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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 December;67(12):855-62

language: English

Uni­lat­er­al spi­nal anes­the­sia (­State of the art)

Casati A., Fanelli G.

From the ­Vita-­Salute Uni­ver­sity of Mila­no Depart­ment of Anes­the­sio­lo­gy IRCCS H. San Raf­faele, ­Milan


The pos­sibil­ity to con­trol the ­spread of intra­the­cal ­drugs, restrict­ing the dis­tri­bu­tion of spi­nal ­block to the oper­at­ed ­side is ­still con­tro­ver­sial. Var­i­ous ­authors report­ed ­that we can not pre­dict the dis­tri­bu­tion of spi­nal ­block; how­ev­er, oth­er ­authors ­described how to ­restrict spi­nal ­block at the oper­at­ed ­side in ­patients receiv­ing sur­gi­cal pro­ce­dures involv­ing one low­er ­limb. There­fore, we ­reviewed clin­i­cal stud­ies on ­this top­ic try­ing to out­line the fea­sibil­ity and poten­tial clin­i­cal ben­e­fits of “uni­lat­er­al spi­nal anes­the­sia”. The ­main ­results of stud­ies recent­ly pub­lished on ­peer ­reviewed jour­nals con­cern­ing the clin­i­cal use of uni­lat­er­al spi­nal anes­the­sia are ­reviewed. The ­main fac­tors we ­must con­sid­er ­when attempt­ing a uni­lat­er­al spi­nal ­block are the use of ­small dos­es of ­local anes­thet­ic solu­tion inject­ed ­through direc­tion­al, pen­cil-­point nee­dles, togeth­er ­with a 15-20 min lat­er­al decub­it­us posi­tion and the use of ­either ­hypo- or hyper­bar­ic anes­thet­ic solu­tion. ­Using 6-8 mg of ­either hyp­er- or hypo­bar­ic bupiv­a­caine pro­vides a uni­lat­er­al dis­tri­bu­tion of sym­pa­thet­ic and sen­so­ry ­blocks in 50 to 70% of ­patients, ­while uni­lat­er­al ­motor ­block can be ­observed in up to 80% of cas­es. Attempt­ing a uni­lat­er­al spi­nal ­block ­results in a ­four-­fold reduc­tion in the inci­dence of clin­i­cal­ly rel­e­vant hypo­ten­sion ­with ­more ­stable car­di­o­vas­cu­lar param­e­ters as com­pared ­with con­ven­tion­al bilat­er­al spi­nal ­block. The ­small ­amount of ­local anes­thet­ic solu­tion inject­ed, as ­well as the ­reduced ­extent of spi­nal ­block, ­also pro­vide a favour­able pro­file of the res­o­lu­tion of spi­nal ­block, ­which can be use­ful in the ambu­la­to­ry set­ting. ­With sim­ple tech­ni­cal ­skill we can reli­ably pro­vide a pref­e­ren­tial dis­tri­bu­tion of spi­nal ­block to the oper­at­ed ­side. ­This ­results in a min­i­mal ­delay in prep­ar­a­tion ­time, but pro­vides ­less hemo­dy­nam­ic ­side ­effects ­with high­er car­di­o­vas­cu­lar stabil­ity, and ­increased auton­o­my ­after sur­gery ­with bet­ter ­patient accep­tance.

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