Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000600003
Brazilian Journal of Anesthesiology
Scientific Article

Efeito da clonidina associada à bupivacaína a 0,5% hiperbárica na anestesia subaracnóidea

Effects of combined clonidine and 0.5% hyperbaric bupivacaine on spinal anesthesia

Neuber Martins Fonseca; Clarissa Aires de Oliveira

http://dx.doi.org/10.1590/S0034-70942001000600003 Braz J Anesthesiol, vol.51, n6, p.483-492, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: A clonidina é um composto imidazolínico agonista parcial dos receptores a2-adrenérgicos com propriedades ansiolíticas e hipnóticas. Administrada no espaço subaracnóideo produz efeitos seletivos na modulação da dor, podendo aumentar a duração da anestesia cirúrgica e do bloqueio motor. O objetivo do estudo foi avaliar o efeito da clonidina associada à bupivacaína a 0,5% hiperbárica na anestesia subaracnóidea. MÉTODO: Foram estudados 30 pacientes de ambos os sexos, escalados para herniorrafia inguinal, estado físico ASA I ou II, com idades entre 16 e 57 anos, distribuídos aleatoriamente em três grupos. Após monitorização, os pacientes foram sedados com midazolam (2 mg), por via venosa, 10 minutos antes do procedimento anestésico, seguindo-se de punção subaracnóidea, L3-L4, paramediana, com agulha Quincke 25G, em decúbito lateral esquerdo. Após saída do LCR injetou-se 1 ml de uma das soluções propostas, de acordo com o grupo estudado juntamente com 15 mg de bupivacaína hiperbárica: Grupo I - 150 µg de clonidina, Grupo II - 75 µg de clonidina + 0,5 ml de água bidestilada e Grupo III - 1 ml de água bidestilada. Foram avaliados o nível do bloqueio com 5, 20 e 30 minutos, tempo para regressão de dois metâmeros, sedação pela escala de 0 a 3, bloqueio motor pela escala modificada de Bromage, dor pós-operatória e necessidade de analgésico. RESULTADOS: Houve uniformidade dos dados antropométricos nos grupos. O nível do bloqueio anestésico (moda) nos pacientes estudados foi uniforme nos grupos. A regressão da anestesia foi retardada no grupo I, assim como o relaxamento muscular, em relação aos outros grupos. Não houve diferença em relação à sedação e aos parâmetros hemodinâmicos entre os grupos. O grupo I apresentou analgesia prolongada em relação aos demais grupos, confirmado pela menor necessidade de analgésicos em função do tempo. CONCLUSÕES: A clonidina não alterou a dispersão cefálica e os efeitos hemodinâmicos do bloqueio subaracnóideo com bupivacaína a 0,5% hiperbárica. Porém, foi efetiva em melhor analgesia observada com quatro horas após o bloqueio, bem como prolongou o tempo de anestesia.

Palavras-chave

ANALGÉSICOS, ANESTÉSICOS, Local, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Clonidine is an imidazolynic compound which exhibits partial alpha2-receptor agonist action, with anxiolytic and hypnotic properties. When spinally administered, it produces selective effects in pain modulation and may prolong surgical anesthesia and motor block. This study aimed at evaluating the effects of combined clonidine and 0.5% hyperbaric bupivacaine on spinal anesthesia. METHODS: Thirth ASA I or II patients off both genders, aged between 16 and 57 years and scheduled to undergo surgical inguinal hernia repair were randomly divided into three groups in this prospective double blind study. After monitoring, patients were sedated with 2 mg venous midazolam 10 minutes before surgery, followed by paramedian spinal puncture (L3-L4) in the left lateral position with a 25G Quincke needle. After CSF confirmation, 1 ml of one of the proposed solutions were injected with 15 mg hyperbaric bupivacaine: Group I - 150 µg clonidine; Group II - 75 µg clonidine + 0.5 ml bi-distilled water; and Group III - 1 ml bi-distilled water. The following parameters were evaluated: sensory block level at 5, 20 and 30 minutes, time for two metamers regression, sedation scores through a 0 to 3 scale, motor block by a modified Bromage’s scale, postoperative pain and analgesics requirement. RESULTS: Demographics and maximum sensory level (mode) were similar for all groups. Anesthesia regression and muscle relaxation were longer for Group I. There were no difference in sedation and hemodynamic parameters between groups. Group I had a prolonged analgesia as compared to other groups, what was confirmed by the less need for analgesics as a function of time. CONCLUSIONS: Clonidine has not changed cephalad spread and hemodynamic effects of spinal anesthesia with 0.5% hyperbaric bupivacaine. However, it has promoted better analgesia during the four hours observed after blockade and a prolonged anesthesia.

Keywords

Analgesics, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional

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