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. Observational values of different parameters on the bases of yes or no

The observational study questioner values on the bases of yes or no presented in the Table-2. In which showing shivering is most common complication of post spinal anesthesia followed by nausea, delirium, hypotension and nausea had the highest prevalence after shivering. This could be used as an applied key in the recovery unit. The most common complication of spinal anesthesia in the recovery was shivering.

Table 2. Showing Mean value, standard deviation and p value

The mean value of non-complication has 164.2222 and complication has35.7778 and obtained p value is <0.00001. As per the results of ANOVA, there is highly significant relationship between gender and shivering (p>0.00001). However, the higher mean prevalence of shivering is no differentiated gender.

The present observational 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 risks.^{7, 8} Needle size and type play role 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 of meninges it will cause. Quicken needle is said to cause more injury and more traction on the meninges and meningeal blood vessels rather than whitacre needle.^{9, 10} Anaesthesiologist at Hasan Sadikin Hospital did not use a whitacre needle due to economical reason and the hospital also go tabundance supplies of Quincke needle from the government.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 our study, the complication after spinal anesthesia shivering is an involuntary vibration of the body due to an underlying condition such as cold and hypothermia (Dorland, 2011)¹³. In the present study, the prevalence of shivering, mostly the mild level, was equal to 22.0% and is similar to Entezari (2001)¹⁴ and also reported to vary between 5-65% in some other studies that’s resembles to our study. Further, Buggy (2000) reported that the shivering was more common among men and our findings also strengthened the same. Shivering increases the consumption of oxygen, which is necessary for the treatment of patients, especially those having the cardiovascular problems. The size of the needle used for anesthesia is also one of the factors causing postoperative shivering. Ghanei & Mehraban (2015)¹⁵ reported that the prevalence of shivering after anesthesia using a 26-gauge needle was equal to 36%. One of the common complications towards recovery mentioned in various references is cardiovascular problems, which are manifested as sudden changes in blood pressure and heart rate. In the present study, 11.5% of patients experienced hypotension. This can be overcome by replacing proper fluids during the surgery. In the study of Ghanei (2015),¹⁵ shown similar as our results to prevent postoperative hypotension. In the present study, bradycardia was observed in 17.5% of participants. Poursheikhian (2012) reported that the prevalence of bradycardia was equal to 18% and its prevalence had a significant relationship with age and heart rate.¹⁶

The prevalence of nausea and vomiting in the present study was equal to 32% and 12%, respectively. These figures in the study of Nasiri (2006) were reported to be 10% and 2.5% as similar to our study so nausea is common compare to vomiting In addition; this group of authors also reported the prevalence of postoperative nausea and vomiting as 12%.¹⁷

It seems that timely diagnosed of delirium in the PACU could be a good guide for nurses in the postoperative care units to perform appropriate interventions to prevent negative complications. Regarding back pain after spinal anesthesia, earlier studies reported that the prevalence of this complication ranges between 2.5% and 54% that’s given by Gregg 1992 and Schultz 1996.¹⁸ In the present study, 13% of patients had complained regarding back pain. This is somewhat consistent with the observation by Haghighi (2012), who reported that 16% of patients experience back pain one day after anesthesia. In the present study, the prevalence of urinary retention was equal to 8%. Najaf (2012) compared the effects of lidocaine and pethidine in spinal anesthesia on the occurrence of urinary retention after anorectal surgery but no significant difference between lidocaine (33.3%) and pethidine (23.3%) in terms of causing urinary retention was evidenced. The study results also showed that 5.5% of participants experienced hypoventilation. Triyasunant (2015) stated that hypoxemia was less prevalent in elective cesarean sections and, as a result, oxygen therapy was also less common in this unit for the treatment of this complication.¹⁹

Most common complication of shivering and nausea were recorded but the high prevalence of complications in the postanesthetic 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.

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