Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000600003
Brazilian Journal of Anesthesiology
Scientific Article

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

Spinal anesthesia for cesarean section. Use of hyperbaric bupivacaine (10 mg) combined with different adjuvants

Angélica Assunção Braga; José Aristeu F Frias; Franklin S Braga; Glória B Potério; Eunice S Hirata; Nathalia A Torres

http://dx.doi.org/10.1590/S0034-70942012000600003 Braz J Anesthesiol, vol.62, n6, p.781-787, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: A associação de anestésicos locais (AL) a adjuvantes por via subaracnóidea melhora a qualidade do bloqueio e prolonga a duração da analgesia. Foram avaliados os efeitos maternos e as repercussões neonatais da associação de sufentanil, morfina e clonidina à bupivacaína hiperbárica em cesariana eletiva. MÉTODO: Estudo prospectivo, randomizado, encoberto, com 96 pacientes distribuídas em quatro grupos: GI (sem adjuvante); GII (sufentanil; 5,0 µg); GIII (morfina; 100 µg); e GIV (clonidina; 75 µg). Foram avaliados: início e nível de bloqueio sensitivo; analgesia peroperatória; grau e tempo para regressão do bloqueio motor; duração da analgesia; sedação; repercussões materno-fetais. RESULTADOS: O início do bloqueio foi significativamente menor nos grupos com adjuvantes em comparação com o Grupo I. No peroperatório, pacientes dos Grupos I e III referiram dor. A duração da analgesia foi significativamente maior no Grupo II e o tempo para desbloqueio motor foi significativamente maior no Grupo IV. Prurido ocorreu nos grupos II e III. A sedação foi significativa no Grupo IV. A hipotensão arterial foi prolongada no Grupo IV. CONCLUSÃO: A adição de sufentanil e clonidina à bupivacaína hiperbárica proporcionou adequada anestesia para cesariana e boa analgesia pós-operatória. A clonidina causou mais sedação peroperatória e maior tempo para desbloqueio motor. O prurido foi evidente quando do emprego de opioides.

Palavras-chave

ANALGÉSICOS, Clonidina, Opióides, morfina, sufentanil, ANESTESIA, Regional, raquianestesia, ANESTÉSICOS, Local, bupivacaína, CIRURGIA, Cesárea

Abstract

BACKGROUND AND OBJECTIVES: Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section. METHOD: Prospective, randomized, blinded study of 96 patients allocated into four groups: Group I (no adjuvant), Group II (sufentanil 5.0 µg), Group III (morphine 100 µg), and Group IV (clonidine 75 µg). It was evaluated the onset and level of sensory block, perioperative analgesia, degree and recovery time of motor block, duration of analgesia, sedation, and maternal-fetal repercussions. RESULTS: The onset of blockade was significantly faster in groups with adjuvants compared with Group I. Patients in Groups I and III reported pain during the perioperative period. Duration of analgesia was significantly higher in Group II and time to motor block recovery was significantly higher in Group IV. Pruritus occurred in Groups II and III. Sedation was significant in Group IV and there was prolonged arterial hypotension in Group IV. CONCLUSION: Addition of sufentanil and clonidine to hyperbaric bupivacaine provided adequate anesthesia for cesarean section and good postoperative analgesia. Clonidine caused more perioperative sedation and longer time to motor block recovery. Pruritus was evident when opioids were used.

Keywords

Anesthesia, Spinal, Bupivacaine; Cesarean Section, Clonidine, Morphine, Sufentanil

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