Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000500007
Brazilian Journal of Anesthesiology
Scientific Article

Incidência de tremores após cesarianas sob raquianestesia com ou sem sufentanil intratecal: estudo aleatório

Incidence of shivering after cesarean section under spinal anesthesia with or without intrathecal sufentanil: a randomized study

Giovani de Figueiredo Locks

http://dx.doi.org/10.1590/S0034-70942012000500007 Braz J Anesthesiol, vol.62, n5, p.680-684, 2012
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Resumo

JUSTIFICATIVA E OBJETIVO: Tremores são causa de desconforto e insatisfação das pacientes submetidas à cesariana. O objetivo deste estudo foi analisar o impacto do uso de sufentanil intratecal na incidência de tremores após cesarianas. PACIENTES E MÉTODOS: Em um ensaio clínico prospectivo aleatório encoberto, foram incluídas no estudo gestantes submetidas à cesariana sob raquianestesia. Foram excluídas as gestantes em trabalho de parto, febris, obesas, com doença hipertensiva da gravidez, com falha do bloqueio anestésico ou complicação cirúrgica. As pacientes foram distribuídas aleatoriamente em dois grupos. No Grupo I foram administrados 10 mg de bupivacaína 0,5% hiperbárica associados a 80 mcg de morfina e 2,5 mcg de sufentanil. No Grupo II foram administrados 10 mg de bupivacaína 0,5% hiperbárica associados a 80 mcg de morfina. Na Sala de Recuperação Pós-Anestésica as pacientes foram avaliadas quanto à presença de sinais de tremores por observador que desconhecia o grupo ao qual a paciente havia sido alocada. RESULTADOS: A amostra constou de 80 pacientes. Em ambos os grupos houve diminuição na temperatura axilar das pacientes após a cesariana (p < 0,001). Essa diminuição não se mostrou diferente entre os grupos (p < 0,21). No Grupo I a incidência de tremores foi de 13/40 (32,5%) pacientes e no Grupo II foi de 25/40 (62,5%) (p < 0,007) - Risco Relativo 0,53 (IC 95% 0,32-0,87). CONCLUSÕES: Sugere-se que a adição de sufentanil à bupivacaína hiperbárica e morfina durante raquianestesia para cesariana proporciona diminuição na incidência de tremores no período pós-operatório imediato.

Palavras-chave

ANALGÉSICOS, Opióides, sufentanil, CIRURGIA, cesárea, COMPLICAÇÕES, Tremores, TÉCNICAS ANESTÉSICAS, Regional, subaracnoidea

Abstract

BACKGROUND AND OBJECTIVES: Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section. The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section. METHOD: In a prospective blinded, randomized clinical trial, pregnant women undergoing cesarean section under spinal anesthesia were enrolled. Pregnant women in labor, febrile, obese, with pregnancy-induced hypertension, anesthetic block failure or surgical complications were excluded. Patients were randomly assigned to two groups. In Group I, 10 mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered. In Group II, 10 mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine were administered. In the post-anesthesia care unit, patients were evaluated for signs of shivering by an investigator blinded to the patient's group allocation. RESULTS: The sample consisted of 80 patients. In both groups there was a decrease in axillary temperature of patients after cesarean section (p < 0.001). This decrease was not different between groups (p < 0.21). In Group I, the incidence of tremor was 32.5% (13/40) and in Group II it was 62.5% (25/40) (p < 0.007); RR 0.53 (CI 95% 0.32-0.87). CONCLUSIONS: It has been suggested that the addition of sufentanil to hyperbaric bupivacaine and morphine during spinal anesthesia for cesarean section provides a decrease in the incidence of shivering in the immediate postoperative period.

Keywords

Cesarean Section, Anesthesia, Spinal, Shivering, Sufentanil

References

Biazzotto CB, Brudniewski M, Schmidt AP, Auler Junior JO. Perioperative hypothermia. Rev Bras Anestesiol. 2006;56:89-106.

Kurz A. Thermal care in the perioperative period. Best Pract Res Clin Anaesthesiol. 2008;22:39-62.

