Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942001000500002
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo entre levobupivacaína a 0,5% e bupivacaína racêmica a 0,5% associadas ao sufentanil na anestesia peridural para cesariana

Comparative study of 0.5% levobupivacaine and 0.5% racemic bupivacaine associated to sufentanil in epidural anesthesia for cesarean delivery

João Batista Santos Garcia; José R Oliveira; Elismar P A Silva; Marcelo S Privado; Américo M Yamashita; Adriana M Issy

http://dx.doi.org/10.1590/S0034-70942001000500002 Braz J Anesthesiol, vol.51, n5, p.377-384, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: Apesar do uso freqüente de anestésicos locais em procedimentos cirúrgicos e obstétricos, a bupivacaína racêmica é associada à cardiotoxicidade potencialmente fatal. Estudos sugerem que a levobupivacaína apresenta ação anestésica local semelhante à bupivacaína racêmica, com a vantagem de menor toxicidade tanto no sistema nervoso central como cardiovascular. Os trabalhos têm demonstrado melhor qualidade anestésica com uso de bupivacaína racêmica associada à sufentanil, via peridural para cesariana. O presente estudo compara a eficácia da bupivacaína racêmica 0,5% com levobupivacaína 0,5%, ambas associadas o sufentanil, via peridural, em parturientes submetidas a cesariana. MÉTODO: Foram investigadas 52 gestantes, submetidas à anestesia peridural para cesariana eletiva. Neste estudo duplamente encoberto, as pacientes foram distribuídas aleatoriamente em dois grupos: Grupo I (n = 26): receberam 27 ml de levobupivacaína 0,5% e 30 µg de sufentanil, Grupo II (n = 26) receberam 27 ml de bupivacaína 0,5% e 30 µg de sufentanil. Foram avaliados as características dos bloqueios motor e sensorial, o tempo necessário para solicitação de analgésicos e a incidência de efeitos adversos no período pós-operatório. RESULTADOS: Os bloqueios motor e sensorial, o tempo para solicitação de analgésicos e os efeitos adversos não diferiram entre os grupos. Entretanto, quando se comparou a duração do bloqueio motor da levobupivacaína com da bupivacaína racêmica, observou-se duração significantemente prolongada para levobupivacaína (p < 0,05). CONCLUSÕES: Apesar da duração do bloqueio motor ser mais prolongado para a levobupivacaína associada ao sufentanil, a eficácia anestésica de ambos os anestésicos locais investigados associados ao sufentanil em cesariana por via peridural, foram iguais.

Palavras-chave

ANALGÉSICOS, Opióides, ANESTÉSICOS, Local, ANESTÉSICOS, Local, CIRURGIA, Obstétrica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Although the widespread use of local anesthetics in surgery and obstetrics, racemic bupivacaine is associated to potentially fatal cardiotoxicity. Data suggest that levobupivacaine has local anesthetic effects similar to racemic bupivacaine with the advantage of less central nervous system and cardiovascular toxicity. Studies have shown that epidural anesthesia with racemic bupivacaine and sufentanil for cesarean sections results in a better quality of anesthesia. This study aimed at comparing the efficacy of 0.5% racemic bupivacaine and 0.5% levobupivacaine, both associated to sufentanil, for epidural anesthesia in parturients undergoing cesarean delivery. METHODS: Participated in this double-blind study 52 obstetric patients submitted to elective cesarean delivery under epidural anesthesia. Patients were randomized to receive 27 ml of 0.5% levobupivacaine and 30 µg sufentanil (Group I n=26) or 27 ml of 0.5% bupivacaine and 30 µg sufentanil (Group II n=26). Characteristics of sensory and motor block, time for analgesics request in the postoperative period and the incidence of side effects were investigated. RESULTS: Sensory and motor block, time for analgesics request and adverse effects did not differ between groups. However, motor block was significantly longer with levobupivacaine as compared to racemic bupivacaine (p < 0.05). CONCLUSIONS: Although a longer motor block duration with 0.5% epidural levobupivacaine associated to sufentanil, the efficacy of both local anesthetics associated to sufentanil for cesarean delivery was similar.

Keywords

ANALGESICS, Opioids, ANESTHETICS, Local, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, SURGERY, Obstetric

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