Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000500004
Brazilian Journal of Anesthesiology
Scientific Article

Baixas doses de bupivacaína hipobárica para raquianestesia unilateral

Low hypobaric bupivacaine doses for unilateral spinal anesthesia

Luiz Eduardo Imbelloni; Lúcia Beato; M A Gouveia

http://dx.doi.org/10.1590/S0034-70942003000500004 Braz J Anesthesiol, vol.53, n5, p.579-585, 2003
PDF
Downloads: 1
Views: 1001

Resumo

JUSTIFICATIVA E OBJETIVOS: Para evitar alterações hemodinâmicas, obter recuperação mais rápida e limitar a dispersão cefálica da raquianestesia apenas no membro operado foi realizado este estudo com bupivacaína a 0,15%, com objetivo de se obter raquianestesia unilateral. MÉTODO: Raquianestesia com 3,3 ml de bupivacaína hipobárica a 0,15% (5 mg) foi realizada através de agulha 27G Quincke em 20 pacientes estado físico ASA I e II submetidos a cirurgias ortopédicas. A punção subaracnóidea foi realizada por via lateral com o paciente em decúbito lateral, com o membro a ser operado voltado para cima, e 3,3 ml de bupivacaína hipobárica foram injetados na velocidade de 1 ml a cada 15 segundos. Bloqueios sensitivo e motor (picada de agulha e escala de 0 a 3) foram comparados entre os lados a ser operado e o contralateral. RESULTADOS: Os bloqueios motor e sensitivo entre o lado operado e o contralateral foram significativamente diferentes em todos os tempos avaliados. Raquianestesia unilateral foi obtida em 75% dos pacientes. Estabilidade hemodinâmica foi observada em todos os pacientes. Nenhum paciente desenvolveu cefaléia pós-raquianestesia. CONCLUSÕES: A bupivacaína hipobárica a 0,15% na dose de 5 mg proporciona um predominante bloqueio unilateral. Vinte minutos são suficientes para a sua instalação. A principal vantagem da raquianestesia unilateral é a estabilidade hemodinâmica.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: The possibility to achieve unilateral spinal anesthesia with 0.15% bupivacaine was studied with the purpose of minimizing hemodynamic changes, limiting the cephalad dispersion of the anesthetic and promoting a faster recovery. METHODS: Twenty ASA I - II patients undergoing orthopedic surgeries were given spinal 0.15% hypobaric bupivacaine through a 27G Quincke needle. Dural puncture was performed with patients in the lateral position, with the limb to be operated upwards, and 3.3 ml (5 mg) hypobaric bupivacaine were injected at the rate of 1 ml.15 s-1. Sensory and motor block (pinprick and 0 to 3 scale) were compared between operated and contralateral sides. RESULTS: Motor and sensory block in operated and contralateral sides were significantly different in all evaluated times. Unilateral spinal anesthesia was achieved in 75% of patients. All patients remained hemodynamically stable, and no one developed post-dural puncture headache. CONCLUSIONS: Hypobaric bupivacaine (5 mg) is able to provide a predominant unilateral block with the patient being kept twenty minutes in the lateral position. Major unilateral spinal anesthesia advantage is hemodynamic stability.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Casati A, Fanelli G, Aldegheri G. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med. 1999;24:214-219.

Imbelloni LE, Beato L, Gouveia MA. Raquianestesia unilateral com bupivacaína hipobárica. Rev Bras Anestesiol. 2002;52:542-548.

Imbelloni LE. O Uso Racional da Raquianestesia. Tratado de Anestesia Raquidiana. 2001;8:74.

Pittoni G, Toffoletto F, Calcarella G. Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. Anesth Analg. 1995;81:73-79.

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med. 2000;25:605-610.

Tanasichuk MA, Schultz EA, Matthews JH. Spinal hemianalgesia: An evaluation of a method, its applicability, and influence of the incidence of hypotension. Anesthesiology. 1961;22:74-85.

