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

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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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