Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000400003
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos da analgesia do sufentanil por via subaracnóidea e bupivacaína a 0,25% por via peridural sobre as concentrações plasmáticas de ocitocina e cortisol em gestantes em trabalho de parto

Effects of analgesic intrathecal sufentanil and 0.25% epidural bupivacaine on oxytocin and cortisol plasma concentration in labor patients

Renato Mestriner Stocche; Luiz Vicente Garcia; Jyrson Guilherme Klamt

http://dx.doi.org/10.1590/S0034-70942001000400003 Braz J Anesthesiol, vol.51, n4, p.285-297, 2001
PDF Português
PDF English
Downloads: 0
Views: 970

Resumo

JUSTIFICATIVA E OBJETIVOS: O sufentanil por via subaracnóidea promove analgesia do trabalho de parto comparável à peridural com anestésicos locais. As duas técnicas diminuem alguns parâmetros da resposta neuroendócrina à dor do parto, e ambas podem atenuar a liberação reflexa de ocitocina em animais. O objetivo deste estudo foi comparar os efeitos das duas técnicas nas concentrações plasmáticas de ocitocina (CPO) e cortisol (CPC) durante o trabalho de parto. MÉTODO: Trinta parturientes com 4 - 7 cm de dilatação foram arroladas neste estudo de forma aleatória e encoberta. No grupo S receberam sufentanil (10 mg) por via subaracnóidea e no grupo B receberam bupivacaína a 0,25% por via peridural. A analgesia foi medida usando Escala Analógica Visual e amostras sangüíneas de ocitocina e cortisol foram obtidas antes, 30 e 60 minutos após a administração das drogas. As CPO e CPC foram determinadas através da técnica de radioimunoensaio. RESULTADOS: A analgesia no grupo S foi mais intensa aos 30 minutos. As CPO e CPC nos dois grupos foram semelhantes antes da analgesia. No grupo S, houve diminuição significativa da CPO aos 60 minutos e CPC aos 30 e 60 minutos, enquanto no grupo B, CPO e CPC permaneceram estáveis durante todo o estudo. CONCLUSÕES: Nas condições deste estudo, a analgesia peridural com bupivacaína esteve associada à manutenção das concentrações plasmáticas de cortisol e ocitocina. Contrariamente, a analgesia promovida pelo sufentanil, por via subaracnóidea, foi mais intensa e produziu diminuição nas concentrações destes hormônios.

Palavras-chave

ANALGESIA, ANALGÉSICOS, Opióides, HORMÔNIOS, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Intrathecal sufentanil provides analgesia comparable to epidural local anesthetics for labor pain. Both techniques decrease some parameters of neuroendocrine response to labor pain and both may mitigate reflex oxytocin release in animals. This study aimed to compare the effect of both techniques on cortisol (CPC) and oxytocin (OPC) plasma concentrations in labor patients. METHODS: Participated in this randomized covered study 30 healthy parturients in spontaneous labor with 4-7 cm cervical dilatation. Group S patients received intrathecal sufentanil (10 mg) and group B received epidural 0.25% bupivacaine. Analgesia was assessed by a visual analogue scale and blood oxytocin and cortisol samples were collected before, 30 and 60 minutes after drug administration. Plasma cortisol and oxytocin concentrations were determined by radioimmunoassay. RESULTS: Group S analgesia was more intense at 30 minutes. OPC and CPC before analgesia were similar for both groups. Group S showed a significant decrease in OPC at 60 minutes and in CPC at 30 and 60 minutes (p<0.05), while for Group B such values remained stable throughout the study. CONCLUSIONS: In the conditions of this study, epidural bupivacaine analgesia was associated to stable plasma cortisol and oxytocin concentrations. Conversely, intrathecal sufentanil promoted a more intense analgesia and decreased OPC and CPC.

Keywords

ANALGESIA, ANALGESICS, Opioids, ANESTHETIC TECHNIQUES, Regional, HORMONES

References

Costa A, De Filippis V, Voglino M. Adrenocorticotropic hormone and catecholamines in maternal, umbilical and neonatal plasma in relation to vaginal delivery. J Endocrinol Invest. 1988;11:703-709.

Carr BR, Parker CRJ, Madden JD. Maternal plasma adrenocorticotropin and cortisol relationship throughout human pregnancy. Am J Obstet Gynecol. 1981;139:416-422.

McLean M, Thompson D, Zhang H. Corticotrophin-releasing hormone and b-endorphin in labour. Eur J Endocrinol. 1994;131:167-172.

Myers RE. Maternal psychological stress and fetal asphyxia: a study in the monkey. Am J Obstet Gynecol. 1975;122:47-59.

Ramin SM, Porter JC, Gilstrap LC. Stress hormones and acid-base status of human fetuses at delivery. J Clin Endocrinol Metab. 1991;73:182-186.

Chen DC, Nommsen -Rivers L, Dewey KG. Stress during labor and delivery and early lactation performance. Am J Clin Nutr. 1998;68:335-344.

Mc Neilly AS, Robinson IC, Houston MJ. Release of oxytocin and prolactin in response to suckling. Br Med J. 1983;286:257-259.

Wotjak CT, Ganster J, Kohl G. Dissociated central and peripheral release of vasopressin, but not oxytocin, in response to repeated swin stress: new insights into the secretory capacities of peptidergic neurons. Neuroscience. 1998;85:1209-1222.

