Racemic 0.25% bupivacaine and 50% enantiomeric excess (S75-R25) 0.25% bupivacaine associated to fentanyl for labor analgesia with patient’s ambulation. Comparative study
Estudo comparativo entre bupivacaína racêmica a 0,25% e bupivacaína com excesso enantiomérico de 50% (S75-R25) a 0,25%, associadas ao fentanil para analgesia de parto com deambulação da parturiente
Carlos Alberto Figueiredo Côrtes ; Luis Fernando Lima Castro ; Maurício Marsaioli Serafim ; Amaury Sanchez Oliveira ; Marcelo Gelmini ; Rodrigo Betiol Petri
Abstract
BACKGROUND AND OBJECTIVES: Clinical studies with levogyrous enantiomers of local anesthetics have shown better safety due to lower cardiotoxicity. Parturients ambulation during labor may be able to shorten it. This study aimed at comparing anesthetic quality and maternal and fetal repercussions, as well as patients’ ambulation and spontaneous micturition ability with continuous epidural racemic or 50% enantiomeric excess (S75-R25) 0.25% bupivacaine, associated to fentanyl during labor.
METHODS: Participated in this study 40 parturients, physical status ASA I and II, single fetus and in labor, submitted to continuous epidural analgesia, who were divided in two groups: Group I received 8 mL (20 mg) of 0.25% bupivacaine (S75-R25) and epinephrine, associated to 100 mg fentanyl; and Group II received racemic 0.25% bupivacaine and epinephrine associated to 100 mg fentanyl. The following parameters were evaluated: onset time, sensory block level, motor block level, Romberg’s test, ambulation and spontaneous micturition ability, labor and delivery time, maternal hemodynamic and respiratory changes in addition to neonates vitality.
RESULTS: There were no statistically significant differences between groups in all evaluated parameters. All parturients presented with muscle strength and ambulation ability and when this was not observed, the reason was Cesarean delivery indication (1 in Group II) or delivery before the time needed to observe such parameter (4 in Group I and 5 in Group II).
CONCLUSIONS0: Both racemic and S75-R25 0.25% bupivacaine associated to fentanyl were effective for labor analgesia.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: Estudos clínicos com enantiômeros levógiros dos anestésicos locais demonstraram maior segurança em função de menor cardiotoxicidade. A deambulação da parturiente durante o trabalho de parto pode abreviar o trabalho de parto. Este estudo visou comparar a qualidade da anestesia e as repercussões maternas e fetais bem como a capacidade de deambulação e micção espontânea das parturientes com o emprego da bupivacaína a 0,25% e da bupivacaína com excesso enantiomérico de 50% (S75-R25) a 0,25%, associadas ao fentanil por via peridural contínua, no trabalho de parto.
MÉTODO: Foram avaliadas 40 parturientes, estado físico ASA I e II, feto único, em trabalho de parto, submetidas a analgesia peridural contínua e divididas em dois grupos: no grupo I, receberam 8 mL (20 mg) de bupivacaína (S75-R25) a 0,25% com epinefrina, associados a 100 µg de fentanil. No grupo II, receberam 8 mL (20 mg) de bupivacaína racêmica a 0,25% com epinefrina, associados a 100 µg de fentanil. Foram avaliados os seguintes parâmetros: tempo de latência, nível de bloqueio sensitivo, grau de bloqueio motor, teste de Romberg, capacidade de deambulação e micção espontânea, duração do trabalho de parto e do período expulsivo, alterações hemodinâmicas e respiratórias maternas além da vitalidade dos recém-nascidos.
RESULTADOS: Não houve diferença estatística significativa entre os grupos nos parâmetros avaliados. Todas as parturientes apresentaram força muscular com capacidade de deambulação, salvo no caso de indicação de cesariana (um caso do grupo II) ou quando o parto aconteceu antes do tempo previsto para avaliação deste parâmetro (quatro casos do grupo I e cinco casos do grupo II).
CONCLUSÕES: Tanto a bupivacaína racêmica quanto a bupivacaína (S75-R25) a 0,25% associadas ao fentanil mostraram ser boa opção para analgesia de parto.
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Referências
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