Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000200002
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos do bloqueio pudendo, peridural e subaracnóideo sobre a coagulação sangüínea de gestantes

Effects of pudendal nerve, epidural and subarachnoid block on coagulation of pregnant women

Alberto Vasconcelos; Lígia Andrade da Silva Telles Mathias

http://dx.doi.org/10.1590/S0034-70942008000200002 Braz J Anesthesiol, vol.58, n2, p.95-105, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: Tem sido atribuída à anestesia regional diminuição significativa das complicações tromboembólicas no pós-operatório, provavelmente por sua ação atenuadora sobre a resposta neuroendócrino-metabólica. As gestantes, que apresentam aumento importante da coagulabilidade sangüínea, podem, teoricamente, beneficiar-se desse efeito por ocasião do parto. O objetivo deste estudo foi verificar o efeito da anestesia regional sobre a coagulação sangüínea em gestantes. MÉTODO: Foram estudadas 30 pacientes no terceiro trimestre de gestação, sendo dez submetidas à anestesia peridural para cesariana, com 150 mg de bupivacaína a 0,5% sem epinefrina e 2 mg de morfina (grupo PD); dez à anestesia subaracnóidea para cesariana com 15 mg de bupivacaína hiperbárica a 0,5% e 0,2 mg de morfina (grupo SA); e dez a bloqueio de pudendo para parto vaginal, com doses de até 100 mg de bupivacaína a 0,5% sem epinefrina (grupo BP). A coagulação sangüínea foi avaliada por meio de coagulograma (tempo de protrombina, tempo de trombina, tempo de tromboplastina parcial ativada) e de tromboelastograma (tempo r, tempo k, tempo r + k, ângulo alfa e amplitude máxima) nos seguintes momentos: antes e após a anestesia, após o nascimento do feto e 24 horas após a anestesia nos grupos PD e SA. No grupo BP a avaliação foi realizada antes da anestesia, após o nascimento do feto e 24 horas após a anestesia. RESULTADOS: Os resultados mostraram que nenhuma das técnicas anestésicas utilizadas teve influência na coagulação sangüínea das gestantes. Demonstraram, também, que durante o trabalho de parto tem início um processo de ativação da coagulação que é responsável pelas alterações encontradas nos três grupos estudados. CONCLUSÕES: Nas condições do presente estudo o bloqueio simpático e o anestésico local não influíram sobre a coagulação em gestantes de termo submetidas à anestesia peridural, subaracnóidea ou bloqueio pudendo.

Palavras-chave

ANESTESIA, Obstétrica, ANESTÉSICOS, Local, SANGUE, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The significant reduction in postoperative thromboembolic complications has been attributed to the use of regional block, probably due to attenuation of the neuroendocrine-metabolic response. Pregnant women, who demonstrate important hypercoagulability, can in theory benefit from this effect during labor. The objective of this study was to determine the effects of regional block on coagulation of pregnant women. METHODS: Thirty patients in the 3rd trimester were enrolled; ten patients underwent epidural block for cesarean section with 150 mg of 0.5% bupivacaine without epinephrine and 2 mg of morphine (PD group); ten underwent subarachnoid block for cesarean section with 15 mg of 0.5% hyperbaric bupivacaine and 0,2 mg of morphine (SA group); and ten, pudendal block for vaginal delivery with up to 100 mg of 0.5% bupivacaine without epinephrine (BP group). Coagulation tests (prothrombin time, thrombin time, activated partial thromboplastin time) and thromboelastography (r-time, k-time, r+k-time, alpha-angle, maximum amplitude) were performed in the following moments: before and after the blockade, after delivery, and 24 hours after the blockade in PD and SA groups. In the BP group, the evaluation was done before the blockade, after delivery, and 24 hours after the blockade. RESULTS: The results indicate that the anesthetic technique did not influence coagulation of pregnant women. They also demonstrate that coagulation is activated during labor, which is responsible for the changes seen in all the study groups. CONCLUSIONS: In the conditions of the present study, the sympathetic blockade and the local anesthetic did not have any influence on the coagulation of pregnant women at term undergoing epidural, subarachnoid, or pudendal nerve block.

Keywords

ANESTHESIA, Obstetric, ANESTHETICS, Local, ANESTHETIC TECHNIQUE, Regional, ANESTHETIC TECHNIQUE, Regional, ANESTHETIC TECHNIQUE, Regional, BLOOD, MEASUREMENT TECHNIQUE

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