Introduction: Various analgesic management strategies have evolved, often the regional analgesic techniques being favored over the systemic administration of opioids. Most anesthesiologists use thoracic epidural, which has a 0.75% incidence of accidental perforation. However, they are reluctant to consider higher levels for spinal anesthesia because of the possibility of direct spinal cord injury.
Aim: The main objective of this retrospective study was to
evaluate the incidence of paresthesia and neurological complications, as well
as cardiocirculatory changes after thoracic spinal anesthesia.
Methods: This retrospective study of patients undergoing thoracic
spinal anesthesia evaluated the following parameters: needle types, needle
insertion, puncture position (sitting or lateral decubitus), thoracic puncture
level, presence of cerebrospinal fluid (CSF) in the needle hub, type of
anesthetic, latency, motor block, incidence of bradycardia and hypotension,
paresthesia (duration) and neurological complications. This study conducted a
retrospective audit, between January 2007 and December 2019. This study
reviewed the record sheets of patients who experienced paresthesia for thoracic
spinal anesthesia with two types of needles of the same gauge, isobaric and
hyperbaric 0.5% bupivacaine and puncture in the sitting or left lateral
position, and median and paramedian insertion.
Results: Paresthesias occurred in 5.9% of patients. In this
observation, 41 patients experienced a paresthesia with cut needle compared
with 43 patients with a pencil point, without statistical difference. All
paresthesias were transient and lasted a maximum of three days. No sequelae
neurologic were observed in all patients during this study. Bradycardia
occurred in 3.1% of the patients and hypotension in 13.2% of the patients,
easily corrected by the use of atropine and vasopressor.
Conclusion: All 84 paresthesias observed in this study were
associated with free flow of CSF when the stylet was removed from the needles.
No association was found between the type of spinal needle and the incidence of
paresthesias. This study with 1,406 patients showed that thoracic spinal
anesthesia is safe and without neurological sequelae, with a puncture between
T8 and T11. If the anesthetist has an adequate knowledge of the relevant modern
anatomy, physiology and pharmacology, safe and satisfactory anesthesia can
easily be obtained to the mutual satisfaction of the patient, surgeon and
anesthetist.
Author
(s) Details
Luiz
Eduardo Imbelloni
CET-SBA Hospital Clínicas Municipal de São Bernardo do Campo, SP,
Senior Researcher of INCA, Rio de Janeiro (RJ), Brazil.
Marcos
Fornasari
Hospital Rio Laranjeiras, Rio de Janeiro (RJ), Brazil.
Raphael
Sant’Anna
Unimed Hospital, Porto Velho, RO, Brazil.
Geraldo
Borges de Morais Filho
UFPB, João Pessoa-PB, Statistician of the Complexo Hospitalar
Mangabeira, João Pessoa- PB, Brazil.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v5/361
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