CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 AFRICA 85 obtaining written informed consent from the patients, the study was conducted on a total of 100 patients aged 18 years and older, with the American Society of Anesthesiologists (ASA) physical status classification I–III, undergoing unilateral lower extremity stripping due to varicose veins within a six-month period at the Prof Dr Cemil Taşçıoğlu City Hospital Anesthesiology and Reanimation Service. We aimed to compare the efficiency of two anaesthesia techniques used for stripping. Fifty patients with single-dose epidural anaesthesia were consecutively included in the epidural anaesthesia (EA) group. For comparison, 50 patients who were operated on under general anaesthesia were included in the GA group. Patients with general anaesthesia due to failed epidural anaesthesia, using surgical methods other than stripping, with neurological deficit, medication allergies and bleeding diathesis were excluded from the study. General anaesthesia was induced with fentanyl (1 µg/kg) and propofol (2.5 mg/kg) 90 seconds before laryngeal mask airway insertion after the loss of eyelash reflex. Maintenance of general anaesthesia was done with sevoflurane (2%) using 4 l/min fresh 50% oxygen and nitrous oxide mixture. An appropriate laryngeal mask for the patient’s age and weight was inserted without using any neuromuscular blocker. Epidural anaesthesia was administered after patients were taken to the operating room, before surgery and after standard monitoring. With patients in a sitting position, the epidural interval was found using the resistance-loss technique with a Tuohy sharpened 18-G epidural needle (Perifix® ONE Paed filter sets) in the lumbar 3–4 intervertebral gap. A total of 20 ml local anaesthetic, 10 ml 2% prilocaine and 10 ml 0.5% bupivacaine was administered into the epidural interval. For 15 minutes after epidural anaesthesia, paresthesia and paralysis assessment was performed every five minutes with the pinprick test. Surgery was permitted to begin after sensory block. The study noted anaesthesia type, duration of surgery, amount of medication consumed, time of first mobilisation, time to discharge from hospital, nausea, vomiting, complications linked to medications and surgery, and pain scores. In the postoperative period, pain scores at rest and while moving were assessed with the visual analogue scale (VAS) from 0 to 10, where 0 means no pain and 10 means the worst pain. Parameters related to patients in the study were recorded in the recovery room. All patients with general anaesthesia had an intra-operative 10-mg/kg dose of intravenous acetaminophen administered routinely. Patients with epidural anaesthesia had no intravenous analgesic administered during the intra-operative period. After recovery, when pain scores in the postoperative period were above five, patients were routinely administered a 1-mg/ kg dose of intravenous tramadol for supplementary analgesia. Additionally, data such as height, weight and age of patients were noted, and these data were statistically analysed. Statistical analysis Statistical analyses used the Number Cruncher Statistical System (NCSS) program (Kaysville, Utah, USA). Descriptive statistical methods [mean, standard deviation (SD), median, frequency, proportion, minimum, maximum] were used when analysing study data. The fit of quantitative data to normal distribution was tested with the Kolmogorov–Smirnov test, Shapiro–Wilk test and visual assessments. For two-group comparisons of quantitative data with normal distribution, we used the Student’s t-test, while for two-group comparisons without normal distribution we used the Mann– Whitney U-test. For assessment of monitored variables without normal distribution we used the Friedman test, and for evaluation of two-way comparisons we used the Bonferroni–Dunn test. Significance was assessed at the p < 0.05 level. Power analysis results using the G*Power program, taking the effect size d = 0.725 for pain score and SD = 2.7 with power = 0.80 and α = 0.05, identified that the sample number in each group was a minimum of 31. Results For both groups, there were no statistically significant differences between age, weight, body mass index (BMI) and BMI classification of patients (Table 1, p > 0.05). There were statistically significant differences between the 30th-minute, and first-, second-, fourth- and sixth-hour VAS measurements for patients between the groups (p = 0.001; p < 0.01) (Fig. 1, Table 2). Patients with epidural anaesthesia had lower 30th-minute VAS scores compared to those administered general anaesthesia. The variation in 30th-minute, and first-, second-, fourth- and sixth-hour VAS measurements in the group receiving general anaesthesia and intravenous intra-operative analgesia was statistically significantly different (Table 2, p = 0.001; p < 0.01). The variation in 30th-minute, and first-, second-, fourth-, and sixth-hour VAS measurements in the group administered epidural anaesthesia were statistically significantly different (p = 0.001; p < 0.01). Table 1. Analysis of demographic characteristics according to anaesthesia group Demographics Total (n = 100) GA (n = 50) EA (n = 50) p-value Age (years) 34.50 ± 12.65 33.60 ± 13.18 35.40 ± 12.17 0.480a Weight (kg) 77.43 ± 12.63 77.94 ± 12.81 76.92 ± 12.55 0.689a BMI (kg/m2) 28.78 ± 4.72 29.32 ± 4.99 28.23 ± 4.41 0.249a BMI level, n (%) Normal weight 23 (23.0) 10 (20.0) 13 (26.0) 0.728b Overweight 40 (40.0) 20 (40.0) 20 (40.0) Obese 37 (37.0) 20 (40.0) 17 (34.0) GA, general anaesthia group; EA, epidural anaesthesia group; BMI, body mass index. aStudent’s t-test; given as mean ± SD; bPearson chi-squared test. General anaesthesia Epidural anaesthesia 6 5 4 3 2 1 0 Meam VAS 30 min 1 hr 2 hr 4 hr 6 hr Fig. 1. VAS measurements according to anaesthesia group. VAS, visual analogue scale.
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