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Abstract

LIDOCAINE FOR DORSAL SPINAL ANESTHESIA FOR AMBULATORY ORTHOPEDIC FOOT SURGERY. A COMPARATIVE STUDY BETWEEN ISOBARIC AND HYPOBARIC SOLUTIONS

*Luiz Eduardo Imbelloni, MD, PhD, Micaela Barbosa L. Sales, MD, Thaís Bezerra Ventura, MD, Luísa Camacho, MD and Geraldo Borges de Morais Filho, MSc

ABSTRACT

Background: Foot surgeries can be performed with the patient in a position of dorsal decubitus, lateral position or ventral decubitus. This study aimed at evaluating the feasibility of performing orthopedic foot surgery in decubitus ventral in outpatient settings with two different solutions of lidocaine. Methods: Two groups of 40 patients, physical status ASA I-II, undergoing foot surgical procedures in a jack-knife position, received 50 mg 2% isobaric lidocaine or 24 mg 0.6% hypobaric lidocaine. Sensory and motor blockade and the need for analgesics were evaluated. Patients were followed until third postoperative day and questioned whether they experienced postdural puncture headache, degree of satisfaction or temporally transitory neurological symptom. Results: The latency time was almost the same regardless of the solutions. All patients with 50 mg isobaric lidocaine and 24 mg hypobaric lidocaine presented sufficient anesthesia for the surgical procedure without need for anesthesia complementation. At 15 minutes all patients with isobaric or hypobaric had thoracic levels of anesthesia. The hypobaric solution provided a more homogeneous cephalic dispersion. Proprioception was observed in all patients with hypobaric lidocaine and none with isobaric lidocaine. There is significant difference between solutions to achieve different degrees of motor block. Complete motor blockade occurred in all patients with isobaric lidocaine. In the hypobaric lidocaine group, 85% of the patients did not present any degree of motor blockade. The analgesia time being significantly higher at isobaric (107 min) than at hypobaric (66 min). Hypotension and post-puncture headache occurred in only one patient. There was no hypotension or bradycardia in both groups. The degree of satisfaction was significantly higher with hypobaric lidocaine. No neurological complications were observed in all patients studied. Conclusions: Spinal block performed in the Jack-Knife position provide surgical analgesia with complete motor block with isobaric lidocaine and without motor block with hypobaric lidocaine for foot surgery. Most importantly, it allowed the patient to remain in this position, providing for better surgical exposure for surgeon and tranquility and safety for the patient. In our study, with hypobaric lidocaine all patients went from the operating table to the stretcher without help, and better degree of satisfaction.

Keywords: ANESTHETIC, Local: lidocaine: ANESTHETIC TECHNIQUE, Regional: isobaric spinal block. Regional: hypobaric spinal block. SURGERY: Orthopedic.


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