Failure of subarachnoid blocks.
OBJECTIVE
Due to the discomfort caused to patients, failure of subarachnoid blocks that happen occasionally even when properly conducted be the most capable professionals have been described since Bier. However, the concept of failure and especially identification of the causes vary. The objective of this report was to identify the causes of this discomfort through a systematic review of publications with a significant number of patients.


BACKGROUND
The analysis was divided in three topics: anatomy and its variations; anesthetic agent, focusing on drug selection, its solutions, and additions to achieve the most appropriate result of the proposed surgery; and the dose, discussing concentration, volume, or gravimetric dose, to obtain the most adequate result regarding the intensity of the blockade and its duration.


CONCLUSIONS
Failures are more commonly secondary to technical factors: adequate anatomic assessment, judicious choice of the needle and puncture site, care when storing the drugs, dose adequacy, and baricity, besides proper patient positioning during and after the puncture, and they all should be adequate for the surgical objective.
Praxedes
Hugo
H
Gerente Médico de Farmacovigilância do Laboratório Cristália.
Oliva Filho
Antonio Leite
AL
D000775:Anesthesia, Spinal / Q000379:methods; D006801:Humans; D013346:Subarachnoid Space; D017211:Treatment Failure