Background: Kidney transplantation is the definite renal replacement therapy for patients with end stage kidney disease (ESKD). On account of comorbidities associated with ESKD, need for minimal drug toxicity to allograft and need for efficient post operative analgesia, an effective and safe anaesthesia is paramount.
Objectives: To evaluate effectiveness and safety of combined spinal and epidural bupivacaine anaesthesia for kidney transplantation and to evaluate efficacy of epidural bupivacaine for post operative analgesia in kidney transplant recipients.
Methods: ESKD patients that were scheduled for kidney transplantation and who consented for combined spinal and epidural anaesthesia (CSEA) were enrolled in the study. Data was collected over a period of 24 months (January 2021 – December 2023). Epidural lumbar puncture was performed at L3/L4 intervertebral space using size 18 Tuohy Needle. Spinal anaesthesia was also performed at the L3/L4 interspace with 26G pencil point spinal needle to deliver 15mg of hyperbaric bupivacaine with 25ug fentanyl. Post operative epidural analgesia was done with 0.1% plain bupivacaine and 2mg/ml fentanyl. Intraoperative haemodynamics (mean arterial blood pressure, heart rate and central nervous pressure), intravenous fluid infused, surgery duration, first hour output and pain score in the recovery room were recorded. Incidence of conversion to general anaesthesia and supplemental conscious sedation were also recorded. Incidence of post-operative post dural puncture headache was also recorded.
Result: Two hundred and sixty-four (264) consecutive patients were enrolled in the study. All the patients had their surgery done and completed successfully with CSEA or conversion to GA. Two hundred and sixty (260) patients completed the surgery under CSEA, giving an effectiveness of 98.5%, out of which 5 (1.9%) required supplemental conscious sedation. Seven (2.7%) of the patients developed post-dural puncture headache which resolved less than 48 hours after the procedure. All the patients rate their post operative pain relief as excellent.
Conclusion: Combined spinal and epidural anaesthesia is a safe and effective technique in well-prepared patients for kidney transplantation. Excellent outcome with CSEA is dependent on the optimal pre-operative work up, close intraoperative monitoring and haemodynamic maintenance.