Abstract

LOWER THORACIC SPINAL ANESTHESIA FOR ORTHOPEDIC SURGERY OF LOWER LIMBS. RETROSPECTIVE STUDY WITH 674 PATIENTS

Luiz Eduardo Imbelloni*, Thaís Bezerra Ventura, Siddharta Lacerda, Bruno Brasileiro, Robson Barbosa, Micaela Barbosa L. Sales, Márcio Duarte and Geraldo Borges de Morais Filho

ABSTRACT

Background: Neuraxial anesthesia is often used for orthopedic surgery. Most anesthesiologists use lumbar puncture with hyperbaric or isobaric 0.5% bupivacaine. The main objective of this study was to compare TSA at three puncture levels, with two needles spinal, with different doses of 0.5% isobaric bupivacaine, and the hemodynamic effects in patients undergoing different types of orthopedic surgery, and neurological complications. Methods: Retrospective study with 674 patients undergoing different types of orthopedic surgeries, undergoing thoracic puncture between T8 and T11, with four different doses of 0.5% isobaric bupivacaine (7.5 to 15 mg). Needle type, puncture site, puncture position, needle insertion, anesthesia latency, duration of sensory and motor blocks, incidence of cardiocirculatory changes, paresthesia, and neurological complications were evaluated. Results: All 674 patients showed satisfactory spinal anesthesia. There was a rapid onset of non-dose-dependent sensory block, a duration of sensory block less than motor block dose-dependent, without neurological complications, and low incidence of cardiocirculatory alterations. Permanence in the ascending head, depending on the dose, was sufficient to maintain the block level below T8 in 94.3% of the patients, resulting in motor block in 81.5% of the patients, without neurological complications, and low incidence of cardiocirculatory alterations. Analgesia with S75:R25 levobupivacaine and lumbosacral plexus block median four 22 hours. Conclusions: Lower TSA (T8 to T11), with different doses of 0.5% isobaric bupivacaine provides excellent anesthesia for different lower limb orthopedic surgery, without neurological sequelae, being a new spinal anesthesia option, should avoid punctures between T12 and L2, responsible for spinal cord injury.

Keywords: Hemodynamics, Regional anesthesia, Techniques, Thoracic spinal anesthesia, Bupivacaine.