TMSS Medical College Journal

Day care surgery gradually increases in Bangladesh.Both regional and gencral anacsthesia can be used for this. Subarachnoid (Spinal) and epidural blocks are simple, cheap and easy to perform. This study was done to evaluate usefulness of spinal and epidural anaesthesia for day care surgery. 30 patients were randomized to either spinal(n=15 and epidural(n=15) group anaesthetized with either 0.5% hyperbaric 2.5 ml bupivacaine or 0.5% 20ml bupivacaine respectively. In spinal group 27 gauze quincke needle and in epidural group 18 gauge tuohy ncedle was used. Both the groups were compared for hacmodynamic stability, side eflects, complications, post anacsthesia discharge score (PADS), time taken to micturate, total duration of stay in hospital and patient satisfaction score for technique. It was observed that spinal anaesthesia had significantly carly onset of anaesthesia and better muscle relaxation as compared to epidural block otherwise both groups were comparable for hacmodynamic stability, side effects or complications. Although more patients in spinal group achieved PADS carlier (in 4 -8 hours) but statistically it was insignificant. Time to micturition (6.02* 0.55 v/s 6.03* 0.47 hours) and total duration of Stay (7.49% 1.36 v/s 8.03 #1.33 hours) were comparable in both in groups. Both spinal and epidural anaesthesia can be used for day care surgery. Spinal anaesthesia with 27 gauge quincke needle and 2.5 ml 0.5% hyperbaric bupivacaine provides added advantage of carly onset and complete relaxation.

Recent advances in anaesthetic and surgical techniques have resulted in increasing number of surgical procedures being performed on day care basis. According to international terminology, day surgery or ambulatory surgery is the admission of selected patients to hospital for a planned, non emergency surgical procedure, returning home on the same day!. The requirements for anaesthesia for day care surgery are those of any anaesthetic agent having rapid, painless induction, profound analgesia and anaesthesia without depression of the cardiovascular and respiratory system and rapid smooth recovery?. There are so many benefits of ambulatory surgery like cost effectiveness, low morbidity and mortality, lower incidence of infection, lack of dependence on the availability of hospital beds and shorter surgical waiting lists?. Different option are available e,g general anaesthesia with newer short acting agent e.g propofol, isofluranes and reginal anacsthetic techniques. However, there are few potential disadvantages of regional anaesthesia which includes time taken for block, insertion and onset, needs active cooperation with patient and surgeon, risk of nerve damage, variable failure rate and urinary retentions. Avantages of regional anaesthesia over general anaesthesia include less cardivascular or respiratory complications, less initial post operative pain, patient's ability to communicate with the surgeon and reduced cost of drugs and equipment involved in regional anaesthesia 6.