Spinal anaesthesia in lower abdominal and limb surgery: A review of 200 cases

Abstract

Background: Modern technology has produced better equipment than was available hitherto with the result that spinal anaesthesia is undoubtedly simpler, cheaper and above all, safer than it used to be. These notwithstanding, it is used infrequently. The aim of the study was to evaluate the safety, benefits and applicability of subarachnoid spinal anaesthesia in a tertiary referral centre in a developing country. Methods: This was a prospective analysis involving 200 patients requiring anaesthesia for lower abdominal and limb surgery at the Jos University Teaching Hospital, Jos. Subarachnoid spinal anaesthesia was performed through the L2/L3 or L3/L4 interspace employing either 0.5% bupivacaine hydrochloride in 8% glucose monohydrate (Marcain heavy Astra) 2-4mls or 5% lignocaine (heavy xylocaine Astra) 1-2mls. Patients with uncorrected or undercorrected hypovolaemia, uncorrected anaemia or heart disease, local sepsis and those on anticoagulant therapy or who had bleeding disorders were excluded. Also excluded were children. Results: A total of 200 patients with age range of 15-90 years and a mean age of 34.48 years were studied. The male to female ratio was 1:1.74. Eighty of them underwent caesarean section (38 emergency and 42 electives), 26 prostatectomy, 24 appendicectomy, 19 herniorraphy, 11 haemorrhoidectomy, 9 fissurectomy, 7 total abdominal hysterectomy, 5 Manchester operation, 4 myomectomy, while the remaining 15 were for other procedures involving the lower abdomen or limb. Complications noted were: nausea (17.50%) and vomiting (3.5%), pain at injection site (15.5%), chills/shivering (15.0%), post-spinal headache (0.5%) and hypotension (3.0%). Subarachnoid anaesthesia was non-fatal. One hundred and ninety patients (95%) were satisfied with spinal anaesthesia. Conclusion: Spinal anaesthesia though safe is not without hazards. Spinal anaesthesia may be used for most operations in the lower abdomen (including caesarean section), perineum or leg.