A COMPARATIVE STUDY BETWEEN THE CLINICAL EFFECTS OF SEQUENTIAL COMBINED EPIDURAL WITH SPINAL ANESTHESIA AND SPINAL ANESTHESIA ON HEMODYNAMIC STABILITY IN PATIENTS UNDERGOING MAJOR ORTHOPEDIC SURGERY

Abstract

Background: Orthopedic surgery is often performed with regional anesthesia, and traditional spinal anesthesia can lead to clinically significant decreases in arterial pressure due to sympathetic blockade, whereas Combined spinal-epidural anesthesia (CSEA) can be used with a lower initial intrathecal dose followed by epidural supplementation.  Aim: To compare the clinical outcomes and clinical hemodynamic stability of CSEA and conventional spinal anesthesia in patients who underwent orthopedic surgery. Methods: A randomized controlled trial was carried out in 60 patients who were randomly divided into two groups; Group A which used conventional spinal anesthesia and Group B which used CSEA. The hemodynamic parameters were measured at preset intervals during the operation, and sensory and motor block features, patient and complications were noted. Statistical comparisons between groups were performed, with p≤0.05 considered statistically significant. Results: The mean age was 72.30 ± 5.75 years in Group A and 70.90 ± 4.53 years in Group B (p=0.150), while mean surgical duration was 54.13 ± 2.32 and 54.87 ± 2.10 minutes, respectively (p=0.102). Baseline MAP was comparable between groups (100.70 ± 5.79 vs. 99.37 ± 5.49 mmHg; p=0.182), but following anesthesia it remained significantly higher in Group B at all recorded time points from 0 to 50 minutes (p<0.05). Significant heart-rate differences were observed at 5 minutes (83.23 ± 10.78 vs. 76.93 ± 8.85 beats/min; p=0.008), 10 minutes (83.40 ± 12.14 vs. 76.53 ± 9.45 beats/min; p=0.009), and 15 minutes (81.53 ± 12.19 vs. 76.30 ± 9.57 beats/min; p=0.035). Sensory block onset, achievement of T10 sensory level, and motor block were significantly faster with conventional spinal anesthesia than CSEA (3.08 ± 0.64 vs. 11.57 ± 1.48 minutes; 6.13 ± 0.90 vs. 15.53 ± 1.50 minutes; and 8.08 ± 1.00 vs. 20.33 ± 1.86 minutes, respectively; all p<0.05). Hypotension occurred in 26.67% versus 13.33% of patients (p=0.390), while shivering was significantly more frequent with spinal anesthesia (13.33% vs. 0.00%; p=0.015). Conclusion: The CSEA was more efficient intraoperative MAP preservation than traditional spinal anesthesia, but the traditional spinal anesthesia yielded much faster sensory and motor blockade. This means that CSEA can prove beneficial in situations where hemodynamic stability is a primary anesthetic consideration, whereas traditional spinal anesthesia can be used where a rapid block realization is needed.