Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942006000400005
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia pós-operatória para cesariana: a adição de clonidina à morfina subaracnóidea melhora a qualidade da analgesia?

Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?

José Francisco Nunes Pereira das Neves; Giovani Alves Monteiro; João Rosa de Almeida; Roberto Silva Sant'Anna; Rodrigo Machado Saldanha; José Mariano Soares de Moraes; Emerson Salim Nogueira; Fernando Lima Coutinho; Mariana Moraes Pereira das Neves; Fernando Paiva Araújo; Paula Brazilio Nóbrega

http://dx.doi.org/10.1590/S0034-70942006000400005 Braz J Anesthesiol, vol.56, n4, p.370-376, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: O mecanismo de ação analgésica a2-adrenérgico tem sido explorado há mais de 100 anos. A clonidina aumenta de maneira dose-dependente a duração dos bloqueios sensitivo e motor e tem propriedades antinociceptivas. O objetivo desse estudo foi avaliar se a adição de clonidina na dose de 15 e 30 µg à raquianestesia, para cesariana, com bupivacaína hiperbárica a 0,5% (12,5 mg) e morfina (100 µg), melhora a qualidade da analgesia pós-operatória. MÉTODO: Foi realizado um estudo prospectivo e aleatório com 60 pacientes divididas em três grupos: BM - bupivacaína hiperbárica a 0,5% (12,5 mg) e morfina (100 µg), BM15 - bupivacaína hiperbárica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (15 µg) e BM30 - bupivacaína hiperbárica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (30 µg), administradas separadamente. No peri-operatório, foram anotados o consumo de efedrina e a avaliação do recém-nascido pelo índice de Apgar. No pós-operatório, a dor foi avaliada na 12ª h pela Escala Analógica Visual, o tempo para solicitação de analgésicos e efeitos colaterais pós-operatórios, como prurido, náuseas, vômitos, bradicardia, hipotensão arterial e sedação. Os valores foram considerados significativos quando p < 0,05. RESULTADOS: Os grupos foram homogêneos. O consumo de efedrina e a avaliação pelo índice de Apgar não exibiram diferença estatística significativa entre os grupos. Os escores de dor e o tempo médio de analgesia mostraram diferença entre os grupos BM e BM15/BM30 e não houve diferença com relação à incidência de efeitos colaterais pós-operatórios. CONCLUSÕES: A adição de clonidina na raquianestesia com bupivacaína hiperbárica a 0,5% (12,5 mg) e morfina (100 µg) para cesariana, melhorou a qualidade da analgesia pós-operatória, sem aumentar a incidência de efeitos colaterais, sendo 15 µg de clonidina a dose sugerida.

Palavras-chave

ANALGESIA, Pós-Operatória, ANALGÉSICOS, CIRURGIA, CIRURGIA, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The mechanism of action of alpha2-adrenergic analgesia has been explored for more than one hundred years. The increased duration of the sensitive and motor blockades caused by clonidine is dose-dependent and has antinociceptive properties. The objective of this study was to evaluate whether the addition of 15 to 30 µg of clonidine to spinal anesthesia for cesarean sections with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 µg) improves the quality of postoperative analgesia. METHODS: We realized a prospective, randomized study that included 60 patients divided in 3 groups: BM - 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 µg), BM15 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 µg), and clonidine (15 mg), and BM30 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 µg), and clonidine (30 µg), administered separately. In the perioperative period the use of ephedrine and the newborn's Apgar score were recorded. In the postoperative period, the pain was evaluated in the 12th h by the VAS, the length of time it took the patient to ask for analgesics, and the postoperative side effects, such as pruritus, nausea, vomiting, bradycardia, hypotension, and sedation. The values were considered significant when p < 0.05. RESULTS: The groups were homogenous. The use of ephedrine and the evaluation by the Apgar score did not show statistically significant differences among the different groups. The pain scores and the average time to start analgesia showed differences among the groups BM and BM15/BM30, and there were no differences regarding the incidence of postoperative side effects. CONCLUSIONS: The addition of clonidine to spinal anesthesia with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 µg) for cesarean section improved the quality of the postoperative analgesia without increasing the incidence of side effects. We suggest that the dose of 15 µg of clonidine should be used.

Keywords

ANALGESIA, Postoperative, ANALGESICS, ANESTHETIC TECHNIQUES, Regional, SURGERY, Obstetric

References

Eisenach JC, De Kock M, Klimscha W. Alpha 2-adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984-1995). Anesthesiology. 1996;85:655-674.

Fonseca NM, Oliveira CA. Efeito da clonidina associada à bupivacaína a 0,5% hiperbárica na anestesia subaracnóidea. Rev Bras Anestesiol. 2001;51:483-492.

Rochette A, Raux O, Troncin R. Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging study. Anesth Analg. 2004;98:56-59.

Duma A, Urbanek B, Sitzwohl C. Clonidine as an adjuvant to local anaesthetic axillary brachial plexus block: a randomized, controlled study. Br J Anaesth. 2005;94:112-116.

Strebel S, Gurzeler JA, Schneider MC. Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: a dose-response study. Anesth Analg. 2004;99:1231-1238.

Schechtmann G, Wallin J, Meyerson B. Intrathecal clonidine potentiates suppression of tactile hypersensitivity by spinal cord stimulation in a model of neuropathy. Anesth Analg. 2004;99:135-139.

Wu CT, Jao SW, Borel CO. The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth Analg. 2004;92:502-509.

Forster JG, Rosenberg PH. Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty. Br J Anaesth. ;2004:670-677.

Davis BR, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added clonidine. Anesth Analg. 2005;100:559-565.

Alves TCA, Braz JRC. Efeitos da associação da clonidina à ropivacaína na anestesia peridural. Rev Bras Anestesiol. 2002;52:410-419.

Braz JRC, Koguti ES, Braz LG. Efeitos da associação da clonidina à bupivacaína hiperbárica na anestesia subaracnóidea alta. Rev Bras Anestesiol. 2003;53:561-572.

Vieira AM, Schnaider TB, Costa FA. Analgesia e sedação da associação da clonidina e ropivacaína a 0,75% por via peridural no pós-operatório de colecistectomia aberta. Rev Bras Anestesiol. 2003;53:586-590.

Roelants F, Lavand'homme PM, Mercier-Fuzier V. Epidural administration of neostigmine and clonidine to induce labor analgesia. Anesthesiology. 2005;102:1205-1210.

Paech MJ, Pavy TJG, Orlikowski CEP. Postcesarean analgesia with spinal morphine, clonidine, or their combination. Anesth Analg. 2004;98:1460-1466.

Benhamou D, Thorin D, Brichant J-F. Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section. Anesth Analg. 1998;87:609-613.

Klimscha W, Chiari A, Krafft P. Hemodynamic and analgesic effects of clonidine added repetitively to continuous epidural and spinal blocks. Anesth Analg. 1995;80:322-327.

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