Spinal anaesthesia: The saviour of day surgery?

摘要

Although commonly used in inpatients, spinal anaesthesia is often a less popular choice for day cases. This may be for historical reasons, but also because of concerns over delayed recovery and adverse effects. Nevertheless, spinal anaesthesia has many advantages and may be an essential measure if day surgery is to be made available to patients with more severe co-existing pathologies. To be suitable for day surgery, spinal anaesthesia must be modified to reduce the extent and duration of motor block while retaining a useful degree of analgesia. This involves the combination of a low dose of local anaesthetic with an analgesic adjuvant, usually an opioid. This chapter will review some of the wide variety of regimens which have been described. While each have their specific advantages, the addition of 10|xg of fentanyl to 5mg of hyperbaric bupivacaine made up to a total volume of 3 ml with saline is a simple regimen which will prove suitable for the majority of cases. Spinal anaesthesia provides good postoperative pain relief and minimises postoperative nausea. With an appropriate technique, discharge should be possible within 3-4 h. Urinary retention is a possible complication, but should be rare unless an excessive opioid dose is used, while post dural-puncture headache can be limited to 1% or less by the use of suitable spinal needles. Low dose spinal anaesthesia, which also provides excellent haemodynamic stability, can significantly extend the population of patients suitable for day surgery.