Preferential Unilateral Epidural Anaesthesia for Lower Limb Orthopaedic Surgeries

Abstract

Background: A preferentially placed unilateral epidural catheter by rotating Touhy needle offers a significant reduction in intra operative and post operative morbidity and mortality when compared to conventional epidural. We aimed to study the effect of Touhy needle rotation on incidence of intra-operative hypotension & requirement of vasopressors and postoperative analgesic requirement.  

Materials & Method: The study was a prospective, randomized evaluation of the effects of epidural needle rotation on the distribution of epidural block and incidence of intraoperative hypotension. Patients of ASA (American Society of Anesthesiologists) physical status 2 and 3 undergoing hip surgeries were grouped as A and B of 15 patients each, receiving conventional and preferential epidural respectively. In contrast to conventional placement, a needle rotation by 45 degree towards operating side, resulted in preferential placement unilaterally which was confirmed by radio contrast X-ray or auscultatory method. Anaesthesia was established with 10 ml of 2% lignocaine with 5ml adrenaline (1:2,00000) after a test dose of 3ml of the same.  

Results: In preferential epidural, maximum sensory block level on the operative side was T9 and non operative side was L3. Significant reduction in incidence of hemodynamic instability, requiring vasopressors and post operative analgesics were noted.  

Conclusion: When compared to conventional epidural, a simple rotation of the Touhy needle by 450 can achieve statistically significant reduction in intraoperative hypotension, vasopressor requirement and the postoperative analgesic dose in old age patients.