Baixas doses de bupivacaína hipobárica para raquianestesia unilateral

Imbelloni, Luiz Eduardo; Beato, Lúcia; Gouveia, Marildo A.

doi:10.1590/s0034-70942003000500004

Cited by 9 publications

(9 citation statements)

References 7 publications

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“… 12 The technique allows titration of the local anesthetic dose according to surgical needs and provides safe anesthesia, particularly for elderly or high-risk patients with unstable hemodynamic status. 13 , 14 The advantage of CSA in relation to CSE is that the CSA technique is easier to perform. Moreover, the intrathecal positioning of the catheter is easily confirmed by aspiration of cerebrospinal fluid.…”

Section: Discussionmentioning

confidence: 99%

Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

2009

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CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING:Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto.METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated.RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA. CLINICAL TRIAL REGISTRATION NUMBER: NCT00616044RESUMO CONTEXTO E OBJETIVOS: Em cirurgias ortopédicas de grande porte, a raquianestesia contínua e o bloqueio combinado raqui-peridural são métodos seguros e confiáveis. Neste estudo prospectivo foram comparadas as propriedades e efeitos colaterais da raquianestesia contínua com o bloqueio combinado raqui-peridural de punção única em pacientes programados para cirurgia ortopédica de quadril, joelho e fraturas de fêmur. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, conduzido no Instituto de Anestesia Regional do Hospital de Base de São José do Rio Preto.MÉTODOS: 240 pacientes com cirurgias de quadril, artroplastia de joelho ou correção de fratura de fêmur programadas foram aleatoriamente arrolados para receberem raquianestesia contínua ou bloqueio combinado raqui-peridural (CSE). Os bloqueios foram realizados com o paciente na posição lateral no interespaço L3-L4. O sucesso das punções, dificuldades técnicas, parestesia, nível do bloqueio sensitivo e bloqueio motor, necessidade de doses complementares de anestésico local, grau de dificuldade técnica, alteração cardiociruculatória e cefaléia pós-punção foram registradas. Ao final da cirurgia, o cateter foi retirado e foi avaliado se havia refluxo de líquor. RESULTADOS:Sete pacientes foram excluídos (3 CSA e 4 CSE). H...

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Section: Discussionmentioning

confidence: 99%

Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

2009

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“…Різниця в щільності між ЦСР та місцевими анестетиками є фактором, який слід враховувати для обмеження розчинення в субарахноїдальному просторі. Уніполярний спінальний блок може бути отриманий за допомогою гіпобаричного [86] або гіпербаричного [87] розчину, введеного в субарахноїдальний простір, так що анестетик утворює шар вище (гіпобаричний) або нижче (гіпербаричний) середньої лінії. Швидкість введення анестетику визначає, чи буде потік ламінарним, чи турбулентним.…”

Section: положення пацієнтаunclassified

“…Турбулентний потік забезпечує швидке змішування місцевого анестетику з ЦСР, утворюючи однорідну суміш, яка зменшує баричний градієнт між ними. Повільне введення забезпечує уніполярне розповсюдження місцевого анестетику [86,87].…”

Section: положення пацієнтаunclassified

Regional anesthetics: traditions and innovations

Haas

Koval

Haas

2018

PMJUA

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The wide implementation of different regional anesthesia techniques is also actual in pediatric anesthesiology. Using modern methods of regional anesthesia (RA) and modern local anesthetics is a new level in development of pediatric anesthesiology. This article is about advantages of regional pediatric anesthesia in intra- and post-surgery pain management and analgesia. We analyse the techniques of spinal and epidural anesthesia, as well as their varieties such as unipolar spinal block and caudal anesthesia, compare their advantages and disadvantages. Some more techniques such as paravertebral block, TAP-block are considered as an alternative to epidural anesthesia. Methods and possibilities of ilioinguinal, iliohypogastric and TAP-blocks are also mentioned here. The use of the above-mentioned methods allows to reduce the use of narcotic analgesics and hypnotics and, as a consequence, reduces their systemic effects on the child’s body. These methods are safer for use, since they allow you to plan a safe anesthetic for each child and minimize complications.

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“…The difference in density between the cerebrospinal fluid (CSF) and local anesthetics is a factor that should be considered to restrict the distribution of solutions within the subarachnoid space. Theoretically, unilateral spinal block could be obtained with hypobaric 1 or hyperbaric 2 solution injected into the subarachnoid space, with the patient in lateral position, so that the anesthetic forms a layer above (hypobaric) or below (hyperbaric) the midline.…”

Section: Introductionmentioning

confidence: 99%

“…In orthopedic outpatients undergoing lower limb surgeries involving only one member, unilateral spinal anesthesia has advantages over conventional anesthesia, such as fewer hypotension 3 , faster recovery from block 1 , and increased patient satisfaction 4 . There are several reasons to control the maximum level of sensory block.…”

Section: Introductionmentioning

confidence: 99%