Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

Eduardo, Imbelloni Luiz; A, Gouveia Marildo; Maluf, Ghorayeb Nathália; Lemos, Neto Sylvio Valença de

doi:10.23937/2377-4630/1410122

Cited by 11 publications

(13 citation statements)

References 44 publications

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“…6 However, it was discussed previously that most anesthesiologists prefer to use the sitting position and 0.5% hyperbaric bupivacaine, demonstrating that spinal anesthesia is much more than the use of this position and this solution. 5 In this article it was demonstrated that the new approach with US in all books and articles prefer the sitting position for the neuraxial approach and spinal anesthesia. 5 This fact demonstrates that the use of US also needs to evolve to perform spinal anesthesia in different puncture positions and different local anesthetic solutions (hyperbaric, isobaric, and hypobaric).…”

Section: Local Anesthetic Solutions and Puncture Positionmentioning

confidence: 97%

“…5 In this article it was demonstrated that the new approach with US in all books and articles prefer the sitting position for the neuraxial approach and spinal anesthesia. 5 This fact demonstrates that the use of US also needs to evolve to perform spinal anesthesia in different puncture positions and different local anesthetic solutions (hyperbaric, isobaric, and hypobaric). 5 Likewise, anesthesiologists need to understand the safety of thoracic spinal anesthesia and its puncture positions, and the local anesthetic solutions used, to increase your possibilities for performing spinal anesthesia safely.…”

Section: Local Anesthetic Solutions and Puncture Positionmentioning

confidence: 97%

“…And some articles explaining all the possibilities of various spinal anesthesia techniques. 5,6,[9][10][11][12][13][14][15][16]…”

Section: Changes In the Concept Of Spinal Anesthesiamentioning

confidence: 99%

“…4 Recently our group wrote an article showing that spinal anesthesia is much more than a single shot injection of hyperbaric anesthetic. 5 Having been listed seven possibilities of lack of knowledge of other possibilities of using spinal anesthesia. In a recent editorial, I defended that for the good use of ultrasound (US) in spinal anesthesia, other puncture positions should be studied with this new method, since most books and publications focus on the sitting position.…”

Section: Introductionmentioning

confidence: 99%

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Spinal anesthesia, puncture position and local anesthetic solutions. Better understanding for better indication

Imbelloni, MD, PhD,

Gouveia, MD,

Neto, MD, PhD

2023

JACCOA

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Two schools teach spinal anesthesia, one prefers the lateral decubitus position and the other the sitting position. The vast majority of anesthesiologists worldwide use routinely the hyperbaric solution of bupivacaine for almost all types of surgery, mainly performed in a sitting position. There is renewed interest in understanding spinal anesthesia about puncture position, the various solutions used, and the position of the operating table during the surgical procedure. Understanding the vertebral column, of the anterior and posterior roots, allows the different puncture positions, and the hyperbaric, isobaric, and hypobaric solutions to offer better quality of these techniques and will be shown in this article. The application of the three solutions in different puncture positions, and the position of the surgical table during the procedure, will be shown in seven items in 14 tables, and 6 figures, for the complete understanding of spinal anesthesia. The possibility of performing hemi-spinal anesthesia (unilateral and posterior), and the possibility of performing completely sensory spinal anesthesia without any degree of motor block are discussed. The explanations in this article with the different puncture positions and the three local anesthetic solutions are applied both in the lumbar region and in the thoracic region.

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Section: Local Anesthetic Solutions and Puncture Positionmentioning

confidence: 97%

Section: Local Anesthetic Solutions and Puncture Positionmentioning

confidence: 97%

“…And some articles explaining all the possibilities of various spinal anesthesia techniques. 5,6,[9][10][11][12][13][14][15][16]…”

Section: Changes In the Concept Of Spinal Anesthesiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Spinal anesthesia, puncture position and local anesthetic solutions. Better understanding for better indication

