| Abstrakt: |
Lower limb orthopaedic surgeries and ligament reconstruction surgeries are often done with touniquet applied under spinal anaesthesia. Tourniquet deflation leads to the redistribution of the circulating volume back into the limb and post ischaemic reactive hyperaemia. The passive leg raising (PLR) test has been proposed as a predictor of fluid responsiveness in critically ill patients. PLR induces a rapid increase in preload because of the auto transfusion of blood contained within the capacitance veins of the legs. Hence we thought it worthwhile to study the effect of bilateral PLR on patient’s blood pressure and heart rate after tourniquet deflation in patients undergoing lower limb surgery under spinal anaesthesia. AIMS & OBJECTIVES To evaluate the effect of bilateral passive leg raising in patients undergoing lower limb surgeries under spinal anaesthesia on tourniquet deflation induced. a) Changes in blood pressure (SBP, DBP, MAP) b) Changes in heart rate (HR) METHODOLOGY After approval from institutional review board, the prospective randomized control study was conducted in 50 patients of either sex, 18-60 years of age, ASA I and II, posted for elective lower limb surgery with expected surgical duration of less than 2 hours. Patients were randomly allocated into two groups. Group RL (n=25) in whom bilateral passive leg raising was conducted prior to deflation of tourniquet and Group SL (n=25) in whom patient’s legs were maintained in supine position prior to deflation of tourniquet. Haemodynamic parameters were recorded at time points T1-T17 prior, during and following deflation of tourniquet. RESULTS The study showed that, within 2 min of tourniquet deflation, there was 8.04%, 9.98% and 9.48% reduction in SBP, DBP and MAP respectively (SBP, p<0.001; DBP, p<0.001; MAP, p<0.001) in the control group. While, the degree of decline was insignificant or minimal in the PLR group i.e. 1.07%, 3.22% and 1.72% respectively (SBP, p=0.202; DBP, p=0.042; MAP, p=0.458) and within 2 min of tourniquet deflation, there was 21.06% increase in HR in control group, while the rise was much less in PLR group i.e. 8.0% and the difference in the rise between the 2 groups is statistically significant (p<0.05). CONCLUSION We conclude that the severity and duration of hypotension and tachycardia following tourniquet deflation were attenuated by bilateral PLR in patients undergoing lower limb surgery under spinal anaesthesia. [ABSTRACT FROM AUTHOR] |
