Is Spinal Anaesthesia Useful in Day Surgery?

58 Vol. 10 No. 2, April-June 2008 Introduction: An increasing number of day-case surgical patients are challenging the presently used methods of anaesthesia:. Surgical anaesthesia should be fast, reliable with rapid recovery and minimal side effects. To compete with modern ambulatory general anaesthesia, knowledge of special spinal anaesthesia techniques is essential. 'Walk-in, walk-out' spinals with an extremely low dose of lidocaine and opioids for gynecological laparoscopy created the concept of selective spinal anaesthesia. Lidocaine was previously the agent used for shortacting spinal anaesthesia, until it was reported to cause transient neurological symptoms (TNSs) (1) and, more seriously, cauda equina syndrome (2) when used intrathecally. These neurological problems made anesthetists seek alternative suitable local-anaesthetic agents and techniques for outpatients. Two specific lowdoses techniques unilateral and selective spinal anaesthesia have been described, although there is an overlap between the two. In some studies, the low-dose spinal-anaesthesia technique means only a reduced dose of local anaesthetic without any specific attempts to restrict the spinal spread. Unilateral Spinal Anaesthesia: The term unilateral spinal anaesthesia is often used to mean a one-sided block with an absence of sensory and motor block on the nonoperative side (3). Enk (3) concluded the importance of 'low-dose, low-volume and low-flow' in the induction of unilateral spinal anaesthesia. The position of the patient (lateral decubitus) with respect to the baricity of the local anaesthetic is the main determinant of the final distribution of the spinal block(4). When producing a unilateral block, the maintenance of the selected position for a specified period (15-30 min) has been criticized because of possible preoperative delay. However, maintaining the lateral decubitus position for only 10 min produced a unilateral motor block in 87-100% of the patients when a low dose of hyperbaric bupivacaine (3-4 mg) was used, along with a strictly standardized injection technique that is low-flow Is Spinal Anaesthesia Useful in Day Surgery?