Albergaria VF, Lorentz MN, Lima FA. Intra and postoperative tremors: prevention and pharmacological treatment. Rev Bras Anestesiol. 2007;57:431-444.

Capogna G, Celleno D. Improving epidural anesthesia during cesarean section: causes of maternal discomfort or pain during surgery. Int J Obstet Anesth. 1994;3:149-152.

Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. 2007;106:843-863.

Braga Ade F, Braga FS, Poterio GM, Pereira RI, Reis E, Cremonesi E. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol. 2003;20:631-635.

De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology. 2002;96:467-484.

Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia. 1994;49:205-207.

Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg. 2007;105:1413-1419.

Ciofolo MJ, Clergue F, Devilliers C, Ben Ammar M, Viars P. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology. 1989;70:737-741.

Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008;33:241-252.

Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-338.

Arkilic CF, Akca O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg. 2000;91:662-666.

Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92:1330-1334.

Braga Ade F, Frias JA, Braga FS, Pinto DR. Spinal block with 10 mg of hyperbaric bupivacaine associated with 5 microg of sufentanil for cesarean section: Study of different volumes. Rev Bras Anestesiol. 2010;60:121-9.

Kelsaka E, Baris S, Karakaya D, Sarihasan B. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med. 2006;31:40-45.

Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg. 2002;94:453-460.

Wrench IJ, Cavill G, Ward JE, Crossley AW. Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering. Br J Anaesth. 1997;79:541-542.

Mohta M, Kumari N, Tyagi A, Sethi A, Agarwal D, Singh M. Tramadol for prevention of postanaesthetic shivering: a randomised doubleblind comparison with pethidine. Anaesthesia. 2009;64:141-146.

Terasako K, Yamamoto M. Comparison between pentazocine, pethidine and placebo in the treatment of post-anesthetic shivering. Acta Anaesthesiol Scand. 2000;44:311-312.

Joris J, Banache M, Bonnet F, Sessler DI, Lamy M. Clonidine and ketanserin both are effective treatment for postanesthetic shivering. Anesthesiology. 1993;79:532-539.

Honarmand A, Safavi MR. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. Br J Anaesth. 2008;101:557-562.

Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg. 2001;93:1288-1292.

Wadhwa A, Sengupta P, Durrani J. Magnesium sulphate only slightly reduces the shivering threshold in humans. Br J Anaesth. 2005;94:756-762.

Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesthesiol Scand. 2007;51:44-49.

Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesth Analg. 2005;101:S30-43.

Roy JD, Girard M, Drolet P. Intrathecal meperidine decreases shivering during cesarean delivery under spinal anesthesia. Anesth Analg. 2004;98:230-234.

Hong JY, Lee IH. Comparison of the effects of intrathecal morphine and pethidine on shivering after Caesarean delivery under combinedspinal epidural anaesthesia. Anaesthesia. 2005;60:1168-72.

Yu SC, Ngan Kee WD, Kwan AS. Addition of meperidine to bupivacaine for spinal anaesthesia for Caesarean section. Br J Anaesth. 2002;88:379-383.

Techanivate A, Rodanant O, Tachawattanawisal W, Somsiri T. Intrathecal fentanyl for prevention of shivering in cesarean section. J Med Assoc Thai. 2005;88:1214-1221.

Castro LFL, Serafim MM, Côrtes CAF, Neto NLdS, Vasconcellos FO, Oliveira AS. Avaliação do estado ácido-básico materno com o uso de sufentanil por via subaracnoidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos. Rev Bras Anestesiol. 2003;53:17-24.

Yazigi A, Chalhoub V, Madi-Jebara S, Haddad F, Hayek G. Prophylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritus after cesarean delivery with intrathecal sufentanilmorphine. J Clin Anesth. 2002;14:183-186.

Woolnough M, Allam J, Hemingway C, Cox M, Yentis SM. Intraoperative fluid warming in elective caesarean section: a blinded randomised controlled trial. Int J Obstet Anesth. 2009;18:346-351.

Yokoyama K, Suzuki M, Shimada Y, Matsushima T, Bito H, Sakamoto A. Effect of administration of pre-warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for Cesarean delivery. J Clin Anesth. 2009;21:242-248.

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