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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A1081
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
| Low Dose Spinal Hyperbaric Bupivacaine for Anorectal Surgery |
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Alberto Garcia-Filoso Alijo, M.D., Modesto Garcia Escobar, M.D., Consuelo Royo Rodriguez, M.D., Javier Agullo Agullo, M.D. Anesthesiology, St. Juan's Hospital, Alicante, Spain |
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Blackground and aims: Selective spinal anesthesia is the practice of using minimal doses of intrathecal agents so that only the nerve roots supplying a specific area and only the modalities that require to be anesthetized are affected. This is interesting in ambulatory surgery, with faster recovery and discharge of patients.
Little studies targering small doses of bupivacaine have demonstrated successful. They concern unilateral spinal block for knee arthroscopy and perianal surgery. Doses vary between 1,5 mg to 4 mg and the rate of failed block are different also. We hypothesized that 2,5mg spinal hyperbaric bupivacaine induces a reliable block and limits to 10 min the postanesthesia care unit stay. Methods: We obtained written, informed consent of 30 ASA physical status 1 and 2 adult patients scheduled for elective short perianal procedures (hemorrhoidectomy, fistulectomy and abscess). Under standard monitoring dural puncture was performed with the patient in stiting position at the L3-L4 or L4-L5 intervertebral space using a 25/27-gauge whitacre needle with its orifice directed caudal during inyection. 2,5 mg of hyperbaric bupivacaine (mini-plasco 4ml Braun) was injected in a tuberculin syringe (0,5 ml). The position was maintained for 7 min before lithotomy position during surgery. Vital functions, motor block using a Bromage's scale, successful block defined as one that did not require any supplementation and any adverse effect was evaluated. Results: There was not motor block in all patients with ability of the patients to position their legs unaided for surgery. Two patients postoperatively expressed numbness in their legs and two other showed little pain during surgical manipulations without need for supplement medication. Hemodynamic stability with discharge of postanesthesia care unit after 10 min in 100 % of patients. No patient suffered from nausea or vomiting. Conclusions: Spinal block can reliably be produced with 2,5 mg of hyperbaric bupivacaine without complications and facilitate early hospital discharge. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |