Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000100001
Brazilian Journal of Anesthesiology
Scientific Article

Concentração plasmática de ropivacaína durante anestesia peridural lombar em crianças

Ropivacaine and bupivacaine plasma concentration during lumbar epidural anesthesia in children

Verônica Vieira da Costa; Denise Pereira de Oliveira Souza; Marcelo Buzzi; Márcio Corrêa de Mello; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942002000100001 Braz J Anesthesiol, vol.52, n1, p.1-8, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A ropivacaína é o mais novo anestésico local de uso na prática clínica. Sua estrutura é semelhante a forma levógira da bupivacaína, tendo portanto baixa toxicidade. Os valores das concentrações plasmáticas que podem ser atingidos em crianças, com o uso desta droga e também da bupivacaína (mesmo a forma racêmica) administradas por via peridural lombar, são ainda pouco conhecidos. O objetivo desse estudo foi avaliar as concentrações sangüíneas de ropivacaína e bupivacaína por via peridural lombar em crianças, em bloqueios eficientes, relacionando-as aos valores descritos como níveis plasmáticos seguros. MÉTODO: Oitenta e um pacientes de ambos os sexos, submetidos à cirurgia de membros inferiores, receberam aleatoriamente ropivacaína (n = 41) ou bupivacaína (n = 40) por via peridural lombar associado à anestesia geral. Foram coletadas oito amostras de sangue venoso nos intervalos de tempo: zero (controle), 5, 25, 40, 60, 120, 180 e 240 minutos, e através de cromatografia de gás foram dosadas as concentrações plasmáticas da ropivacaína e da bupivacaína. RESULTADOS: Não houve diferença estatisticamente significante com relação aos dados antropométricos e variáveis fisiológicas estudadas entre os pacientes que receberam ropivacaína e bupivacaína. As doses médias administradas de ropivacaína e bupivacaína foram 2,35 mg.kg-1 e 2,13 mg.kg-1, respectivamente, que geraram as concentrações plasmáticas de 2,334 µg.ml-1 e 1,111 µg.ml-1, aos 25 e 40 minutos. Ambas abaixo do nível considerado seguro (3 µg.kg-1). CONCLUSÕES: A administração peridural lombar de ropivacaína e bupivacaína em crianças, nas doses abaixo de 3 mg.kg-1, produz bloqueio anestésico eficaz e determina concentrações plasmáticas que podem ser consideradas seguras.

Palavras-chave

ANESTÉSICOS, Local, ANESTÉSICOS, Local, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Ropivacaine is the newest local anesthetic drug for clinical practice. Its structure is similar to levogyrous bupivacaine, therefore exibiting low toxicity. Little is known about plasma concentrations that can be reached in children after lumbar epidural administration of these drugs (including racemic bupivacaine). The aim of this study was to evaluate ropivacaine and bupivacaine plasma concentrations following successful lumbar epidural blocks in children, correlating them to known safe plasma levels. METHODS: Eight-one children of both genders, aged between 2 and 16 year, scheduled to undergo lower limbs surgeries, were randomly divided in two groups to receive lumbar epidural ropivacaine ( n = 41) or bupivacaine (n = 40), associated to general anesthesia. Venous blood samples were collected at times 0 (control), 5, 25, 40, 60, 120, 180 and 240 minutes. Ropivacaine and bupivacaine plasma concentrations were measured by gas chromatography. RESULTS: There was no statistically significant difference in anthropometric and physiological variables between groups. Mean ropivacaine and bupivacaine doses were 2.35 mg.kg-1 and 2.13 mg.kg-1 respectively, leading to peak plasma concentrations of 2.334 µg.ml-1 and 1.111 µg.ml-1 at 25 and 40 minutes respectively, both below the safety level of 3 µg.ml-1. CONCLUSIONS: Lumbar epidural administration of ropivacaine and bupivacaine in children, in doses below 3 mg.kg-1, result in efficient anesthetic blocks and safe plasma concentrations.

Keywords

ANESTHETICS, Local, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional

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