Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego

Derya Arslan Yurtlu; Kadir Kaya

doi:10.1590/S0034-70942013000100007

Scientific Article

Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego

Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study

Derya Arslan Yurtlu; Kadir Kaya

http://dx.doi.org/10.1590/S0034-70942013000100007 Braz J Anesthesiol, vol.63, n1, p.92-98, 2013

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Resumo

JUSTIFICATIVA E OBJETIVOS: Iniciar a anestesia peridural com anestésicos locais de longa duração consome uma quantidade significativa de tempo, o que pode ser problemático em centros de anestesia obstétrica muito movimentados. Aventamos a hipótese de que uma combinação de articaína e ropivacaína proporcionaria início mais rápido e mesmo uma recuperação precoce das características do bloqueio sensório-motor. MÉTODOS: Sessenta parturientes a termo agendadas para cesariana eletiva foram randomicamente alocadas em três grupos para receber 20 mL de articaína a 2% (Grupo A), 10 mL de articaína a 2% + 10 mL de ropivacaína a 0,75% (Grupo AR) ou 20 mL de ropivacaína a 0,75% (Grupo R) via cateter peridural. O tempo de início do bloqueio sensorial até T10-T6 e o nível máximo de bloqueio, o tempo para a regressão de dois segmentos do nível máximo de bloqueio sensorial e o tempo de início e duração do bloqueio motor foram todos registrados. A necessidade de analgésicos adicionais, intra- e pós-operatoriamente, também foi registrada. RESULTADOS: Os dados demográficos foram semelhantes. Os tempos de início do bloqueio sensorial até os níveis T10 e T6 foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p < 0,05). Os tempos de início do bloqueio motor foram semelhantes em todos os grupos, mas um bloqueio motor mais profundo foi observado no Grupo R (p < 0,05). O tempo para a regressão de dois segmentos e a duração do bloqueio motor foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p < 0,05). A necessidade de analgésico adicional no período intraoperatório foi maior no Grupo A do que nos outros dois grupos (p < 0,05). CONCLUSÃO: A combinação de 2% articaína e 0,75% ropivacaína para anestesia peridural em cesariana deve ser preferida à administração peridural de ropivacaína a 0,75% sozinha.

Palavras-chave

ANESTÉSICOS, Local, ropivacaína, carticaína, CIRURGIA, Cesárea, TÉCNICAS ANESTÉSICAS, Regional, peridural

Abstract

BACKGROUND AND OBJECTIVES: Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. METHODS: Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A), 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR) or 20 mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. RESULTS: Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p < 0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p < 0.05). CONCLUSION: A combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.

Keywords

Anesthesia, Epidural, Anesthetics, Local, Carticaine, Cesarean Section

References

Carrie LES. Extradural, spinal or combined block for obstetric surgical anaesthesia. Br J Anaesth. 1990.

Dresner MR, Freeman JM. Anaesthesia for caesarean section. Best Pract Res Clin Obstet Gynaecol. 2001;15:127-143.

Gogarten W. Spinal anaestesia for obstetrics. Best Pract Res Clin Anaesthesiol. 2003;17:377-392.

Kallio H, Paloheimo M, Maunuksela EL. Hyaluronidase as an adjuvant in bupivacaine-lidocaine mixture for retrobulbar/ peribulbar block. Anesth Analg. 2000;91:934-937.

Axelsson K, Gupta A. Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol. 2009;22:649-654.

Capogna G, Celleno D, Costantino P, Muratori F, Sebastiani M, Baldassini M. Alkalinization improves the quality of lidocainefentanyl epidural anaesthesia for caesarean section. Can J Anaesth. 1993;40:425-430.

Vercauteren M. Obstetric spinal analgesia and anesthesia. Curr Opin Anaesthesiol. 2003;16:503-507.

Liepert DJ, Douglas MJ, McMorland GH, Gambling DR, Kim JH, Ross PL. Comparison of lidocaine CO2, two per cent lidocaine hydrochloride and pH adjusted lidocaine hydrochloride for caesarean section anesthesia. Can J Anaesth. 1990;37:333- 336.

Goring-Morris J, Russell IF. Randomised comparison of 0.5% bupivacaine with a lidocaine/ epinephrine/ fentanyl mixture for epidural top-up for emergency caesarean section after "low dose" epidural for labour. Int J Obstet Anesth. 2006;15:109-114.

Howell P, Davies W, Wrigley M, Tan P, Morgan B. Comparison of four local extradural anaesthetic solutions for elective caesarean section. Br J Anaesth. 1990;65:648-653.

Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine. Acta Anaesthesiol Scand. 1988;32:571-578.

Marsh CR, Hardy PAJ. Ropivacaine: a new local anaesthetic agent. Br J Hosp Med. 1991;45:94-95.

Stienstra R. The place of ropivacaine in anesthesia. Acta Anaesthesiol Belg. 2003;54:141-148.

Malamed SF, Gagnon S, Leblanc D. Articaine hydrochloride: a study of the safety of a new amid local anesthetic. JADA. 2001;132:177-185.

Oertel R, Rahn R, Kirch W. Clinical pharmacokinetics of articaine. Clin Pharmacokinet. 1997;33:417-425.

