Effects of Spinal and Epidural Anaesthesia on Brain Oxygenation in Lumbar Disc Surgery

Abstract

Aim: Due to the sympathetic blockage in spinal and epidural anesthesia applied in lumbar disc surgery, hemodynamic effects are different from each other and these effects may cause changes in cerebral oxygenation. In our study, we aimed to compare the effects of spinal and epidural anesthesia on brain oxygenation in patients undergoing elective LDS.

Material and Methods: ASA I-II, 50 patients were included in our study. Group S: (n = 25) 15mg(3ml) 5% isobaric bupivacaine intrathecal and Group E: (n = 25) 40mg(8ml) isobaric bupivacaine (5%), 70mg(3.5ml) lidocaine hydrochloride (2%), 75 µg(1.5ml) fentanyl and 3 ml saline were applied to lomber epidural gap. The hemodynamic variables and bilateral regional cerebral oxygen saturation (rScO2) of the patients were recorded with the Near-Infrared Spectroscopy (NIRS) method in the basal, supine position in the 5th, 10th minutes after the central block, 10th minute in the prone position and the patient was placed in the supine position again.

Results: In demographic data, hemodynamic parameters and periodic measurements in Group S and Group E, brain right and left hemisphere rScO2 values (Group S: right hemisphere rScO2 (basal) 69.7 ± 5.5, (60 minutes) 64 ± 7; left hemisphere rScO2 (basal) 70.2 ± 5.1, (60 minutes) 64 ± 8, Group E: right hemisphere rScO2 (basal) 71.6 ± 7.2, (60 minutes) 66.6 ± 5; left hemisphere rScO2 (basal) 71.7 ± 7.3, (60 minutes) 66.8 ± 5), no statistically significant difference was found (p> 0.05).

Conclusion: Spinal and Epidural anesthesia affect rScO2 in a similar way. Since epidural anesthesia causes a more balanced anesthesia, it can balance cerebral blood volume and oxygenation. This study may be a guide for studies evaluating the effects of spinal and epidural anesthesia on brain oxygenation, especially in geriatric patient groups.

Keywords: Lumbar disc surgery, Spinal anaesthesia, Epidural anaesthesia, Near-Infrared Spectroscopy (NIRS), Regional Brain Oxygenation Saturation(rScO2)

DOI: 10.7176/JHMN/79-09

Publication date:August 31^st 2020