Sequential Combined Spinal Epidural Block Superior To Epidural Block For Total Abdominal Hysterectomy In Patient And Surgeons Perspective: Double Blind Randomized Control Trial

Introduction: The aim of this study was to compare sequential combined spinal epidural with epidural block for total abdominal hysterectomy to assess quality of block in terms of surgeon and patient's satisfaction. Methods: 100 patients of ASA grade I & II were randomly divided into 2 groups. Group A patients received CSE using “needle through needle technique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block through catheter using 15 ml of 0.5% plain bupivacaine. In all patients, subsequent dosage of 0.5% plain bupivacaine (1.5 ml per unblocked segment) was administered to achieve a block up to T4-5. The quality of block was rated from excellent to poor by surgeon and anesthetist. Patient satisfaction was rated on 0 to 100 linear visual analog scale. Results: The surgical analgesia and motor blockade occurred significantly early in CSE group. The quality of analgesia as assessed by anesthetist was excellent in 92% of patients in group A as compared to 30% in group B (p=0.000). In 88% cases in CSE group surgical conditions were reported as excellent by surgeons as compared to only 36% in epidural group. VAS scores for patient satisfaction were also much lower in CSE group (11.2±7.304 versus 26.4±22.94 in epidural group) (p=0.000). Conclusion: The quality of block is superior in CSE as compared to epidural block and associated with greater degree of patient and surgeon satisfaction.