title: [Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures].
abstract: OBJECTIVE
  The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1,330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique.
  
  
  BACKGROUND
  Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period.
  
  
  CONCLUSIONS
  Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.
authors.affiliation: Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil. Electronic address: perbec@hotmail.com.
authors.forename: Percio Ramón Becker
authors.initials: PR
authors.lastname: Benitez
authors.affiliation: Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil.
authors.forename: Celso Schmalfuss
authors.initials: CS
authors.lastname: Nogueira
authors.affiliation: Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil.
authors.forename: Ana Cristina Carvalho de
authors.initials: AC
authors.lastname: Holanda
authors.affiliation: Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil.
authors.forename: Jose Caio
authors.initials: JC
authors.lastname: Santos
keywords: Cirurgia plástica; Complications; Intercorrências; Plastic surgery; Prevention; Prevenção; Raquianestesia; Spinal anesthesia; Tratamento; Treatment