacaine using Taylor’s approach was associated with slower onset of MLSB and less haemodynamic disturbances compared to the classical lumbar approach at L4/5.

References

  1. Aidan M O Donnell, Irwin TH Foo MB BChir. Anaesthesia for transuretheral resection of the prostrate. Br J Anaesth 2009; 9(3): 92-6.
  2. Chia-Chu Liu,Shu-Pin Huang,Yii –Her Chou, Chii-Jye Wang, Chun- Hsiung Huang. current indication for Transuretheral resection of prostrate and associated complications. Kaohsiung J Med sci 2003;19: 49-54.
  3. Vitalis Mung’ayi, Karen Mbaya, Thikra Sharif, Dorothy Kamya. A randomized controlled trial comparing haemodynamic stability in elderly patients undergoing spinal anaesthesia at L5-S1 versus spinal anaesthesia at L3-L4 at a tertiary African hospital. African  health science 2015; 15(2): 466-79.
  4. Rafiqul Islam,Mozaffer Hossain,Quazi Arefin Kabir, Abdul Alim. Paramedian approach for subarachnoid blockade – A marvelous technique having less attention. Journal of BSA 2006; 19: 51-3.
  5. P. Chalapathy, Dr. E. Jayasundaram. Taylors approach is best apporoach to overcome difficulty in lumbar puncture in difficult spinal cases. IORS-JDMS 2016;15-12
  6. Litz, R.J, Brandt, M.; Wiessner, D.; Heller, A.R.; Koch, T. spinal anaesthesia using Taylors lumbosacral approach reducing incidence and severity of hemodynamic side effect in patient undergoing transuretheral surgery. EJA 2006; 23: 114.
  7. Kumkum Gupta, Bhawna Rastogi, Prashant K .Gupta, Avinash Rastogi, Manish Jain and V.P. Singh. Subarachnoid block with Taylors approach for surgery of lower half of body and lower limb:A clinical study. Anesth Essays Res.2012; 6(1): 38-41
  8. H. Olsen , T.H Nielsen, E. Kristoffersen , H.C .Husegaard, M. Wernberg and J . Dorup. Spinal analgesia with 0.5% bupivacaine administered at spinal interspace L2-L3 or L4-L5 . Br J Anaesth 1990; 64: 170-2.

Corresponding Author

Dr Kamini Randhawa

Junior Resident, Department of Anaesthesiology, Indira Gandhi Medical College, Shimla