Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000400004
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos da associação da clonidina à ropivacaína na anestesia peridural

Clinical evaluation of clonidine associated to ropivacaine for epidural anesthesia

Túlio César Azevedo Alves; José Reinaldo Cerqueira Braz

http://dx.doi.org/10.1590/S0034-70942002000400004 Braz J Anesthesiol, vol.52, n4, p.410-419, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os efeitos e o potencial sinergismo entre a clonidina, um agonista alfa2-adrenérgico, e a ropivacaína ainda não foram estudados em pacientes sob anestesia peridural. O objetivo da pesquisa foi estudar os efeitos da associação da clonidina com a ropivacaína, nas características do bloqueio peridural. MÉTODO: Participaram do estudo duplamente encoberto, 60 pacientes distribuídos em dois grupos de 30 pacientes. No grupo G controle, foi usada apenas a ropivacaína a 0,75% (150 mg) na anestesia peridural; no grupo G clonidina, foram utilizadas clonidina (300 µg) e ropivacaína a 0,75% (150 mg) na anestesia peridural. Foram analisados os seguintes atributos: bloqueio analgésico completo (tempo de latência), instalação do bloqueio motor, duração dos bloqueios analgésico e motor, nível máximo do bloqueio analgésico, nível de consciência, necessidade de analgesia e sedação complementar no per-operatório, ocorrência de hipotensão arterial no per e pós-operatórios, intensidade da dor pós-operatória, duração da analgesia e efeitos colaterais. RESULTADOS: A clonidina (300 µg), por via peridural, não influenciou a latência (p > 0,05); porém prolongou a duração dos bloqueios analgésico e motor (p < 0,0001) e a analgesia pós-operatória (p < 0,001). A proporção de hipotensão arterial foi pequena e semelhante entre os grupos, mas houve maior incidência de bradicardia (p < 0,02) e sedação (p < 0,001) no grupo que utilizou a clonidina. A incidência de tremores foi menor no grupo da clonidina (p < 0,001). CONCLUSÕES: Nas condições deste estudo e nas doses empregadas, pode-se concluir que há sinergismo evidente entre a clonidina e a ropivacaína na anestesia peridural. A clonidina aumenta a duração dos bloqueios analgésico e motor da anestesia peridural com a ropivacaína e prolonga a analgesia pós-operatória. A clonidina apresenta como vantagens adicionais, o aumento da sedação dos pacientes e a redução na incidência de tremores, mas aumenta a ocorrência de bradicardia.

Palavras-chave

ANALGÉSICOS, ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Clinical effects and the potential synergism between clonidine, an alpha2-adrenergic agonist, and ropivacaine have not been studied in patients undergoing epidural anesthesia. This research aimed at clinically evaluating clonidine associated to ropivacaine for epidural anesthesia. METHODS: Participated in this double-blind study 60 patients of both genders who were distributed in two groups: G control = epidural 0.75% ropivacaine (150 mg); G clonidine = epidural 0.75% ropivacaine (150 mg) plus clonidine (300 µg). The following parameters were studied: total analgesic block (onset time), motor block onset, analgesic and motor block duration, upper level of analgesia, consciousness level, need for intraoperative analgesia and supplemental sedation, peri and postoperative arterial hypotension, intensity of postoperative pain, analgesia duration, and side-effects. RESULTS: Epidural clonidine (300 µg) had not affected onset (p > 0.05) but has prolonged sensory and motor block duration (p < 0.0001) and postoperative analgesia (p > 0.001). Arterial hypotension rate was the same for both groups, but the incidence of bradycardia and sedation was higher in the clonidine group (p < 0.02 and p < 0.001 respectively). Shivering was more common in the control group (p < 0.001). CONCLUSIONS: In the conditions of our study, there has been a clear synergism between epidural clonidine and ropivacaine. Clonidine increases sensory and motor block duration during epidural anesthesia with ropivacaine and prolongs postoperative analgesia. Additional advantages of clonidine are increased sedation and decreased shivering, but its drawback is to increase the incidence of bradycardia.

Keywords

ANALGESICS, ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Bonnet F, Boico O, Rostaing S. Clonidine-induced analgesia in postoperative patients: epidural versus intramuscular administration. Anesthesiology. 1990;72:423-427.

Eisenach JC, Detweiler D, Hood D. Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology. 1993;78:277-287.

