European Journal of Cardiovascular Medicine

Spinal anaesthesia is a regional anaesthetic procedure done by injecting anaesthetic drugs into cerebrospinal fluid (CSF) that surrounds the spinal cord. It causes the area below the umbilicus to become numb without interfering with consciousness level. Indications for spinal anaesthesia include lower abdominal, perineal, obstetrics-gynaecology, urology, and lower extremities surgery¹. There are major known contraindications to spinal anaesthesia. The absolute contraindications are lack of consent from the patient, elevated intracranial pressure (ICP) primarily due to intracranial mass, and infection at the site of the procedure (risk of meningitis). There are some benefits of spinal anaesthesia. It is a straightforward procedure compared to general anaesthesia, relatively cheaper, causing minimum systemic effects, and quicker recovery of digestive system function². Lestari et al (2016) reported that 44.15% anaesthesiologists in West Java preferred spinal anaesthesia procedure.  Aside from its benefits, it also has its complications. There are some risk factors that play role in causing complications. Causing factors of patient, such as age and gender are highly depending correlate with anaesthetic component factors and its related tools such as needle size and anaesthetic drug being used, and surgical factors such as type of surgery and duration of the surgery³. Complications after spinal anaesthesia are categorized into intra-operative and postoperative complications. Intraoperative complications are hypotension, bradycardia, cardiac arrest, hematoma, and spinal cord trauma. Postoperative complications are post-dural puncture headaches (PDPH), back pain, nausea and vomiting, shivering, transient hearing loss, and urinary retention ⁴. Considering the above facts, the present study aims to find out the prevalence of complications after spinal anaesthesia in a postsurgical unit.

Back pain is a worldwide health problem affecting 50% and 80% of people at some time in their lives and it is a major physical and economic burden for the individual and the society⁵. The lifetime incidence of nonspecific low back pain is more than 84%, the incidence of chronic low back pain is about 23%, and 11-12% of the population suffered disability with this pain. ⁶ Anesthesia recoveries is one of the three stages of anesthesia that begins after discontinuation of anesthetic drugs. This stage involves transferring the postoperative care unit and caring for them until they are taken to their bed. Recovery is one of the most crucial stages of anesthesia and there are many reports of high prevalence of respiratory and cardiovascular complications, nausea and vomiting, chills, restlessness, and shivering. Recent studies have indicated the high prevalence of postoperative complications via considering the above figures and facts.

Aims & Objective

The present study aims to find out the prevalence of spinal anesthesia complications in the post operative unit of anesthesia department Saraswati Medical College, Unnao Uttar Pradesh

This descriptive observational study was conducted in Dept. of Anesthesia and critical care (Post Operative Unit), Saraswati Medical College, Unnao Uttar Pradesh on 200 patients aged 18-70 undergone a surgery in different department such as orthopedic, gynecology etc. influencing spinal anesthesia. This observational study based on questioner in which included post complications after spinal anesthesia such as hypotension, bradycardia, delirium, nausea, vomiting, urinary retention, back pain, hypoventilation and shivering (Mild, Moderate, Severe) by yes or no. All the patients underwent spinal anesthesia with 0.5% Bupivacain heavy (Anawin Heavy) using the 23, 25 and 27 guage needle. The required data were collected using a set of questionnaires, consisted of complications after spinal anesthesia such as Hypotension, Bradycardia, Delirium, Nausea, Vomiting, Urinary retention, Back pain, Hypoventilation and Shivering. The data were analyzed using descriptive statistical analysis.

Performed ANOVA Turkey HSD statistical analysis on the observational value and found data as present below table.

Table 1: Showing gender division in which 48% male and 52 % female consider for the study group.

Table 2 showing min age 12 and max age 66, mean age showing of the study group 36.97

Table 3: Observational values of different parameters on the bases of yes=1 or no=0, showing means value.

The observational study questioner values on the bases of yes or no presented by 1 or 0, as showing in material and method sectioned of this study. In table 3, which showing nausea (0.45) is most common complication of post spinal anesthesia followed by delirium (0.36), hypotension (0.34) bradycardia (0.31) had the highest prevalence. After statistical analysis p value obtained

>0.05 (p=0.00001) that’s highly significant. This could be used as an applied key in the recovery unit or post operative unit or ward.

