Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000600001
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia peridural lombar ou bloqueio do plexo lombar combinados à anestesia geral: eficácia e efeitos hemodinâmicos na artroplastia total do quadril

Epidural lumbar block or lumbar plexus block combined with general anesthesia: efficacy and hemodynamic effects on total hip arthroplasty

Leonardo Teixeira Domingues Duarte; Paulo Sérgio Siebra Beraldo; Renato Ângelo Saraiva

Downloads: 1
Views: 1128

Resumo

JUSTIFICATIVA E OBJETIVOS: A anestesia para artroplastia total do quadril (ATQ) constitui desafio devido à idade avançada e às doenças associadas dos pacientes. O objetivo do estudo foi avaliar se o bloqueio do plexo lombar combinado à anestesia geral se equivale à anestesia peridural lombar quanto à eficácia do bloqueio nociceptivo, efeitos hemodinâmicos secundários, dificuldade na sua execução e influência no sangramento operatório em pacientes submetidos à ATQ. MÉTODO: Pacientes estado físico ASA I a III foram alocados aleatoriamente nos grupos Peridural e Lombar. No grupo Peridural, foi realizada anestesia peridural lombar contínua com ropivacaína a 0,5% 10 a 15 mL. No grupo Lombar, foi realizado bloqueio do plexo lombar pela via posterior com ropivacaína a 0,5% 0,4 mL.kg-1. Todos os pacientes foram submetidos à anestesia geral. Foram estudados: a dificuldade na execução dos bloqueios, sua eficácia e efeitos hemodinâmicos secundários. RESULTADOS: 41 pacientes foram incluídos no estudo. O tempo para execução do bloqueio peridural foi menor, mas o número de tentativas de posicionamento da agulha foi semelhante nos dois grupos. O bloqueio peridural foi mais eficaz. No grupo Lombar, houve aumento da pressão arterial diastólica e média (PAM) e no duplo produto após a incisão e o consumo anestésico durante a operação foi maior. Após o bloqueio, a PAM foi menor nos momentos 50, 60 e 70 minutos após a realização do bloqueio peridural. O sangramento foi semelhante nos dois grupos. CONCLUSÕES: A técnica peridural promoveu bloqueio nociceptivo mais eficaz sem se associar à instabilidade hemodinâmica quando combinada à anestesia geral. O bloqueio do plexo lombar mostrou-se uma técnica útil em combinação com a anestesia geral quando a anestesia peridural estiver contraindicada.

Palavras-chave

CIRURGIA, Ortopédica, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Anesthesia for total hip arthroplasty (THA) is a challenge due to the advanced age and associated diseases of patients. The objective of this study was to evaluate whether the efficacy of the nociceptive blockade, secondary hemodynamic effects, difficulty to execute the technique, and influence in intraoperative bleeding of lumbar plexus block combined with general anesthesia is equivalent to epidural lumbar block in patients undergoing THA. METHODS: Patients with physical status ASA I to III were randomly separated into two groups, Epidural and Lumbar. In the Epidural group, continuous epidural lumbar block with 10 to 15 mL of 0.5% ropivacaine was performed. Patients in the Lumbar group underwent posterior lumbar plexus block with 0.4 mL.kg-1 of 0.5% ropivacaine. All patients underwent general anesthesia. The difficulty to perform the technique, its efficacy, and secondary hemodynamic effects were evaluated. RESULTS: Forty-one patients were included in this study. The length of time to execute the epidural block was shorter, but the number of attempts to position the needle was similar in both groups. Epidural block was more effective. In the Lumbar group, an increase in diastolic blood pressure and mean arterial pressure (MAP) and in the double product was observed after the incision, and anesthetic consumption was greater. After the blockade, MAP was lower 50, 60, and 70 minutes after the epidural block. Bleeding was similar in both groups. CONCLUSIONS: Nociceptive blockade, which was not associated with hemodynamic instability when combined with general anesthesia, was more effective in epidural block. Lumbar plexus block proved to be a useful technique when combined with general anesthesia when epidural block is contraindicated.

Keywords

ANESTHETIC TECHNIQUES, Regional, ANESTHETIC TECHNIQUES, Regional, SURGERY, Orthopedic

References

Fischer HB, Simanski CJ. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia. 2005;60:1189-1202.

Singelyn FJ, Ferrant T, Malisse MF. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Reg Anesth Pain Med. 2005;30:452-457.

Türker G, Uçkunkaya N, Yavasçaoglu B. Comparison of the catheter-technique psoas compartment block and the epidural bock for analgesia in partial hip replacement surgery. Acta Anaesthesiol Scand. 2003;47:30-36.

Capdevila X, Barthelet Y, Biboulet P. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8-15.

Horlocker TT, Wedel DJ. Anticoagulation and neuraxial block: historical perspective, anesthetic implications, and risk management. Reg Anesth Pain Med. 1998;23(6^s2):129-134.

Capdevila X, Macaire P, Dadure C. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606-1613.

Stevens RD, Van Gessel E, Flory N. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology. 2000;93:115-121.

Horlocker TT. Peripheral nerve blocks-regional anesthesia for the new millennium. Reg Anesth Pain Med. 1998;23:237-240.

Chayen D, Nathan H, Chayen M. The psoas compartment block. Anesthesiology. 1976;45:95-99.

Vaghadia H, Kapnoudhis P, Jenkins LC. Continuous lumbosacral block using a Touhy needle and catheter technique. Can J Anaesth. 1992;39:75-78.

Chudinov A, Berkenstadt H, Salai M. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Reg Anesth Pain Med. 1999;24:563-568.

Parkinson SK, Mueller JB, Little WL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989;68:243-248.

Farny J, Girard M, Drolet P. Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine. Can J Anaesth. 1994;41:486-491.

Birnbaum K, Prescher A, Hessler S. The sensory innervation of the hip joint-an anatomical study. Surg Radiol Anat. 1997;19:371-375.

Indelli PF, Grant SA, Nielsen K. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250-255.

Mannion S, O'Callaghan S, Walsh M. In with the new, out with the old?: Comparison of two approaches for psoas compartment block. Anesth Analg. 2005;101:259-264.

Litz RJ, Vicent O, Wiessner D. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med. 2004;29:60-64.

De Biasi P, Lupescu R, Burgun G. Continuous lumbar plexus block: use of radiography to determine catheter tip location. Reg Anesth Pain Med. 2003;28:135-139.

Jankowski CJ, Hebl JR, Stuart MJ. A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2003;97:1003-1009.

Destrube M, Guillou N, Orain C. Bloc du plexus lombaire par voie posterieure realise sous anesthesie generale: etude descriptive de 93 cas. Ann Fr Anesth Reanim. 2007;26:418-422.

Morin AM, Kratz CD, Eberhart LH. Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med. 2005;30:434-445.

Kaloul I, Guay J, Cote C. The posterior lumbar plexus (psoas compartment) block and the three-in-one femoral nerve block provide similar postoperative analgesia after total knee replacement. Can J Anaesth. 2004;51:45-51.

Tessler MJ, Kardash K, Wahba RM. The performance of spinal anesthesia is marginally more difficult in the elderly. Reg Anesth Pain Med. 1999;24:126-130.

Guay J. The effect of neuraxial blocks on surgical blood loss and blood transfusion requirements: a meta-analysis. J Clin Anesth. 2006;18:124-128.

Davies AF, Segar EP, Murdoch J. Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty. Br J Anaesth. 2004;93:368-374.

5dd58bc60e88259050c8fca8 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections