Continuous spinal anaesthesia/analgesia for the perioperative management of high-risk patients

The intraoperative effects of continuous spinal anaesthesia, and the effica cy of postoperative continuous spinal analgesia in 48 elderly high risk pat ients undergoing major abdominal, vascular or orthopaedic surgery is report ed. Intraoperative anaesthetic technique proved to be safe and provided sat isfactory results in the immediate postoperative period. Furthermore, the p ostoperative analgesic regimen which involved intrathecal fentanyl and bupi vacaine, and intravenous tenoxicam, provided effective analgesia for ail pa tients. The intrathecal analgesic regimen was administered continuously thr ough a PCA pump which had the facility to provide bolus doses when requeste d in predetermined lockout intervals. The mean doses of fentanyl and bupiva caine infused intrathecally for the first 24 h postoperatively were 14.5 +/ - 1.5 mu g h(-1) (mean +/- SD) and 0.72 +/- 0.08 mg h(-1) (mean +/- SD), re spectively, while the requirements for analgesia decreased progressively ov er time but lasted for 118 h. The technique provided effective analgesia wi th low pain scores that was reflected by the ease in performing physical ex ercises and the pleasant co-operation with the physiotherapist. Only minor complications related to anaesthesia/analgesia were encountered.