Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000300006
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos da administração subaracnóidea de grandes volumes de lidocaína a 2% e ropivacaína a 1% sobre a medula espinhal e as meninges: estudo experimental em cães

Effects of spinal administration of large volumes of 2% lidocaine and 1% ropivacaine on spinal cord and meninges: experimental study in dogs

Eliana Marisa Ganem; Pedro Thadeu Galvão Vianna; Mariângela Marques; Yara Marcondes Machado Castiglia; Luiz Antonio Vane

http://dx.doi.org/10.1590/S0034-70942003000300006 Braz J Anesthesiol, vol.53, n3, p.351-360, 2003
PDF
Downloads: 0
Views: 972

Resumo

JUSTIFICATIVA E OBJETIVOS: A injeção de grandes volumes de anestésico local no espaço subaracnóideo, após punção dural acidental, é complicação da anestesia peridural. O objetivo desta pesquisa foi investigar as possíveis alterações clínicas e histológicas desencadeadas por grandes volumes de lidocaína a 2% e ropivacaína a 1%, simulando injeção subaracnóidea acidental, em cães. MÉTODO: Vinte e um cães foram distribuídos aleatoriamente em 3 grupos, que receberam por via subaracnóidea: G1 - cloreto de sódio a 0,9%; G2 - lidocaína a 2% e G3 - ropivacaína a 1%. A punção subaracnóidea foi realizada no espaço intervertebral L6-L7. O volume de anestésico local administrado foi de 1 ml para cada 10 cm de distância entre a protuberância occipital e o espaço lombossacral (5 - 6,6 ml). Após 72 horas de observação clínica os animais foram sacrificados e foi removida a porção lombossacral da medula para exame histológico, por microscopia óptica. RESULTADOS: Nenhum animal do G1 apresentou alterações clínicas ou histológicas da medula espinhal. Foram observados dois casos de necrose do tecido nervoso em G2, porém mudanças clínicas, em somente um desses cães e em outros dois animais que não apresentaram alterações histológicas. Foi encontrada necrose focal do tecido nervoso medular em um animal de G3. Todos os animais de G3 permaneceram clinicamente normais. CONCLUSÕES: Conclui-se que grandes volumes de lidocaína a 2% determinaram alterações clínicas e histológicas mais intensas que os de ropivacaína a 1%.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS, ANIMAL, COMPLICAÇÕES, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Spinal injection of large local anesthetic volumes after accidental dural puncture is an epidural anesthesia complication. This study aimed at investigating potential clinical and histological changes triggered by large volumes of 2% lidocaine or 1% ropivacaine in a simulated accidental spinal injection in dogs. METHODS: Twenty one dogs were randomly allocated into three experimental groups, which received spinal injections of: G1 - 0.9% sodium chloride, G2 - 2% lidocaine, G3 - 1% ropivacaine. Spinal puncture was performed in L6-L7 interspace. Anesthetic volume was 1 ml per 10 cm-distance between the occipital protuberance and the lumbosacral space (5 - 6.6 ml). After 72 hours of clinical observation animals were sacrificed and their spinal cords were removed for histological examination under light microscopy. RESULTS: No G1 animal presented clinical or histological changes in the spinal cord. There were two cases of nervous tissue necrosis in G2, however clinical changes were only observed in one of these dogs and in two other dogs which had no histological changes. There has been focal necrosis in the spinal cord nervous tissue of one G3 animal. All G3 animals remained clinically normal. CONCLUSIONS: Large volumes of 2% lidocaine have determined more intensive clinical and histological changes as compared to 1% ropivacaine.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANIMAL, COMPLICATIONS, COMPLICATIONS

References

de Jong RH. Local Anesthetic Pharmacology. Regional Anesthesia and Analgesia. 1996;8:124-142.

Veering BT - Local Anesthetics, em: Brown DL. Regional Anesthesia and Analgesia. Philadelphia: W. B. Saunders. 1996;12:188-207.

Herman N. Neurologic complications of regional anesthesia. Semin Anesth Perioper Med Pain. 1998;17:64-72.

