Abstract ID: A25
Abstract Title: EPIDURAL ANESTHESIA COMBINED WITH SPINAL CORD STIMULATION (SCS)FOR ORTHOPAEDIC SURGERY
Poster Type: Poster
ABSTRACT BODY
EPIDURAL ANESTHESIA COMBINED WITH SPINAL CORD STIMULATION (SCS)FOR ORTHOPAEDIC SURGERY
Di-Si Hao General Surgery of Province Hospital of Heilongjiang 150036. Jian-Ying Hao 2nd Teaching Hospital of Harbin Medical University 150086
AIM: The aim of this study was to clarify whether spinal cord stimulation could induce anesthetic effect in operation.
METHOD:Eighty patients ASA I II were divided into two groups average randomly male 57cases female 23 cases ,age 20~55 years, B.W 55~65 Kg,W.H.165~175cm,osteotomy 20 cases,knee joints 20 cases, fracture of lower extremities 40 cases. In order to be included in this study all subjects had to have a negative neurological and medical work up in vertebral canal. Group A: Epidural anesthesia combined with SCS. After successed epidural puncture in L2~3 interspace a epidural catheter with microelectrode was inserted into epidural space in 3 cm toward the sacrum. Then connected to a spinal cord stimulator was employed, the stimulation was used with D.D.wave 2 Hz and 100Hz alternatively for 15 min..Then different doses of anesthetic solution were injected into epidural space. Group B:The standardized epidural anesthesia was performed . noninvasive blood pressure , heart rate, and respiratory were measured during the operation. When a satisfactory response was obtained at 15 min. after stimulation. Motor block was assessed according to the following scale: 1. absence of motor block 2. motor block almost complete ( possible movement but not against resistance ).3.complete motor blockage ( absence of movement ).Patients satisfaction with anesthetic technique was evaluated by means of a categorical scale:1. satisfactory 2. unsatisfactory.
RESULTS: The dose of anesthetic solution in the operation ,GroupA: in 5ml was 10 cases, in 10ml was 21 cases, in 15ml was 9 cases, average dose was 9.87ml.Group B: in 15ml was 3 cases, in 20ml was 8 cases, in 25ml was 22 cases, in 30ml was 7 cases, average dose was 24.13ml p<o.oo1.Dolantin GroupA in 50 mg was 31 cases, in 75mg was 9 cases, average dose in Group A was 55.63mg and Group B in 50 mg was 35 cases , in75mg was 5 cases , average dose was 53.12mg.p>0.1. B.P.decreased ,Group A in 10 mmHg was 15 cases ,nochanged was 25 cases.GroupB : in 10 mmHg was 15 cases ,in 20mmHm was 20 cases, in 30mmHg was 1 case nochange was 4 cases. Motor block: Group A: Scale 1.was 15 cases, 2. was 20 cases ,3. was 5 cases. Group B : Scale 1 . was zero, 2. was 10 cases, 3 . was 30 cases.
DISCUSSION : The pain relief of spinal cord stimulation was demonstrated in this study ,combined with epidural anesthesia may decreased the anesthetic solution ,the adverse reaction decreased also. B.P. H.R. R.R. were stable during the operation, motor block was moderated, it is convenient for surgeon. We did not design this study to determined the mechanism by which SCS exists it’s anesthetic effects, however this finding supports the original explanation proposed by Melzark and based on the Gate Control Theory.
CONCLUSION: Pain relief of SCS was demonstrated in this study, combined with epidural anesthesia in orthopaedic surgery is a effective method, SCS was safety in human being.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A25