None listed
Conditions
Brief summary
While choosing an anesthetic technique for renal surgeries, desirable characteristics include hemodynamic stability, lesser blood loss, early ambulation, better post-operative analgesia and lower incidence of side-effects such as nausea and vomiting, shivering, cough, headache, respiratory depression. General anesthesia has remained the most common technique for renal surgeries because of the discomfited body position duringprocedures. General anesthesia carries risks such as stress response and cardiac complications during induction of anesthesia, airway difficulties during intubation, awareness, analgesia in the post-operative period, difficult extubation, post-operative restlessness, over-sedation and agitation. Previous studies have compared combined spinal-epidural anaesthesia and general anesthesia for renal surgeries. These studies reported that, the only disadvantage with the combined approach is the hemodynamic instability and unpredictable sensory blockade levels. we plan our study to compare general anesthesia versus combined spinal and paravertebral block technique in patients undergoing renal surgeries. The study will compare the haemodynamic parameters, surgical conditions, surgeon's satisfaction intra-operatively and patient's satisfaction in the immediate post-operative period in the two groups. The secondary outcome includes the side-effects associated with the anesthesia techniques.
Interventions
All patients will receive ranitidine 150 mg as premedication a night before and on the morning of surgery with a sip of water. In the operation theatre, intravenous (IV) access will be secured with 18G cannula and all patients were pre-loaded with 10 ml/kg of Ringer lactate solution. Standard monitoring include electrocardiogram, pulse oximetry (SpO 2 ), non-invasive blood pressure, urinary output and respiratory rate (RR).
Group I: includes patients for whom paravertebral catheter will
All patients will receive ranitidine 150 mg as premedication a night before and on the morning of surgery with a sip of water. In the operation theatre, intravenous (IV) access will be secured with 18G cannula and all patients were pre-loaded with 10 ml/kg of Ringer lactate solution. Standard monitoring include electrocardiogram, pulse oximetry (SpO 2 ), non-invasive blood pressure, urinary output and respiratory rate (RR). Group I: includes patients for whom paravertebral catheter will be inserted on the proposed side of operation, in sitting posture, under strict aseptic precautions and after infiltration with local anesthetic, 2.5 cm lateral to the tip of spinous process of T10 vertebra, Tuohy needle was advanced perpendicular to the skin in all planes to contact the transverse process of the vertebra, typically at a depth of 2 to 4 cm. After the transverse process was identified, the needle was redirected cephalad and gradually advanced until loss of resistance was felt 1 to 1.5 cm distal to its superior edge. Through the needle a 18G epidural catheter was placed 3 cm inside T10–T11 paravertebral space. Then, spinal anesthesia was performed with spinal needle 25 gauge at the level of L3-L4 with 2 ml bupivacine 0.5%. Sensory levels were checked with bilateral pin -prick method while motor blockade was assessed with modified Bromage scale (0 = no block, 1 = inability to raise extended leg, 2 = inability to flex the knee and 3 = inability to flex ankle and foot). Paravertebral block was performed with 10 ml bupivacine 0.5%. Equipments for general anesthesia will be ready in case of failure of regional technique.
Sponsors
Ahmed A. Eldaba
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
American Society of Anesthesiologists (ASA) Class-I and II adult patients of either gender in the age group of 18-60 years undergoing renal surgeries (pyelo-lithotomy, uretero-lithotomy, and nephrectomy) will be enrolled in the study. A written informed consent will be obtained from all the patients
Exclusion criteria
diabetes mellitus, uncontrolled hypertension, cardiac rhythm disturbances, obesity, severe pulmonary disease, hepatic impairment, deranged coagulation profile, cerebrovascular disorder.
Outcome results
None listed