Bupivacaína a 0,15% hipobárica para raquianestesia posterior (dorsal) versus bupivacaína a 0,5% hiperbárica para procedimentos cirúrgicos anorretais em regime ambulatorial

Luiz Eduardo Imbelloni; Eneida Maria Vieira; M. A. Gouveia; João Gomes Netinho; José Antonio Cordeiro

doi:10.1590/S0034-70942006000600002

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Bupivacaína a 0,15% hipobárica para raquianestesia posterior (dorsal) versus bupivacaína a 0,5% hiperbárica para procedimentos cirúrgicos anorretais em regime ambulatorial

Hypobaric 0.15% bupivacaine versus hyperbaric 0.5% bupivacaine for posterior (dorsal) spinal block in outpatient anorectal surgery

Luiz Eduardo Imbelloni; Eneida Maria Vieira; M. A. Gouveia; João Gomes Netinho; José Antonio Cordeiro

http://dx.doi.org/10.1590/S0034-70942006000600002 Braz J Anesthesiol, vol.56, n6, p.571-582, 2006

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JUSTIFICATIVA E OBJETIVOS: Estudar baixa dose de bupivacaína hipobárica a 0,15% e hiperbárica a 0,5% em pacientes ambulatoriais para procedimentos cirúrgicos anorretais. MÉTODO: Dois grupos de 50 pacientes, estado físico ASA I e II, submetidos a intervenções cirúrgicas anorretais, em posição de canivete, receberam 6 mg de bupivacaína a 0,15% hipobárica na posição cirúrgica (Grupo 1) ou 6 mg de bupivacaína a 0,5% hiperbárica na posição sentada por cinco minutos, e depois colocados em posição de canivete (Grupo 2). Avaliou-se bloqueio sensitivo e motor, primeira micção, deambulação, complicações e necessidade de analgésico. Foram acompanhados até o terceiro dia de pós-operatório e questionados sobre cefaléia pós-punção ou sintomas neurológicos transitórios, e até 30 dias sobre complicação neurológica permanente. Para análise estatística foram utilizados os testes t de Student, mediana de Mood e Exato de Fisher, sendo p < 0,05 significativo. RESULTADOS: O bloqueio seletivo das raízes sacrais posteriores foi obtido em todos os pacientes do Grupo 1 e bloqueio das raízes anteriores e posteriores foi observado nos pacientes do Grupo 2. O bloqueio foi significativamente mais alto no Grupo 1. O bloqueio motor foi muito menos intenso no Grupo 1. Quarenta e nove pacientes do Grupo 1 passaram para a maca sem ajuda enquanto apenas 40 pacientes do Grupo 2 conseguiram fazê-lo. A recuperação ocorreu em 105 ± 25 minutos no Grupo 1 e de 95 ± 15 minutos no Grupo 2, sem diferença significativa. Não ocorreu alteração hemodinâmica, náusea ou vômito, retenção urinária ou cefaléia pós-punção. CONCLUSÕES: A intervenção cirúrgica anorretal sob raquianestesia com baixas doses de bupivacaína, hiperbárica ou hipobárica, pode ser conduzida com segurança.

Palavras-chave

ANESTÉSICOS, Local, CIRURGIA, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The aim of this study was to study low dose hypobaric 0.15% bupivacaine and hyperbaric 0.5% bupivacaine in outpatient anorectal surgical procedures. METHODS: Two groups of 50 patients, physical status ASA I and II, undergoing anorectal surgical procedures in a jackknife position, received 6 mg of hypobaric 0.15% bupivacaine in the surgical position (Group 1) or 6 mg of hyperbaric 0.5% bupivacaine in the sitting position for 5 minutes, after which they were placed in a jackknife position (Group 2). Sensitive and motor blockade, time of first urination, ambulation, complications, and the need for analgesics were evaluated. Patients were followed until the third postoperative day and questioned whether they experienced post-puncture headache or temporary neurological symptoms, and until the 30th day and questioned about permanent neurological complications. The test t Student, Mood's median, and Fisher Exact test were used for statistical analysis, and a p < 0.05 was considered significant. RESULTS: Every patient in Group 1 presented selective blockade of the posterior sacral nerve roots, while patients in Group 2 experienced blockade of the anterior and posterior nerve roots. Blockade was significantly higher in Group 1. Motor blockade was significantly less severe in Group 1. Forty-nine patients in Group 1 transferred to the stretcher unassisted while only 40 patients in Group 2 were able to do so. Recovery in Group 1 occurred in 105 ± 25 minutes and in 95 ± 15 minutes in Group 2, and this difference was not statistically significant. There were no hemodynamic changes, nausea or vomiting, urine retention, or post-puncture headache. CONCLUSIONS: Anorectal surgical procedures under spinal block with low dose bupivacaine, hyperbaric or hypobaric, can be safely done.

Keywords

ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, SURGERY

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Bupivacaína a 0,15% hipobárica para raquianestesia posterior (dorsal) versus bupivacaína a 0,5% hiperbárica para procedimentos cirúrgicos anorretais em regime ambulatorial

Hypobaric 0.15% bupivacaine versus hyperbaric 0.5% bupivacaine for posterior (dorsal) spinal block in outpatient anorectal surgery

Luiz Eduardo Imbelloni; Eneida Maria Vieira; M. A. Gouveia; João Gomes Netinho; José Antonio Cordeiro

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