Casati A, Fanelli G, Cappelleri G. Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth. 1998;45:850-854.

Casati A, Fanelli G, Berti M. Cardiac performance during unilateral lumbar spinal block after crystalloid preload. Can J Anaesth. 1997;44:623-628.

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. Low-dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee. Anaesthesia. 1999;54:540-545.

Cangiani LM. Determinação da densidade e da baricidade das misturas para anestesia subaracnóidea. Rev Bras Anestesiol. 2000;50:92-94.

Gouveia MA, Labrunie GM. Raquianestesia hipobárica com bupivacaína 0,15%. Rev Bras Anestesiol. 1985;35:519-521.

Lui ACP, Polis TZ, Cicutti NJ. Densities of cerebrospinal fluid and spinal anaesthetic solutions in surgical patients at body temperature. Can J Anesth. 1998;45:297-303.

Holman St J, Robinson RA, Beardsley D. Hyperbaric dye solution distribution characteristics after pencil-point needle injection in a spinal cord model. Anesthesiology. 1997;86:966-973.

Enk D, Prien T, Van Aken H. Success rate of unilateral spinal anesthesia is dependent on injection flow. Reg Anesth Pain Med. 2001;26:420-427.

Casati A, Fanelli G, Cappelleri G. Effects of speed of intrathecal injection on unilateral spinal block by 1% hyperbaric bupivacaine. A randomized, double-blind study. Minerva Anestesiol. 1999;65:5-10.

Fanelli G, Borghi B, Casati A. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Can J Anaesth. 2000;47:746-751.

Esmaoglu A, Boyaci A, Ersoy Ö. Unilateral spinal anaesthesia with hyperbaric bupivacaine. Acta Anaesthesiol Scand. 1998;42:1083-1087.

Iselin-Chaves I, Van Gessel EF, Donald F. The effects of solution concentration and epinephrine on lateral distribution of hyperbaric tetracaine spinal anesthesia. Anesth Analg. 1996;83:755-759.

Imbelloni LE, Carneiro ANG, Sobral MGC. Tempo de gotejamento de líquido cefalorraquidiano com agulhas espinhais de fino calibre. Rev Bras Anestesiol. 1995;45:155-158.

Imbelloni LE, Sobral MGC, Carneiro ANG. Cefaléia pós-raquianestesia e o desenho das agulhas. Experiência com 5050 casos. Rev Bras Anestesiol. 2001;51:43-52.

Cameron AE, Arnold RW, Ghoris MW. Spinal analgesia using bupivacaína 0.5% plain. Anaesthesia. 1981;36:318-322.

Niemi L, Tuominen M, Pitkänen M. Effect of late posture change on the level of spinal anaesthesia with plain bupivacaine. Br J Anaesth. 1993;71:807-809.

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. A low-dose hypobaric bupivacaine spinal for knee arthroscopies. Reg Anesth. 1997;22:534-538.

Kuusniemi KS, Pihlajamäki KK, Kirvelä OA. Spinal anesthesia with hypobaric bupivacaine for knee arthroscopies: Effect of posture on motor block. Reg Anesth Pain Med. 2001;26:30-34.

Kuusniemi KS, Pihlajamäki KK, Irjala JK. Restricted spinal anesthesia for ambulatory surgery: a pilot study. Eur J Anesth. 1999;16:2-6.

Ben-David B, Levin H, Solomon E. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg. 1996;83:716-720.

Beardsley D, Holman S, Gant R. Transient neurologic deficit after spinal anesthesia: Local anesthetic maldistribution with pencil-point needles?. Anesth Analg. 1995;81:314-320.

Casati A, Fanelli G, Cappelleri G. Does speed of intrathecal injection affect the distribution of 0.5% hyperbaric bupivacaine?. Br J Anesth. 1998;81:355-357.

Gouveia MA, Labrunie GM. Raquianestesia hipobárica com tetracaína 0,1%. Rev Bras Anestesiol. 1985;35:232-233.

5ddc42730e8825b625f2c920 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections