Practice of Unilateral Spinal Anesthesia During Varicose Lower Limb Surgery in Morafeno University Hospital Toamasina

Marie Osé Judicael HARIOLY NIRINA, Toky Rafanomezantsoa, Josoa Andrianiaina RAKOTOARISOA, Maximin Totoamby, Nicole Cathérine Rakotoarison, Andry Mampionona Riel, Andriambelo Tovohery Rajaonera


Introduction: To our knowledge, unilateral spinal anesthesia in the Atsinanana region of Madagascar has not been studied to date. Our study aims were mainly to describe our current practice in performing unilateral spinal anesthesia during varicose surgery of the lower limb and secondarily to assess the factors influencing success of the technique.

Methods and Patients: This is a prospective, observational, descriptive and analytic non-randomized, single-center study over a period of 18 months, including all patients requiring lower limb surgery.

Result: Forty-two (42) patients were selected for our study. The mean age of our study population was 47.5 ± 19.82 years with extremes of 16 to 86 years. The average installation time of the blocks was 14.5 ± 2.87 minutes with the extremes of 13 to 30 minutes. The average regression time of the blocks was 125.26 ± 32.24 minutes with the extremes of 15 to 180 minutes. The types of intervention were crossectomy with stripping, phlebectomy and stripping. The failures concerned bilateralisation, early regression and absence of sensory block. The success rate of anesthesia was 85.6%. The dose of hyperbaric bupivacaine and patient positioning had a significant impact on the success rate of anesthesia.

Conclusion: Although it is a simple technique, an effort in drafting a protocol to standardize the practitioner attitude still needs to be provided in order to improve the effectiveness rate.


unilateral spinal anesthesia, varicose vein surgery, hyperbaric bupivacaine.

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French Society of Anesthesia and Resuscitation. Recommendations for clinical practice: Perimedullary blocks in adults. Paris: SFAR; 2008.

Josée G. Total knee arthroplasty Anesthetic approaches. Chir Arthro and Sports Trauma. 2015 October; 12: 48-54.

Dufeu N, Gentili M. The unilateral spinal anesthesia. The practitioner in anesthesia resuscitation. December 2009; 12 (6): 429-434. 10.1016 / j.pratan.2009.10.002.

Ferré F, Marty P, Asehnoune K, Minville V. Rachianesthesie unilaterally. Treaty of anesthesia and resuscitation. Fourth edition. Paris: Medicine Sciences Publication; 2014

Rasamimanana R, Randrianirina R, Rajaonera TA, Raveloson NE, Randriamiarana MJ. Preliminary results of a study on unilateral spinal anesthesia at CHU-JRA (Madagascar). Rev. anesth.réanim. med. emergency 2012; 4: S1-S17.

Rasamimanana R. Evaluation of unilateral rachianesthesia in ortho-traumatological surgery from cases seen at HUJRA Madagascar [Thesis]. Anesthesia resuscitation: Antananarivo; 2013. 32p.

Patrick J. Varicose vein surgery by outpatient vein removal and phlebectomy. 2010; 4: 2.

Magar JS, Bawdane KD, Patil R. Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery. J Clin Diagn Res. 2017 Jul ; 11 (7) : UC17-UC20. Doi : 10.7860/JCDR/2017/26235.10215.

Leyla T. K, Ulufer S G, Birsen E, Ayse H, Hale D. Comparison of unilateral spinal and continous spinal anesthesia for hip surgery in elderly patients. Saudi J Anaesth. 2013 Oct-Dec; 7(4): 404–409. Doi : 10.4103/1658-354X.121054.

Errando C L, Peiró C M, Gimeno A, Soriano J L. Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study. Rev Esp Anestesiol Reanim. 2014 Nov; 61(9): 481-8. Doi: 10.1016/j.redar.2014.02.004. Epub 2014 Jul 21

Chevaleraud É, Bouyer L. Rachianesthésie latéralisée. Le Praticien En Anesthésie Réanimation. 2008 juin ; 12 (3) : 182–186. Doi : 10.1016/j.pratan.2008.04.008.

Li Zhu, Chun Tian, Min Li et al. The stress response and anestheticpotency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients. Pharm.Sci, 2014 November; 27: 2029-2034.

Mohammad A. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery. Rev. Bras. Anestesiol. 2014May/June; 64 (3).

Apaydin Y, Erk G,Sacan Oetal. Characteristics of unilateral spinal anesthesia at different speeds of intrathecal injection. J Anesth. 2011 25 (3): 380–385.

Bergmann I, Hesjedal B, Crozier TA et al (2015) Selective unilateral spinal anaesthesia for outpatient knee arthroscopy using real-time monitoring of lower limb sympathetic tone. Anaesth Intensive Care 43 (3): 351–356.

Marildo G A, Luiz Eduardo I. Spinal Hemianesthesia: Unilateral and Posterior. Austin J Anesthesia and Analgesia. 2014; 1 (1): 1003.

Ferhane S, Minville V. Accompagnement des patients lors d’une anesthésie locorégionale : rôle de l’infirmier anesthésiste. SFAR 2010 ; 9 : 1.

Christophe A. Rachianesthesia: essential in 2013. SFAR 2013; 57: 2-6

Nair GS, Abrishami A, Lermitte J et al. Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth. 2009; 102(3):307–315.

Etchebarne I. Bilateral anesthesia with chloroprocaine versus unilateral spinal anesthesia with bupivacaine in short-term surgery of the lower limb in outpatient [Thesis]. Anesthesia Resuscitation: Bordeaux; 2014. 66 p

Büttner B et al. Unilateral spinal anesthesia: Literature review and recommendations. Anaesthesist. 2016 Nov; 65 (11): 847-865.

Singh TK, Anabarsan A, Srivastava U et al. Unilateral spinal anaesthesia for lower limb orthopaedic surgery using low dose Bupivacaine with Fentanyl or Clonidine:A randomised control study. J Anesth Clin Res 2014.5 (12): 484.

Gaiser RR Postdural puncture headache:a headache for the patient and a headache for the anesthesiologist. Curr Opin Anaesthesiol. 2013; 26 (3): 296–303.


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