To Study Preloading and Relative Efficacy of Ringer’s Lactate and Pentastarch 6% Prior to Spinal Anaesthesia in Lower Abdominal and Lower Limb Surgeries

Abstract

Background and Objectives: Hypotension after spinal anaesthesia remains a common and a serious
complication. Various method have been recommended for the prevention and treatment of this problem.
Preloading has become the cornerstone for prophylaxis of hypotension post spinal anaesthesia. This current
study reassessed the efficacy of this volume preloading and also compared the efficacy between Ringer’s
lactate and Pentastarch 6%.
Method: In this study, 60 patients (ASA I & II) presenting for elective lower abdominal and lower limb
surgeries under spinal anaesthesia were allocated into two groups, group P and group R to receive 5 ml/kg of
6% Pentastarch and 10 ml/kg of Ringer’s lactate preload respectively. After institution of spinal anaesthesia
in a sitting position with 3.8 ml of Bupivacaine 0.5% (heavy) using 23G Quincke spinal needle, patients
were made to assume supine position. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood
pressure(DBP) were monitored intra-operatively every 2 minutes for first 10 minutes and every 5 minutes
for next one hour and every 15 minutes thereafter. Electrocardiogram (ECG) and oxygen saturation(SpO2)
were monitored continuously. The amount of ephedrine, used intra-operatively were noted and compared
among the different groups.
Results: The incidence of hypotension in group R was more than that in group P. There were no significant
difference in HR and the SpO2 between the groups. The difference in mean basal SBP and DBP were
statistically insignificant in both groups. Thereafter, the fall in SBP and DBP was more prominent in group
R at all time intervals with a statistically highly significant difference between the two groups (p value
<0.001). The amount of ephedrine used in group R was more than that used in group P. There were minimal
complications like shivering and vomiting which were statistically non–significant . There were no allergic
reactions to the fluids used.
Conclusion: Volume preloading, still has a substantial role in reducing the incidence and severity of
hypotension in patients operated under spinal anaesthesia. Pentastarch 6% is found to be a better agent for
preloading, as it is safe and effective in preventing spinal-induced hypotension in patients.