Scull TJ, Hemmings GT, Carli F. Epidural analgesia in early labour blocks the stress response but uterine contrations remain unchanged. Can J Anaesth. 1998;45:626-630.

Goodfellow CF, Hull MG, Swaab DF. Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol. 1983;90:214-219.

Behrens O, Goeschen K, Luck HJ. Effects of lumbar epidural analgesia on prostaglandin F2alpha release and oxytocin secretion during labor. Prostaglandins. 1993;45:285-296.

Lindow SW, van der Spuy ZM, Hendricks MS. The effect of morphine and naloxone administration on plasma oxytocin concentratios in the first stage of labour. Clin Endocrinol. 1992;37:349-353.

Russell JA, Leng G, Bicknell RJ. Opioid tolerance and dependence in the magnocellular oxytocin system: a physyological mechanism?. Exp Physiol. 1995;80:307-340.

Vieira JGH. Radioimunoensaio do cortisol sérico. :1-67.

Shnider SM, Wright RG. Hypotension and Regional Anesthesia in Obstetrics. Anesthesia for Obstetrics. 1993:397-406.

Norris M C, Grieco W M, Borkowski M. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg. 1994;79:529-537.

D’Angelo R, Anderson MT, Philip J. Intratecal sufentanil compared to epidural bupivacaine for labor analgesia. Anesthesiology. 1994;80:1209-1215.

Souza H, Stiller R. Cisternal CSF and arterial plasma levels of fentanyl, alfentanil and sufentanil after lumbar epidural injection. Anesthesiology. 1989;71:A838.

Ferouz F, Norris MC, Arkoosh VA. Baricity, needle direction, and intrathecal sufentanil labor analgesia. Anesthesiology. 1997;86:592-598.

Richardson MG, Wissler R. Densities of dextrose-free intrathecal local anesthetics, opioids, and combinations measured at 37 ºC. Anesth Analg. 1997;84:95-99.

Chaim W, Mazor M. The relationship between hormones and human parturiation. Arch Gynecol Obstet. 1998;262:43-51.

Wu W, Nathanielsz PW. Changes in oxytocin receptor messenger RNA in the endometrium, myometrium, mesometrium, and cervix of sheep in late gestation and during spontaneous and cortisol-induced labor. J Soc Gynecol Investig. 1994;1:191-196.

Wood CE, Keller-Wood M. Induction of parturiation by cortisol: effects on negative feedback sensitivity and plasma CRF. J Dev Physiol. 1991;16:287-292.

Patel FA, Clifton VL, Chwalisz K. Steroid regulation of prostaglandin dehydrogenase activity and expression in human term placenta and chorio-decidua in relation to labor. J Clin Endocrinol Metab. 1999;84:291-299.

Reynolds JL. Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. CMAJ. 1997;156:831-835.

Mahomed K, Gulmezoglu AM, Nikodem VC. Labor experience, maternal mood and cortisol and catecholamine levels in low-risk primiparous women. J Psychosom Obstet Gynaecol. 1995;16:181-186.

Bacigalupo G, Riese S, Rosendahl H. Quantitative relationships between pain intensities during labor and beta-endorphin and cortisol concentration in plasma. J Perinat Med. 1990;18:289-296.

Cover PO, Buckingham JC. Effects of seletive opioid-receptor blockade on the hypothalamo-pituitary-adrenocortical responses to surgical trauma in the rat. J Endocrinol. 1988;121:213-220.

Chard T, Gibbens GL. Spurt release of oxytocin during surgical indution of labor in women. Am J Obstet Gynecol. 1983;147:678-680.

Gazarek F, Pohanka J, Talãs M. Plasma oxytocin and oxytocinase levels in thrird trimester of pregnancy and at labour. Endocrinol Exp. 1976;10:283-287.

Bicknell RJ, Chalman C, Leng G. Effects of opioid agonist and antagonist on oxytocin and vasopressin release in vitro. Neuroendocrinology. 1985;41:142-148.

Haldar J, Bade V. Involvement of opioid peptides in the inhibition of oxytocin release by heat stress in lactating mice. Proc Soc Exp Biol Med. 1981;168:10-14.

Rossier J, Battenberg E, Pittman Q. Hypothalamic enkephalin neurones may regulate the neurohypophysis. Nature. 1979;277:653-655.

Sumner BEH, Coombes JE, Pumford KM. Opioid receptor subtypes in the supraoptic nucleus and posterior pituitary gland of morphine-tolerant rats. Neuroscience. 1990;37:635-645.

Douglas AJ, Neumann I, Meeren HK. Central endogenous opioid inhibition of supraoptic oxytocin neurons in pregnant rats. J Neurosci. 1995;15:5049-5057.

Russel JA, Gosden RG, Humphreys EM. Interruption of parturiation in rats by morphine: a result of inhibition of oxytocin secretion. J Endocrinol. 1988;121:521-536.

Lindow SW, Van Der Spuy ZM, Hendricks MS. The effect of morphine and naloxone administration on the maternal oxytocin concentration in late pregnancy. Clin Endocrinol. 1993;39:671-675.

Pumford KM, Leng G, Russell JA. Excitatory sinaptic drive offsets opiod inhibition of oxytocin neurons. Ann N Y Acad Sci. 1993;689:656-658.

5dd8123f0e8825b45913f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections