Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000300003
Brazilian Journal of Anesthesiology
Scientific Article

Ropivacaína para raquianestesia unilateral: hiperbárica ou hipobárica?

Ropivacaine for unilateral spinal anesthesia; hyperbaric or hypobaric?

Mehmet Cantürk; Oya Klci; Dilş; en Ornek; Levent Ozdogan; Yasar Pala; Ozlem Sen; Bayazit Dikmen

http://dx.doi.org/10.1590/S0034-70942012000300003 Braz J Anesthesiol, vol.62, n3, p.304-311, 2012
PDF Português
PDF English
Downloads: 0
Views: 1284

Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi comparar a unilateralidade do bloqueio subaracnoide obtido com ropivacaína hiperbárica e hipobárica. MÉTODOS: Estudo prospectivo aleatorizado conduzido em centro cirúrgico ortopédico. No total, 60 pacientes (ASA I-III) programados para cirurgia eletiva de artroplastia total do joelho foram incluídos no estudo. O grupo hipo (n = 30) recebeu 11,25 mg de ropivacaína (7,5 mg.mL-1) + 2 mL de água destilada (a densidade em temperatura ambiente foi 0,997) e o grupo hiper (n = 30) recebeu 11,25 mg de ropivacaína + 2 mL (5 mg.mL-1) de dextrose (a densidade em temperatura ambiente foi 1,015). Os pacientes no grupo hiperbárica foram posicionados com o lado operado para baixo e na posição de Fowler a 15º e os pacientes do grupo hipobárica foram posicionados com o lado operado para cima e na posição de Trendelenburg a 15º. O bloqueio combinado de raquianestesia e anestesia peridural (ACRP) foi realizado na linha mediana do interespaço lombar em L3 e L4. Foram avaliados os parâmetros hemodinâmicos e de bloqueio da coluna vertebral, tempo de regressão, sucesso da raquianestesia unilateral, conforto do paciente, do cirurgião e da cirurgia, tempo até a primeira requisição analgésica e efeitos adversos. RESULTADOS: O tempo necessário para atingir o nível de dermátomo T10 no lado operado foi menor no grupo hiper (612,00 ± 163,29 segundos) comparado ao grupo hipo (763,63 ± 208,35 segundos) (p < 0,05). O tempo para a regressão de dois segmentos do nível de bloqueio sensorial nos lados operado e não operado foi menor no grupo hipo do que no grupo hiper. CONCLUSÃO: A ropivacaína tanto hiperbárica quanto hipobárica (11,25 mg) proporcionou anestesia adequada e confiável para artroplastia total do joelho (ATJ), com um alto nível de conforto para o paciente e cirurgião. As soluções anestésicas hipobáricas locais fornecem um alto nível de anestesia unilateral, com rápida recuperação dos bloqueios sensitivo e motor e, portanto, pode ser preferível em regime ambulatorial.

Palavras-chave

anestesia, combinada, anestésicos, local, ropivacaína, técnicas anestésicas, regional, hiperbárica, hipobárica

Abstract

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the unilaterality of subarachnoid block achieved with hyperbaric and hypobaric ropivacaine. METHODS: The prospective, randomized trial was conducted in an orthopedics surgical suite. In all, 60 ASA I-III patients scheduled for elective total knee arthroplasty were included in the study. Group Hypo (n = 30) received 11.25 mg of ropivacaine (7.5 mg.mL-1) + 2 mL of distilled water (density at room temperature was 0.997) and group Hyper (n = 30) received 11.25 mg of ropivacaine (7.5 mg.mL-1) + 2 mL (5 mg.mL-1) of dextrose (density at room temperature was 1,015). Patients in the hyperbaric group were positioned with the operated side down and in the 15º Fowler position, versus those in the hypobaric group with the operated side facing up and in the 15º Trendelenburg position. Combined spinal epidural anesthesia was performed midline at the L3-4 lumbar interspace. Hemodynamic and spinal block parameters, regression time, success of unilateral spinal anesthesia, patient comfort, surgical comfort, surgeon comfort, first analgesic requirement time, and adverse effects were assessed. RESULTS: Time to reach the T10 dermatome level on the operated side was shorter in group Hyper (612.00 ± 163.29 s) than in group Hypo (763.63 ± 208.35 s) (p < 0.05). Time to 2-segment regression of the sensory block level on both the operated and non-operated sides was shorter in group Hypo than in group Hyper. CONCLUSION: Both hyperbaric and hypobaric ropivacaine (11.25 mg) provided adequate and dependable anesthesia for total knee replacement surgery, with a high level of patient and surgeon comfort. Hypobaric local anesthetic solutions provide a high level of unilateral anesthesia, with rapid recovery of both sensory and motor block, and therefore may be preferable in outpatient settings.

