Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.06.014
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery

Comparação dos efeitos e das complicações de raquianestesia unilateral versus raquianestesia padrão em cirurgia ortopédica de membros inferiores

Seyyed Mostafa Moosavi Tekye; Mohammad Alipour

http://dx.doi.org/10.1016/j.bjane.2013.06.014 Braz J Anesthesiol, vol.64, n3, p.173-176, 2014
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Abstract

Introduction: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes. This prospective randomized study compared unilateral and bilateral spinal anesthesia with respect to the intra- and postoperative advantages and complications of each technique. Material and methods: Spinal anesthesia was induced with 0.5% hyperbaric bupivacaine and a 25-G Quincke needle (Dr. J) in two groups of patients with physical status ASA I-II who had been admitted for orthopedic surgeries. In group A, dural puncture was performed with the patient in a seated position using 2.5 cm3 of hyperbaric bupivacaine. Each patient was then placed in the supine position. In group B, dural puncture was performed with the patient in the lateral decubitus position with 1.5 cm3 of hyperbaric bupivacaine. The lower limb was the target limb. The speed of injection was 1 mL/30 s, and the duration of time spent in the lateral decubitus position was 20 min. Results: The demographic data were similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group A (p = 0.00). The duration of motor and sensory block was shorter in group B (p < 0.05). The success rate for unilateral spinal anesthesia in group B was 94.45%. In two patients, the spinal block spread to the non-dependent side. The incidence of complications (nausea, headache, and hypotension) was lower in group B (p = 0.02). Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during orthopedic surgery on a lower limb. Patients were more satisfied with this technique as opposed to the conventional approach. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.

Keywords

Spinal anesthesia, Unilateral, Bupivacaine, Lower limb

Resumo

Introdução: um bloqueio simpático restrito durante a raquianestesia pode minimizar as alterações hemodinâmicas. Este estudo prospectivo e randômico comparou a raquianestesia unilateral e bilateral em relação às vantagens intra- e pós-operatórias e as complicações de cada técnica. Material e métodos: raquianestesia foi induzida com bupivacaína hiperbárica a 0,5% e agulha Quincke de calibre 25 (Dr. J) em dois grupos de pacientes com estado físico ASA I-II, admitidos para cirurgias ortopédicas. No grupo A, a punção dural foi feita com o paciente em posição sentada, com 2,5 cm3 de bupivacaína hiperbárica. Cada paciente foi então posicionado em decúbito dorsal. No grupo B, a punção foi feita com o paciente em decúbito lateral, com 1,5 cm3 de bupivacaína hiperbárica. O membro inferior foi o alvo. A velocidade da injeção foi de 1 mL/30 segundos e o tempo de permanência em decúbito lateral foi de 20 minutos. Resultados: os dados demográficos foram semelhantes em ambos os grupos. O tempo para o início do bloqueio sensitivo e motor foi significativamente menor no grupo A (p = 0,00). A duração do bloqueio motor e sensorial foi menor no grupo B (p < 0,05). A taxa de sucesso para raquianestesia unilateral no grupo B foi de 94,45%. Em dois pacientes, o bloqueio espinhal difundiu-se para o lado não dependente. A incidência de complicações (náuseas, cefaleia e hipotensão) foi menor no grupo B (p = 0,02). Conclusão: a administração de raquianestesia unilateral com a técnica de dose, volume e fluxo de injeção baixos fornece bloqueio sensoriomotor adequado e ajuda a obter parâmetros hemodinâmicos estáveis durante a cirurgia ortopédica de membros inferiores. A satisfação dos pacientes foi maior com essa técnica, em comparação com o método convencional. Além disso, essa técnica evita a paralisia desnecessária do lado não operado.

Palavras-chave

Raquianestesia, Unilateral, Bupivacaína, Membros inferiores

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