Anestesia peribulbar com ropivacaína: estudo da ação vasoconstritora

Catia Sousa Govêia; Edno Magalhãe

doi:10.1590/S0034-70942010000500006

Scientific Article

Anestesia peribulbar com ropivacaína: estudo da ação vasoconstritora

Ropivacaine in peribulbar anesthesia: vasoconstrictive properties

Catia Sousa Govêia; Edno Magalhãe

http://dx.doi.org/10.1590/S0034-70942010000500006 Braz J Anesthesiol, vol.60, n5, p.495-512, 2010

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JUSTIFICATIVA E OBJETIVOS: A anestesia peribulbar pode reduzir o fluxo sanguíneo ocular (FSO) por elevação da pressão intraocular (PIO) ou ação de fármacos. A ropivacaína tem baixa toxicidade e ação vasoconstritora intrínseca ainda não comprovada sobre vasculatura ocular. Medidas da amplitude de pulso ocular (APO) permitem avaliação indireta do FSO. O objetivo deste estudo é avaliar, via FSO, a ação vasoconstritora da ropivacaína em anestesia peribulbar. MÉTODO: Quarenta olhos submetidos a bloqueio peribulbar com 7 mL de solução anestésica, sem vasoconstritor, foram separados aleatoriamente em dois grupos: ropivacaína (n = 20) e bupivacaína (n = 20). Foram avaliados PIO, pressão de perfusão ocular (PPO), APO, variáveis hemodinâmicas e grau de acinesia antes e aos 5 e 10 minutos após bloqueio peribulbar. Para avaliação dos parâmetros oculares, utilizou-se tonômetro de contorno dinâmico. A sedação foi idêntica nos dois grupos. RESULTADOS: Não houve variação significativa dos parâmetros hemodinâmicos e da intensidade de bloqueio motor entre os grupos. Aos 5 e 10 minutos houve diferença de PIO, PPO e APO entre os grupos (p < 0,05). A variação da PIO aos 5 e 10 minutos foi, respectivamente, de -0,88% e -4,54% com ropivacaína e 17,61% e 16,56% com bupivacaína. A alteração da PPO após 5 e 10 minutos foi de 1,5% e 4,2% com ropivacaína, e de -7% e -6% com bupivacaína. A APO variou -55,59% e -59,67% com ropivacaína aos 5 e 10 minutos, e -34,71% e -28,82% com bupivacaína. CONCLUSÕES: A ropivacaína reduziu mais intensamente a amplitude de pulso ocular, apesar das pequenas alterações de PIO e PPO. A diminuição do fluxo sanguíneo ocular pela ropivacaína pode ser atribuída ao seu efeito vasoconstritor

Palavras-chave

ANESTÉSICOS, Local, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Peribulbar anesthesia can reduce ocular blood flow (OBF) by increasing intraocular pressure (IOP) or due to the action of drugs. Ropivacaine has low toxicity and intrinsic vasoconstrictive properties, yet to be proven on the ocular vasculature. Measurements of ocular pulse amplitude (OPA) allow the indirect evaluation of the OBF. The objective of the present study was to evaluate through the OBF the vasoconstrictive properties of ropivacaine in peribulbar anesthesia. METHODS: Forty eyes undergoing peribulbar anesthesia with 7 mL of anesthetic solution without vasoconstrictor were randomly divided into two groups: ropivacaine (n = 20) and bupivacaine (n = 20). The IOP, ocular perfusion pressure (OPP), OPA, hemodynamic parameters, and the degree of akinesia before and 5 and 10 minutes after the blockade were evaluated. A dynamic contour tonometer was used to evaluate ocular parameters. Sedation was similar in both groups. RESULTS: A significant variation in hemodynamic parameters and intensity of the motor blockade was not observed between groups. Differences in IOP, OPP, and OPA (p < 0.05) were observed between both groups at 5 and 10 minutes. The variation of IOP at 5 and 10 minutes was -0.88% and -4.54%, respectively with ropivacaine, and 17.61% and 16.56% with bupivacaine. The change in OPP after 5 and 10 minutes was 1.5% and 4.2% with ropivacaine, and -7% and -6% with bupivacaine. Ocular pulse amplitude varied -55.59% and -59.67% with ropivacaine at 5 and 10 minutes, and -34.71% and -28.82% with bupivacaine. CONCLUSIONS: Ropivacaine reduced more intensely the ocular pulse amplitude despite little changes in IOP and OPP. The reduction in ocular blood flow caused by ropivacaine can be attributed to its vasoconstrictive effect

Keywords

ANESTHESICS, Local, ANESTHESICS TECHNICS, Regional, MEASUREMENT TECHNICS

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Anestesia peribulbar com ropivacaína: estudo da ação vasoconstritora

Ropivacaine in peribulbar anesthesia: vasoconstrictive properties

Catia Sousa Govêia; Edno Magalhãe

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