Efeitos da inclinação de agulha peridural e diferentes velocidades de injeção na distribuição de anestesia peridural

Ozlem Sen; N Ferah Donmez; Dilsen Ornek; Dilek Kalayci; Mahmut Arslan; Bayazit Dikmen

doi:10.1590/S0034-70942012000600010

Special Article

Efeitos da inclinação de agulha peridural e diferentes velocidades de injeção na distribuição de anestesia peridural

Effects of epidural needle rotation and different speeds of injection on the distribution of epidural block

Ozlem Sen; N Ferah Donmez; Dilsen Ornek; Dilek Kalayci; Mahmut Arslan; Bayazit Dikmen

http://dx.doi.org/10.1590/S0034-70942012000600010 Braz J Anesthesiol, vol.62, n6, p.857-862, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: Este estudo prospectivo e randomizado avaliou o efeito das velocidades da injeção na anestesia peridural unilateral sobre as características do bloqueio, parâmetros hemodinâmicos e critérios de alta hospitalar em 60 pacientes. Levobupivacaína a 5% foi administrada nos pacientes (n = 30) do Grupo F durante 1 minuto (rápido) e durante 3 minutos nos pacientes (n = 30) do Grupo S (lento), com agulha em ângulo de 5º-10º a partir da linha média. O sucesso da anestesia peridural unilateral foi mais significante no Grupo S do que no Grupo F (70,3% vs 16%, p < 0,001). Nos pacientes do Grupo S, o tempo necessário para o nível máximo de bloqueio sensitivo nos lados não operados foi mais curto e o tempo de regressão para dois segmentos, mais longo (p < 0,05). O tempo para walk-out foi mais longo no Grupo F (p < 0,05). Consideramos que a administração lenta de anestésico local em anestesia peridural unilateral é mais eficaz do que a administração rápida.

Palavras-chave

ANESTÉSICOS, Local, bupivacaína levógira, CIRURGIA, Ortopédica, EQUIPAMENTOS, Cateter peridural, TÉCNICAS ANESTÉSICAS, Regional, peridural

Abstract

BACKGROUND AND OBJECTIVES: This prospective, randomised study examined the effect of injection speeds for unilateral epidural anesthesia on block characteristics, hemodynamic parameters, and discharge criteria in 60 patients. Levobupivacaine 5% was administered to Group F over 1 min (fast) and to Group S over 3 min (slow) (n = 30 each) with the needle angulated at 5º-10º from the midline. Unilateral epidural block was significantly more successful in Group S than in Group F (70.3% vs. 16%; p < 0.001). On the non-operated sides in group S, the maximal sensorial block time was shorter and the regression time for 2 segments was longer (p < 0.05). And the walk-out time was longer in group F (p < 0.05). We consider that the slow administration of local anesthetic in unilateral epidural anesthesia is more effective than rapid administration.

Keywords

Anesthesia, Epidural, Bupivacaine, Catheters, Indwelling, Injections, Epidural, Orthopedic Procedures

Referências

Pollock JE, Mulroy MF, Bent E, Polissar NL. A comparison of two regional anesthetic techniques for outpatient knee arthroscopy. Anesth Analg. 2003;97:397-401.

Mulroy MF, Larkin KL, Hodgson PS. A comparison of spinal, epidural and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2000;91:860-864.

Hogan Q. Epidural catheter tip position and distribution of injectate evaluated by computed tomography. Anesthesiology. 1999;90(4):964-970.

Buchheit T, Crews JC. Lateral cervical epidural catheter placement for continuous unilateral upper extremity analgesia and sympathetic block. Reg Anesth Pain Med. 2000;25:313-317.

Borghi B, Agnoletti V, Ricci A. A prospective, randomized evaluation of the effects of epidural needle rotation on the distribution of epidural block. Anesth Analg. 2004;98:1473-1478.

Dikmen B, Peker A, Horasanlı E. Is intentional unilateral epidural catheterization reliable on pain management?. Pain Clinic. 2005;17(4):377-382.

Urban MK. Anaesthesia for orthopedic surgery. Miller's Anesthesia. 2010:2241-2259.

White PF, Matthew RE. Ambulatory (outpatient) anesthesia: regional anesthesia for ambulatory surgery. Miller's Anesthesia. 2010:2419-2459.

Vloka JD, Hadzic A, Mulcare R. Femoral and genitofemoral nerve blocks versus spinal anesthesia for outpatients undergoing long saphenous vein stripping surgery. Anesth Analg. 1997;84.

Hogan Q. Epidural catheter tip position and distribution of injectate evaluated by computed tomography. Anesthesiology. 1999;90(4):964-970.

Fumio A, Fumio G. Radiographic findings of unilateral epidural block. Anesth Analg. 1996;83:519-522.

Boezaart AP. Computerized axial tomo-epidurographic documentation of unilateral epidural analgesia. Can J Anesth. 1989;36:697-700.

Usubiaga JE, Reis A, Usubiaga LE. Epidural misplacement of catheters and mechanisms of unilateral blockade. Anesthesiology. 1977;32:150-161.

McCrae AF, Whitfield A, McClure JH. Repeated unilateral epidural blockade. Anesthesia. 1992;47:859-861.

Withington DE, Weeks SK. Repeat epidural analgesia and unilateral block. Can J Anesth. 1994;41(7):568-571.

Gallart L, Blanco D, Samsó E, Vidal F. Clinical and radiologic evidence of the epidural plica mediana dorsalis. Anesth Analg. 1990;71:698-701.

Fumio A, Naomi H, Masao O, Ikuo I, Ichiro N, Yasuto K, Tadahide T. A median epidural septum is not a common cause of unilateral epidural blockade. Anesth Analg. 1990;71:427-429.

Marshall SI, Chung F. Discharge criteria and complications of after ambulatory surgery. Anesth Analg. 1999;88:508-517.

Vaghadia H, Viskari D, Berrill A. Selective spinal anesthesia for outpatient laparoscopy. Can J Anesth. 2001;48(3):256-260.

Efeitos da inclinação de agulha peridural e diferentes velocidades de injeção na distribuição de anestesia peridural

Effects of epidural needle rotation and different speeds of injection on the distribution of epidural block

Ozlem Sen; N Ferah Donmez; Dilsen Ornek; Dilek Kalayci; Mahmut Arslan; Bayazit Dikmen

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