الفهرس 
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Abstract
In this study we evaluated the effect of intrathecal hyperbaric bupivacaine 0.5% versus the effect of GA using isoflurane-atracurium in twenty patients of either sex who were subjected to LDS.
Thorough history taking, proper clinical examination and preoperative preparation were performed in all the patients. They were allocated into two equal groups : GA group and SA group.
GA group (ten patients): preoxygenation with 100% O2 followed by lidocaine 1.5 mg/kg IV then atracurium 0.5 mg/kg IV to facilitate intubation which was performed after induction of anaesthesia with thiopentone Na in a dose of 5 mg/kg IV. Maintenance of anaesthesia by isoflurane 1.5% supplemented by additional doses of atracurium in a dose of 0.1 mg/kg BW till the end of surgery at which atropine-neostigmine mixture in a dose of 1-2.5 mg for reversal of the residual neuromuscular blockade.
SA group (ten patients): Intrathecal injection of hyperbaric bupivacaine 0.5% in the lateral or sitting position at L2-3 interspace and after stabilization of the block level (10-15 min), patients were rolled onto prone position frame.
Intraoperative monitoring of HR, MAP and SP02 in both groups regularly every 15 min till the end of surgery. Estimation of the surgical and total anaesthesia time. Measuring the amount of blood loss and fluid intake.
In the immediate postoperative period, recording of fluctuations in HR and blood pressure every 15 min. for 45 min and assessment of nausea and vomiting, VAS for nausea and pain, analgesic and antiemetics intake and total length of PACU stay.
Twenty-four hr post discharge from PACU: recording of nausea and vomiting, analgesic intake and headache.
This study clearly demonstrated that SA with hyperbaric bupivacaine 0.5% is superior to GA in LDS in reducing surgical and anaesthesia time, blood loss while providing minimal adverse effects on intraoperative haemodynamics. It also reduced postoperative pain with its concomitant need for analgesics and its associated adverse effects. The postoperative nausea and vomiting were also reduced with SA. So, the major advantage of this technique is the excellent quality of postoperative recovery: postoperative analgesia, reduced nausea and vomiting. Besides, the lower cost of regional anaesthesia which is a considerable advantage, since a single intrathecal injection of one drug will produce complete anaesthesia, muscle relaxation and a reduction in the amount of bleeding without the need of polypharmacy or complex general anaesthetic equipment affecting the patient’s life.
Despite the mentioned advantages, a cooperative surgeon who can perform the procedure in a reasonable time is imperative, as we found tolerance to the prone positioning on the frame to be reduced after approximately two hours. We believe SA to be superior to GA in patients undergoing LD excision and/or laminectomy with intraoperative time of two hours or less.
Microsurgical techniques are growing up and regional blocks are a real favor for these techniques as it facilitate the verbal communication between the surgeon and the patient with proper assessment of the success for surgical interference. We think that regional blocks will be a must in the future for microsurgical lumbar discectomy.