Cauda equina syndrome following combined spinal-epidural anesthesia with levobupivacaine for cesarean section

Marinho, S.; Frias, P.; Oliveira, I.; Bento, Cleonice Alves de Melo; Rodrigues, F.; Paiva, A.

doi:10.1016/j.redare.2020.08.012

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…Por su alta liposolubilidad, la buprenorfina tiene mayor afinidad por la sustancia blanca, la grasa peridural y la mielina, y de ahí es aclarada al plasma con rapidez, llegando a los receptores opiáceos sólo un 8% (5) . Por su liposolubilidad su actividad es sobre las fibras tipo C, por lo que es necesario mezclarla con bupivacaína hiperbárica que trabaja a nivel axonal de las fibras A delta y C, y en concentraciones bajas para disminuir su posible neurotoxicidad y lisis simpática (13)(14)(15)(16) ; con dexmedetomidina que prolonga la duración del anestésico local (17,18) y con morfina que por ser hidrosoluble sí llega a los receptores medulares ofreciendo analgesia postoperatoria (19,20) . Continúan haciendo falta más estudios para apoyar los resultados del presente.…”

Section: Resultsunclassified

Eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales: ensayo clínico

de Alba-Valverde,

Aguilar-González,

Moreno-Barrón

2024

Revista Mexicana De Anestesiología

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RESUMEN. Introducción: la buprenorfina en la anestesia multimodal intratecal ofrece buena eficacia anestésica en histerectomías, pero por el mal entendimiento de su farmacocinética su efecto no está bien descrito. Objetivo: evaluar la eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales. Material y métodos: ensayo clínico, controlado, aleatorizado, doble ciego, en mujeres programadas para histerectomía abdominal, distribuidas en tres grupos: grupo BBMD: buprenorfina 150 μg + bupivacaína hiperbárica 0.15% 4.5 mg + morfina 150 μg + dexmedetomidina 7.5 μg; grupo FBMD: fentanilo 50 μg + bupivacaína hiperbárica 0.15% 4.5 mg + morfina 150 μg + dexmedetomidina 7.5 μg; y grupo BM: bupivacaína hiperbárica 0.42% 12.5 mg + morfina 150 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la entrada de compresas a cavidad abdominal, en la salida de compresas de cavidad abdominal y en el postquirúrgico inmediato. Resultados: se analizaron 108 mujeres. Los tres grupos tuvieron muy buena eficacia anestésica; sin embargo, al salir compresas, antes de la dosis peridural y en el postquirúrgico inmediato, el grupo BM fue el que tuvo más molestias (p = 0.004, 0.01 y 0.01, respectivamente). Conclusión: la anestesia multimodal con BBMD demostró muy buena eficacia anestésica.

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Section: Resultsunclassified

Eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales: ensayo clínico

de Alba-Valverde,

Aguilar-González,

Moreno-Barrón

2024

Revista Mexicana De Anestesiología

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“…In terms of safety, neurotoxicity, cauda equina syndrome, and spinal headache are serious potential complications of SA. Nneurotoxicity has been reported mostly in association with intrathecal injection of bupivacaine and levobupivacaine [ 21 , 22 ]. Nevertheless, ropivacaine has been identified smaller neurotoxic potential [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Spinal anesthesia for L5-S1 interlaminar endoscopic lumbar discectomy: a retrospective study

