Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000500010
Brazilian Journal of Anesthesiology
Clinical Information

Raquianestesia contínua com altas doses de anestésicos locais

Continuous spinal anesthesia with high dose of local anesthetics

Luiz Eduardo Imbelloni; Savino Gasparini Neto; Eliana Marisa Ganem

http://dx.doi.org/10.1590/S0034-70942010000500010 Braz J Anesthesiol, vol.60, n5, p.537-543, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: A maior vantagem da raquianestesia contínua é o melhor controle de nível, intensidade e duração da analgesia espinal. Com o advento dos cateteres intermediários (cateter por foral da agulha) e sua baixa incidência de cefaleia e sintomas neurológicos, a técnica vem ganhando credibilidade. O objetivo de caso é relatar a possível segurança do uso do novo cateter com grande dose de bupivacaína hiperbárica a 0,5% com glicose a 1,6% associada à lidocaína 2% hiperbárica com glicose a 1,6%. RELATO DO CASO: Paciente do sexo masculino, 78 anos, 85 kg, 168 cm, estado físico ASA III, hipertenso, coronariopata e insuficiência renal crônica. Candidato à cirurgia de volumosas hérnias inguinal bilateral e umbilical, sendo submetido por uma semana a pneumoperitôneo para criar espaço. Após venóclise com cateter 18G, monitoração com cardioscópio, pressão arterial não invasiva e oximetria de pulso, foi sedado com 1 mg de midazolam e fentanil 100 µg por via venosa e colocado em decúbito lateral esquerdo. Submetido à raquianestesia contínua por via mediana em L3-L4, com conjunto de agulha cortante 27G e cateter 22G. A dose total de anestésico utilizada no procedimento foi 25 mg de bupivacaína 0,5% (hiperbárica com glicose a 1,6%) e 160 mg de lidocaína 2% (hiperbárica com glicose a 1,6%) e morfina (100 µg). Paciente acompanhado até o 30º dia sem queixa neurológica. CONCLUSÕES: Recentemente, a má distribuição do anestésico local através de microcateter foi atribuída como causa de síndrome de cauda equina. Este relato de caso mostrou que, com a administração de altas doses de anestésicos hiperbáricos através do novo cateter, não houve má distribuição nem risco de síndrome de cauda equina

Palavras-chave

ANESTÉSICO, Local, CIRURGIA, Abdominal, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter) and its low incidence of headaches and neurological symptoms, the technique has been gaining credibility. The objective of this paper is to report the possible safety of the new catheter with a large dose of hyperbaric 0.5% bupivacaine with 1.6% glucose associated with hyperbaric 2% lidocaine with 1.6% glucose. CASE REPORT: Male patient, 78 years old, 85 kg, 168 cm, physical status ASA III, with hypertension, coronary artery disease, and chronic renal failure. The patient was candidate for surgery for huge bilateral inguinal and umbilical hernias, being submitted to preoperative pneumoperitoneum for one week to stretch abdominal cavity. After venoclysis with an 18G catheter, he was monitored with cardioscope, non-invasive blood pressure, and pulse oximetry; he was sedated with 1 mg of midazolam and 100 µg of fentanyl intravenously, and placed in left lateral decubitus. He underwent continuous spinal anesthesia by a median puncture in L3-L4 with a set with a 27G cut-bevel needle and 22G catheter. The total dose of anesthetic used was 25 mg of 0.5% bupivacaine (hyperbaric, with 1.6% glucose), 160 mg of 2% lidocaine (hyperbaric, with 1.6% glucose), and morphine (100 µg). The patient was followed-up until the 30th postoperative day without neurological complaints. CONCLUSIONS: Recently, the poor distribution of the local anesthetic through the microcatheter was attributed as the cause of cauda equina syndrome. This case report showed that, with the administration of high doses of hyperbaric anesthetics through the new catheter, poor distribution or risk of cauda equina syndrome were not observed

Keywords

ANESTHETIC, Local, ANESTHETIC TECHNIQUE, Regional, SURGERY, Abdominal

References

Hurley RJ, Lambert DH. Continuous spinal anesthesia with a microcatheter technique: Preliminary experience. Anesth Analg. 1990;70:97-102.

