Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000500002
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo entre levobupivacaína a 0,5% e bupivacaína racêmica a 0,5% associadas ao sufentanil na anestesia peridural para cesariana

Comparative study of 0.5% levobupivacaine and 0.5% racemic bupivacaine associated to sufentanil in epidural anesthesia for cesarean delivery

João Batista Santos Garcia; José R Oliveira; Elismar P A Silva; Marcelo S Privado; Américo M Yamashita; Adriana M Issy

http://dx.doi.org/10.1590/S0034-70942001000500002 Braz J Anesthesiol, vol.51, n5, p.377-384, 2001
PDF Português
PDF English
Downloads: 0
Views: 998

Resumo

JUSTIFICATIVA E OBJETIVOS: Apesar do uso freqüente de anestésicos locais em procedimentos cirúrgicos e obstétricos, a bupivacaína racêmica é associada à cardiotoxicidade potencialmente fatal. Estudos sugerem que a levobupivacaína apresenta ação anestésica local semelhante à bupivacaína racêmica, com a vantagem de menor toxicidade tanto no sistema nervoso central como cardiovascular. Os trabalhos têm demonstrado melhor qualidade anestésica com uso de bupivacaína racêmica associada à sufentanil, via peridural para cesariana. O presente estudo compara a eficácia da bupivacaína racêmica 0,5% com levobupivacaína 0,5%, ambas associadas o sufentanil, via peridural, em parturientes submetidas a cesariana. MÉTODO: Foram investigadas 52 gestantes, submetidas à anestesia peridural para cesariana eletiva. Neste estudo duplamente encoberto, as pacientes foram distribuídas aleatoriamente em dois grupos: Grupo I (n = 26): receberam 27 ml de levobupivacaína 0,5% e 30 µg de sufentanil, Grupo II (n = 26) receberam 27 ml de bupivacaína 0,5% e 30 µg de sufentanil. Foram avaliados as características dos bloqueios motor e sensorial, o tempo necessário para solicitação de analgésicos e a incidência de efeitos adversos no período pós-operatório. RESULTADOS: Os bloqueios motor e sensorial, o tempo para solicitação de analgésicos e os efeitos adversos não diferiram entre os grupos. Entretanto, quando se comparou a duração do bloqueio motor da levobupivacaína com da bupivacaína racêmica, observou-se duração significantemente prolongada para levobupivacaína (p < 0,05). CONCLUSÕES: Apesar da duração do bloqueio motor ser mais prolongado para a levobupivacaína associada ao sufentanil, a eficácia anestésica de ambos os anestésicos locais investigados associados ao sufentanil em cesariana por via peridural, foram iguais.

Palavras-chave

ANALGÉSICOS, Opióides, ANESTÉSICOS, Local, ANESTÉSICOS, Local, CIRURGIA, Obstétrica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Although the widespread use of local anesthetics in surgery and obstetrics, racemic bupivacaine is associated to potentially fatal cardiotoxicity. Data suggest that levobupivacaine has local anesthetic effects similar to racemic bupivacaine with the advantage of less central nervous system and cardiovascular toxicity. Studies have shown that epidural anesthesia with racemic bupivacaine and sufentanil for cesarean sections results in a better quality of anesthesia. This study aimed at comparing the efficacy of 0.5% racemic bupivacaine and 0.5% levobupivacaine, both associated to sufentanil, for epidural anesthesia in parturients undergoing cesarean delivery. METHODS: Participated in this double-blind study 52 obstetric patients submitted to elective cesarean delivery under epidural anesthesia. Patients were randomized to receive 27 ml of 0.5% levobupivacaine and 30 µg sufentanil (Group I n=26) or 27 ml of 0.5% bupivacaine and 30 µg sufentanil (Group II n=26). Characteristics of sensory and motor block, time for analgesics request in the postoperative period and the incidence of side effects were investigated. RESULTS: Sensory and motor block, time for analgesics request and adverse effects did not differ between groups. However, motor block was significantly longer with levobupivacaine as compared to racemic bupivacaine (p < 0.05). CONCLUSIONS: Although a longer motor block duration with 0.5% epidural levobupivacaine associated to sufentanil, the efficacy of both local anesthetics associated to sufentanil for cesarean delivery was similar.

Keywords

ANALGESICS, Opioids, ANESTHETICS, Local, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, SURGERY, Obstetric

References

Denson DD, Behbehani MM, Gregg RV. Enantiometer-specific effects of an intravenously administered arrythmogenic dose of bupivacaine on neurons of the nucleus tractus solitarius and the cardivascular system in tne anesthetized rat.. Reg Anesth,. 1992;17:311-316.

Nancarrow C, Rutten AJ, Runciman WB. Myocardial and cerebral drug concentrations and the mechanisms of death after fatal intravenous doses of lidocaine, bupivacaine, and ropivacaine in the sheep. Anesth Analg. 1989;69:276-283.

Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and lidocaine in the conscious dog.. Anesth Analg. 1989;69:794-801.

Cox CR, Faccenda KA, Gilhooly C. Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine. Br J Anaesth. 1989;80:289-293.

Naulty JS, Datta S, Ostheimer GW. Epidural fentanyl for postcesarean delivery pain management. Anesthesiology. 1985;63:694-698.

Jones G, Paul DL, Elton RA. Comparison of bupivacaine and bupivacaine with fentanyl in continuous extradural analgesia during labour.. Br J Anaesth. 1989;63:254-259.

McMorland GH, Douglas MJ, Kim JHK. Epidural sufentanil for post-Cesaean section analgesia: lack of benefit of epinephrine. Can J Anaesth. 1990;37:432-437.

De Leon-Casasola AO, Lema MJ. Postoperative epidural opioid analgesia: what are the choices?. Anesth Analg. 1996;83:867-875.

Crews JC, Hord AH, Denson DD. A comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery.. Anesth Analg. 1999;89:1504-1509.

Van Zudert A, Vaes L, Van der AAP. Motor blockade during epidural anesthesia. Anesth Analg. 1986;65:333-336.

Sokal RR, Rohlf FJ. Biometry. 1969:776.

Siegel S, Castellan Jr NJ. Nonparametric Statistics. 1988:399.

Bardsley H, Gristwood R, Baker H. A comparison of the cardiovascular effects of levobupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol. 1998;46:245-249.

Thomas JM, Stephan AS. Recent advances in the pharmacokinetics of local anaesthetics. Long-acting amide enantiomers and continuous infusions.. Clin Pharmacokinet. 1999;36:67-83.

Cox CR, Checketts MR, Mackenzie N. Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supracla- vicular brachial plexus block. Br J Anaesth. 1998;80:594-598.

Bader AM, Tsen LC, Camman WR. Clinical effects and maternal and fetal plasma concentrations of 0.5% epidural levobupivacaine versus bupivacaine for cesarean delivery.. Anesthesiology. 1999;90:1596-1601.

Delfino J, Vale NB, Magalhães Filho E. 0.45% ropivacaine and levobupivacaine associated to opioids in epidural anesthesia for cesarean section: a comparative study. Rev Bras Anestesiol. 1999;49:244-248.

McClellan KJ, Spencer CM. Levobupivacaine. Drugs. 1998;56:355-362.

Van Steenberge A, Debroux HC, Noorduin H. Extradural bupivacaine with sufentanil for vaginal delivery. Br J Anaesth. 1987;59:1518-1522.

Johnson C, Oriol N. Comparison of onset time between bupivacaine 0.5% and 2-chloroprocaine 35 with and without fentanyl 75mcg. Anesth Analg. 1990;70:S179.

5dd7f1630e8825d60613f286 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