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Posterior anesthesia for lower limb varicose veins: a case report with video


Journal of Anesthesia & Critical Care: Open Access
Luiz Eduardo Imbelloni, MD, PhD,<sup>1</sup> Eneida Maria Vieira, MD, PhD,<sup>2</sup> Anna Lúcia Calaça Rivoli, MD,<sup>3</sup> Sylvio Valença de Lemos Neto, MD, PhD,<sup>4</sup> Patrícia L Procópio Lara, MD,<sup>5</sup> Ana Cristina Pinho, MD<sup>6</sup>

Abstract

Background: Patient with a history of dissatisfaction during spinal anesthesia for orthopedic surgery, due to the unpleasant long duration of motor blockade of the lower limbs. During the pre-anesthetic consultation, she requested another type of anesthesia for the surgical treatment of varicose veins in the
lower limbs.
Case report: A 58-year-old female patient presented with varicose veins, for surgical treatment without removing the saphenous vein, only the collaterals. Patient with a history of controlled hypertension, normal blood tests, normal ECG, and chest X-ray. Abbreviation for fasting with 200 ml CHO. Venous access with #20G extract and monitoring with continuous ECG, NIBP, SpO2, and EtCO2 through a nasal catheter. Cleaning the skin with chlorhexidine and local anesthesia with 3 ml of 1% lidocaine. The spinal puncture was performed with the patient in the ventral position, by the median line in the L3-L4 interspaces using a 27G Quincke needle, after the appearance of CSF 7.5 mg of 0.15% hypobaric bupivacaine was administered at a speed of 1 mL/15s. Immediate latency, superior level T10 analgesia, without any degree of motor block. The surgical procedure posterior lasted 1:40 hours, and anterior lasted 1:20 hours, both without any degree of motor blockade and without cardiocirculatory and respiratory changes. The patient mobilized alone on the surgical table, without assistance from the prone position to the supine position. At PACU she received 200 ml of CHO and was discharged to her room. At the end of the day, she was released to her residence.
Conclusion: The practice of prone positioning for performing posterior dorsal anesthesia remains relatively unfamiliar to many anesthetists. The use of a low dose of 0.15% hypobaric bupivacaine, the low cephalic dispersion of the analgesia, and the predominance of sensory roots allow the surgery to be performed without any degree of motor blockade, and proprioception remains. The use of posterior spinal anesthesia and the abbreviation of fasting before and immediately after surgery allowed excellent patient satisfaction.

Keywords

anesthetics, hypobaric local anesthetic, anesthetic techniques, posterior spinal anesthesia, surgery, varicose veins in the lower limbs

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