Anest. intenziv. Med. 2003;14(2):77-81
Subarachnoidální anestezie 0,5% levobupivakainem(Chirokainem) k elektivním ortopedickýma traumatologickým výkonům v oblasti dolníchkončetinČlánky
- Anesteziologicko-resuscitační oddělení Klaudiánovy nemocnice, Mladá Boleslav, přednosta MUDr. Ivan Herold, CSc.
- 1 Ortopedicko-traumatologické oddělení Klaudiánovy nemocnice, Mladá Boleslav, přednosta MUDr. Michal Trnovský
Cíl studie:
Nové lokální anestetikum - chirální levobupivakain - bylo dosud používáno převážně k epidurální anestezii,pooperační analgezii a k anestezii pletení a nervových kořenů. S použitím ke spinální anestezii (SA) je zatím málo zkušeností.Cílem studie bylo ověřit účinnost a bezpečnost 0,5% levobupivakainu k SA v indikacích, u nichž byl dosud používánvýlučně racemický bupivakain.Typ studie: prospektivní, observační, nekomparativní.Název a místo pracoviště: Anesteziologicko-resuscitační a ortopedicko-traumatologické oddělení Klaudiánovy nemocnicev Mladé Boleslavi.
Materiál a metoda: 30 pacientů (ASA I-III, věk 15-80 let, výška ≥ '
Klíčová slova: levobupivakain; subarachnoidální anestezie; nástup a regrese blokády; hemodynamika; kvalita anestezie; pooperační analgezie; retence moče; operace dolních končetin
Subarachnoid Anaesthesia with 0,5% Levobupivacaine (Chirocaine) for Lower Limb in ElectiveOrthopaedic and Trauma Surgery
Objective:
New chiral local anaesthetic levobupivacaine has been used until now mostly for epidural anaesthesia/analgesia,plexus and major nerve blocks. There are only a few reports of its use for subarachnoid anaesthesia (SA). The study aimedto evaluate the efficacy and safety of intrathecal administration of 0.5% levobupivacaine, where previously racemicbupivacaine was used almost exclusively.Setting: Department of Anaesthesiology and Intensive Care, Department of Orthopaedic Surgery and Traumatology ofRegional Klaudian's Hospital, Mladá Boleslav.
Material and methods: The authors enrolled 30 patients (ASA I-III, age 15-80, height ≥ ' 2.52 ± 0.56 of the modified Bromage scale. On average, 11.66 ± 1.95 segments were blocked, with upper level of blockadeat Th 9.68 ± 1.83 and lower of S 3.56 ± 0.6. The most frequently anaesthetized segments were L1-S2 (30x), Th12 (29x) andS3 (28x). The most frequent distribution of blocks was: Th10-S4 (5x), Th11-S4 (4x) and Th12-S4 (4x). 2-segmental sensoryblock regression was observed after 138.1 ± 65.49 min,time to motor block regression 235 ± 49.1min.Systolic blood pressurefell compared to basal values after 18., 20., 40. and 60.min (P < 0.05), but the decrease was less than 25%. Similarly, theheart rate fell after 40. and 60. min. (P < 0.05), but the lower level of 50/min was not reached. Quality of anaesthesia,musclerelaxation and comfort of patient evaluated by a 3 point scale were high (2.76 ± 0.4, resp. 2.92 ± 0.3, resp. 2.92 ± 0.24). Duringsurgery, 21 patients (70%) were sedated, mostly with midazolam. Administration of analgesics (mostly pethidin) after thesurgery was required in 21 patients (70%), with first dose required only after 470 ± 162 min from start of anaesthesia. It wasnecessary to insert a bladder catheter for urinary retention in two young men. Other adverse events were not observed.
Conclusion: 15 mg of 0.5% isobaric levobupivacaine was used successfully in a wide range of orthopaedic procedures inlower extremities. Time limitation of estimated length of surgery up to 2,5 hrs corresponded with the observed effectivelength of block and motor regression of block. A high level of satisfaction of anaesthesiologist, surgeon and patient wasachieved. The haemodynamics are not adversely affected.
Keywords: levobupivacaine; subarachnoidal anaesthesia; onset and regression of block; haemodynamic changes; quality of anaesthesia; postoperative analgesia; urinary retention; lower extremity surgery
Zveřejněno: 1. duben 2003 Zobrazit citaci
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