O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

Canan Salman; Nurten Kayacan; Fatma Ertuğ; rul; Zekiye Bı; gat; Bilge Karslı

doi:10.1590/S0034-70942013000300007

Scientific Article

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia

Canan Salman; Nurten Kayacan; Fatma Ertuğ; rul; Zekiye Bı; gat; Bilge Karslı;

http://dx.doi.org/10.1590/S0034-70942013000300007 Braz J Anesthesiol, vol.63, n3, p.267-272, 2013

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Avaliamos os efeitos da administração peridural de levobupivacaína ou solução salina, extensão do volume peridural (EVE), em bloqueio combinado raqui-peridural (BCRP) para cesariana. MÉTODOS: Foram incluídas no estudo 138 pacientes com gravidez a termo de 37-42 semanas programadas para cesariana. O Grupo 1 (n = 48) recebeu raquianestesia com dose única (RADU), o Grupo 2 (n = 45) recebeu BCRP-EVE com solução salina e o Grupo 3 recebeu BCRP-EVE com levobupivacaína. As características do bloqueio motor e sensorial os efeitos nas alterações hemodinâmicas maternas e nos recém-nascidos foram comparados. RESULTADOS: O tempo para atingir o bloqueio sensorial máximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de regressão do bloqueio sensório em dois segmentos foi significativamente menor no Grupo 1, enquanto foi significativamente maior no Grupo 3 em relação ao Grupo 2 (p < 0,05). O tempo de início do bloqueio motor foi significativamente maior no Grupo 1 do que nos grupos 2 e 3 (p < 0,05). O tempo para atingir o bloqueio motor máximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de recuperação do bloqueio motor foi significativamente maior no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo para o primeiro analgésico foi significativamente maior no Grupo 3 (p < 0,05). CONCLUSÃO: Bloqueio sensório-motor rápido e adequado foi obtido em todas as pacientes do presente estudo; no entanto, o bloqueio sensório-motor teve início mais rapidamente, foi mais prolongado e atingiu um novel mais alto nos grupos 2 e 3; esses efeitos foram mais acentuados no Grupo 3.

Palavras-chave

ANESTÉSICOS, Local, bupivacaína, levobupivacaína, CIRURGIA, Cesárea, Injeções epidurais, TÉCNICAS ANESTÉSICAS, Regional, peridural, subaracnóidea

Abstract

BACKGROUND AND OBJECTIVES: We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. METHODS: One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n = 48) received single-shot spinal anesthesia (SSS), group 2 (n = 45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. RESULTS: Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p < 0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p < 0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p < 0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p < 0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p < 0.05). The time to first analgesic was significantly longer in group 3 (p < 0.05). CONCLUSIONS: Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.

Keywords

Anesthesia, Spinal, Epidural, Injections, Epidural, Anesthetics, Local, Bupivacaine, Cesarean Section

References

Ithnin F, Lim Y, Sia AT, Ocampo CE. Combined spinal epidural causes higher level of block than equivalent single-shot spinal anaesthesia in elective cesarean patients. Anesth Analg. 2006;102:577-580.

Rawal N. Combined spinal-epidural anaesthesia. Curr Opin Anaesthesiol. 2005;18:518-521.

Beale N, Evans B, Plaat F, Columb MO, Lyons G, Stocks GM. Effect of epidural volume extension on dose requirement of intrathecal hyperbaric bupivacaine at caesarean section. Br J Anaesth. 2005;95:500-503.

Lew E, Yeo SW, Thomas E. Combined spinal-epidural anaesthesia using epidural volume extension leads to faster motor recovery after elective cesarean delivery: a prospective, randomized, double-blind study. Anesth Analg. 2004;98:810-814.

Stienstra R, Dahan A, Alhadi BZ, van Kleef JW, Burm AG. Mechanism of action of an epidural top-up in combined spinal epidural anaesthesia. Anesth Analg. 1996;83:382-386.

Mardirosoff C, Dumont L, Lemédioni P, Pauwels P, Massaut J. Sensory block extension during combined spinal and epidural. Reg Anesth Pain Med. 1998;23:92-95.

Cook TM. Combined spinal-epidural techniques. Anaesthesia. 2000;55:42-64.

Takiguchi T, Okano T, Egawa H, Okubo Y, Saito K, Kitajima T. The effect of epidural saline injection on analgesic level during combined spinal and epidural anaesthesia assessed clinically and myelographically. Anesth Analg. 1997;85:1097-1100.

Trautman WJ 3rd, Liu SS, Kopacz DJ. Comparison of lidocaine and saline for epidural top-up during combined spinal-epidural anaesthesia in volunteers. Anesth Analg. 1997;84:574-577.

Choi DH, Park NK, Cho HS, Hahm TS, Chung IS. Effects of epidural injection on spinal block during combined spinal and epidural anaesthesia for cesarean delivery. Reg Anesth Pain Med. 2000;25:591-595.

Tyagi A, Kumar A, Sethi AK, Mohta M. Epidural volume extension and intrathecal dose requirement: plain versus hyperbaric bupivacaine. Anesth Analg. 2008;107:333-338.

Blumgart CH, Ryall D, Dennison B, Thompson-Hill LM. Mechanism of extension of spinal anaesthesia by extradural injection of local anaesthetic. Br J Anaesth. 1992;69:457-460.

Bremerich DH, Kuschel S, Fetsch N, Zwissler B, Byhahn C, Meininger D. Levobupivacaine for parturients undergoing elective caesarean delivery: A dose-finding investigation. Anaesthesist. 2007;56:772-779.

Celleno D, Parpaglioni R, Frigo MG, Barbati G. Intrathecal levobupivacaine and ropivacaine for cesarean section: New perspectives. Minerva Anestesiol. 2005;71:521-525.

Parpaglioni R, Frigo MG, Lemma A, Sebastiani M, Barbati G, Celleno D. Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for caesarean section. Anaesthesia. 2006;61:110-115.

Stienstra R, Dilrosun-Alhadi BZ, Dahan A, van Kleef JW, Veering BT, Burm AG. The epidural "top-up" in combined spinal-epidural anaesthesia: the effect of volume versus dose. Anesth Analg. 1999;88:810-814.

Goy RW, Sia AT. Sensorimotor anaesthesia and hypotension after subarachnoid block: combined spinal-epidural versus single-shot spinal technique. Anesth Analg. 2004;98:491-496.

Camorcia M, Capogna G, Berritta C, Columb MO. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg. 2007;104:904-907.

Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for caesarean section. Br J Anaesth. 2003;91:684-689.

Bremerich DH, Fetsch N, Zwissler BC, Meininger D, Gogarten W, Byhahn C. Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for caesarean section. Curr Med Res Opin. 2007;23:3047-3054.

Bouvet L, Da-Col X, Chassard D. ED50 and ED95 of intrathecal levobupivacaine with opioids for caesarean delivery. Br J Anaesth. 2011;106:215-220.

Gori F, Corradetti F, Cerotto V, Peduto VA. Influence of positioning on plain levobupivacaine spinal anaesthesia in caesarean section. Anesthesiol Res Pract. 2010.

Choi DH, Ahn HJ, Kim JA. Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery. Int J Obstet Anesth. 2006;15:13-17.

Brizzi A, Greco F, Malvasi A, Valerio A, Martino V. Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section. Minerva Anestesiol. 2005;71:701-709.

Riley ET, Cohen SE, Macario A, Desai JB, Ratner EF. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg. 1995;80:709-712.

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia

Canan Salman; Nurten Kayacan; Fatma Ertuğ; rul; Zekiye Bı; gat; Bilge Karslı;

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol