RESUMO
BACKGROUND AND OBJECTIVES: Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. CASE REPORT: Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. CONCLUSIONS: During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
RESUMO
JUSTIFICATIVA E OBJETIVOS: O uso espinhal de opióides pode causar alguns efeitos indesejáveis, dentre os quais, o mais freqüente é o prurido que, apesar de sua baixa morbidade, pode proporcionar desconforto intenso ao paciente e prolongar o período de internação. O objetivo deste estudo foi avaliar diversas opções terapêuticas no tratamento profilático do prurido após administração de sufentanil por via subaracnóidea. MÉTODO: Foram distribuídos de maneira aleatória, por sorteio, 100 pacientes a serem submetidos à intervenção cirúrgica não-obstétricas em cinco grupos, de acordo com o tratamento utilizado: controle (ausência de tratamento - C); droperidol 2,5 mg (D); nalbufina 10 mg (N); associação dos medicamentos anteriores (DN) e ondansetron 8 mg (O). O prurido foi avaliado quantitativamente 30 minutos, 1, 2, e 3 horas após a administração subaracnóidea de sufentanil. RESULTADOS: Os grupos C e O apresentaram incidência significativamente maior de prurido em relação aos grupos D, N e DN. Entretanto, não houve diferença significativa na necessidade de tratamento específico com naloxona entre os grupos tratados. CONCLUSÕES: O tratamento profilático do prurido neste estudo, independentemente do fármaco utilizado, diminuiu sua intensidade e limitou a necessidade de tratamento específico com naloxona.
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Prurido/tratamento farmacológico , Sufentanil/efeitos adversos , Ondansetron/uso terapêutico , Droperidol/uso terapêutico , Nalbufina/uso terapêutico , Combinação de MedicamentosRESUMO
BACKGROUND AND OBJECTIVES: Spinal opioids may cause some undesirable effects, the most frequent of which is itching. In spite of its low morbidity rate, itching may cause severe discomfort to patients in addition to prolonging hospital stay. This study aimed at evaluating different therapeutic options to prevent itching after spinal sufentanil. METHODS: Participated in these study 100 patients scheduled for non-obstetric procedures, who were randomly distributed in five groups: control (no treatment - C); 2.5 mg droperidol (D); 10 mg nalbuphine (N); association of previous drugs (DN); and 8 mg ondansetron (O). Pruritus was quantitatively evaluated at 30 minutes, 1, 2 and 3 hours after spinal sufentanil. RESULTS: Groups C and O had significantly higher incidence of itching as compared to groups D, N and DN. However, there has been no significant difference in the need for specific treatment with naloxone among groups. CONCLUSIONS: Itching prevention in our study, regardless of the drug used, has decreased its severity and has limited the need for specific treatment with naloxone.