Refining anaesthesia techniques in day surgery
LOW-DOSE SPINALS FOR AMBULATORY SURGERY
S Watts
Sir Charles Gairdner Hospital, Perth, WA
Traditional teaching has favoured the use of general anaesthesia for day case surgery on the grounds of faster operating theatre turnaround and improved discharge times. The use of central neuraxial techniques in this population has largely been confined to caudal analgesia in the paediatric patient. Spinals are usually reserved for patients with contraindications to GA or those expressing a firm desire to be kept awake.
There is however an increasing body of evidence supporting the routine use of low-dose intrathecal analgesia in the day surgery environment. The technique is particularly applicable for gynaecological laparoscopy and knee arthroscopy. Potential benefits being improved postoperative analgesia when compared to opioid-based alternatives, and shortened (or even bypassed) PACU times.
Hyperbaric solutions are favoured for the creation of ipsilateral block prior to knee surgery, whereas hypobaric solutions are better suited for laparoscopic procedures.
Successful use of doses of bupivacaine as low as 4mg (0.8ml) have been reported, although the optimum appears to be in the region of 6-8mg (1.2-1.6ml).
This presentation will outline some of the principles associated with using subclinical doses of local anaesthetic, combined with other intrathecal agents, to create an optimal surgical environment with minimal postoperative sequelae. Controversies surrounding needle choice, patient positioning, onset time and choice of drug will be addressed.
Time of Presentation
Saturday 13 May 2006 - 1530-1700
References
1. Salinas FV, Liu SS, Best Prac Res Clin Anaesthesiol 2002 16(2) 195- “Spinal Anaesthesia: Local anaesthetics and adjuncts in the ambulatory setting”
2. Vaghadia H, Viskari D, Mitchell GW, Berrill A, Can J Anaesth 2001 48(3) 256-60 “Selective spinal anesthesia for outpatient laparoscopy”
3. Valanne JV, Korhonen AM et al, Anesth Analg 2001 93(6) 1377-9 “Selective spinal anesthesia: Hyperbaric bupivacaine 4mg versus 6mg for outpatient knee arthroscopy”
