Baixas doses de bupivacaína a 0,5% isobárica para raquianestesia unilateral

Luiz Eduardo Imbelloni; Lúcia Beato; M.A. Gouveia

doi:10.1590/S0034-70942004000300014

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Baixas doses de bupivacaína a 0,5% isobárica para raquianestesia unilateral

Low isobaric 0.5% bupivacaine doses for unilateral spinal anesthesia

Luiz Eduardo Imbelloni; Lúcia Beato; M.A. Gouveia

http://dx.doi.org/10.1590/S0034-70942004000300014 Braz J Anesthesiol, vol.54, n3, p.423-430, 2004

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Resumo

JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar diversas vantagens, principalmente no paciente ambulatorial. Baixas doses de anestésicos locais, lenta velocidade de injeção subaracnóidea e posição de decúbito lateral são relacionados com a facilidade de produzir distribuição unilateral na raquianestesia. Neste estudo, foi verificada a possibilidade de se obter raquianestesia unilateral com bupivacaína a 0,5% isobárica. MÉTODO: A raquianestesia com 1 ml de bupivacaína isobárica a 0,5% (5 mg) foi realizada através de agulha 27G Quincke em 25 pacientes, estado físico ASA I e II submetidos à cirurgias ortopédicas. A punção subaracnóidea foi realizada por via lateral com o paciente em decúbito lateral, com o membro a ser operado voltado para cima, e 1 ml de bupivacaína isobárica foi injetado na velocidade de 1 ml.30s-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 tempos avaliados. No membro operado todos os pacientes apresentaram anestesia cirúrgica. No membro contralateral, aos 20 minutos, 9 pacientes apresentaram bloqueio sensitivo; aos 40 minutos 18 pacientes e aos 60 minutos 17 pacientes. Portanto, o bloqueio sensitivo unilateral ocorreu em 7 pacientes (28%) e em ambos os membros em 18 pacientes (72%). Raquianestesia unilateral foi obtida em 28% dos pacientes. Estabilidade hemodinâmica foi observada em todos os pacientes. Nenhum paciente desenvolveu cefaléia pós-punção dura-máter. CONCLUSÕES: A bupivacaína isobárica (5 mg) proporciona predominante bloqueio unilateral após 20 minutos na posição lateral. A solução isobárica de bupivacaína se mobiliza dentro do LCR após 20 minutos, resultando num bloqueio unilateral em apenas 28% dos pacientes. A principal vantagem da raquianestesia unilateral é a estabilidade hemodinâmica e sua rápida regressão, podendo ser uma nova opção para cirurgia ambulatorial.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia may be advantageous, especially in the outpatient setting. Low local anesthetic doses, slow spinal injection rate and the lateral position have been related to the easiness of inducing unilateral spinal anesthesia. This study aimed at investigating the possibility of inducing unilateral spinal anesthesia with isobaric 0.5% bupivacaine. METHODS: Spinal anesthesia with 1 mL isobaric 0.5% bupivacaine (5 mg) was induced through 27G Quincke needle in 25 physical status ASA I and II patients undergoing orthopedic procedures. Dural puncture was performed with patients in lateral decubitus with the limb to be operated facing upwards. One mililiter of isobaric bupivacaine was injected in 30 seconds. Sensory and motor blocks were compared between the operated and the contralateral side. RESULTS: Motor and sensory blocks on operated and contralateral sides were significantly different in all studied moments. All patients presented surgical anesthesia in the operated limb. At 20 minutes, nine patients presented sensory block in the contralateral side; at 40 minutes they were 18 and at 60 minutes they were 17 patients. So, unilateral block was present in seven patients (28%) and bilateral block was present in the remaining 18 patients (72%). No patient developed post-dural puncture headache. CONCLUSIONS: Isobaric bupivacaine (5 mg) provides predominant unilateral block after 20 minutes in the lateral position. Isobaric bupivacaine moves in the CSF after 20 minutes resulting in just 28% unilateral blocks. Major advantages of unilateral spinal anesthesia are hemodynamic stability and short duration and it might be a new alternative for outpatient procedures.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

Referencias

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

Imbelloni LE, Beato L, Gouveia MA. Unilateral spinal anesthesia with hypobaric bupivacaine. Rev Bras Anestesiol. 2002;52:27-33.

Imbelloni LE, Beato L, Gouveia MA. A low dose of hypobaric bupivacaine for unilateral spinal anesthesia. Rev Bras Anestesiol. 2003;53:579-585.

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

Casati A, Fanelli G, Cappelleri G. Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth. 1998;45:850-854.

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

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. Low-dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee. Anaesthesia. 1999;54:540-545.

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

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

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

Enk D, Prien T, Van Aken H. Success rate of unilateral spinal anesthesia is dependent on injection flow. Reg Anesth Pain Med. 2001;26:420-427.

Casati A, Fanelli G, Cappelleri G. Effects of speed intrathecal injection on unilateral spinal block by 1% hyperbaric bupivacaine: A randomized, double-blind study. Minerva Anestesiol. 1999;65:5-10.

Fanelli G, Borghi B, Casati A. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Can J Anaesth. 2000;47:746-751.

Gouveia MA, Labrunie GM. Raquianestesia hipobárica com bupivacaína 0,15%. Rev Bras Anestesiol. 1985;35:519-521.

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

Iselin-Chaves I, Van Gessel EF, Donald F. The effects of solution concentration and epinephrine on lateral distribution of hyperbaric tetracaine spinal anesthesia. Anesth Analg. 1996;83:755-759.

Imbelloni LE, Carneiro ANG, Sobral MGC. Tempo de gotejamento de líquido cefalorraquidiano com agulhas espinhais de fino calibre. Rev Bras Anestesiol. 1995;45:155-158.

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

Imbelloni LE, Sobral MGC, Carneiro ANG. Cefaléia pós-raquianestesia e o desenho das agulhas: Experiência com 5050 casos. Rev Bras Anestesiol. 2001;51:43-52.

Cameron AE, Arnold RW, Ghoris MW. Spinal analgesia using bupivacaína 0. 5% plain. Anaesthesia. 1981;36:318-322.

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

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies. Reg Anesth. 1997;22:534-538.

Kuusniemi KS, Pihlajamäki KK, Kirvelä OA. Spinal anesthesia with hypobaric bupivacaine for knee arthroscopies: effect of posture on motor block. Reg Anesth Pain Med. 2001;26:30-34.

Ben-David B, Levin H, Solomon E. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg. 1996;83:716-720.

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

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

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

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

Baixas doses de bupivacaína a 0,5% isobárica para raquianestesia unilateral

Low isobaric 0.5% bupivacaine doses for unilateral spinal anesthesia

Luiz Eduardo Imbelloni; Lúcia Beato; M.A. Gouveia

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Abstract

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