Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína

José Ricardo Pinotti Pedro; Lígia Andrade Silva Telles Mathias; Judymara Lauzi Gozzani; Flavia Salles de Souza Pinotti Pedro; José Carlos Rittes

doi:10.1590/S0034-70942009000600002

Scientific Article

Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína

Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine

José Ricardo Pinotti Pedro; Lígia Andrade Silva Telles Mathias; Judymara Lauzi Gozzani; Flavia Salles de Souza Pinotti Pedro; José Carlos Rittes

http://dx.doi.org/10.1590/S0034-70942009000600002 Braz J Anesthesiol, vol.59, n6, p.665-673, 2009

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JUSTIFICATIVA E OBJETIVOS: O bloqueio de plexo braquial é técnica anestésica utilizada para procedimentos em membros superiores. O plexo braquial é território potencial para absorção de anestésicos locais. Estudos dos estereoisômeros da bupivacaína vêm demonstrando menor potencial de toxicidade da fração levógira (levobupivacaína) sobre o sistema cardiovascular. Porém, é discutida a eficácia anestésica (bloqueio sensitivo e motor) da levobupivacaína em anestesia do neuroeixo. Este estudo visa demonstrar a eficácia anestésica da levobupivacaína, comparandoa com a bupivacaína racêmica em bloqueio de plexo braquial, via perivascular subclávia. MÉTODO: Cinquenta pacientes adultos de ambos os sexos, ASA I e II, foram submetidos à anestesia de plexo braquial via perivascular subclávia para procedimentos ortopédicos de membros superiores, com auxílio de neuroestimulador. Foram divididos de modo aleatório em dois grupos: G BUPI - bupivacaína racêmica e G LEVO - levobupivacaína, num volume de 30 mL a 0,5%. O bloqueio sensitivo foi avaliado pelo método de "picada de agulha" nos metâmeros de C5 a C8; e o bloqueio motor, nos intervalos em minutos 1, 2, 5, 10, 15, 20, 25, 30 ou até instalação do bloqueio em movimentos dos dedos, mão, antebraço e braço. RESULTADOS: Não houve diferença estatística entre os dois grupos quanto à latência, incidência de falhas e grau do bloqueio motor, bem como incidência de falhas do bloqueio sensitivo, mas verificou-se diferença estatística da latência do bloqueio sensitivo em todos os metâmeros analisados. Não houve efeitos adversos inerentes à aplicação do anestésico local. CONCLUSÕES: A levobupivacaína demonstrou eficácia anestésica em bloqueio de plexo braquial, equiparável à solução racêmica usualmente empregada.

Palavras-chave

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

Abstract

BACKGROUND AND OBJECTIVES: Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local anesthetics. Studies on bupivacaine isomers have shown reduced cardiovascular toxicity of its levorotatory form (levobupivacaine). However, the anesthetic efficacy (sensorial and motor blockades) of levobupivacaine in neuroaxis blocks has been debated. The objective of this study was to demonstrate the anesthetic efficacy of levobupivacaine in brachial plexus block, using the perivascular subclavian approach, by comparing it to racemic bupivacaine. METHODS: Fifty adult patients of both genders, ASA I and II, underwent subclavian perivascular brachial plexus block, with the aid of a peripheral neurostimulator, for orthopedic surgeries of the upper limbs. Patients were randomly divided into two groups: G BUPI - racemic bupivacaine, and G LEVO - levobupivacaine, and they received 30 mL of the 0.5% solution. Sensorial blockade was evaluated by pinprick stimulation from C5 to C8 metameres; and the motor blockade was assessed 1, 2, 5, 10, 15, 20, 25, and 30 minutes after the administration of the local anesthetic or until blockade of fingers, hand, forearm, and arm movements was observed. RESULTS: Statistical differences in latency, failure rate, and degree of the motor blockade, and failure of the sensorial blockade between both groups were not observed, but the latency of the sensorial blockade in all metameres analyzed showed statistically significant differences. Adverse events inherent to the administration of local anesthetics were not observed. CONCLUSIONS: The anesthetic efficacy of levobupivacaine in brachial plexus block was similar to that of the racemic solution commonly used.

Keywords

ANESTHETICS, Local, ANESTHETICS, Local, ANESTHETIC TECHNIQUE, Regional

Referencias

Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology. 1985;62:396-405.

Bernards CM, Carpenter RL, Kenter ME. Effect of epinephrine on central nervous system and cardiovascular system toxicity of bupivacaine in pigs. Anesthesiology. 1989;71:711-717.

Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine and lidocaine in the conscious dog. Anesth Analg. 1989;69:794-801.