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

Benson JS. FDA Safety alert: Cauda equina syndrome associated use of small-bore catheters in continuous spinal anesthesia. DANA J. 1992;60.

Imbelloni LE, Gouveia MA. Assessment of a new catheter for continuous spinal anesthesia. Rev Bras Anestesiol. 1999;49:315-319.

Imbelloni LE, Gouveia MA. Comparison between continuous spinal anesthesia with around-needle catheter and combined spinal-epidural anesthesia for orthopedic surgery. Rev Bras Anestesiol. 2000;50:419-424.

Imbelloni LE, Gouveia MA. Continuous spinal anesthesia with Spinocath® for obstetric analgesia. Int J Obstetric Anesth. 2006;15:171-172.

Labaille Th, Benhamou D, Westermann J. Hemodynamic effects of continuous spinal anesthesia: a comparative study between low and high doses of bupivacaine. Reg Anesth. 1992;17:193-196.

Ilias WK, Klimcha W, Skrbensky G. Continuous microspinal anaesthesia: another perspective on mechanisms inducing cauda eqüina syndrome. Anaesthesia. 1998;53:618-623.

Rigler ML, Drasner K. Distribution of chateter injected local anesthetic in a model of the subarachnoid space. Anesthesiology. 1991;75:884-892.

Ross BK, Coda B, Heath CH. Local anesthetic distribution in a spinal model: A possible mechanism of neurologic injury after continuous spinal anesthesia. Reg Anesth. 1992;17:69-77.

Cheney FW, Domino KB, Caplan RA, Posner KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology. 1999;90:1062-1069.

Hogan Q. Anatomy of spinal anesthesia: some old and new findings. Reg Anesth Pain Med. 1998;23:340-343.

Hampl KF, Schneider MC, Pargger H. A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine. Anesth Analg. 1996;83:1051-1054.

Pollock JE, Liu SS, Neal JM. Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology. 1999;90:445-450.

Hampl KF, Schneider MC, Thorin D. Hyperosmolarity does not contribute to transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine. Reg Anesth. 1995;20:363-368.

Pollock JE, Neal JM, Stephenson CA. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology. 1996;84:1361-1367.

Gurun MS, Leinbach R, Moore L. Studies on the safety of glucose and paraben-containing neostigmine for intrathecal administration. Anesth Analg. 1997;85:317-323.

Kalichman MW, Calcutt NA. Local anesthetic-induced conduction block and nerve fiber injury in streptozotocin-diabetic rats. Anesthesiology. 1992;77:941-947.

Sakura S, Chan VWS, Ciriales R, Drasner K. The addition of 7.5% glucose does not alter the neurotoxicity of 5% lidocaine administered intrathecally in the rat. Anesthesiology. 1995;82:236-240.

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

Sakura S, Sumi M, Sakaguchi Y. The addition of phenylephrine contributes to the development of transient neurologic symptoms after spinal anesthesia with 0.5% tetracaine. Anesthesiology. 1997;87:771-778.

Pires SRO, Ganem EM, Marques M. Effects of increasing spinal hyperbaric lidocaine concentrations on spinal cord and meninges: Experimental in dogs. Rev Bras Anestesiol. 2006;56:253-262.

Silva DM, Ganem EM, Marques M. Lidocaína hiperbárica a 5% administrada pela via subaracnóidea com agulha de Quincke em diferentes velocidades de injeção: Efeitos sobre a medula e meninges. Rev Bras Anestesiol. 2004;54(^sSuppl).

Holst D, Möllmann M, Scheuch E, Meissner K, Wendt M. Intrathecal local anesthetic distribution with the new spinocath catheter. Reg Anesth Pain Med. 1998;23:463-468.

Vianna PTG, Resende LA, Ganem EM. Cauda equina syndrome after spinal tetracaine: electromyografic evaluation - 20 years follow-up. Anesthesiology. 2001;95:1290-1291.

Pollock JE, Burkhead D, Neal JM. Spinal nerve function in five volunteers experiencing transient neurologic symptoms after lidocaine subarachnoid anesthesia. Anesth Analg. 2000;90:658-665.

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