Liu,

Zhao,

Yuan

et al. 2023

BMC Musculoskelet Disord

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Objective This study aimed to report our experience with spinal anesthesia (SA) in patients undergoing L5-S1 interlaminar endoscopic lumbar discectomy (IELD) and clarify its advantages and disadvantages. Methods One hundred twelve patients who underwent IELD for an L5-S1 disc herniation under SA were retrospectively analyzed. SA with 0.5% ropivacaine was administered using a 27-gauge fine needle. Intraoperatively, the volume and level of SA, surgical time, blood loss, and cardiopulmonary complications were documented. Postoperative data was collected included the number of patients who ambulated on the day of surgery, incidence of complications and were then statistically analyzed. Results Analgesia was complete throughout the entire operation in all patients and no other adjuvant intraoperative analgesic drugs were needed. Mean visual analog scale scores for intraoperative and early postoperative (24 h) pain were 0 and 2.43 ± 1.66. SA was administered at the L3-4 interspace in 34 patients (30.4%) and the L2-3 interspace in 78 (69.6%). Administration was successful with the first attempt in all patients. Mean operation time was 70.12 ± 6.52 min. Mean intraoperative blood loss volume was 20.71 ± 5.26 ml. Ninety-eight patients ambulated on the same day as surgery. Mean length of hospital stay was 24.36 ± 3.64 h. Dural injury without damaging the nerve root occurred in one patient. One patient experienced recurrent disc herniation. Intraoperative hypotension and respiratory distress occurred in five (4.5%) and three (2.7%) patients, respectively. Three patients (2.7%) received postoperative analgesia therapy and two (1.8%) experienced nausea. Two patients (1.8%) developed urinary retention. Spinal headache, cauda equina syndrome, and neurotoxicity did not occur. Conclusion SA can achieve satisfactory pain control for patients undergoing IELD with a low incidence of adverse events. SA may be a useful alternative to local and general anesthesia for IELD surgery. Future randomized controlled trials are warranted to investigate.

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“…There are many ways to treat lumbar disc herniation in clinical practice [3]. According to research reports by Shen Qixiang et al, simple nucleus pulposus removal can be performed using local anesthesia + additional anesthesia, continuous epidural anesthesia, lumbar anesthesia, and low dose, low concentration lumbar epidural anesthesia [4].…”

Section: Discussionmentioning

confidence: 99%

The Improvement Effect of Combined Lumbar Epidural Anesthesia on Intraoperative Analgesia and Muscle Relaxation in Patients with Lumbar Disc Herniation and Adverse Reactions

Ding,

Fan

2023

IJCEMR

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Objective:To analyze the clinical effects of combined lumbar epidural anesthesia and epidural anesthesia in the surgery of patients with lumbar disc herniation. Method: Sixty patients with lumbar disc herniation admitted to our hospital from March 2014 to August 2015 were selected as the study subjects. They were randomly divided into a study group and a control group with 30 cases each. The study group received combined lumbar epidural anesthesia, while the control group received epidural anesthesia. The clinical efficacy, incidence of adverse reactions, and analgesic and muscle relaxant effects of the two groups of patients after treatment were compared. Result: The total effective rate of group A using lumbar epidural anesthesia was significantly higher than that of the control group, and the difference was statistically significant (P<0.05); Compared with the control group, the study group had a shorter onset time of anesthesia, lower dosage of anesthetic drugs, and longer duration of anesthesia. The difference between the two groups was statistically significant (P<0.05); There was no significant difference in the incidence of adverse reactions between the two groups of patients receiving lumbar epidural anesthesia and epidural anesthesia, and the comparison was not statistically significant (P>0.05); The optimal rates of analgesic and muscle relaxation effects in the study group were higher than those in the control group, with statistically significant differences (P<0.05). Conclusion: The use of lumbar epidural anesthesia during surgery for patients with lumbar disc herniation has a significant therapeutic effect and is a safe and effective anesthesia method that is worthy of clinical promotion.

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Cauda equina syndrome following combined spinal-epidural anesthesia with levobupivacaine for cesarean section

Cited by 6 publications

References 2 publications

Eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales: ensayo clínico

Eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales: ensayo clínico

Spinal anesthesia for L5-S1 interlaminar endoscopic lumbar discectomy: a retrospective study

The Improvement Effect of Combined Lumbar Epidural Anesthesia on Intraoperative Analgesia and Muscle Relaxation in Patients with Lumbar Disc Herniation and Adverse Reactions

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