الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
The patient population undergoing vascular surgery presents a challenge because of systemic co-morbidities, including hypertension, diabetes mellitus, congestive heart failure, and renal impairment. Ninety-two percent of patients with peripheral vascular disease have angiographic evidence of CAD, and likely carotid and abdominal aortic atherosclerotic disease. Some degree of myocardial ischemia may occur in up to 28% of patients undergoing major vascular surgery, in addition, the high prevalence of active smoking in the patient population increases the risk of perioperative pulmonary complications. Lower extremity PAD is now known to be associated with equal morbidity and mortality and comparable (or higher) health economic costs as CHD and ischemic stroke. Anesthesia techniques are controversial, as vascular procedures can be performed under local, regional, general or combined regional and general anesthesia. Regional anesthesia is appealing for surgical anesthesia and postoperative pain management in these patients to decrease side effects of systemic medication, avoiding end tracheal intubation and reduce hemodynamic fluctuations from sympathetic activation. Spinal and epidural blocks result in sympathetic, sensory and motor blockade depending on the dose, concentration, or volume of local anesthetic after insertion of needle in the plane of neuroaxis. The spread of the block can be better regulated by intermittent administration of small doses of a local anesthetic through the spinal catheter and the risk of abrupt decreases in arterial pressure can be reduced. Also, an adequate level of anesthesia can be maintained in prolonged surgery. And the spinal catheter can be utilized for CSPA. However, there are a few studies that compare between CSEA and CSA in such patients as well as the effect on hemodynamics and degree of postoperative analgesia. The aim of this study was to compare the continuous spinal block versus combined spinal epidural block in elderly patients undergoing vascular surgeries in lower extremities. This study was carried out on 50 patients were underwent vascular surgeries in lower limbs. Patients were divided into two equal groups: group I (continuous spinal group): were given continuous spinal block. group II (combined spinal epidural group): were given combined spinal epidural block. Summary of the results • Demographic data (age, gender, weight, height, BMI, ASA and duration of surgery) were insignificantly different between continuous spinal group and combined spinal epidural group. • Heart rate at 15 min was significantly higher in combined spinal epidural group than continuous spinal group and was insignificantly different at baseline, 5, 30, 60 and 120 min between the two groups. • Mean arterial blood pressure at 15 min was significantly lower in combined spinal epidural group than continuous spinal group and was insignificantly different at baseline, 5, 30, 60 and 120 min between the two groups. • Onset and duration of sensory and motor block were insignificantly different between continuous spinal group and combined spinal epidural group. • Intraoperative characteristics (bleeding, muscle relaxation and immobility of the patient) were insignificantly different between continuous spinal group and combined spinal epidural group. • NRS was insignificantly different between continuous spinal group and combined spinal epidural group • Total dose of bupivacaine was significantly higher in combined spinal epidural group than continuous spinal group (P value <0.001). • Time for first analgesia was significantly higher in combined spinal epidural group than continuous spinal group (P value <0.001). • Side effects (bradycardia, hypotension, nausea, and vomiting) were insignificantly different between continuous spinal group and combined spinal epidural group. • Combined spinal epidural technique was significantly more difficult than continuous spinal technique (P value =0.007). • Surgeon‘s and patient‘s satisfaction was insignificantly different between continuous spinal group and combined spinal epidural group.