Cefaléia pós-raquianestesia e o desenho das agulhas: experiência com 5050 casos / Postdural puncture headache and spinal needle design: experience in 5050 cases

Justificativas e Objetivos: Modificaçöes no desenho e calibre das agulhas tem sido realizadas com objetivo de reduzir a incidência de cefaléia pós-raquianestesia (CPR). O objetivo do estudo foi avaliar se estas estratégias säo efetivas na reduçäo da CPR. Método: Cinco mil e cinqüenta raquianestesias utilizando agulhas descartáveis tipo Quincke, Whitacre ou Atraucan foram administradas em Hospitais Privados entre Janeirode 1991 e junho de 1999. A punçäo subaracnóidea foi realizada pela via mediana ou paramediana através dos espaços L2-L3 ou L3-L4, com pacientes na posiçäo lateral ou sentados, utilizando agulhas calibre 25G, 26G, 27G ou 29G tipo Quincke; 26G tipo Atraucan ou 27G tipo Whitacre, sem introdutor. A raquianestesia foi realizada com soluçöes hiperbáricas ou isobáricas de anestésicos locais. Os seguintes parâmetros foram estudados: incidência de cefaléia, número de tentativas de punçäo e a relaçäo com a cefaléia. Resultados: Quarenta pacientes desenvolveram cefaléia pós-raquianestesia (CPR) com incidência de 0,8 por cento. Vinte e três foram puncionados com uma tentativa, seis com duas tentativas e onze com três ou mais tentativas. Todos os pacientes foram tratados conservadoramente, sem necessidade de tampäo sangüíneo peridural. Observou-se menor incidência de CPR quando se comparou agulhas cortantes com näo cortantes, assim como quando se comparou agulhas de fino calibre com agulhas de grosso calibre com o mesmo desenho. Conclusöes: Concluímos que agulhas de ponta näo cortantes podem ser utilizadas em pacientes com alto risco de desenvolver CPRe que agulhas de menor calibre podem ser usadas em todos os pacientes

Tempo de gotejamento do líquido cefalorraquidiano com agulhas espinhais tipo Quincke / Time for cerebrospinal fluid backflow through Quinckle spinal needles

Background and objectives - Postdural puncture headache (PDPH) has discouraged many anesthesiologists to use spinal anesthesia, specially in young patients. It is accepted that PDPH results from the leakage of cerebrospinal fluid (CSF) to the epidural space, which is related to the size of the hole produced by the needle in the duramater. The purpose of this study was to evaluate the time for CSF backflow in healthy patients undergoing spinal anesthesia with 25G, 27G and 29G Quincke needles. Methods - Sixty-nine patients undergoing spinal anesthesia were included in the study and allocated into three groups according to the needle gauge (25G, 27G or 29G). Following subarachnoidal punctureand removal of the mandril, time to filling of the needle hub with CSF was observed. - Results - Time for CSF backflow through 29G needles was significantly longer as compared to that observed for 25G and 27G needles. No differences were observed between 25G and 27G needles. Conclusions - The literature reports increased anesthetic failure and further reduction of PDPH with 29G Quincke needles. Additionally, the prolonged backflow time through 29G needles observed in this study should encourege the use of 27G needles, wich are similar to 25G needles in the regard

Incidência e causas de falhas em anestesia subracnóidea em hospital particular: estudo prospectivo / Incidence and causes of failures in spinal anesthesia in a private hospital: a prospective study

Background and objectives - Recent studies in the USA and Finland in three large university affiliated hospitals and in a small community hospital showed the incidence of failures in spinal anesthesia to vary between 3 an 17 per cent. Considering the lack of similar studies in the Brazilian literature, we decided to study the incidence of and the factors associated with failures in spinal anesthesia in a private hospital. Methods - This prospective stdy involved 778 consecutive spinal anesthetics performed along 18 months by experienced anesthesiologists. The anesthetics were performed with 25G, 27G or 29G needles, with plain or glucose containing anesthetic solutions. The following local anesthetics, from different laboratories, were used: 5 per cent hyperbaric lidocaine (laboratories A and B), 2 per cent lidocaine (laboratory A), 0.5 per cent hyperbaric bupivacaine (laboratories A and B) and 0.5 per cent isobaric bupivacaine (laboratory A). Anesthetic failures were classified as follows: 1) no analgesia; 2) insufficient level of analgesia; 3) pain during peritoneum traction; 4) insufficient duration of analgesia. Anesthetic failures were also related to the puncture site and to the patient's position during injection. Results - The overall failure rate was 8.3 per cent. The failure rate was higher with 29G needles and lower with 25G needles and higher when the puncture was performed in the sitting position. No significant differences were observed regarding different laboratories, plain or glucose containing solutions and puncture site (L2-L3,L3-L4). A significant lower incidence of failure was observed with isobaric colutions. Conclusions - Various causes may have contributed to the failures of spinal anesthesia observed in this study. Most of them, however, were associated with technical factors

Efeito da postura nas características do bloqueio subaracnóideo com a bupivacaína 0,5 por cento isobárica / Effect of posture on the spread of isobaric 0,5 por cent bupivacaine

The effect of the sitting position on the segmental spread of 4 ml of 0,5 por cent isobaric bupivacaine injected into the subarachnoidal space was studied in 50 patients. Fifty patients received the injection in the lateral horizontal position and acted as controls. The spread of analgesia was significantly greater in the sitting position. Motor block was complete in all patients in both groups. Arterial hypotension was more frequent in patients who more frequent in patients who received bupivacaine is excellent for orthopedic surgery