Raquianestesia posterior para cirurgias anorretais em regime ambulatorial: estudo piloto

Luiz Eduardo Imbelloni; Eneida Maria Vieira; Marildo Assunção Gouveia; José Antônio Cordeiro

doi:10.1590/S0034-70942004000600004

Scientific Article

Raquianestesia posterior para cirurgias anorretais em regime ambulatorial: estudo piloto

Restricted dorsal spinal anesthesia for ambulatory anorectal surgery: a pilot study

Luiz Eduardo Imbelloni; Eneida Maria Vieira; Marildo Assunção Gouveia; José Antônio Cordeiro

http://dx.doi.org/10.1590/S0034-70942004000600004 Braz J Anesthesiol, vol.54, n6, p.774-780, 2004

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Resumo

JUSTIFICATIVA E OBJETIVOS: O aumento do número de cirurgias ambulatoriais exige o emprego de métodos anestésicos que permitam a liberação do paciente após a cirurgia. Freqüentemente, as cirurgias anorretais são realizadas com os pacientes hospitalizados. Este estudo examina a possibilidade de esses procedimentos serem realizados em regime ambulatorial com baixas doses de bupivacaína hipobárica. MÉTODO: Trinta pacientes, estado físico ASA I e II, foram submetidos à raquianestesia com solução hipobárica de bupivacaína a 0,15% através de agulha 27G Quincke para cirurgias anorretais. A punção subaracnóidea foi realizada com o paciente em decúbito ventral com auxílio de coxim em seu abdômen para corrigir a lordose lombar e o espaço intervertebral. RESULTADOS: O bloqueio sensitivo foi obtido em todos os pacientes. A sua dispersão variou de T10 a L2 com moda em T12. Apenas três pacientes apresentaram algum grau de bloqueio motor. A duração do bloqueio foi de 122,17 ± 15,35 minutos. Estabilidade hemodinâmica foi observada em todos os pacientes. Nenhum paciente desenvolveu cefaléia pós-punção da dura-máter. CONCLUSÕES: Seis miligramas de bupivacaína a 0,15% em solução hipobárica proporcionaram um bloqueio predominantemente sensitivo, quando injetados em decúbito ventral. As principais vantagens são rápida recuperação, estabilidade hemodinâmica e satisfação do paciente, sendo uma boa indicação para anestesia ambulatorial.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, CIRURGIA, TECNICAS ANESTÉSICAS, TECNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: The increasing number of ambulatory procedures requires anesthetic methods allowing patients to be discharged soon after surgery completion. Currently, anorectal procedures are performed in inpatient settings. This study aimed at evaluating the feasibility of performing these procedures in outpatient settings with low hypobaric bupivacaine doses. METHODS: Participated in this study 30 patients physical status ASA I and II, submitted to spinal anesthesia with 0.15% hypobaric bupivacaine with 27G Quincke needle for anorectal procedures. Spinal puncture was performed with patients in the prone position with the help of a pad under the abdomen to correct lumbar lordosis and the vertebral interspace. RESULTS: Sensory block was obtained in all patients. Sensory block spread varied T10 to L2 (mode = T12). Only three patients presented motor block. Blockade length was 122.17 ± 15.35 minutes. No hemodynamic changes were observed in all patients. No patient developed post-dural puncture headache. CONCLUSIONS: Hypobaric bupivacaine (6 mg) has provided predominantly sensory block after injection in the prone position. Major advantages were hemodynamic stability and patients' satisfaction, being a good indication for outpatient anesthesia.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, SURGERY

References

Dahl V, Raeder J. Regional anaesthesia in ambulatory surgery. Curr Opin Anaesthesiol. 2003;16:471-476.

Katayama M, Laurito GM, Vieira JL. Anestesia subaracnóidea para artroscopia de joelho em regime ambulatorial. Rev Bras Anestesiol. 1991;41:173-178.

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

Imbelloni LE, Gouveia MA. Unilateral spinal anesthesia with hypobaric bupivacaine. Rev Bras Anestesiol. 2002;52:542-548.

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

Imbelloni LE. O Uso Racional da Raquianestesia. Tratado de Anestesia Raquidiana. 2001:74-86.

Buckenmaier CC, Nielsen KC, Pietrobon R. Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting. Anesth Analg. 2002;95:1253-1257.

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

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.

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

Kahn CH, Blank JW, Warfield CA. Lumbar Spinal Nerve Root. Regional Anesthesia: an Atlas of Anatomy and Techniques. 1996:285-294.

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

McConnell JC, Khubchandani IT. Long-term follow-up of closed haemorrhoidectomy. Dis Colon Rectum. 1983;26:797-799.

Prasad ML, Abcarian H. Urinary retention following operation for benign anorectal diseases. Dis Colon Rectum. 1978;21:490-492.

Bleday R, Pena JP, Rothenberger DA. Symptomatic hemorrhoids: current incidence and complications of operative treatment. Dis Colon Rectum. 1992;35:477-478.

Ben-David B, Maryanovsky M, Gurevitch A. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg. 2000;91:865-870.

Freedman JM, Li DK, Drasner K. Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1,863 patients. Anesthesiology. 1998;89:633-641.

Moore DC, Thompson GE. Commentary: neurotoxicity of local anesthetics - an issue or a scapegoat?. Reg Anesth Pain Med. 1998;23:605-610.

Raquianestesia posterior para cirurgias anorretais em regime ambulatorial: estudo piloto

Restricted dorsal spinal anesthesia for ambulatory anorectal surgery: a pilot study

Luiz Eduardo Imbelloni; Eneida Maria Vieira; Marildo Assunção Gouveia; José Antônio Cordeiro

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