Spinal Anaesthesia for Quicker Recovery in Fast-Track Abdominal Hysterectomy
Introduction: Fast-track approach during hysterectomy has revolutionized the postoperative recovery. In this study we tried to analyse the effect of one more component (spinal anaesthesia versus general anaesthesia) during hysterectomy for benign gynaecological conditions to further hasten the p...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2017-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/10920/28884_021217_28884_CE(RA1)_F(T)_PF1(PB_SS)_PFA(MJ_AP).pdf |
| Summary: | Introduction: Fast-track approach during hysterectomy has
revolutionized the postoperative recovery. In this study we tried
to analyse the effect of one more component (spinal anaesthesia
versus general anaesthesia) during hysterectomy for benign
gynaecological conditions to further hasten the postoperative
recovery and thus evolve the concept.
Aim: To compare recovery among those who receive spinal
anaesthesia versus those who receive general anaesthesia
during fast tract abdominal hysterectomy.
Materials and Methods: A total of 97 women were recruited
who were planned for hysterectomy for benign conditions and
agreed to follow the fast-track protocol. Forty six consented
for spinal anaesthesia (three cases were excluded later) and 51
for general anaesthesia. Fast-track protocol was followed that
included preoperative counselling, and no preoperative sedation.
Postoperatively all patients were monitored for pain, vomiting,
drowsiness and fatigue. Early oral intake and ambulation was
encouraged. Postoperative events and complications as well
as duration of hospital stay were compared among the two
groups. Differences in continuous variables were analysed with
student’s t-test for normally distributed data and the MannWhitney U Test for skewed data. Pain score was analysed by
repeated measures of ANOVA.
Results: Mean operating time in spinal anaesthesia group, was
much less (92.72±23.61 minutes) than in general anaesthesia
group (124.20±33.61 minutes), the difference being statistically
significant (p<0.001). Mean blood loss was also less in spinal
anaesthesia group (298.14±61.34 ml versus 404.90±110.57 ml;
p<0.001). Women in this group could be started on oral fluids earlier,
had less vomiting and fatigue postoperatively, and passed motion
earlier. Duration of hospital stay was not found to be much different
between the groups. However, patients who were in the spinal
anaesthesia resumed their routine activities earlier (15.47±2.77
versus 18.55±4.25 days; p<0.001). We also noted an interesting
finding yet undiscussed in the literature that general anaesthesia
group had more than 2.5 times higher incidence of postoperative
cough which has the potential to influence postoperative recovery
following any abdominal surgery.
Conclusion: Spinal anaesthesia should be considered in cases
that are planned for hysterectomy under fast-track setting to
optimise the results. |
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| ISSN: | 2249-782X 0973-709X |