Thoracic epidural anesthesia with ropivacaine for plastic surgery.

Abstract:

BACKGROUND AND OBJECTIVES:Thoracic epidural blockade is a method of hypotensive anesthesia able to reduce bleeding during surgery. This non-comparative study aimed at evaluating the results of thoracic epidural blockade with 0.5% ropivacaine associated to propofol continuous infusion sedation in plastic surgery. METHODS:Participated in this study 60 female patients aged 18 to 62 years, physical status ASA I or II, scheduled for combined plastic surgeries of breast, abdomen, gluteus and liposuction. After epidural puncture in T9-T10 or T10-T11, patients received 40 ml of 0.5% ropivacaine and 15 microg sufentanil. Additional local anesthetic doses were administered through an epidural catheter, if necessary. Sedation was induced with 40 to 50 microg kg(-1) min(-1) propofol continuous infusion. Blockade installation and regression, hemodynamic and respiratory parameters and the incidence of adverse effects were investigated. RESULTS:Upper sensory block level was T2 in 52 patients (86.6%), C4 in 4 (6.6%), and T3 in 4 (6.6%). Mean onset time was 9.1 +/- 8.2 min. Motor block grade 2 was obtained in 61.7% of patients, and grade 1 in 38.3%. Mean time for complete motor block regression was 377.9 +/- 68.5 min. Mean time for first spontaneous pain complaint was 965.1 +/- 371.3 min. SBP, DBP, MBP and HR mean values have significantly decreased as compared to control as from 15 min after local anesthetic injection, thus characterizing hypotensive anesthesia. Thirteen patients (21.7%) with SBP < 65 mmHg and/or MBP < 50 mmHg received a vasopressor (ethylphedrine) and 4 patients (6.7%) with HR < 50 bpm received atropine. No patient needed blood transfusion. CONCLUSIONS:Thoracic epidural blockade with 0.5% ropivacaine and 15 microg sufentanil associated to propofol continuous infusion sedation is a satisfactory hypotensive anesthesia technique for combined plastic surgeries involving breast, abdomen, gluteus and liposuction. Continuous monitoring of hemodynamic and respiratory parameters as well as controlling blockade effects on those parameters are critical for the success and safety of the technique.

journal_name

Rev Bras Anestesiol

authors

Nociti JR,Serzedo PS,Zuccolotto EB,Gonzalez R

subject

Has Abstract

pub_date

2002-04-01 00:00:00

pages

156-65

issue

2

eissn

0034-7094

issn

1806-907X

pii

S0034-70942002000200003

journal_volume

52

pub_type

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