Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000200003
Brazilian Journal of Anesthesiology
Scientific Article

Ropivacaína em bloqueio peridural torácico para cirurgia plástica

Thoracic epidural anesthesia with ropivacaine for plastic surgery

José Roberto Nociti; Paulo Sérgio Mateus Serzedo; Eduardo Barbin Zuccolotto; Raul Gonzalez

http://dx.doi.org/10.1590/S0034-70942002000200003 Braz J Anesthesiol, vol.52, n2, p.156-165, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio peridural torácico constitui técnica de anestesia hipotensiva, capaz de reduzir o sangramento no campo operatório. O presente estudo não-comparativo tem por finalidade observar os resultados do bloqueio peridural torácico com ropivacaína a 0,5% associado a sedação com infusão contínua de propofol em cirurgia plástica. MÉTODO: Participaram do estudo sessenta pacientes do sexo feminino com idades entre 18 e 62 anos, estado físico ASA I ou II, submetidas a cirurgias plásticas combinadas envolvendo mama, abdômen, glúteos, lipoaspiração. Após punção peridural em T9-T10 ou T10-T11, receberam 40 ml de solução de ropivacaína a 0,5% e sufentanil 15 µg. Doses subseqüentes do anestesia local foram administradas através de cateter quando necessárias. Sedação foi obtida com infusão venosa contínua de propofol 40 a 50 µg.kg-1.min-1. Foram avaliadas as características de instalação e regressão do bloqueio, a evolução dos parâmetros hemodinâmicos e respiratórios, a incidência de eventos adversos. RESULTADOS: O nível superior de bloqueio sensorial foi T2 em 52 pacientes (86,6%), C4 em 4 (6,6%) e T3 em 4 (6,6%). A média para o tempo de latência foi 9,1 ± 8,2 minutos. Obteve-se bloqueio motor grau 2 em 61,7% das pacientes e grau 1 em 38,3%. A média para o tempo de regressão completa do bloqueio motor foi 377,9 ± 68,5 minutos. A média para o tempo da primeira queixa espontânea de dor foi 965,1 ± 371,3 minutos. Os valores médios de PAS, PAD, PAM e FC decresceram significativamente em relação ao controle a partir dos 15 min após a injeção do anestésico local, caracterizando anestesia hipotensiva. Treze pacientes (21,7%) que apresen- taram PAS < 65 mmHg e/ou PAM < 50 mmHg receberam vasopressor (etilfedrina) e 4 (6,7%) que apresentaram FC < 50 bpm receberam atropina. Não foi necessária transfusão sangüínea em nenhum paciente. CONCLUSÕES: O bloqueio peridural torácico com ropivacaína a 0,5% e sufentanil 15 µg, associado à sedação com propofol em infusão contínua, constitui método de anestesia hipotensiva de boa qualidade para cirurgias plásticas combinadas envolvendo mama, abdômen, glúteos e lipoaspiração. A monitorização contínua dos parâmetros hemodinâmicos e respiratórios e o controle dos efeitos do bloqueio sobre estes parâmetros são indispensáveis para o sucesso e a segurança da técnica.

Palavras-chave

ANESTÉSICOS, Local, CIRURGIA, Plástica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Thoracic epidural blockade is a method of hypotensive anesthesia able to reduce bleeding during surgery. This non-comparative study aimed at evaluating the results of thoracic epidural blockade with 0.5% ropivacaine associated to propofol continuous infusion sedation in plastic surgery. METHODS: Participated in this study 60 female patients aged 18 to 62 years, physical status ASA I or II, scheduled for combined plastic surgeries of breast, abdomen, gluteus and liposuction. After epidural puncture in T9-T10 or T10-T11, patients received 40 ml of 0.5% ropivacaine and 15 µg sufentanil. Additional local anesthetic doses were administered through an epidural catheter, if necessary. Sedation was induced with 40 to 50 µg.kg-1.min-1 propofol continuous infusion. Blockade installation and regression, hemodynamic and respiratory parameters and the incidence of adverse effects were investigated. RESULTS: Upper sensory block level was T2 in 52 patients (86.6%), C4 in 4 (6.6%), and T3 in 4 (6.6%). Mean onset time was 9.1 ± 8.2 min. Motor block grade 2 was obtained in 61.7% of patients, and grade 1 in 38.3%. Mean time for complete motor block regression was 377.9 ± 68.5 min. Mean time for first spontaneous pain complaint was 965.1 ± 371.3 min. SBP, DBP, MBP and HR mean values have significantly decreased as compared to control as from 15 min after local anesthetic injection, thus characterizing hypotensive anesthesia. Thirteen patients (21.7%) with SBP < 65 mmHg and/or MBP < 50 mmHg received a vasopressor (ethylphedrine) and 4 patients (6.7%) with HR < 50 bpm received atropine. No patient needed blood transfusion. CONCLUSIONS: Thoracic epidural blockade with 0.5% ropivacaine and 15 µg sufentanil associated to propofol continuous infusion sedation is a satisfactory hypotensive anesthesia technique for combined plastic surgeries involving breast, abdomen, gluteus and liposuction. Continuous monitoring of hemodynamic and respiratory parameters as well as controlling blockade effects on those parameters are critical for the success and safety of the technique.

