Anesthesia; Adverse Effect, Spinal and Epidural Clinical Trial
Official title:
Unilateral Versus Bilateral Spinal Anesthesia in Day Case Procedures: Difference in Block Characteristics, Micturition Quality and Discharge Time
The purpose of this study is to compare unilateral spinal anesthesia using hyperbaric Prilocaine with "classical bilateral spinal anesthesia" using plain Prilocaine according to block characteristics and quality of micturition, standardized to the subjects own functional bladder capacity. Our hypothesis is that unilateral spinal anesthesia will provide faster time to micturtition and discharge, lesser hypotension and lesser micturition problems.
Many studies have been published in search of the ideal locoregional anesthetic for day case
procedures under spinal anesthesia.
Transient neurological symptoms (TNS) and bladder retention are two side effects, which have
been described in literature with incidences ranging from 0-80%.
Lidocaine, which was our hospital standard for spinal anesthesia in day case surgery, has a
high incidence of TNS. Besides changing the product, dose or additive, optimisation of spinal
anesthesia can be performed by changing anesthetic technique or fluid policy.
There is no consensus in literature about fluid policy and the risk of urinary retention. In
a previous study we found that urge sensation and bladder capacity is subject to a high
variability.
There are a few studies published about unilateral anesthesia for day-case surgery. For
bilateral anesthesia it was shown that recuperation of the detrusor function comes with the
regression of the sensory block to the S2 dermatome . However, little is known about bladder
function during unilateral block of the sacral segments, not to mention the detrusor function
and micturition with an asymmetric recovery of the sensory and motor block.
Prilocaine has found to induce reasonably short durations of spinal blockade, without causing
TNS while manufactured in plain and hyperbaric solutions .
We expect that with a unilateral technique patients can void faster and can reach discharge
criteria faster then with a bilateral technique.
We will compare unilateral spinal anesthesia with hyperbaric prilocaine with bilateral spinal
anesthesia with plain prilocaine. The two techniques will be compared on the following
subject
- quality of the motor and sensory block
- recovery from the sensory and motor block
- hemoynamic changens (blood pressure and hart rate)
- time to micturition
- micturition quality
- discharge time
- complications
Sensory block will be tested by loss of cold sensation. Quality of unilateral block will be
tested by QST.
Protocol for catheterisation will be adjusted according to the patients individual bladder
capacitity, based on a bladder diary. Quality of micturition will be based on
bladderscanning, uroflow and subjective complaints. A micturition score from one of our
previous studies is used.
Two days and one week postoperative patients will be called and asked if they experienced one
of the following symptoms:
- Back pain
- Symptoms of TNS
- Headache
- Micturition problems
- Use of per oral pain medication
- Other
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