Epidural Vs. Spinal Anesthesia in Lower Limb Orthopedic Surgries

Abstract

Neuraxial anesthesia, including spinal (SA) and combined spinal-epidural anesthesia (CSEA), is widely used in lower extremity orthopedic surgeries for its regional pain control, reduced opioid dependence, and faster recovery. Despite its advantages, conflicting evidence exists regarding the comparative efficacy, perioperative complications, and patient satisfaction between SA and CSEA. While SA offers rapid onset and hemodynamic stability, CSEA provides prolonged analgesia, yet consensus on optimal technique remains elusive. This study addresses this gap by evaluating their clinical outcomes and complications to guide evidence-based decisions. The objective: To systematically compare SA and CSEA in achieving analgesic adequacy, assess perioperative complications (hemodynamic instability, neurological effects), and analyze patient outcomes (satisfaction, recovery duration, postoperative analgesia needs). A prospective, randomized, double-blind controlled trial was conducted at the Department of Orthopedics and Anesthesiology, General Hospital, Lahore, over four months. Sixty patients (18–70 years, ASA I-II) undergoing elective lower limb surgeries were allocated to SA (n=30) or CSEA (n=30) groups. Sensory/motor block onset, hemodynamic stability, pain scores (Visual Analog Scale), and complications were monitored. Statistical analysis employed Student’s t-test and chi-square (α=0.05). Ethical approval and informed consent were obtained. Main findings SA demonstrated faster sensory block onset (3.0±0.9 vs. 14.9±2.1 minutes, p<0.001) and higher intraoperative hemodynamic stability (hypotension: 13.3% vs. 30%, p=0.04). CSEA provided prolonged postoperative analgesia (240±45 vs. 156±32 minutes, p<0.001) but required more vasopressor support. Patient satisfaction was comparable (SA: 86.7%, CSEA: 83.3%, p=0.65), though 72% reported suboptimal postoperative pain relief. Side effects like headache (14%) and transient paresthesia (8%) were frequent but minor. SA is optimal for rapid surgical readiness, while CSEA excels in prolonged pain management. Suboptimal postoperative analgesia underscores the need for multimodal approaches. Hemodynamic monitoring remains critical for CSEA. Tailored anesthetic selection, guided by patient risk and surgical demands, is recommended.