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2005, Número 4

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Cir Cir 2005; 73 (4)


Anestesia epidural cervical para la cirugía de miembro torácico con tres formulaciones de anestésicos locales

Guevara-López U, Bárcenas-Olivares J, Gutiérrez-Sougarret B, Aldrete JA, Olascoaga-Ortega G

Idioma: Español
Referencias bibliográficas: 66
Paginas: 273-281
Archivo PDF: 115.75 Kb.


RESUMEN

Objetivo: evaluar la eficacia y seguridad del bloqueo peridural cervical en cirugía de miembros torácicos, administrando lidocaína a 2 %, bupivacaína a 5 % y la mezcla de ambos anestésicos locales.
Material y métodos: ochenta y cinco pacientes operados del miembro torácico bajo bloqueo peridural cervical se asignaron a uno de tres grupos: grupo I recibió 100 mg de lidocaína a 2 %; grupo II, 30 mg de bupivacaína a 0.5 %; grupo III, una mezcla de 60 mg de lidocaína a 2 % más 15 mg de bupivacaína a 0.5 %. Se evaluó el efecto sobre los signos vitales, la calidad del bloqueo, la comodidad del paciente y los efectos adversos.
Resultados: la técnica fue considerada como satisfactoria en 80 % de los casos por cirujanos y anestesiólogos. Se observaron diferencias significativas en el grupo II respecto al bloqueo motor completo (100 %), presentándose escasa repercusión sobre los signos vitales en los tres grupos; se observó presencia de vómito en los grupos II y III y punción inadvertida de la duramadre en 6.7 % de los casos del grupo II.
Conclusión: este estudio pone de manifiesto la eficacia y seguridad del bloqueo peridural cervical en la cirugía de miembro torácico.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Kehlet H. The surgical stress response: should it be prevented? Can J Surg 1991;34:565-567.

  2. 2. Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anesth 1989;63:189-195.

  3. 3. Ballantyne JC, Carr DB, Chalmers TC, Dear KGB, Angelillo IF, Mosteller F. Postoperative patient-controlled analgesia: meta-analysis of initial randomized controlled trials. J Clin Anesth 1993;5:182-193.

  4. 4. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology 1995;82:1494-1506.

  5. 5. Garland TA, Ramarmurthy S, Bready LL, Ritter RA. Axillary block of the brachial plexus. Comparison of different techniques. Reg Anesth 1986;11:57.

  6. 6. Hickey R, Hoffman J, Tingle JL, Rogers NJ, Mamamurtthy S. Comparison of the clinical efficacy of three perivascular techniques for axillary brachial plexus block. Reg Anesth 1993;18:335-338.

  7. 7. Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo MI. Association of perioperative myocardical ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 1990;323:1781-1788.

  8. 8. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990;

  9. 72:153-184.

  10. 9. Becker K, Carriethers J. A practical method of cost containment program in anesthesia and surgery. J Clin Anesth 1994;6:388-399.

  11. 10. Macario A, Vitez ST, Dunn B, McDonald T. Where are the costs in perioperative care? Anesthesiology 1995;83:1138-1144.

  12. 11. Bromage PR. Mechanism of action of epidural analgesia. Philadelphia: WB Saunders; 1978. pp. 119-159.

  13. 12. Grene NM, Brull SJ. Physiology of spinal anesthesia. 4th ed. Baltimore: Williams and Wilkins; 1993. p. 48.

  14. 13. Kaiser JA, Holland BA. Imaging of the cervical spine. Spine 1998;

  15. 23:2701-2712.

  16. 14. Bogduk N. Clinical anatomy of the cervical dorsal rami. Spine 1982;

  17. 7:319-330.

  18. 15. Hogan Q. Size of human lower thoracic and lumbosacral nerve roots. Anesthesiology 1996;85:37-42.

  19. 16. Philipp L, Kolbitsch C, Putz G, Colvin J, Colvin HP, Lorenz I, Keller C, Kirchmair L, Rieder J, Moriggl B. Cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline. Anesthesiology 2003;

  20. 99:1387-1390.

  21. 17. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology 1990;73:308-327.

  22. 18. Kehlet H. Epidural analgesia and the endocrine metabolic response to sur-

  23. gery. Update and perspectives. Acta Anaesthesiol Scand 1984;28:125-127.

  24. 19. Woolf PD. The prevention of postoperative pain. Pain 1998;33:289-290.

  25. 20. Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaest 1993;70:434-439.

  26. 21. Bernards C, Shen DD, Sterling ES, Adkins J, Risler LB, Phillips B, Ummenhofer W. Epidural, cerebrospinal fluid, and plasma pharmaco-kinetics of epidural opioids (part 1): differences among opioids. Anes-

  27. thesiology 2003;99:455-465.

  28. 22. George KA, Chisakuta AM, Gamble JA, Browne GA. Thoracic epidural infusion for postoperative pain relief following abdominal aortic surgery: bupivacaine, fentanyl or a mixture of both. Anesthesia 1992;47:388-394.

  29. 23. Eisenach JC, DuPen S, Dubois M, Miguel R, Allin D. Epidural clonidine study group: epidural clonidine analgesia for intractable cancer pain. Pain 1995;61:391-399.

  30. 24. Eisenach JC, Gebhart GF. Intrathecal amitriptiline acts as an N-methyl-D-aspartate receptor antagonist in the presence of inflammatory hyperalgesia in rats. Anesthesiology 1995;83:1046-1054.

  31. 25. Yaksh TL. Epidural ketamine: a useful, mechanistically novel adjuvant for epidural morphine? Reg Anesth 1996;21:508-513.

  32. 26. Nystrom UM, Nystrom NA. Continuous cervical epidural anesthesia in reconstructive hand surgery. J Hand Surg 1997;22:906–912.