Paech MJ, Pavy TJ, Orlikowski CE. Postoperative epidural infusion: a randomized, double-blind, dose-finding trial of clonidine in combination with bupivacaine and fentanyl. Anesth Analg. 1997;84:1323-1328.

Murga G, Samso E, Valles J. The effect of clonidine on intraoperative requirements of fentanyl during combined epidural/general anaesthesia. Anaesthesia. 1994;49:999-1002.

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 analgesia from a combined low-dose epidural bupivacaine and morphine regimen. Anesth Analg. 1992;75:607-610.

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.

Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand. 1965;16:619-622.

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

O’Meara ME, Gin T. Comparison of 0.125% bupivacaine with 0.125%, bupivacaine and clonidine as extradural analgesia in the first stage of labor. Br J Anaesth. 1993;71:651-656.

Chassard D, Mathon L, Dailler F. Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labor. Br J Anaesth. 1996;77:458-462.

Constant I, Gall O, Gouyet L. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth. 1998;80:294-298.

Huntoon M, Eisenach JC, Boese P. Epidural clonidine after cesarean section: appropriate dose and effect of prior local anesthetic. Anesthesiology. 1992;76:187-193.

Eisenach JC, De Kock M, Klimscha W. - alpha2-adrenergic agonists for regional anesthesia. Anesthesiology. 1996;85:655-674.

Berkowitz DE, Schwinn DA. New advances in receptor pharmacology. Curr Opin Anesth. 1991;4:486-496.

Mizobe T, Maze M. alpha2-adrenoreceptor agonists and anesthesia. Int Anesth Clin. 1995;33:81-102.

Datta S, Camann W, Bader A. Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine versus bupivacaine for cesarean section. Anesthesiology. 1995;82:1346-1352.

Ota K, Namiki A, Ujike Y. Prolongation of tetracaine spinal anesthesia by oral clonidine. Anesth Analg. 1992;79:1121- 1125.

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

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

Butterworth JF, Strichartz GR. The alpha2-adrenergic agonists clonidine and guanfacine produce tonic and phasic block of conduction in rat sciatic nerve fibers. Anesth Analg. 1993;76:295-301.

Rodrigo A, Aghajanian GK. Opiate and alpha 2-adrenoceptor- induced hyperpolarization of locus coeruleus neurons in brain slices: reversal by cyclic adenosine 3’5’- monophosphate analogues. J Neurosc. 1985;5:2359-2364.

Le Polain B, De Koch M, Scholtes JL. Clonidine combined with sufentanil and bupivacaine with adrenaline for obstetric analgesia. Br J Anaesth. 1993;71:657-660.

Timmermans PB, Brands A, Van Zwietan PA. Lipophilicity and brain disposition of clonidine and structurally related imidazolines. Arch Pharmacol. 1997;300:217-226.

Doze VA, Chen B-X, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha2-adrenoceptors. Anesthesiology. 1989;71:75-79.

Correa-Sales C, Rabin B, Maze M. A hypnotic response to dexmedetomidine, an alpha2-agonist, is mediated in the locus coeruleus in rats. Anesthesiology. 1992;76:948-952.

Nacif-Coelho C, Correa-Sales C, Chang LL. Perturbation of ion channel conductance alters the hypnotic response to the alpha2-adrenergic agonist dexmedetomidine in the locus coeruleus of the rat. Anesthesiology. 1994;81:1527-1534.

Eisenach JC, Dupen S, Dubois M. Epidural clonidine study group: epidural clonidine analgesia for intractable cancer pain. Pain. 1995;61:391-399.

Eisenach JC, Hood DD, Tuttle R. Computer-controlled epidural infusion to targeted cerebro-spinal fluid concentrations in humans. Anesthesiology. 1995;83:33-47.

De Kock M, Crochet B, Morimont C. Intravenous or epidural clonidine for intra and postoperative analgesia. Anesthesiology. 1993;77:525-531.

Rauck RL, Eisenach JC, Jackson K. Epidural clonidine treatment for refractory reflex sympathetic distrophy. Anesthesiology. 1993;79:1163-1169.

Alves TCA, Braz JRC, Vianna PTG. alfa2-Agonistas em anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. 2000;50:396-404.

Capogna G, Celleno D. IV clonidine for post-extradural shivering in parturients: a preliminary study. Br J Anaesth. 1993;71:294-295.

Nicolaou G, Chenn AA, Johnston CE. - Clonidine decreases vasoconstriction and shivering thresholds, without affecting the sweating threshold. Can J Anesth. 1997;44:636-642.

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