COMPARATIVE STUDY OF UNILATERAL SPINAL ANAESTHESIA AND ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK IN INGUINAL HERNIA REPAIR SURGERY IN GERIATRIC PATIENTS

1. o
CONCLUSION
Unilateral spinal block provides quick and better operating condition but TAP block is more efficacious for inguinal hernia repair in geriatric patients in
terms of long post operative analgesia, excellent hemodynamic stability, minimal incidence of side effects or complications . Hence TAP block may be a
better and safer alternative to unilateral spinal anaesthesia in geriatric population
REFERENCES
1.Jenkins JT, O'Dwyer PJ; Inguinal hernias. BMJ. 2008 Feb 2; 336(7638):269-72.
2. Millers, 7th edition, vol.2, chapter 71, page 2263.
3.Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906–916.
COMPARATIVE STUDY OF UNILATERAL SPINAL ANAESTHESIA AND ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK IN INGUINAL
HERNIA REPAIR SURGERY IN GERIATRIC PATIENTS
Dr. Mahtab Alam Ansari ,Dr.Parvez Arshad khan, Dr. Satish kumar, Dr.Raka rani, Dr.Shahbaz ahmad, Dr.Santosh kumar sharma, Dr.Narendra deo , Dr. Priyanka dwivedi
BRD MEDICAL COLLEGE, GORAKHPUR, UP
INTRODUCTION
Material and Method
DISCUSSION
RESULT
Geriatric patients have poor cardiovascular and
respiratory reserves . Inguinal hernia repair
surgery which is one of the commonest surgery in
this group of patients done under regional
anaesthesia lead to hypotension and other
hemodynamic instability
Unilateral spinal and recently introduced TAP block
offer us the advantage of better hemodynamics
Our aim was to compare the haemodynamic
stability, block characteristics and duration of
postop analgesia between unilateral spinal and
TAP block
Study done at department of anaesthesiology,
Nehru Hospital,BRD Medical college,Gorakhpur,U.P.
which included 40 male adult patients of >60 year
age, ASA grade I and II
Group- T (n=20) :TAP block (USG guided) with 25 ml
0.5% isobaric bupivacaine.
Group- S(n=20) : Unilateral spinal anaesthesia with
2 ml of 0.5% hyperbaric bupivacaine
Sensory block - pin prick method
Motor block - modified bromage scale.
Post-operative analgesia was assessed for 24 hrs;
time of first rescue analgesic was noted.
Statistical comparison done using “t” test
1.Group T- required longer time for onset and
maximum level of sensory blockade with no
motor blockade and good hemodynamic stability
and significantly longer postop analgesia
2.Group S - required shorter onset time with
good unilateral motor block
• The time of onset of sensory block
-Group-T (5.5±0.88 min) > Group-S (2.65±0.67 min)
, (p <0.001).
• The time to reach highest/maximum level of
sensory block
-Group-T (28±1.29 min) > group-S (6.68±0.74 min),
(p<0.001).
• There was no motor blockade in group-T
whereas mean modified Bromage scale grade
was 2.05±0.75 in group-S , (p<0.001).
• The duration of analgesia (the time taken for
first rescue analgesia)
- Group-T (941±235.68 min) >Group-S (240.75±5.44
min).
• Hemodynamic stability was more in group T as
compared to group S
Comparison of various variables between Group T and GroupS
PARAMETERS GROUP T(N=20)
GROUP
S(N=20)
P VALUE SIG
Time for first
analgesic
requirement
postoperative
941.0±235.68(13
pts did not
require rescue
analgesia)
240.75±5.44 ˂ 0.001 S
Total rescue
analgesic
(tramadol in
mg)
17.5±24.5 110±20.5 ˂ 0.001 S
Total fentanyl
mcg
76.25±23.61 50.0±0.0 ˂ 0.001 S
Quality of
block (4/3/2/1)
0/6/12/2 19/1/0/0 ˂ 0.001 S
60
70
80
90
100
110
120
130
140
150
160
Hemodynamicvalues
Time (min)
Comparison of Hemodynamic Parameters in both Groups
HR group T
HR Group S
SBP group T
SBP Group S
MAP Group
T
MAP Group
S
5 10 15 20 30 45 60 after surgery