  33. 27. Smitt PS, Tsafka A, Teng-Van de Zande F, et al. Outcome and complications of epidural analgesia in patients with chronic cancer pain. Cancer 1998;83:2015-2022.

  34. 28. Pollock EJ, Neal MJ, Stephenson, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996;84:1361-1367.

  35. 29. Angle PJ, Kronberg JE, Thompson DE, Ackerley C, Szalai JP, Duffin J, Faure P. Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle, and bevel orientation. Anesthesiology 2003;99:1376-1382.

  36. 30. Biboulet P, Deschodt J, Capdevilla X, et al. Hemodynamic effects of 0.375 % bupivacaine versus 0.25 % bupivacaine during cervical epidural anesthesia for hand surgery. Reg Anesth 1995;20:33-40.

  37. 31. Capdevilla X, Biboulet P, Rubenovitch J, et al. The effects of cervical epidural anesthesia with bupivacaine on pulmonary function in conscious patients. Anesth Analg 1998;86:1033-1038.

  38. 32. Tanaka M, Goyagi T, Kimura T, Nishikawa T. The effects of cervical and lumbar epidural anesthesia on heart rate variability and spontaneous sequence baroreflex sensitivity. Anesth Analg 2004;99:924-929.

  39. 33. Matsukawa T, Sessler ID, Christensen BA, Ozaki M. Heart flow and distribution during epidural anesthesia. Anesthesiology 1995;83:961-967.

  40. 34. Glaser C, Marhofer P, Zimpfer G, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 2002;94:194-198.

  41. 35. Lee L, Posner K, Domino KB, Caplan RA, Cheney FW. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology 2004;01:143-152.

  42. 36. Yuen EC, Layzer RB, Weitz SR, Olney RK. Neurologic complications of lumbar epidural anesthesia and analgesia. Neurology 1995;45:1795-1801.

  43. 37. Merle JC, Mazoit JX, Desgranges P, Abhay K, Rezaiguia S, Dhonneur G, Duvaldestin A. Comparison of two techniques for cervical plexus blockade: evaluation of efficacy and systemic toxicity. Anesth Analg 1999;89:1366.

  44. 38. Davies JM, Murphy A, Smith M, O’Sullivan G. Subdural haematoma after dural puncture headache treated by epidural blood patch. Br J Anaesth 2001;86:720-723.

  45. 39. Tekkok IH, Carter DA, Brinker R. Spinal subdural haematoma as a complication of immediate epidural blood patch. Can J Anaesth 1996;43:306-309.

  46. 40. Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 2000;93:858-875.

  47. 41. Pavel M, Ivan D, Milos AMD, Libor J. Cervical epidural anesthesia for combined neck and upper extremity procedure: a pilot study. Anesth Analg 2004;99:1833-1836.

  48. 42. Wallace M, Yaksh TL. Long term spinal analgesics delivery: a review of the preclinical and clinical literature. Reg Anesth Pain Med 2000;25:117-157.

  49. 43. Bonnet F, Derosier JP, Pluskwa E, et al. Cervical epidural anaesthesia for carotid artery surgery. Can J Anaesth 1990;37:353-358.

  50. 44. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology 1995;82:1474-1506.

  51. 45. Krames ES. Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manage 1993;8:36-46.

  52. 46. Weitz RS, Drasner K. Local anesthetic test dose as a predictor of effective epidural opiod analgesia. Anesthesiology 1995;100:83-96.

  53. 47. Aldrete JA. Epidural injections of indomethacin for postlaminectomy syndrome: a preliminary report. Anesth Analg 2003;96:463-468.

  54. 48. Dogliotti AM. A new method of block anesthesia: segmental peridural spinal anesthesia. Am J Surg 1933;20:107-118.

  55. 49. Mayumi T, Dohi S, Takahashi T. Plasma concentrations of lidocaine associated with cervical, thoracic, and lumbar epidural anesthesia. Anesth Analg 1983;62:578-580.

  56. 50. Tissot S, Frering B, Gagnieu MC, et al. Plasma concentrations of lidocaine and bupivacaine after cervical plexus block for carotid surgery. Anesth Analg 1997;84:1377-1379.

  57. 51. McClure JH. Ropivacaine. Br J Anaesth 1996;76:300-307.

  58. 52. Sztark F, Malgat M, Dabadie P, Mazat JP. Comparison of the effects of bupivacaine and ropivacaine on heart cell mitochondrial bioenergetics. Anesthesiology 1998;88:1340-1349.

  59. 53. Erichsen CJ, Sjövall J, Kehlet H, Hedlund C, Arvidsson T. Pharmaco-

  60. kinetics and analgesic effect of ropivacaine during continuous epi-

  61. dural infusion for postoperative pain relief. Anesthesiology 1996;

  62. 84:834-842.

  63. 54. McLeod GA, Burke D. Levobupivacaine. Anaesthesia 2001;56:331-341.

  64. 55. Alley EA, Kopacz DJ, McDonald SB, et al. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002;94:188-193.

  65. 56. Standl, T, Stanek A, Burmeister M, Gruschow S, Wahlen B, Muller K, Biscoping J, Adams H-A. Spinal anesthesia performance conditions and side effects are comparable between the newly designed ballpen and the Sprotte needle: results of a prospective comparative randomized multicenter study. Anesth Analg 2004;98(2):512-517.

  66. 57. Olausson K, Magnusdottir H, Lurje L, Wennerblom B, Emanuelsson H, Ricksten SE. Anti-ischemic and anti-anginal effects of thoracic epidural anesthesia versus those of conventional medical therapy in the treatment of severe refractory unstable angina pectoris. Circulation 1997;96:2178-2182.




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