*Address for Correspondence: Luiz Eduardo Imbelloni, Department of Anesthesiology Hospital Clinicas Municipal José de Alencar, São Bernardo do Campo, SP - Brazil. Mobile: +55.11.99429-3637; Email: dr.imbelloni@hotmail.com
Received: 19 August 2020; Accepted: 05 September 2020; Published: 07 September 2020
Citation of this article: Imbelloni LE, Sakamoto JW, Viana EP, de Araujo AA, Souza NN, et al. (2020) Hypobaric Bupivacaine 0.1% (5 mg) for Dorsal Anorectal Surgery Compared with Hyperbaric Bupivacaine 0.5% (5 mg) for Anorectal Lithotomy Surgery on an Outpatient Basis. Rea Int J of Community med and Pub Health. 1(1): 023-028. DOI: 10.37179/rijcmph.000004.
Background: A wide variety of anorectal surgeries can be performed on an outpatient basis. The purpose of the study was to compare a low dose of 0.1% bupivacaine in a jack-knife position with a 0.5% bupivacaine lithotomy position in outpatient anorectal surgical.
Methods: Two groups of 50 patients, physical status ASA I and II, undergoing anorectal surgical procedures in a jack-knife position, received 5 mg of hypobaric 0.1% bupivacaine in the surgical position or 5 mg of hyperbaric 0.5% bupivacaine in the sitting position. Sensitive and motor blockade, proprioception at the big toe, time of ????first, duration of blockade and surgery, complications, fasting time, and reintroduction of oral feeding in the PACU and POUR. Patients were followed until the third postoperative day and questioned whether they experienced post-puncture headache or temporary neurological symptoms, and until the 30th day and questioned about permanent neurological complications. The p-value ≤ of 0.05 was considered significant.
Results: All patients in Group 1 presented selective blockade of the posterior sacral nerve roots, while patients in Group 2 experienced blockade of the anterior and posterior nerve roots in 33 patients. The onset time of anesthesia was the same with both solutions. There was evidence that de hyperbaric bupivacaine resulted in a longer duration of the block. Proprioception in the 1st toe was observed in 47 patients at 15 minutes in group 1 versus 20 patients in group 2, with a significant difference. At end of the surgery, all patients passed the operating table to the stretcher without help. There were no hemodynamic changes, nausea, or vomiting, POUR, or neurologic complications. Analgesia with pudendal nerve block averaged 19 hours without the need for opioids.
Conclusions: Anorectal surgical procedures under the spinal block with low dose hypobaric or hyperbaric bupivacaine, in a jack-knife position
or lithotomy position on an outpatient basis can be safe and efficacy.
Keywords: Local, Bupivacaine, Regional, Hypobaric Spinal Block, Hyperbaric Spinal Block, Pudendal Nerve Block, Surgery, Anorectal.
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