Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000200003
Brazilian Journal of Anesthesiology
Scientific Article

Efeito da adição de clonidina subaracnóidea à bupivacaína hiperbárica e sufentanil para analgesia de parto

The effect of adding subarachnoid clonidine to hyperbaric bupivacaine and sufentanil during labor analgesia

Mônica Maria Siaulys Capel Cardoso; Fabio V. Papa; Roberta F. Vieira; Mário M. Kondo; Marcelo Luis Abramides Torres

http://dx.doi.org/10.1590/S0034-70942006000200003 Braz J Anesthesiol, vol.56, n2, p.119-125, 2006
PDF Português
PDF English
Downloads: 4
Views: 2096

Resumo

JUSTIFICATIVA E OBJETIVOS: A adição de clonidina subaracnóidea (um alfa-agonista), prolonga a ação analgésica da combinação do sufentanil e da bupivacaína isobárica em analgesia combinada para o trabalho de parto. O objetivo desse estudo foi comparar a qualidade e a duração de analgesia e a incidência de efeitos colaterais após a adição de clonidina subaracnóidea à bupivacaína hiperbárica e sufentanil em anestesia combinada raqui-peridural para o trabalho de parto. MÉTODO: Foram estudadas 26 gestantes de termo, estado físico ASA I, em trabalho de parto, que receberam aleatoriamente no espaço subaracnóideo: clonidina, sufentanil e bupivacaína (n = 13), denominado Grupo Clon/Sufenta/Bupi, 2,5 mg de bupivacaína hiperbárica a 0,5% associada a 2,5 µg de sufentanil e 30 µg de clonidina; sufentanil e bupivacaína (n = 13), denominado Grupo Sufenta/Bupi, 2,5 mg de bupivacaína hiperbárica a 0,5% associada a 2,5 µg de sufentanil. O estudo foi duplamente encoberto. A dor e os efeitos colaterais (náusea, vômito, prurido, hipotensão arterial e sedação) foram avaliados a cada cinco minutos nos primeiros 15 minutos e, a seguir, a cada 15 minutos até o nascimento. A dor foi avaliada com a escala analógica visual de 0-10 cm (VAS = 0, ausência de dor e 10, dor insuportável), e o estudo foi encerrado no momento em que foi necessária complementação analgésica peridural (dor > 3 cm) ou ao nascimento. A análise estatística foi realizada com os testes t de Student e Exato de Fisher, considerando como significativo p < 0,05. RESULTADOS: As médias de dor nos momentos - 0 min (8,9 ± 1,6/7,6 ± 2,1), 5 min (3,4 ± 2,3/2,3 ± 3,1), 10 min (1,5 ± 2,5/1,4 ± 2,2) e 15 min (0,26 ± 0,8/1,4 ± 2,2) nos grupos Clon/Sufenta/Bupi e Sufenta/Bupi foram semelhantes, respectivamente. Não se observaram diferenças em relação à duração da analgesia (58,8 ± 32 min / 55,4 ± 53 min), ocorrência de prurido (4/13 e 4/12 pacientes), náusea (1/13 e 1/12 pacientes), vômito (1/13 e 0/12 pacientes) e hipotensão arterial (2/13 e 1/12 pacientes) nos grupos Clon/Sufenta/Bupi e Sufenta/Bupi, respectivamente. Não se observou efeito sedativo da clonidina em nenhuma paciente. Uma paciente do grupo Sufenta/Bupi foi excluída do estudo por falha total do bloqueio após 15 minutos. CONCLUSÕES: Nas condições estudadas, a adição de clonidina em baixa dose (30 µg) e quando associada a soluções hiperbáricas não prolonga a duração da analgesia, não melhora a qualidade do bloqueio e não determina ocorrência de hipotensão arterial e/ou sedação.