Keywords

anesthesia, epidural, anesthesia, spinal, anesthetics, local, specific gravity

References

Tanasichuk MA, Schultz EA, Matthews JH, Van Bergen FH. Spinal hemianalgesia: An evaluation of a method, its acceptibility, and inflence on the incidence of hypotension. Anesthesiology. 1961;22:74-85.

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

Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose-response characteristics of spinal bupivacaine in volunteers: Clinical implications for ambulatory anesthesia. Anesthesiology. 1996;85:729-736.

Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Can J Anesth. 2000;47:746-751.

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

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

Casati A, Fanelli G, Cappelleri GL. Effects of spinal needle type on lateral distribution of 0,5% hyperbaric bupivacaine. Anesth Analg. 1998;87:355-359.

Casati A, Albertin A. Unilateral spinal block: Technical Issues. Highlights in Regional Anaesthesia and Pain Therapy: IX. 2000:208-211.

Casati A, Fanelli G, Gianluca C. Low dose bupivacaine for unilateral spinal anesthesia. Can J Anesth. 1998;45:850-854.

Kuusiniemi KS, PihlajamΔki KK, Pitkanen MT, Korkeila JE. Low-dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee. Anaesthesia. 1999;54:540-545.

Kaya M, Oguz S, Aslan K, Kadıoàulları N. A low-dose bupivacaine: A comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia. Reg Anesth and Pain Med. 2004;29(1):17-22.

Gentili ME, Mamelle JC, Le Foll G. Combination of low dose bupivacaine and clonidine for unilateral spinal anesthesia in arthroscopy knee surgery (Letter). Reg Anesth. 1995;20:169-170.

Casati A, Fanelli G. Restricting spinal block to the operative side: Why Not?. Reg Anesth and Pain Med. 2004;29(1):4-6.

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

Esmaoàlu A, Boyaci A, Ersoy O, Güler G, Talo R, Tercan E. Unilateral spinal anesthesia with hyperbaric bupivacaine. Acta Anaesthesiol Scand. 1998;42:1083-1087.

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

Kuusiniemi KS, PihlajamΔki KK, Pitkanen MT, Korkeila JE. A lowdose hypobaric bupivacaine spinal anesthesia for knee arthroscopies. Reg Anesth. 1997;22:534-538.

Chohan U, Afshan G, Hoda MQ, Mahmud S. Haemodynamic effects of unilateral spinal anesthesia in high risk patients. J Pak Med Assoc. 2002;52(2):66-69.

Moellmann M, Kösters C, Cord S. Unilateral spinal anesthesia: (Poster Discussion). ASRA Spring. 2001.

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

Stienstra R, Gielen M, Kroon JW, Van Poorten F. The influence of temperature and speed of injection on the distribution of a solution containing bupivacaine and methylene blue in a spinal canal model. Reg Anesth. 1990;15:6-11.

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

Casati A, Fanelli G, Beccaria P. Block distribution and cardiovascular effects of unilateral spinal anesthesia by 0.5% hyperbaric bupivacaine: A clinical comparison with bilateral spinal block. Minerva Anestesiol. 1998;64:307-312.

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

Serpell MG, Gray WM. Flow dynamics through spinal needles. Anaesthesia. 1997;52:229-236.

5dd2e10e0e8825c01bc63494 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