The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Is It Useful and Safe to Maintain the Sitting Position During Only One Minute before Position Change to the Jack-knife Position?

  • Park, Soo-Young (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Park, Jong-Cook (Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine) ;
  • Park, Sang-Hyun (Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine)
  • Received : 2010.07.07
  • Accepted : 2010.07.26
  • Published : 2010.09.01
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Abstract

Background: Conventional spinal saddle block is performed with the patient in a sitting position, keeping the patient sitting for between 3 to 10 min after injection of a drug. This amount of time, however, is long enough to cause prolonged postoperative urinary retention. The trend in this block is to lower the dose of local anesthetics, providing a selective segmental block; however, an optimal dose and method are needed for adequate anesthesia in variable situations. Therefore, in this study, we evaluated the question of whether only 1 min of sitting after drug injection would be sufficient and safe for minor anorectal surgery. Methods: Two hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). They were then placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day, urination and 11-point numeric rating scale (NRS) for postoperative pain were assessed. Results: None of the patients required additional analgesics during surgical manipulation. Postoperative sensory levels were T10 [T8-T12] in patients, and no significant differences were observed between sex (P = 0.857), height (P = 0.065), obesity (P = 0.873), or age (P = 0.138). Urinary retention developed in only 7 patients (3.2%). In this group, NRS was $5.0{\pm}2.4$ (P = 0.014). Conclusions: The one-minute sitting position for spinal saddle block before the jack-knife position is a safe method for use with minor anorectal surgery and can reduce development of postoperative urinary retention.

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References

  1. Wassef MR, Michaels EI, Rangel JM, Tsyrlin AT. Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block. Anesth Analg 2007; 104: 1594-6. https://doi.org/10.1213/01.ane.0000261510.37489.00
  2. Gudaityte J, Marchertiene I, Pavalkis D, Saladzinskas Z, Tamelis A, Tokeris I. Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study. Medicina (Kaunas) 2005; 41: 675-84.
  3. Rä tsch G, Niebergall H, Hauenstein L, Reber A. Spinal anaesthesia in day-case surgery. Optimisation of procedures. Anaesthesist 2007; 56: 322-7. https://doi.org/10.1007/s00101-007-1141-9
  4. Bigat Z, Boztug N, Karsli B, Cete N, Ertok E. Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia. Clin Drug Investig 2006; 26: 35-41. https://doi.org/10.2165/00044011-200626010-00005
  5. Vicent O, Litz RJ, Hubler M, Koch T. Secondary cranial extension after spinal anesthesia with isobaric 0.5% bupivacaine following postural change. Anaesthesist 2003; 52: 1035-8. https://doi.org/10.1007/s00101-003-0578-8
  6. Neigh JL, Kane PB, Smith TC. Effects of speed and direction of injection on the level and duration of spinal anesthesia. Anesth Analg 1970; 49: 912-8.
  7. Kitahara T, Kuri S, Yoshida J. The spread of drugs used for spinal anesthesia. Anesthesiology 1956; 17: 205-8. https://doi.org/10.1097/00000542-195601000-00030
  8. Wildsmith JAW, Rocco AG. Current concepts in spinal anesthesia. Reg Anesth 1985; 10: 119-24.
  9. Higuchi H, Adachi Y, Kazama T. The influence of lumbosacral cerebrospinal fluid volume on extent and duration of hyperbaric bupivacaine spinal anesthesia: a comparison between seated and lateral decubitus injection positions. Anesth Analg 2005; 101: 555-60. https://doi.org/10.1213/01.ANE.0000158465.17547.F1
  10. Charuluxananan S, Sriprajittichai P, Sirichotvithyakorn P, Rodanant O, Kyokong O. Factors related to patient satisfaction regarding spinal anesthesia. J Med Assoc Thai 2003; 86(Suppl 2): S338-43.
  11. Gudaityte J, Marchertiene I, Pavalkis D. Anesthesia for ambulatory anorectal surgery. Medicina (Kaunas) 2004; 40: 101-11.
  12. Stienstra R, van Poorten JF. Plain or hyperbaric bupivacaine for spinal anesthesia. Anesth Analg 1987; 66: 171-6. https://doi.org/10.1213/00000539-198702001-00171
  13. Veering BT, Immink-Speet TT, Burm AG, Stienstra R, van Kleef JW. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effects of duration spent in the sitting position. Br J Anaesth 2001; 87: 738-42. https://doi.org/10.1093/bja/87.5.738
  14. Povey HM, Jacobsen J, Westergaard-Nielsen J. Subarachnoid analgesia with hyperbaric 0.5% bupivacaine: effect of a 60-min period of sitting. Acta Anaesthesiol Scand 1989; 33: 295-7. https://doi.org/10.1111/j.1399-6576.1989.tb02911.x
  15. Arai YC, Ueda W, Takimoto E, Manabe M. The influence of hyperbaric bupivacaine temperature on the spread of spinal anesthesia. Anesth Analg 2006; 102: 272-5. https://doi.org/10.1213/01.ANE.0000184252.16045.0E
  16. Kuusniemi KS, Pihlajamä5ki KK, Pitkänen MT, Helenius HY, KirveläOA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000; 91: 1452-6. https://doi.org/10.1097/00000539-200012000-00029
  17. Chik B, Law WL, Choi HK. Urinary retention after haemorrhoidectomy: impact of stapled haemorrhoidectomy. Asian J Surg 2006; 29: 233-7. https://doi.org/10.1016/S1015-9584(09)60094-4
  18. Lingaraj K, Ruben M, Chan YH, Das SD. Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience. Singapore Med J 2007; 48: 213-6.
  19. O'Riordan JA, Hopkins PM, Ravenscroft A, Stevens JD. Patient-controlled analgesia and urinary retention following lower limb joint replacement: prospective audit and logistic regression analysis. Eur J Anaesthesiol 2000; 17: 431-5. https://doi.org/10.1097/00003643-200007000-00004
  20. Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, et al. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis 2006; 21: 676-82. https://doi.org/10.1007/s00384-005-0077-2
  21. Kamphuis ET, Ionescu TI, Kuipers PW, de Gier J, van Venrooij GE, Boon TA. Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology 1998; 88: 310-6. https://doi.org/10.1097/00000542-199802000-00007
  22. Tarkkila P, Huhtala J, Tuominen M. Home-readiness after spinal anaesthesia with small doses of hyperbaric 0.5% bupivacaine. Anaesthesia 1997; 52: 1157-60. https://doi.org/10.1111/j.1365-2044.1997.223-az0358.x
  23. Bourke DL, Sprung J, Harrison C, Thomas P. The dribble speed for spinal anesthesia. Reg Anesth 1993; 18: 326-7.
  24. Atchison SR, Wedel DJ, Wilson PR. Effect of injection rate on level and duration of hypobaric spinal anesthesia. Anesth Analg 1989; 69: 496-500.
  25. Horlocker TT, Wedel DJ, Wilson PR. Effect of injection rate on sensory level and duration of hypobaric bupivacaine spinal anesthesia for total hip arthroplasty. Anesth Analg 1994; 79: 773-7.
  26. Simon L, Boulay G, Ziane AF, Noblesse E, Mathiot JL, Toubas MF, et al. Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section. Int J Obstet Anesth 2000; 9: 10-4. https://doi.org/10.1054/ijoa.1999.0348

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