Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000300004
Brazilian Journal of Anesthesiology
Scientific Article

Baixa dose de bupivacaína isobárica, hiperbárica ou hipobárica para raquianestesia unilateral

Low dose isobaric, hyperbaric, or hypobaric bupivacaine for unilateral spinal anesthesia

Luiz Eduardo Imbelloni; Lúcia Beato; Marildo A Gouveia; José Antônio Cordeiro

http://dx.doi.org/10.1590/S0034-70942007000300004 Braz J Anesthesiol, vol.57, n3, p.261-270, 2007
PDF Português
PDF English
Downloads: 0
Views: 937

Resumo

JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar vantagens principalmente em pacientes em regime ambulatorial. Baixa dose da solução anestésica, velocidade lenta da injeção espinal e a posição lateral facilitam a obtenção da distribuição unilateral na raquianestesia. Foram comparadas soluções isobárica, hiperbárica e hipobárica de bupivacaína com objetivos de se obter raquianestesia unilateral em pacientes submetidos a intervenções cirúrgicas ortopédicas em regime ambulatorial. MÉTODO: Cento e cinqüenta pacientes foram aleatoriamente separados em três grupos para receberem 5 mg de bupivacaína a 0,5% isobárica (Grupo Iso), ou 5 mg de bupivacaína a 0,5% hiperbárica (Grupo Hiper), ou 5 mg de bupivacaína a 0,15% hipobárica (Grupo Hipo). As soluções foram administradas no interespaço L3-L4 com o paciente na posição lateral e permanecendo nesta posição por 20 minutos. A anestesia sensitiva foi avaliada pelo teste da picada da agulha. O bloqueio motor avaliado pela escala modificada de Bromage. Ambos os bloqueios foram comparados com o lado não operado e entre si. RESULTADOS: Existiu diferença significativa entre o lado operado e não-operado em todos os três grupos aos 20 minutos, mas maior freqüência de raquianestesia unilateral foi obtida com as soluções hiperbárica e hipobárica de bupivacaína. Bloqueio sensitivo e motor foram observados em 14 pacientes do Grupo Iso, 38 pacientes no Grupo Hiper e 40 pacientes no Grupo Hipo. Não ocorreram alterações hemodinâmicas em nenhum paciente. Não foram observados cefaléia pós-punção nem sintomas neurológicos temporários. CONCLUSÕES: A raquianestesia com soluções hipobárica e hiperbárica proporcionou maior freqüência de unilateralidade. Após 20 minutos a solução isobárica de bupivacaína mobilizou-se no líquido cefalorraquidano (LCR), resultando em apenas 28% de raquianestesia unilateral.

Palavras-chave

ANESTÉSICOS, CIRURGIA, Ortopédica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia has its advantages, especially in patients undergoing outpatient basis surgeries. Low dose, slow speed of administration, and the lateral positioning make easier the unilateral distribution in spinal anesthesia. Isobaric, hyperbaric, and hypobaric solutions of bupivacaine were compared in the unilateral spinal anesthesia in patients undergoing outpatient basis orthopedic surgeries. METHODS: One hundred and fifty patients were randomly divided in three groups to receive 5 mg of 0.5% isobaric bupivacaine (Iso Group), 5 mg of 0.5% hyperbaric bupivacaine (Hyper Group), or 5 mg of 0.15% hypobaric bupivacaine (Hypo Group). The solutions were administered in the L3-L4 space with the patient in the lateral decubitus and remaining in this position for 20 minutes. Sensitive anesthesia was evaluated by the pin prick test. Motor blockade was determined by the modified Bromage scale. Both blockades were compared with the opposite side and among themselves. RESULTS: There was a significant difference between the side of the surgery and the opposite side in all three groups at 20 minutes, but the frequency of unilateral spinal anesthesia was greater with the hyperbaric and hypobaric solutions. Sensitive and motor blockades were observed in 14 patients in the Iso Group, 38 patients in the Hyper Group, and 40 patients in the Hypo Group. Patients did not develop any hemodynamic changes. Postpuncture headache and transitory neurological symptoms were not observed. CONCLUSIONS: Spinal anesthesia with hypobaric and hyperbaric solutions present a higher frequency of unilateral anesthesia. After 20 minutes, isobaric bupivacaine mobilized into cerebrospinal fluid (CSF) resulted in unilateral spinal anesthesia in only 28% of the patients.

Keywords

ANESTHETICS, ANESTHETIC TECHNIQUES, Regional, SURGERY, Orthopedics

References

Logan MR, McLure JH, Wildsmith JAW. Plain bupivacaine with epinephrine. Anesthesia and analgesia. Br J Anaesth. 1986;58:292-296.

Tuominen M, Kalso E, Rosenberg PH. Effects of posture on the spread of spinal anaesthesia with isobaric 0.75% or 0.5% bupivacaine. Br J Anaesth. 1982;54:313-318.

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

Kuusniemi KS, Pihlajamaki KK, Pitkanen MT. A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies. Reg Anesth. 1997.

Hartmann B, Junger A, Klasen J. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis of automated data collection. Anesth Analg. 2002.

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.

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

Vaghadia H. Spinal anaesthesia for outpatients: controversies and new techniques. Can J Anaesth. 1998;45:R64-R75.

Enk D. Unilateral spinal anaesthesia: gadget or tool?. Curr Opin Anaesthesiol. 1998;11:511-515.

Imbelloni LE, Beato L, Gouveia MA. Raquianestesia unilateral com bupivacaína hipobárica. Rev Bras Anestesiol. 2002;52:542-545.

Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand. 1965;16:55-69.

Casati A, Fanelli G. Unilateral spinal anestesia. State of the art. Minerva Anestesiol. 2001;67:855-862.

Povey HM, Jacobsen J, Westergaard-Nielsen J. Subarachnoid analgesia with hyperbaric 0.5% bupivacaine: effect of 60-min period of sitting. Acta Anaesthesiol Scand. 1989;33:295-297.

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

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

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

Imbelloni LE, Beato L, Gouveia MA. Baixas doses de bupivacaína a 0,5% isobárica para raquianestesia unilateral. Rev Bras Anestesiol. 2004;54:423-430.

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

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

Stienstra R, Green NM. Factors affecting the subarachnoid spread of local anesthetic solution. Reg Anesth. 1991;16:1-6.

Meyer J, Enk D, Penner M. Unilateral spinal anesthesia using low-flow injection through a 29-gauge Quincke needle. Anesth Analg. 1996;82:1188-1191.

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

Lotz SMN, Crosgnac M, Katayama M. Anestesia subaracnóidea com bupivacaína 0,5% hiperbárica: Influência do tempo de permanência em decúbito lateral sobre a dispersão cefálica. Rev Bras Anestesiol. 1992;42:257-264.

Kaya M, Oguz S, Aslan K. A low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia. . 2004;29:17-22.

Carpenter RL, Caplan RA, Brown Dl. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906-916.

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

5dd835850e88258e4113f286 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