Bloqueo cervical peridural

Comparación de tres formulaciones diferentes de anestésicos locales para anestesia cervical epidural durante cirugía de tiroides  Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery. Jain G, Bansal P, Garg GL, Singh DK, Yadav G. Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, India. Indian J Anaesth. 2012 Mar;56(2):129-34. Abstract BACKGROUND: To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA) using lignocaine (1%), bupivacaine (0.25%) and ropivacaine (0.5%) for thyroid surgery. METHODS: In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications. RESULTS: Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups. CONCLUSION: We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371486/?tool=pubmed     Anestesia epidural cervical con ropivacaína al 0,75% en la cirugía de hombro  F. Domínguez, T. Laso, T. Tijero, J. Ruiz-Moyano, J. Hernández, A. Puig Servicio de Anestesiología y Reanimación. Hospital Ramón y Cajal. Madrid. Rev. Esp. Anestesiol. Reanim. 2002; 49: 39-43. Resumen Presentamos tres casos clínicos programados para cirugía de hombro bajo anestesia epidural cervical con ropivacaína 0,75%. En los tres la técnica fue exitosa y exenta de complicaciones. Las dosis totales de ropivacaína administradas en los tres casos fueron 67, 90 y 109 mg respectivamente. Es recomendable la premedicación con atropina IV. La anestesia epidural cervical presenta ventajas respecto a la anestesia general y otras técnicas regionales en la cirugía de hombro: analgesia postoperatoria, menor dosis total de anestésico local y necesidad de una única punción sin provocación de parestesias o movimientos musculares. La técnica conlleva cambios hemodinámicos y respiratorios que dependen de la extensión e intensidad del bloqueo. La afectación de los segmentos torácicos altos ocasiona un bloqueo simpático cardíaco total o parcial con disminución de frecuencia cardíaca, presión arterial y gasto cardíaco. Limitar la dosis inicial y sucesivas a un bloqueo sensitivo en el territorio quirúrgico disminuirá las  complicaciones hemodinámicas. La ropivacaína permite un eficaz bloqueo sensitivo junto a un escaso bloqueo motor que limita el síndrome restrictivo pulmonar asociado a la anestesia epidural cervical. Palabras clave:Técnicas: anestesia epidural cervical. Anestésicos locales: ropivacaína. Cirugía de hombro. http://demo1.sedar.es/restringido/2002/n1_2002/39-43.pdf

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