Abstract

HIGH DOSE SPINAL ANESTHESIA WITH GLUCOSE FREE 0.5% BUPIVACAINE FOR IPSILATERAL FRACTURE OF THE FEMUR AND TIBIA

Luiz Eduardo Imbelloni*, Eloísa Gabriele Costa and Lara de Freitas R

ABSTRACT

Background: The altered hemodynamics, and therefore the arterial hypotension is the most prevalent adverse effect after subarachnoid anesthesia. The aim of the case report was evaluated efficacy and safety of high dosage of 0.5% isobaric bupivacaine with respect to maximal and regression spread, total duration of analgesia and hemodynamic side-effects. Case Report: A 31-year old patient (body weight 91 kg, height 170 cm, ASA II) with fracture of the femoral condyle, distal patella and proximal tibia, was planned to have an elective orthopedic surgery under spinal anaesthesia. With the patient on sitting position, in the L3-L4 interspaces using 27G Quincke needle, after CSF 30 mg of 0.5% isobaric bupivacaine were administered at a speed of 1 mL/15s. Onset of sensory analgesia was rapid. Fifteen minutes after the injection, the cephalad level of analgesia was T7. Maximal cephalad spread was achieved after 30 minutes, the level was T6. The time for complete motor blockade (Grade 3) of the lower limbs was 7 minutes. A duration of complete motor blockade was 350 minutes. At the end of surgery, we performed a lateral combined femoral-sciatic nerve approach via a single skin puncture and analgesia was 20 hours. Conclusions: The use of high dose of 0.5% isobaric bupivacaine (30 mg) for surgical treatment of complex orthopedic surgery was justified by the long duration of the surgery. Under the conditions of our patient, spinal anesthesia proved to be satisfactory for a large surgery of long duration, with excellent cardiocirculatory stability and without adverse events.

Keywords: Spinal Anesthesia, Isobaric Bupivacaine, Motor Block.