Mazoit JX, Boico O, Samii K. Myocardial uptake of bupivacaine: II. Pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in the isolated perfused rabbit heart. Anesth Analg. 1993;77:477-482.

Simonetti MPB, Batista RA, Ferreira FMC. Estereoisomeria: a interface da tecnologia industrial de medicamentos e da racionalização terapêutica. Rev Bras Anestesiol. 1998;48:390-399.

Santos AC, DeArmas PI. Systemic toxicity of levobupivacaine, bupivacaine and ropivacaine during continuous intravenous infusion to nonpregnant and pregnant ewes. Anesthesiology. 2001;95:1256-1264.

Ohmura S, Kawada M, Ohta T. Systemic toxicity and resuscitation in bupivacaine-, levobupivacaine-, or ropivacaine-infused rats. Anesth Analg. 2001;93:743-748.

Gristwood RW. Cardiac and CNS toxicity of levobupivacaine: strengths of evidence for advantage over bupivacaine. Drug Saf. 2002;25:153-163.

Tanaka PP, Ogleari M, Valmorbida . Estudo comparativo entre soluções a 0,5% de levobupivacaína, bupivacaína em excesso enantiomérico de 50% e bupivacaína racêmica em anestesia peridural para cirurgia de abdômen inferior. Rev Bras Anestesiol. 2005;55:597-605.

Koch T, Fichtner A, Schwemmer U. Levobupivacaine for epidural anaesthesia and postoperative analgesia in hip surgery: a multi-center efficacy and safety equivalence study with bupivacaine and ropivacaine. Anaesthesist. 2008;57:475-482.

Luck JF, Fettes PD, Wildsmith JA. Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth. 2008;10:705-710.

Mantouvalou M, Ralli S, Arnaoutoglou H. Spinal anesthesia: comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesthesiol Belg. 2008;59:65-71.

De Negri P, Ivani G, Tirri T. A comparison of epidural bupivacaine, levobupivacaine, and ropivacaine on postoperative analgesia and motor blockade. Anesth Analg. 2004;99:45-48.

Beilin Y, Guinn NR, Bernstein HH. Local anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine. Anesth Analg. 2007;105:756-763.

Camorcia M, Capogna G, Berritta C. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg. 2007;104:904-907.

Lacassie HJ, Habib AS, Lacassie HP. Motor blocking minimum local anesthetic concentrations of bupivacaine, levobupivacaine, and ropivacaine in labor. Reg Anesth Pain Med. 2007;32:323-329.

Cox CR, Checketts MR, Mackenzie N. Comparison of S(-)- bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block. Br J Anesth. 1998;80:594-598.

Crews JC, James RL. 0,5% Levobupivacaine for axillary plexus anaesthesia: efficacy, safety, pharmacokinetics. Eur J Anaesthesiol. 2000;17:100-109.

Casati A, Borghi B, Fanelli G. Interscalene brachial plexus anesthesia and analgesia for open shoulder surgery: a randomized, double-blinded comparison between levobupivacaine and ropivacaine. Anesth Analg. 2003;96:253-259.

Cline E, Franz D, Polley RD. Analgesia and effectiveness of levobupivacaine compared with ropivacaine in patients undergoing an axillary brachial plexus block. AANA J. 2004;72:339-345.

Liisanantti O, Luukkonen J, Rosenberg PH. High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block. Acta Anaesthesiol Scand. 2004;48:601-606.

Nuñez Aguado D, López Alvarez S, Salamanca Montaña ME. Bloqueo del plexo braquial a nivel humeral con levobupivacaina: estúdio comparativo alta concentración/pequeiio volumen frente a baja concentración/alto volumen. Rev Esp Anestesiol Reanim. 2005;52:529-535.

Kean J, Wigderowitz CA, Coventry DM. Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder: A double-blind, randomised controlled trial. J Bone Joint Surg Br. 2006;88:1173-1177.

Zhao X, Wang YW, Chen H. Efficacy of low dose levobupivacaine (0.1%) for axillary plexus block using multiple nerve stimulation. Anaesth Intensive Care. 2008;36:850-854.

Winnie AP, Collins VJ. The subclavian perivascular technique of brachial plexus anesthesia. Anesthesiology. 1964;25:353-363.

Liu SS, Hodgson PS. Local Anesthetics. Clinical Anesthesia. 2001:449-469.

Crews JC, Weller RS, Moss J. Levobupivacaine for axillary brachial plexus block: a pharmacokinetic and clinical comparison in patients with normal renal function or renal disease. Anesth Analg. 2002;95:219-223.

Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína

Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine

José Ricardo Pinotti Pedro; Lígia Andrade Silva Telles Mathias; Judymara Lauzi Gozzani; Flavia Salles de Souza Pinotti Pedro; José Carlos Rittes

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