Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000600008
Brazilian Journal of Anesthesiology
Scientific Article

Influência de anestésicos locais sobre o bloqueio neuromuscular produzido pelo rocurônio: ação da lidocaína e da mistura enantiomérica em excesso de 50% de bupivacaína na junção neuromuscular

Influence of local anesthetics on the neuromuscular blockade produced by rocuronium: effects of lidocaine and 50% enantiomeric excess bupivacaine on the neuromuscular junction

Angélica de Fátima de Assunção Braga; Vanessa Henriques Carvalho; Franklin Sarmento da Silva Braga; Léa Rodrigues-Simioni; Yolanda Christina S Loyola; Glória Braga Potério

http://dx.doi.org/10.1590/S0034-70942009000600008 Braz J Anesthesiol, vol.59, n6, p.725-734, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os efeitos dos anestésicos locais (AL) na transmissão neuromuscular e sua influência no bloqueio neuromuscular produzido por bloqueadores neuromusculares competitivos são ainda alvo de pouca investigação. O objetivo do estudo foi avaliar in vitro os efeitos da lidocaína e da mistura enantiomérica em excesso de 50% de bupivacaína (S75-R25) no bloqueio neuromuscular produzido pelo rocurônio. MÉTODOS: Ratos foram distribuídos em cinco grupos (n = 5) de acordo com o fármaco estudado: lidocaína, bupivacaína (S75-R25), rocurônio, isoladamente (grupos I, II e III); rocurônio em preparações previamente expostas aos AL (grupos IV e V). As concentrações utilizadas foram: 20 µg.mL-1, 5 µg.mL-1 e 4 µg.mL¹ para lidocaína, bupivacaína (S75-R25) e rocurônio, respectivamente. Avaliaram-se: 1) a força de contração muscular do diafragma à estimulação elétrica indireta, antes e 60 minutos após a adição dos AL e do rocurônio isoladamente, e a associação AL-rocurônio; 2) os efeitos dos AL sobre o potencial de membrana (PM) e potenciais de placa terminal em miniatura (PPTM). Em preparação biventer cérvicis de pintainho, foi avaliado o efeito do AL na resposta contraturante à acetilcolina. RESULTADOS: A lidocaína e a bupivacaína (S75-R25) isoladamente não alteraram as respostas musculares e os valores do PM. Nas preparações expostas aos AL, o bloqueio pelo rocurônio foi significativamente maior em relação ao produzido pelo rocurônio isoladamente. Em preparação biventer cervicis de pintainho, a lidocaína e a bupivacaína (S75-R25) diminuíram a resposta de contração à acetilcolina. A lidocaína aumentou a frequência dos PPTM, seguido de bloqueio; a bupivacaína (S75-R25) produziu diminuição seguida de bloqueio. CONCLUSÕES: Os anestésicos locais potencializaram o bloqueio neuromuscular causado pelo rocurônio. Os resultados mostraram ação pré-sináptica e póssináptica.

Palavras-chave

ANESTÉSICOS, Local, ANESTÉSICOS, Local, ANIMAIS, BLOQUEADORES NEUROMUSCULARES, Não despolarizantes

Abstract

BACKGROUND AND OBJECTIVES: The effects of local anesthetics (LA) on neuromuscular transmission and their influence on the neuromuscular blockade produced by competitive neuromuscular blockers have not been fully investigated. The objective of this study was to evaluate, in vitro, the effects of lidocaine and 50% enantiomeric excess bupivacaine (S75-R25) on the neuromuscular blockade produced by rocuronium. METHODS: The rats were divided in five groups (n = 5) according to the drug used: isolated lidocaine, bupivacaine (S75-R25), or rocuronium (groups I, II, and II); and rocuronium in preparations previously exposed to LAs (groups IV and V). The concentrations used were as follows: 20 µg.mL-1, 5 µg.mL-1, and 4 µg.mL-1 of lidocaine, bupivacaine (S75-R25), and rocuronium, respectively. The following parameters were evaluated: 1) the strength of muscular contraction of the diaphragm to indirect electrical stimulations, before and 60 minutes after the isolated addition of the LAs and rocuronium, and the association AL-rocuronium; and 2) the effects of LAs on membrane potential (MP) and miniature end-plate potentials (MEPP). The effect of LAs on muscle contraction in response to acetylcholine was evaluated in chick biventer cervicis preparations. RESULTS: Isolated lidocaine and bupivacaine (S75-R25) did not change the muscular response and the levels of MPs. In preparations exposed to LAs, rocuroniuminduced blockade was significantly greater than that produced by rocuronium alone. In chick biventer cervicis preparations, lidocaine and bupivacaine (S75R25) decreased contraction in response to acetylcholine. Lidocaine increased the frequency of MEPPs, which was followed by the blockade; bupivacaine (S75R25) caused a reduction in MEPPs followed by blockade. CONCLUSIONS: Local anesthetics caused a potentiation of the neuromuscular blockade produced by rocuronium. The results showed pre- and post-synaptic effects.

Keywords

ANESTHETICS, Local, ANESTHETICS, Local, ANIMALS, NEUROMUSCULAR BLOCKERS, Non-depolarizing

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