Phillips OC, Ebner H, Nelson AT. Neurologic complications following spinal anesthesia with lidocaine: a prospective review of 10.440 cases. Anesthesiology. 1969;30:284-289.

Rigler ML, Drasner K, Krejcie TC. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. 1991;72:275-281.

Lambert DH, Hurley RJ. Cauda equina syndrome and continuous spinal anesthesia. Anesth Analg. 1991;72:817-819.

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

Loo CC, Irestedt L. Cauda equina syndrome after spinal anaesthesia with hyperbaric 5% lignocaine: a review of six cases of cauda equina syndrome reported to the Swedish pharmaceutical insurance 1993-1997. Acta Anaesthesiol Scand. 1999;43:371-379.

Drasner K, Rigler M, Sessler DI. Cauda equina syndrome following intended epidural anesthesia. Anesthesiology. 1992;77:582-585.

Cheng ACK. Intended epidural anesthesia as possible cause of cauda equina syndrome. Anesth Analg. 1994;78:157-159.

Lee DS, Bui T, Ferrarese J. Cauda equina syndrome after incidental total spinal anesthesia with 2% lidocaine. J Clin Anesth. 1998;10:66-69.

McClure JH. Ropivacaine. Br J Anaesth. 1996;76:300-307.

Hendrix PK, Raffe MR, Robinson EP. Epidural administration of bupivacaine, morphine, or their combination for postoperative analgesia in dogs. J Am Vet Med Assoc. 1996;209:598-607.

Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg. 1981;60:150-161.

Li DF, Bahar M, Cole F. Neurological toxicity of the subarachnoid infusion of bupivacaine, lignocaine or 2-chloroprocaine in the rat. Br J Anaesth. 1985;57:424-429.

Lambert LA, Lambert DH, Strichartz GR. Irreversible conduction block in isolated nerve by high concentrations of local anesthetics. Anesthesiology. 1994;80:1082-1093.

Gold MS, Reichling DB, Hampl KF. Lidocaine toxicity in primary afferent neurons from the rat. J Pharmacol Exp Ther. 1998;285:413-421.

Kalichman MW. Physiologic mechanisms by which local anesthetics may cause injury to nerve and spinal cord. Reg Anesth. 1993;18:448-452.

Byers MR, Fink BR, Kennedy RD. Effects of lidocaine on axonal morphology, microtubules, and rapid transport in rabbit vagus nerve in vitro. J Neurobiol. 1973;4:125-143.

Malinovsky JM, Pinaud M. Neurotoxicité des agents administrés par voie intrathécale. Ann Fr Anesth Réanim. 1996;15:647-658.

Dahlström A. “Axoplasmatic Transport”: The catering and communication system within nerve cells. Anesthesiology. 1974;41:537-541.

Myers RR, Sommer C. Methodology for spinal neurotoxicity studies. Reg Anesth. 1993;18:439-447.

Kristensen JD, Karlsten R, Gordh T. Spinal cord blood flow after intrathecal injection of ropivacaine: a screening for neurotoxic effects. Anesth Analg. 1996;82:636-640.

Iida H, Watanabe Y, Dohi S. Direct effects of ropivacaine on spinal pial vessels in canine: comparison with bupivacaine. Anesthesiology. 1995;83:A828.

Crosby G. Local spinal cord blood flow and glucose utilization during spinal anesthesia with bupivacaine in conscious rats. Anesthesiology. 1985;63:55-60.

Benveniste H, Qui H, Hedlund LW. In vivo diffusion-weighted magnetic resonance microscopy of rat spinal cord: effect of ischemia and intrathecal hyperbaric 5% lidocaine. Reg Anesth Pain Med. 1999;24:311-318.

Takenami T, Yagishita S, Asato F. Neurotoxicity of intrathecally administered tetracaine commences at the posterior roots near entry into the spinal cord. Reg Anesth Pain Med. 2000;25:372-379.

5ddd370a0e8825cf0a1da3e9 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