Imbelloni, MD, PhD,

Gouveia, MD,

Neto, MD, PhD

2023

JACCOA

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“…3 In a recent article, we showed that spinal anesthesia is much more than the use of a single injection of hyperbaric bupivacaine. 4 There are several techniques for treating varicose veins. [1][2][3] Being the most serious and operated on in the SUS system, they normally require anesthesia, with spinal anesthesia being the most used.…”

Section: Meaningmentioning

confidence: 99%

Posterior anesthesia for lower limb varicose veins: a case report with video

Lmbelloni, MD, PhD,

Vieira, MD, PhD,

Calaça Rivoli, MD

et al. 2024

JACCOA

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Background: Patient with a history of dissatisfaction during spinal anesthesia for orthopedic surgery, due to the unpleasant long duration of motor blockade of the lower limbs. During the pre-anesthetic consultation, she requested another type of anesthesia for the surgical treatment of varicose veins in the lower limbs. Case report: A 58-year-old female patient presented with varicose veins, for surgical treatment without removing the saphenous vein, only the collaterals. Patient with a history of controlled hypertension, normal blood tests, normal ECG, and chest X-ray. Abbreviation for fasting with 200 ml CHO. Venous access with #20G extract and monitoring with continuous ECG, NIBP, SpO2, and EtCO2 through a nasal catheter. Cleaning the skin with chlorhexidine and local anesthesia with 3 ml of 1% lidocaine. The spinal puncture was performed with the patient in the ventral position, by the median line in the L3-L4 interspaces using a 27G Quincke needle, after the appearance of CSF 7.5 mg of 0.15% hypobaric bupivacaine was administered at a speed of 1 mL/15s. Immediate latency, superior level T10 analgesia, without any degree of motor block. The surgical procedure posterior lasted 1:40 hours, and anterior lasted 1:20 hours, both without any degree of motor blockade and without cardiocirculatory and respiratory changes. The patient mobilized alone on the surgical table, without assistance from the prone position to the supine position. At PACU she received 200 ml of CHO and was discharged to her room. At the end of the day, she was released to her residence. Conclusion: The practice of prone positioning for performing posterior dorsal anesthesia remains relatively unfamiliar to many anesthetists. The use of a low dose of 0.15% hypobaric bupivacaine, the low cephalic dispersion of the analgesia, and the predominance of sensory roots allow the surgery to be performed without any degree of motor blockade, and proprioception remains. The use of posterior spinal anesthesia and the abbreviation of fasting before and immediately after surgery allowed excellent patient satisfaction.

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Comparison between thoracic paravertebral block and segmental thoracic spinal anesthesia in breast cancer surgery

Mazy

El-Domiaty

Mageed

et al. 2022

Ain-Shams J Anesthesiol

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Background Thoracic paravertebral block (TPVB) and segmental thoracic spinal anesthesia (STSA) can be used as sole anesthesia techniques alternative to general anesthesia for modified radical mastectomy in some critical patients. Both techniques were compared for efficacy and safety including detailed block characteristics, analgesia, patient’s and surgeon’s satisfaction, hemodynamics, respiration, and side effects. Results Both techniques were successful, but fentanyl requirements were higher in TPVB group. The sensory loss was faster, wider, and longer in STSA group; however, it was associated with more hypotension. There was no motor block in the upper or lower limbs in TPVB group, while all patients in STSA group showed ipsilateral handgrip affection and to less extent wrists and then elbow flexion. While the ipsilateral lower limbs motor block was partial and short. Postoperatively, there was no difference in analgesic requirements or side effects. Satisfaction was higher in STSA group. Conclusions Both TPVB and STSA were effective and safe as sole techniques for mastectomy providing adequate anesthesia with low complications, considerable analgesia, and satisfaction. Anesthesia was faster, wider, and longer in STSA group, with lower fentanyl requirements; however, it was associated with more hypotension.

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Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

Cited by 11 publications

References 44 publications

Spinal anesthesia, puncture position and local anesthetic solutions. Better understanding for better indication

Spinal anesthesia, puncture position and local anesthetic solutions. Better understanding for better indication

Posterior anesthesia for lower limb varicose veins: a case report with video

Comparison between thoracic paravertebral block and segmental thoracic spinal anesthesia in breast cancer surgery

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