Abstract

SENSITIVE SPINAL ANESTHESIA WITH 0.6% HYPOBARIC LIDOCAINE FOR ANORECTAL SURGERY IN JACK-KNIFE POSITION WITH VIDEO. A RETROSPECTIVE STUDY

Luiz Eduardo Imbelloni*, MD, PhD, Anna Lúcia Calaça Rivoli, MD, Tolomeu A. A. Casali, MD, PhD, Sylvio Valença de Lemos Neto, MD, PhD, Ana Cristina Pinho, MD, Antonio Fernando Carneiro, MD, MSc, PhD, Marciano de Souza Nóbrega, MD, MSc and Geraldo Borges de Morais Filho – MSc

ABSTRACT

Background: The three primary positions used in anorectal surgery include dorsal lithotomy, left lateral decubitus, and prone position. Hypobaric local anesthetics are not produced by the pharmaceutical industry. However, a hypobaric solution can be obtained by diluting isobaric local anesthetics with water. The aim of this retrospective study was to evaluate the lowest dose (18 mg) of 0.6% hypobaric lidocaine for anorectal surgeries operated in the prone position. Methods: From 1998 to 2018, 450 anorectal surgeries were performed with different doses of 0.6% hypobaric lidocaine. Of these, 270 patients operated on with the lowest dose of 18 mg of the solution were selected. Patients of both sexes aged between 20 and 60 years, weighing between 50 and 80 kg, height between 150 and 180 cm, ASA I and II, were punctured with a 27G Quincke needle. Latency, sensory and motor block, proprioception in the 1st toe, duration of surgery, duration of anesthesia, cardiocirculatory changes, complications and patient satisfaction were evaluated. Results: The onset of action was rapid (< 1 minute), the duration of action was short (< 1 hour), with the dose used being sufficient for the average surgery time of 36 minutes, without any degree of motor blockage in the lower limbs and with 75% of patients having proprioception in the first two toes. At 15 minutes, the cephalic dispersion of analgesia was between L2-T12, sufficient to perform the surgery, and there is no need for supplementation in any patient. Proprioception was present in 75% of patients. There were no cardiocirculatory changes. There were no neurological complications or post-puncture headache. Analgesia with pudendal nerve block averaged 22 hours without need for opioids. Conclusions: Anorectal surgical procedures under spinal block with low dose 0.6% hypobaric lidocaine, in Jack-knife position on an outpatient basis can be safety and efficacy. Hypobaric lidocaine did not present any neurological complications.

Keywords: Local: lidocaine; Regional: hypobaric spinal block; pudendal nerve block, Surgery: Anorectal.