Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000500013
Brazilian Journal of Anesthesiology
Miscellaneous

Raquianestesia unilateral com baixa dose de bupivacaína a 0,5% hiperbárica

Unilateral spinal anesthesia with low 0.5% hyperbaric bupivacaine dose

Luiz Eduardo Imbelloni; Lúcia Beato; José Antônio Cordeiro

http://dx.doi.org/10.1590/S0034-70942004000500013 Braz J Anesthesiol, vol.54, n5, p.700-706, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar vantagens, principalmente em pacientes ambulatoriais. Baixas doses da solução anestésica, agulhas ponta de lápis ou ponta cortante, lenta velocidade de injeção e a posição lateral têm sido relatados como facilitadores da produção de raquianestesia unilateral. O presente estudo longitudinal investiga o grau de raquianestesia unilateral utilizando 5 mg de bupivacaína a 0,5% hiperbárica injetada através de agulha 27G tipo Quincke no paciente em decúbito lateral, com membro a ser operado voltado para baixo. MÉTODO: Raquianestesia com bupivacaína a 0,5% foi realizada através da agulha 27G Quincke em 30 pacientes estado físico ASA I e II, submetidos à cirurgias ortopédicas. A punção subaracnóidea foi realizada com o paciente previamente colocado com o lado a ser operado voltado para baixo e foram injetados 5 mg de bupivacaína a 0,5% hiperbárica na velocidade de 1 ml.15s-1. 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 momentos. Raquianestesia unilateral foi obtida em 85,7% dos pacientes. Estabilidade hemodinâmica foi observada em todos os pacientes. Nenhum paciente desenvolveu cefaléia pós-raquianestesia. CONCLUSÕES: Nas condições deste estudo a bupivacaína hiperbárica a 0,5% (5 mg) proporcionou um predominante bloqueio unilateral. Vinte minutos foram suficientes para a instalação do bloqueio. As principais vantagens da raquianestesia unilateral são a estabilidade hemodinâmica, a satisfação do paciente e recuperação mais rápida da anestesia.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia may be advantageous, especially for outpatient procedures. Low anesthetic doses, pencil point or cutting point needles, slow injection rate and the lateral position have been reported as helping unilateral spinal anesthesia technique. This longitudinal study aimed at investigating the depth of unilateral spinal anesthesia with 5 mg of 0.5% hyperbaric bupivacaine injected with 27G Quincke needle with patients in the lateral position and limb to be operated on facing downward. METHODS: Spinal anesthesia with 0.5% bupivacaine and 27G Quincke needle was induced in 30 patients physical status ASA I-II submitted to orthopedic surgeries. Spinal puncture was performed with patients previously placed with the side to be operated on facing downward and 5 mg of 0.5% hyperbaric bupivacaine were injected at 1 mL.15s-1. Sensory and motor blocks (pinprick and 0 to 3 scores) were compared between operated and contralateral sides. RESULTS: Motor and sensory blocks between operated and contralateral sides were significantly different in all moments. Unilateral spinal anesthesia was obtained in 85.7% of patients. There has been hemodynamic stability in all patients. No patient has developed post dural puncture headache. CONCLUSIONS: In the conditions of our study, 0.5% hyperbaric bupivacaine (5 mg) has provided predominantly unilateral block. Twenty minutes were enough for blockade installation. Major unilateral spinal anesthesia advantages are hemodynamic stability, patients’ satisfaction and faster anesthetic recovery.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

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