Kallio H, Snäll E-VT, Luode T, Rosenberg PH. Hyperbaric articaine for day-case spinal anaesthesia. Br J Anaesth. 2006;97:704- 709.

Vree TB, van Oss GE, Gielen MJ, Booıj LH. Epidural metabolism of articaine to its metabolite articainic acid in five patients after epidural administration of 600 mg articaine. J Pharm Pharmacol. 1997;49:158-163.

Vree TB, Simon MA, Gielen M J, Booij LH. Regional metabolism of articaine in 10 patients undergoing intravenous regional anaesthesia during day case surgery. Br J Clin Pharmacol. 1997;44:29-34.

Culea M, Palibroda N, Moldovan Z, Abraham AD, Frangopol PT. Gas chromatographic study of some local anesthetics. Chromatographia. 1989;28:24-26.

Arslan G, Karamanlıoğlu B, Pamukçu Z. Epidural anestezide % 2 kartikain ve % 0.5 bupivakain. Türk Anest Rean Cem Mecmuası. 1999;27:355-360.

Calculator. .

Graf BM, Niesel HC. Pharmakologie der Lokalnaesthetika. Lokalnaesthesie, Regionalanaesthesie, Regionale Schmerztherapie. 2003.

Magee DA, Sweet PT, Holland AJC. Epidural anaesthesia with mixtures of bupivacaine and lidocaine. Can Anaesth Soc J. 1983;30:174-178.

Cuvillon P, Nouvellon E, Ripart J. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009;108:641-649.

Ye F, Feng YX, Lin JJ. A ropivacaine-lidocaine combination for caudal blockade in haemorrhoidectomy. J Int Med Res. 2007;35:307-313.

Seow LT, Lips FJ, Cousins MJ, Mather LE. Lidocaine and bupivacaine mixtures for epidural blockade. Anesthesiology. 1982;56:177-183.

Karahan E, Eroğlu F, Ceylan BG, Uçar A, Ergin Ç. Epidural anestezide bupivakaine artikain ilavesi duyusal blok başlangıcını hızlandırmaktadır. Türk Anest Rean Der Dergisi. 2004;32:193-199.

Morton CP, Bloomfield S, Magnusson A, Jozwiak H, McClure H. Ropivacaine 0.75 % for extradural anaesthesia in elective caesarean section: an open clinical and pharmacokinetic study in mother and neonate. Br J Anaesth. 1997;79:3-8.

Bjqrnestad E, Smedvig JP, Bjerkreim T, Narverud G, Kollerqs D, Bergheim R. Epidural ropivacaine 7.5 mg/ml for elective Caesarean section: a double-blind comparison of efficacy and tolerability with bupivacaine 5 mg/ml. Acta Anaesthesiol Scand. 1999;43:603-608.

Kaukinen L, Kaukinen S, Karkkainen S. Epidural anaesthesia with carticaine in cesarean section: A comparison with bupivacaine. Anaesthesist-Reg Anaesth. 1986;9:79-83.

Kaukinen S, Kaukinen L, Eerola R. Epidural anaesthesia with mixtures of bupivacaine-lidocaine and etidocaine-lidocaine. Ann Chir Gynaecol. 1980;69:281-286.

Donner B, Tryba M, Sokolew J, Strumpf M. Does the mixture of bupivacaine and prilocaine as opposed to bupivacaine afford a clinical advantage in epidural anesthesia?. Anaesthesist. 1993;42:295-299.

Keeffe NJO, Healy TEJ. The role of new local agents. Pharm Ther. 1999;84:233-248.

Irestedt L, Emanuelsson BM, Ekblom A, Olofsson C, Reventlid H. Ropivacaine 7.5 mg/ml for elective Caesarean section: A clinical and pharmacokinetic comparison of 150 mg and 187.5 mg. Acta Anaesthesiol Scand. 1997;41:1149-1156.

Chestnut DH. Anesthesia and maternal mortality. Anesthesiology. 1997;86:273-276.

McKinlay J, Lyons G. Obstetric neuraxial anaesthesia: which pressor agents should we be using?. Int J Obst Anaesth. 2002;11:117-121.

Lee A, Kee WDN, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for Cesarean delivery. Anesth Analg. 2002;94:920-926.

Jorgensen H, Fomsgaard JS, Dirks J, Wetterslev J, Andreasson B, Dahl JB. Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. Br J Anaesth. 2001;87:577-583.

Stevens RA, Mikat-Stevens M, Flanigan R. Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?. Urology. 1998;52:213-218.

Wattwil M, Thoren T, Hennerdal S, Garvill JE. Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy. Anesth Analg. 1989;68:353-358.

De Jong R, Bonin J. Mixtures of local anesthetics are no more toxic than the parent drugs. Anesthesiology. 1981;54:177-181.

Moore DC, Bridenbaugh LD, Bridenbaugh PO, Thomson GE, Tucker GT. Does compounding of local anesthetic agents increase their toxicity humans?. Anesth Analg. 1972;51:579-585.

Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego

Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study

Derya Arslan Yurtlu; Kadir Kaya

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