Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica

Marcus Vinícius Martins Novaes; Carlos Roberto Lopes Francisco; Karina Bernardi Pimenta; Paulo Sérgio Gomes Lavinas

doi:10.1590/S0034-70942001000600004

Scientific Article

Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica

Comparison between 0.25% bupivacaine and 0.2% ropivacaine in epidural anesthesia for thoracic surgery

Marcus Vinícius Martins Novaes; Carlos Roberto Lopes Francisco; Karina Bernardi Pimenta; Paulo Sérgio Gomes Lavinas

http://dx.doi.org/10.1590/S0034-70942001000600004 Braz J Anesthesiol, vol.51, n6, p.493-502, 2001

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JUSTIFICATIVA E OBJETIVOS: A anestesia peridural associada à anestesia geral tem sido usada em várias especialidades cirúrgicas. Em cirurgia torácica seu uso é pouco discutido na literatura. Este estudo teve como objetivo avaliar os efeitos hemodinâmicos e ventilatórios da anestesia peridural torácica com bupivacaína a 0,25% e ropivacaína a 0,2% associada à anestesia geral em pacientes submetidos à toracotomia. MÉTODO: Participaram deste estudo prospectivo, comparativo e aleatório quarenta pacientes divididos em dois grupos de vinte. Cada grupo recebeu um volume de 10 ml de anestésico local, por via peridural torácica. Grupo B (Bupivacaína 0,25%) e o Grupo R (Ropivacaína 0,2%). O bloqueio peridural foi realizado com os pacientes em decúbito lateral, punção paramediana e cateter para injeção dos fármacos A seguir todos os pacientes receberam anestesia geral com IOT. Foram analisados parâmetros hemodinâmicos e ventilatórios em 9 momentos. RESULTADOS: A pressão arterial sistólica foi menor no momento 5 e pressão arterial diastólica nos momentos 1 e 5, ambas no grupo B. A necessidade de efedrina para corrigir hipotensão arterial foi de 8/20 no grupo B, contra 6/20 no grupo R. A pressão de pico nas vias aéreas superiores foi sempre mais elevada no grupo R e os valores da CAM do isoflurano foram mais elevados nos momentos 5 e 6 também no Grupo R. CONCLUSÕES: A técnica combinada peridural torácica e anestesia geral mostrou-se eficaz e segura nos pacientes submetidos à toracotomia. Quando se utilizou bupivacaína, a diminuição da pressão arterial foi maior e a pressão máxima nas vias aéreas foi menor do que quando foi utilizada ropivacaína.

Palavras-chave

ANESTÉSICOS, Local, ANESTÉSICOS, Local, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Combined general/epidural anesthesia has been used for several surgical procedures. Little has been published in the literature about its use in thoracic surgery. This study aimed to evaluate hemodynamic and ventilatory effects of combined general/epidural anesthesia with 0.25% bupivacaine and 0.2% ropivacaine in patients submitted to thoracotomy METHODS: Participated in this prospective, comparative and randomized study 40 patients divided in two groups of 20. Each group received 10 ml of epidural local anesthetics. Group B received 0.25% bupivacaine and Group R received 0.2% ropivacaine. Epidural anesthesia was induced with the patients in lateral position, using the paramedian approach and a catheter for drug injection. General anesthesia was then induced in all patients with tracheal intubation. Hemodynamic and ventilatory parameters were evaluated in 9 moments. RESULTS: In Group B, systolic blood pressure was lower at moment 5 and diastolic blood pressure was lower at moments 1 and 5. The need for ephedrine to correct hypotension was 8/20 in Group B as compared to 6/20 in Group R. Upper airway peak pressures and isoflurane MAC values were higher at moments 5 and 6 in Group R. CONCLUSIONS: The association of thoracic epidural anesthesia and general anesthesia was safe and efficient for patients submitted to thoracotomy. Bupivacaine has produced a higher decrease in blood pressure and lower peak airway pressures as compared to ropivacaine.

Keywords

ANESTHETICS, Local, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional

Referencias

Kenny GNC, Scott NB, Turfrey DJ. Thoracic epidural anaesthesia for coronary artery bypass graft surgery. Anaesthesia. 1997;52:1090-1113.

Meifsnerma A, Rolf N, Van Akenmo H. Thoracic epidural anesthesia and the patient with heart disease: benefits, risks, and controversies. Anesth Analg. 1997;85:517-528.

Mark AL. The bezoldjarisih reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983;1:90-102.

Saada M, Duval AM, Bonnef F. Abnormalities in myocardial segmentary wall motion during lumbar epidural anesthesia. Anesthesiology. 1989;71:26-32.

Desborough JP. Thoracic epidural analgesia in cardial surgery. Anaesthesia. 1996;51:805-807.

Liem TH, Hansembos MA, Booij LH. Coronary artery bypass grafting using two different anaesthetic techniques part II: Postoperative outcome. J Cardioth Vasc Anesth. 1992;6:156-161.

Swensow JD, Hullander RM, Wingler K. Early extubation after cardiac surgery using combined intrathecal sufentanil and morphine. J Cardioth Vasc Anesth. 1994;8:509-514.

Moore CM, Cross MH, Desborrough JP. Hormonal effects of thoracic extradural analgesia for cardial surgery. Br J Anaesth. 1995;75:387-393.

Kock M, Blombergs , Emanuecsson H. Thoracic epidural anesthesia improves global and regional left ventricular function during stress with coronary artery disease. Anesth Analg. 1990;71:625-630.

Maniciliam B, Lantineau JP, Bertrano M. Improvement or diaphragmatic function by a thoracic extradural block after upper abdominal surgery. Anesthesiology. 1988;68:379-386.

Fratacci MD, Kimball WR, Wain JC. Diaphragmatic shortening after thoracic surgery in humans: effects of mechanical ventilation and thoracic epidural anesthesia. Anesthesiology. 1993;79:654-665.

Steele SM, Slangter TF, Greenberrg CS. Epidural anesthesia and analgesia: implications for perioperative coagulabity. Anesth Analg. 1991;73:883-885.

Henny CP, Odoom JA, ten Cate H. Effects of extradural bupivacaine on the haemostatic system. Br J Anaesth. 1986;56:301-305.

Modig J, Malmberg P, Karlstrom G. Effects of epidural versus general anesthesia on calf blood flow. Acta Anaesthesiol Scand. 1980;24:305-309.

Simonetti MPB. Ropivacaína: estado atual e perspectivas futuras. Rev Bras Anestesiol. 1995;45:131-140.

Shinichi S, Yoji S, Yoshihiro K. The effects of epidural anesthesia on ventilatory response to hypercapnia and hypoxia in elderly patients. Anesth Analg. 1996;82:306-311.

Laszlo LS, Bardoczky GI, Engelman EE. Airway pressure changes during one-lung ventilation. Anesth Analg. 1997;84:1034-1037.

Nociti JR, Cagnolati CA, Nunes AMM. Ropivacaína a 0,75% e 1% em anestesia peridural para cirurgia: estudo comparativo. Rev Bras Anestesiol. 1998;48:169-176.

Tanskanen P, Kutta J, Randell T. The effect of patient positioning on dynamic lung compliance. Acta Anaesthesiol Scand. 1997;41:602-606.

Wahbawn C, Don HF, Beckare MR. The cardio-respirarory effects of thoracic epidural anesthesia. Can Anesth Soc J. 1972;19:8-19.

Tenling A, Joachimsson PO, Tyden H. Thoracic epidural anesthesia as an adjunct to general anesthesia for cardiac surgery: effects on ventilation - perfusion relationship. J Cardiothorac Vasc Anesth. 1999;13:258-264.

Arena L, Bitossi U, Di Filippo A. Anesthesia combinata in chirurgia toracica: risposta cardiocircolatoria all' induzione. Minerva Anesthesiol. 1993;59:313-316.

Hachenberg T, Holçst D, Ebel C. Effects of thoracic epidural anesthesia on ventilation-perfusion distribution and intrathoracic blood volume before and after induction of general anaesthesia. Acta Anaesthesiol Scand. 1997;41:1142-1148.

Di Lacio JVL, Victoria LGF. Anestesia peridural torácica para cirurgias estética de mama ou mama e abdome. Rev Bras Anestesiol. 1988;38:273-276.

Imbeloni LE, Maia CP. Estudo comparativo entre bupivacaína 0,5%. pura e com epinefrina para anestesia peridural torácica associada anestesia geral inalatória endotraqueal. Rev Bras Anestesiol. 1988;38:107-111.

Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica

Comparison between 0.25% bupivacaine and 0.2% ropivacaine in epidural anesthesia for thoracic surgery

Marcus Vinícius Martins Novaes; Carlos Roberto Lopes Francisco; Karina Bernardi Pimenta; Paulo Sérgio Gomes Lavinas

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