Keywords

ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, SURGERY, Plastic

References

Lawson NW, Thompson DS, Nelson CL. A dosage nomogram for sodium nitroprusside-induced hypotension under anesthesia. Anesth Analg. 1976;55:574-580.

Thompson GE, Miller RD, Stevens WC. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology. 1978;48:91-96.

Nocite JR. Hipotensão induzida ou anestesia hipotensiva?. Rev Bras Anestesiol. 1988;38:391-392.

Adams AP. Techniques of vascular control for deliberate hypotension during anaesthesia. Br J Anaesth. 1975;47:777-784.

Vieira JL, Vanetti LFA. Hipotensão arterial induzida durante cirurgia: fisiologia, técnica, riscos. Rev Bras Anestesiol. 1982;32:185-206.

Nociti JR, Cagnolati CA, Nunes AMM. Ropivacaína a 0,75% e 1% em anestesia peridural para cirurgia: estudo comparativo. Rev Bras Anestesiol. 1998;48:169-176.

Zaric D, Nydahl P, Philipson L. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) and 0.25% bupivacaine on sensory and motor blockade in volunteers: a double-blind study. Reg Anesth. 1996;21:14-22.

Knudsen K, Suurkula MB, Blomberg S. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-514.

Jenkins MT, Giesecke AH. Balanced Salt Solution in Clinical Anesthesia. Refresher Courses in Anesthesiology. 1974;2:107-116.

Sommer B, Breuninger H. Composition of the Solution for Tumescent Anesthesia. Tumescent Local Anesthesia. 2001:9-13.

Klein JA. The tumescent technique for liposuction surgery. The Amer J Cosmet Surg. 1987;4:263-267.

Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993;92:1085-1098.

Bromage PR. Epidural Analgesia. 1978:144.

Carli F, Klubien K. Thoracic epidurals: is analgesia all we want?. Can J Anaesth. 1999;46:409-414.

Bromage PR, Camporesi EM, Leslie J. Epidural narcotics in volunteers: sensitivity to pain and to carbon dioxide. Pain. 1980;9:145-160.

Bromage PR. Thoracic epidurals: reply to Hough. Reg Anesth Pain Med. 1999;24:273.

Meissner A, Rolf N, Van Aken H. Thoracic epidural anesthesia and the patient with heart disease: benefits, risks, and controversies. Anesth Analg. 1997;85:517-528.

Watwil M, Sundberg A, Olsson J. Thoracolumbar epidural anaesthesia blocks the circulatory response to laryngoscopy and intubation. Acta Anaesthesiol Scand. 1987:529-531.

Koch M, Blomberg S, Emanuelsson H. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery diseases. Anesth Analg. 1990;7:625-630.

Reiz S, Nath S. Cardiotoxicity of local anaesthetic agents. Br J Anaesth. 1986;58:736-746.

Albright CA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979;51:285-287.

Reiz S, Haggmark S, Johansson G. Cardiotoxicity of ropivacaine: a new amide local anaesthetic agent. Acta Anaesthesiol Scand. 1989;33:93-98.

Pitkanen M, Covino BG, Feldman HS. Chronotropic and inotropic effects of ropivacaine, bupivacaine, and lidocaine in the spontaneously beating and electrically paced isolated, perfused rabbit heart. Reg Anesth. 1992;17:183-192.

Schwarz S, Bergfeld D, Sommer B. Pharmacology. Tumescent Local Anesthesia. 2001:14-27.

Smith NT, Corbascio AN. The use and misuse of pressor agents. Anesthesiology. 1970;33:58-63.

Leão DG. Peridural torácica: estudo retrospectivo de 1240 casos. Rev Bras Anestesiol. 1997;47:138-147.

Gouveia MA, Ribeiro RC. Anestesia peridural cervico-torácica: Apreciação clínica. Rev Bras Anestesiol. 1974;24:238-248.

Stevens RA, Artusio JD, Kao TC. Changes in human plasma catecholamine concentrations during epidural anesthesia depends on the level of block. Anesthesiology. 1991;74:1029-1034.

Herrero E, Del Valle SG, La Quintana B. Sedación con propofol durante anestesia locorregional. Rev Esp Anest Rean. 1993;40(^s1):31.

Wilson E, Mackenzie N, Grant IS. A comparison of propofol and midazolam by infusion to provide sedation in patients who receive spinal anaesthesia. Anaesthesia. 1988;43(^sSuppl):91-94.

Nocite JR, Cagnolati CA, Nunes AMM. Sedação com propofol durante anestesia peridural. Rev Bras Anestesiol. 1996;46:259-266.

Sundberg A, Wattwil M, Arvill A. Respiratory effects of high thoracic epidural anaesthesia. Acta Anaesthesiol Scand. 1986;30:215-217.

Aida S, Baba H, Yamamura T. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesth Analg. 1999;89:711-716.

Kurz A, Ikeda T, Sessler DI. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology. 1997;86:1046-1054.

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