title: [High thoracic epidural anesthesia associated or not to low thoracic epidural anesthesia in outpatient procedures: clinical implications.].
abstract: OBJECTIVE
  Hemodynamic changes are easily controlled under low or median thoracic epidural block. Since high thoracic epidural block (T2-T3) often affects brachial plexus roots (C4) C5-T1(T2), some of them responsible for phrenic nerve formation (C3-C4-C5), potential motor repercussions on this nerve are to be expected. Our study performed during cosmetic surgeries under isolated segmental epidural block in T2-T3 or associated to segmental epidural block in T11-T12, has evaluated motor repercussions on respiratory dynamics, upper and lower limbs.
  
  
  METHODS
  Participated in this study 32 patients physical status ASA I and II, without active bronchospastic pulmonary disease and body weight equal to or above 50 kg, 21 of whom were submitted to isolated thoracic epidural blocks in T2-T3 and the remaining patients (11) were submitted to a combined thoracic epidural blocks in T11-T12 with 7.5% ropivacaine (45 to 90 mg) associated to sufentanil (10 to 20 microg). Hemodynamic, respiratory and upper and lower limbs motor repercussions were evaluated by noninvasive monitoring, spirometry hand grasping strength and Bromage score, respectively.
  
  
  RESULTS
  Mean mammary surgeries duration was 105 minutes with upper limbs motor depression (p < 0.001), with motor recovery at 117.2 +/- 51.3 min and first pain complaint at 485 +/- 221.2 min. Combined surgeries with mean duration of 165 min, with lower limbs motor depression level 1 in 40% and level 2 in 60% of patients according to Bromage score, with recovery at 223.9 +/- 57.1 min and first pain complaint at rest at 555 +/- 197.9 min. Pulmonary functions VEF1 (L/sec); PFE (L.min-1); FVC (liters) were changed in 15.20% (p < 0.009); 13.36% (p < 0.029) and 18.09% (p < 0.007), respectively, with 8.75% VEF1/FVC increase (p < 0.162). There has been hypotension (< 30% above baseline values) and bradycardia (< 55 pbm) in 5 patients and shivering during blockade in 13 patients.
  
  
  CONCLUSIONS
  Under high thoracic or cervico-thoracic blockades with decreased anesthetic solution doses and volumes, there have been upper limbs and pulmonary functions motor repercussions. However, according to preliminary observations and this study, spirometric changes were statistically significant, but without clinical expression in respiratory dynamics, being essentially more a consequence of intercostal nerves than of phrenic nerve paralysis.
authors.affiliation: Clínica Rio Branco.
authors.forename: Djalma
authors.initials: D
authors.lastname: Sperhacke
authors.forename: Karl Otto
authors.initials: KO
authors.lastname: Geier
authors.forename: João Carlos Correia
authors.initials: JC
authors.lastname: Eschiletti