Table 4. Showing Mean value, standard deviation and p value obtained from total sample

The mean value of complication has 26.0±14.09 and non complication has 74.0±14.09 and obtained p value is <0.000036. As per the results of ANOVA, there is highly significant relationship between gender and complications (p>0.00001). However, the higher mean prevalence of nausea.

Table: 5 Showing total horizontal value core of questioner related symptoms and signs of individuals highly correlate with anxiety level

The present analytical observational study research was conducted in Saraswati Medical College, Unnao Uttar Pradesh on the subject towards the recovery related complications. Bupivacaine 0.5% hyperbaric is a local anaesthetic that is largely used for spinal anaesthesia because of its long duration of action. Our finding strengthens theory and previous study that higher drug dosage circulated in the bloodstream will increase complication. ⁸ Needle size and type of needle play in causing the size of a tear in the dura layer and how much CSF loss after the puncture. The bigger needle size being used, the bigger rupture it will causes meninges. Quincke needle is said to cause more injury and more traction on the meninges and meningeal blood vessels rather than whitacre needle.^{9, 10, 11} In this study, the surgery that caused complication the most after spinal anaesthesia is urology surgery, followed by lower extremity or orthopedic surgery, and obstetrics and gynaecology surgery. Different results were reported by Sholihah et al with orthopedic surgery caused complications the most after spinal anaesthesia. It may be due to higher dosage used in urology surgery rather than other surgical departments.¹² In this study, nausea and headache (PDPH) is the most common complication after spinal anaesthesia. Similar to previous studies, headache can be caused by the loss of cerebrospinal fluid (CSF) and traction in the meninges after the spinal procedure.¹³ Nausea and vomiting are also common complications experienced by the subject. It can be caused by direct stimulation from an anaesthetic drug in the chemoreceptor trigger zone (CTZ) or visceral organ from a surgical area that sends afferent impulse through the vagus nerve.¹⁴ Shivering and urinary retention experienced by some of the subjects. Shiver increases consumption of oxygen, which is necessary for the recovery process.¹⁵ Urinary retention can be caused by undetected benign prostate hyperplasia (BPH), or the amount of anaesthetic drug being used in spinal anaesthesia.¹⁶ The least experienced complication was transient hearing loss (0%). There was no report of hearing loss, or it can be due to subjects paying less attention to it. Previous study reported that hearing loss after spinal anaesthesia is a rare complication and is a subclinical symptom so it should be cross-checked with audiometry.¹⁷ All signs correlate with anxiety and found highly significant.

It is known that concerns about anaesthesia and surgery in the preoperative period lead to anxiety. Even though, not life-threatening, there is also high peri-operative anxiety and stress. This may result from numerous conditions; in addition to concerns such as being apart from home and relatives and interruption of daily activities, there are also concerns about likely complications during or after surgery, not having adequate information about anaesthesia

as about pain during and after surgery. Disability that the physical disease brings along, despair, concern about the loss of ability, concern about the probability of injury of body organs or parts, fear of death, and the meaning attributed to the disease influence the severity of anxiety that the individual experiences.^18,19,20,21

A well-coordinated postoperative and/or peri- operative pain treatment with the appropriate surgical procedure enhances patient satisfaction and favorably influences long-term clinical outcomes. Duration of hospital stay is shortened and treatment cost is decreased.²² There are publications defending or opposing the presence of a correlation between increased age and anxiety score in surgery patients. Age and preoperative anxiety levels of the patients are associated with postoperative pain.²³

Most common complication of headache followed by nausea, delirium, hypotension, bradycardia, shivering, urinary retention, hypoventilation, vomiting and hearing loss occurs. As compare to others least complication of hearing loss. Anxiety level increased with headache nausea and others due to post operative complications so prevalence of complications in the post anesthetic care unit can be considered as an alarming state so skilled personnel and monitoring equipment is required in this unit. This can increase the health level of patients and prevent the waste of time and cost as our results we can recommended study should be high level with more individuals or samples for more appropriate results in this region.

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