Palavras-chave

ANALGESIA, ANALGÉSICOS, Opióides, ANESTÉSICOS, Local, CIRURGIA, Obstétrica, DROGAS, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Adding subarachnoid clonidine (an alpha -agonist) prolongs the analgesic effect of the combination of sufentanil and isobaric bupivacaine when combined during labor analgesia. The aim of this study was to compare the quality and duration of the analgesia as well as the incidence of side-effects after the addition of subarachnoid clonidine to hyperbaric bupivacaine and sufentanil in a combined spinal-epidural analgesia during labor. METHODS: Twenty-six patients, physical status ASA I in full-term pregnancy were studied. They randomly received the following in the subarachnoid space: clonidine, sufentanil and bupivacaine (n = 13) - referred to as the Clon/Sufenta/Bupi Group - wherein 2.5 mg of 0.5% hyperbaric bupivacaine was added to 2.5 µg of sufentanil and 30 µg of clonidine; sufentanil and bupivacaine (n = 13) - referred to as the Sufenta/Bupi Group - wherein 2.5 mg of 0.5% hyperbaric bupivacaine was added to 2.5 µg of sufentanil. This was a double-blind study. Evaluations of pain and side effects (nausea, vomiting, itching, low blood pressure and sedation) were conducted every five minutes for the first 15 minutes and after that, every 15 minutes up until the birth of the baby. Pain was evaluated using a visual analogic scale ranging from 0-10 cm (VAS 0 = absence of pain and 10 = unbearable pain). The study was over whenever complementary epidural anasthesia was found necessary (pain > 3 cm) or at the moment of birth. A Student t-test statistical analysis was performed and the results were significant (p < 0.05). RESULTS: The mean pain scores at the times measured were similar for the Clon/Sufenta/Bupi and Sufenta/Bupi Groups respectively: 0 min (8.9 ± 1.6/ 7.6 ± 2.1), 5 min (3.4 ± 2.3/ 2.3 ± 3.1), 10 min (1.5 ± 2.5/ 1.4 ± 2.2) and 15 min (0.26 ± 0.8/ 1.4 ± 2.2). No differences between the Clon/Sufenta/Bupi and Sufenta/Bupi Groups, respectively, were observed regarding: the duration of the analgesia (58.8 ± 32 min / 55.4 ± 53 min), itching (4/13 and 4/12 patients), nausea (1/13 and 1/12 patients), vomiting (1/13 and 0/12 patients) and low blood pressure (2/13 and 1/12 patients). The sedative effect of clonidine was not observed in any patient. One patient from the Sufenta/Bupi group was eliminated from the study because the anaesthesia failed to take effect after 15 minutues. CONCLUSIONS: Under the conditions observed in the study, adding a low dosage of clonidine when combined with a hyperbaric solution does not prolong the duration of the analgesia, does not improve the quality of the action and does not act as the determining factor for the occurence of low blood pressure or sedation.

Keywords

ANALGESIA, ANALGESICS, Opioids, ANESTHETICS, Local, SURGERY, Obstetrics, DRUGS, ANESTHETIC TECHNIQUES, Regional

Referencias

Yamaguchi ET, Fonseca US, Carvalho JCA. Sufentanil subaracnóideo associado à bupivacaína hiperbárica para analgesia de parto: É possível reduzir a dose de opióide?. Rev Bras Anestesiol. 2004;54:145-152.

D'Ängelo R, Evans E, Dean LA. Spinal clonidine prolongs labor analgesia from spinal sufentanil and bupivacaine. Anesth Analg. 1999;88:573-576.

Amaral JLG, Rodrigues GR, Rocha RGA. Sedação Analgesia e Bloqueio Neuromuscular em UTI. 1996:75-94.

Amaro AR, Capelli EL, Cardoso MMSC. Manual left uterine displacement or modified crawford's edge: A comparative study in spinal anesthesia for cesarean delivery. Braz J Anesthesiol Int Issue. 1999;10:11-14.

Gautier PE, De Kock M, Fanard L. Intrathecal clonidine combined with sufentanil for labor analgesia. Anesthesiology. 1998;88:651-666.

Cardoso MMSC, Amaro AR, Yamaguchi ET. Intrathecal sufentanil added to either plain or hyperbaric bupivacaine for labor analgesia. Anesthesiology. 2003;99:A1169.

Nicol ME, Holdcroft A. Density of intrathecal agents. Br J Anaesth. 1992;68:60-63.

Guyenet PG, Cabot JB. Inhibition of sympathetic preganglionic neurons by cathecolamines and clonidine: mediation by an alpha adrenergic receptor. J Neurosci. 1981;1:908-917.

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

De Kock M. Site of hemodynamic effects of alpha2-adrenergic agonists. Anesthesiology. 1991;75:715-716.

Eisenach JC, Tong CY. Site of hemodynamic effects of intrathecal alpha2-adrenergic agonists. Anesthesiology. 1991;74:766-771.

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

Chiari A, Lorber C, Taslimi R. Combination of low dose intrathecal sufentanil and clonidine for obstetric analgesia. Reg Anesth. 1996;21:390.

5dd433880e88254e41c63495 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections