Bloqueio inadvertido do neuroeixo durante artroplastia vertebral: relato de caso

Michelle Nacur Lorentz; Virgínia Gomes Martins; Raquel Reis Soares

doi:10.1590/S0034-70942006000500011

Clinical Information

Bloqueio inadvertido do neuroeixo durante artroplastia vertebral: relato de caso

Accidental spinal block during vertebral artroplasty: case report

Michelle Nacur Lorentz; Virgínia Gomes Martins; Raquel Reis Soares

http://dx.doi.org/10.1590/S0034-70942006000500011 Braz J Anesthesiol, vol.56, n5, p.524-529, 2006

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Resumo

JUSTIFICATIVA E OBJETIVOS: A cirurgia de artroplastia vertebral com uso do cimento ósseo tem suas particularidades e complicações. Na maioria das vezes o procedimento é realizado sob anestesia local com sedação, mas algumas vezes é realizado bloqueio subaracnóideo ou peridural com morfina com o intuito de fornecer analgesia pós-operatória. O objetivo deste relato foi discutir as possíveis complicações em cirurgias de artroplastia vertebral. RELATO DO CASO: Paciente do sexo masculino, 76 anos, apresentando fratura patológica em T12, foi admitido para cirurgia de artroplastia vertebral e biopsia óssea. Foi realizada sedação com midazolam e fentanil, o paciente foi colocado em decúbito ventral e o cirurgião infiltrou anestésico local desde a pele até o corpo vertebral de T12 a seguir biopsiou a vértebra e injetou 6 mL de cimento ósseo em T12. Ao final do procedimento o paciente apresentava paralisia dos membros inferiores. CONCLUSÕES: A intervenção cirúrgica na coluna vertebral não é procedimento isento de complicações. Quando se associa bloqueio espinal pode-se retardar o diagnóstico de complicação cirúrgica; além disto corre-se o risco de se imputar à anestesia um problema proveniente do procedimento cirúrgico.

Palavras-chave

CIRURGIA, COMPLICAÇÕES, COMPLICATIONS, SURGERY

Abstract

BACKGROUND AND OBJECTIVES: Vertebral artroplasty with bone cement has its particularities and complications. Most often the procedure is performed under local anesthetic and sedation, but sometimes it is done under subarachnoid or epidural block with morphine to achieve postoperative analgesia. The objective of this report is to discuss the possible complications of vertebroplasties. CASE REPORT: Male patient, 76 years old, presenting pathologic fracture in T12 was admitted for vertebral artroplasty and bone biopsy. Patient was sedated with midazolam and fentanyl, placed in the prone position, and the surgeon injected local anesthetic from the skin until the vertebral body of T12. He then took a biopsy of the vertebra and injected 6 mL of bone cement in T12. At the end of the procedure the patient presented paralysis of the lower limbs. CONCLUSIONS: Surgeries in the spinal column are not free of complications. When it is associated with spinal block, the diagnosis of surgical complications might be delayed. Besides, anesthesia might be blamed for a problem caused by the surgical procedure.

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Bloqueio inadvertido do neuroeixo durante artroplastia vertebral: relato de caso

Accidental spinal block during vertebral artroplasty: case report

Michelle Nacur Lorentz; Virgínia Gomes Martins; Raquel Reis Soares

Resumo

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Abstract

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