Failed spinal anaesthesia- management by giving a second spinal

Abstract

Background: Since its introduction to clinical use in 1899 by August Bier, spinal anaesthesia has stood the test of time. In the last five decades it has gained in popularity. Apart from avoiding the complications of general anaesthesia, it is a simple, reliable and a cheap procedure and is relatively easy to master. But sometimes we come across partial or complete failure of spinal anaesthesia. Methods: This prospective study was undertaken in our institution for one year, from December 2009 to November 2010 to1) determine the incidence of failed spinal anaesthesia, 2) manage such cases by giving a second spinal immediately, if surgery has not started 3) find out the intraoperative, post- operative and late complications of the second spinal, if any. All patients undergoing lower abdominal, perineal and lower limb surgeries were included. After ten minutes of giving the spinal anaesthesia with bupivacaine, if no effect was seen as determined by sensory level and motor blockade, a second spinal was given preferably at a higher level. Demographic, anaesthetic and surgical data were collected and analysed. Patients were followed up in the postoperative room and in the ward till their discharge, for any possible complications. Patients were asked to report to the hospital if they developed any problems after discharge. Results: 42 patients out of a total number of 1673 developed partial or complete failure.19 complained of pain after surgery had started. Of these 19, five were managed by giving intravenous analgesia, one N2O/O2 50:50 inhalation, and three by manipulating the table.11 were converted to general anaesthesia. Out of 42 patients, 23 were given a second spinal. In all these patients, the second injection acted well giving good muscle relaxation and adequate sensory block. One patient developed high spinal soon after the second injection. Another patient developed severe bradycardia and hypotension during the surgery. There were no complications in the post- operative period. None of the patients who have come for follow up; have reported any problems related to the second spinal anaesthetic to date. Conclusion: Repeating a spinal anaesthetic after a failed one is a good method of management, if conditions permit and proper care is taken. By this all the indications for giving spinal anaesthesia in the first instance is well preserved.