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
PDF Português
PDF English
Downloads: 0
Views: 920

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

Referências

Bernard JM, Quintin L, Pinaud M. Clonidine: du traitement de I´hipertension artérielle à I´utilisation en aneasthésie: II: Utilisation périopératorie. Ann Fr Anesth Réanim. 1990;9:423-432.

Eisenach JC. a2: adrenergic agonists in anesthesia practice. ASA Refresher Courses in Anesthesiology. 1999;25:55-62.

Racle JP, Benkhadra A, Poy JY. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66:442-446.

Filos KS, Goudas LC, Patroni O. Intrathecal clonidine as a sole analgesic for pain relief after cesarean section. Anesthesiology. 1992;77:267-274.

Chiari A, Lorber C, Eisenach JC. Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor. Anesthesiology. 1999;91:388-396.

Yaksh TL, Reddy SVR. Studies in the primate on the analgesic effects associated with intrathecal action of opiates, alpha adrenergic agents and baclofen. Anesthesiology. 1981;59:743-750.

Yaksh TL. Pharmacology of spinal adrenergic systems which modulate spinal nociceptive processing. Pharmacol Biochem Behav. 1985;22:845-858.

Racle JP, Benkhadra A, Poy JY. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66:442-446.

Bonnet F, Brun-Buisson V, Saada M. Dose-related prolongation of hyperbaric tetracaine spinal anesthesia by clonidine in humans. Anesth Analg. 1989;68:619-622.

Nishikawa T, Dohi S. Clinical evaluation of clonidine added to lidocaine solution for epidural anesthesia. Anesthesiology. 1990;73:853-859.

Mogensen T, Eliasen K, Ejlersen E. Epidural clonidine enhances postoperative analgesics from a combined low-dose epidural bupivacaine and morphine regimen. Anesth Analg. 1992;75:607-610.

Bonnet F, Buisson V, Francois Y. Effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine. Reg Anesth. 1990;15:211-214.

Ota K, Namiki A, Iwasaki H. Dose-related prolongation of tetracaine spinal anesthesia by oral clonidine in humans. Anesth Analg. 1994;79:1121-1125.

Bromage PR. A comparation of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand. 1965;16:55-59.

Spiegel S. Estadística no Paramétrica Aplicada a las Ciencias de la Conducta. 1975:346.

Hollander M, Wolfe DA. Nonparametric Statistical Methods. 1973:503.

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

Maze M, Tranquilli W. a2 Adrenergic agonists: defining the role in clinical anaesthesia. Anesthesiology. 1991;74:581-605.

Pouttu J, Scheinin B, Rosenberg PH. Oral premedication with clonidine: effects on stress responses during general anaesthesia. Acta Anaesthesiol Scand. 1987;31:730-734.

Segal IS, Jarvis DJ, Ducan SR. Clinical efficacy of oral-transdermal clonidine combination during the perioperative period. Anesthesiology. 1987;74:220-225.

Ghignome M, Quintin L, Duke PC. Effects of clonidine on narcotics requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology. 1986;64:36-42.

Ghignome M, Calvillo O, Quintin ?. Anesthesia and hypertension: the effects of clonidine on preoperative hemodynamics and isoflurane requirements. Anesthesiology. 1987;67:3-10.

Eisenach JC, Hood DD, Cury RN. Intrathecal clonidine reduces acute pain more than IV clonidine. Reg Anesth Pain Med. 1998;23:3.

Fogarty DJ, Carabine UA, Milligan KR. Comparison of the analgesic effects of intrathecal clonidine and intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacement. Br J Anaesth. 1993;71:661-664.

Brunschwiler M, Van Gessel E, Foster A. Comparison of clonidine, morphine or placebo mixed with bupivacaine during continuous spinal anaesthesia. Can J Anaesth. 1998;45:735-740.

Racle JP, Benkhadra A, Poy JY. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66:442-446.

Bonnet F, Brun-Buisson V, Saada M. Dose-related prolongation of hyperbaric tetracaine spinal anesthesia by clonidine in humans. Anesth Analg. 1989;68:619-622.

Singh H, Liu J, Gaines GY. Effect of oral clonidine and intrathecal fentanyl on tetracaine spinal block. Anesth Analg. 1994;79:1113-1116.

Alves TCA, Braz JRC, Ganem EM. Influência da medicação pré-anestésica com clonidina sobre a associação de sufentanil e bupivacaína na anestesia subaracnóidea. Rev Bras Anestesiol. 1999;49:320-326.

Larsen B, Dorscheid E, Macher-Hanselmann F. Does intrathecal clonidine prolong the effect of spinal anesthesia with hyperbaric mepivacaine. Anaesthesit. 1998;47:741-746.

De Jonge A, Timmermans PB, van Zweiten PA. Participation of cardiac presynaptic a2-adrenoceptors in the bradycardic effects of clonidine and analogues. Naunyn Schmiedebergs Arch Pharmacol. 1991;137:8-12.

Kubo T, Misu Y. Pharmacological characterization on the a-adrenoceptor responsible for a decrease of blood pressure in the nucleus tractus solitaire of the rat. Naunyn Schmiedebergs Arch Pharmacol. 1981;317:120-125.

Alves TCA, Braz JR, Vianna PTG. a2-agonistas em anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. 2000;5:396-404.

Klimscha W, Chiari A, Krafft P. Hemodynamic and analgesic effects of clonidine added repetitively to continuous epidural and spinal blocks. Anesth Analg. 1995;80:322-327.

Filos KS, Goudas LC, Patroni O. Hemodynamic and analgesic profile after intrathecal clonidine in humans. Anesthesiology. 1994;81:591-601.

Carvalho WA, Lemônica L. Mecanismos centrais de transmissão e de modulação da dor: Atualização terapêutica. Rev Bras Anestesiol. 1998;48:221-240.

5dd7eb6e0e8825437613f286 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections