Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000200001
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos adversos do sufentanil associado ao anestésico local pelas vias subaracnóidea e peridural em pacientes submetidas à analgesia de parto

Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia

Isabel C.F. Salem; Fernanda B. Fukushima; Giane Nakamura; Fábio Ferrari; Laís C. Navarro; Yara Marcondes Machado Castiglia; Eliana Marisa Ganem

http://dx.doi.org/10.1590/S0034-70942007000200001 Braz J Anesthesiol, vol.57, n2, p.125-135, 2007
PDF Português
PDF English
Downloads: 0
Views: 1532

Resumo

JUSTIFICATIVA E OBJETIVOS: A associação do opióide ao anestésico local melhora a qualidade da analgesia de parto e reduz o risco de toxicidade sistêmica pelo anestésico local. Os opióides, entretanto, podem determinar efeitos colaterais. O objetivo desta pesquisa foi comparar os efeitos adversos determinados pelo sufentanil, administrado por via subaracnóidea, associado à bupivacaína, com aquele determinado pelo sufentanil por via peridural, associado à ropivacaína, nas doses utilizadas no Serviço de Anestesia, em gestantes submetidas à analgesia de parto. MÉTODO: Participaram do estudo 60 pacientes, estado físico ASA I e II, com idade entre 15 e 42 anos, com gestação a termo e fetos saudáveis, submetidas à analgesia de parto. Foram distribuídas de forma aleatória em dois grupos: G1 - Duplo bloqueio - bupivacaína a 0,5% (2,5 mg) e sufentanil (5 µg) pela via subaracnóidea, G2 - Peridural - ropivacaína a 0,2% (20 mg) e sufentanil (10 µg) pela via peridural. Para doses complementares foi administrada ropivacaína a 0,2% (12 mg) e para resolução do parto, ropivacaína a 1% (50 mg). As pacientes foram avaliadas após analgesia (M1) com relação a hipotensão arterial, bradicardia materna, prurido, náusea, vômito, depressão respiratória e sedação. No pós-operatório (M2), quanto à presença de náusea, vômito, prurido, sedação, retenção urinária e dor. Os recém-nascidos foram avaliados pelo índice de Apgar. Para análise estatística, foram utilizados teste t de Student, Mann-Whitney e Qui-quadrado. RESULTADOS: Os grupos foram similares com relação à idade, ao peso, à altura, à duração do período de trabalho de parto após analgesia, ao Apgar dos recém-nascidos, à ocorrência de hipotensão arterial, bradicardia, náusea, vômito, prurido e retenção urinária. A sedação foi mais freqüente nas pacientes de G2, em M1 (50%) com diferença estatística significativa. CONCLUSÕES: O sufentanil nas doses utilizadas, administrado por via subaracnóidea ou peridural, associado aos anestésicos locais, determinou similaridade na duração do trabalho de parto após analgesia e no Apgar dos recém-nascidos. A sedação foi o efeito adverso mais freqüente nas pacientes que receberam o opióide pela via peridural.

Palavras-chave

ANALGESIA, Obstétrica, ANALGÉSICOS, Opióides, ANESTÉSICOS, Local, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The association of an opioid with a local anesthetic improves the quality of labor analgesia and reduces the risk of systemic toxicity of the local anesthetic. However, opioids are not devoid of side effects. The aim of this study was to compare the side effects of subarachnoid sufentanil associated with bupivacaine to those caused by epidural sufentanil associated with ropivacaine in the doses used in the Anesthesiology Department in pregnant women undergoing labor analgesia. METHODS: Sixty pregnant women, ASA physical status I and II, ages between 15 and 42 years, at term and with healthy fetuses, undergoing labor analgesia were enrolled in this study. They were randomly divided in two groups: G1 - combined spinal epidural anesthesia - 0.5% bupivacaine (2.5 mg) and subarachnoid sufentanil (5 µg); G2 - Epidural Block - 0.2% ropivacaine (20 mg), and epidural sufentanil (10 µg). Complementary doses of 0.2% ropivacaine (12 mg) were administered whenever necessary, and 1% ropivacaine (50 mg) was administered for labor resolution. Patients were evaluated after analgesia (M1) regarding the presence of hypotension, maternal bradycardia, pruritus, nausea, vomiting, respiratory depression, and sedation. They were also evaluated postoperatively (M2) regarding the presence of nausea, vomiting, pruritus, sedation, urinary retention, and pain. Newborns were evaluated by the Apgar score. The test t Student, Mann-Whitney test, and Chi-Square test were used for the statistical analysis. RESULTS: Both groups were similar regarding age, weight, height, duration of labor after analgesia, Apgar score of the newborns, hypotension, maternal bradycardia, nausea, vomiting, pruritus, and urinary retention. Sedation was more frequent in patients in G2 at M1 (50%), which was statistically significant. CONCLUSION: Subarachnoid or epidural sufentanil, in the doses used in this study, associated with local anesthetics, had the same effect on the duration of labor after analgesia and in the Apgar score of newborns. Sedation was the most frequent side effect in patients receiving epidural sufentanil.

Keywords

ANALGESIA, Obstetric, ANALGESICS, Opioids, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS

Referencias

Thomas . Anesthesia for labor and delivery. Probl Anesth. 1999;11:307-323.

Castro LFL, Serafim MM, Côrtes CAF. Avaliação do estado ácido-base materno com o uso de sufentanil por via subaracnóidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos. Rev Bras Anestesiol. 2003;1:17-24.

Nakamura G, Castiglia YMM, Nascimento Jr P. Bupivacaína, ropivacaína e levobupivacaína em analgesia e anestesia de parto: Repercussões materno-fetais. Rev Bras Anestesiol. 2000;50:105-111.

Pleuvry BJ. Opioid receptors and their relevance to anaesthesia. Br J Anaesth. 1993;72:119-126.

Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med. 1995;332:1685-1690.

Hepner D, Dalta S. Labor analgesia pratices for the new millennium. Sem Anesth Periop Med Pain. 2000;19:35-45.

Campbell DC, Camann WR, Datta S. The addiction of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Analg. 1995;81:305-309.

D'Angelo R, Anderson MT, Philip J. Intrathecal sufentanil compared to bupivacaine for labor analgesia. Anesthesiology. 1994;80:1209-1215.

Riley ET, Ross . Epidural and Spinal Analgesia/Anesthesia. Section II: Opioid Techniques. Obstetric Anesthesia: Principles and Practice. 1999:394-400.

Eisenach JC. Combined spinal-epidural analgesia in obstetrics. Anesthesiology. 1999;91:299-302.

Sia AT, Chong JL, Chiu JW. Combination of intrathecal sufentanil 10 µg plus bupivacaine 2,5 mg for labor analgesia: is half the dose enough?. Anesth Analg. 1999;88:362-366.

Cheng CJ, Sia AT, Lim EH. Either sufentanil or fentanyl, in addition to intrathecal bupivacaine, provide satistactory early labour analgesia. Can J Anaesth. 2001;48:570-574.

Norris MC, Fogel ST, Holtmann B. Intrathecal sufentanil (5 vs 10 µg) for labor analgesia: efficacy and side effects. Reg Anesth Pain Med. 1998;23:252-257.

Honet JE, Arkoosh VA, Norris MC. Comparison among intrathecal fentanyl, meperidine and sufentanil for labour analgesia. Anesth Analg. 1992;75:734-739.

Cousins MJ, Mather LR. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61:276-310.

Yamaguchi ET, Carvalho JCA, Fonseca US. Sufentanil subaracnóideo associado à bupivacaína hiperbárica para analgesia de parto: é possível reduzir a dose de opióide?. Rev Bras Anestesiol. 2004;54:145-152.

Fournier R, Weber A, Gamulin Z. Intrathecal sufentanil is more potent than intravenous for postoperative analgesia after total-hip replacement. Reg Anesth Pain Med. 2005;30:249-254.

Camann WR, Abouleish A, Eisenach JC. Intrathecal sufentanil and epidural bupivacaine for labor analgesia: dose-response of individual agents and combination. Reg Anesth Pain Med. 1998;23:457-462.

Gürkan Y, Toker K. Prophylatic ondansetron reduces pruritus. Anesth Analg. 2002;95:1763-1766.

Pham LH, Camann WR, Smith MP. Hemodynamic effects of intrathecal sufentanil compared with epidural bupivacaine in laboring parturients. J Clin Anesth. 1996;8:497-501.

Riley ET, Ratner EF, Cohen SE. Intrathecal sufentanil for labor analgesia: do sensory changes predict better analgesia and greater hypotension?. Anesth Analg. 1997;84:346-251.

Eriksson SL, Blomberg I, Olofsson C. Single-shot intrathecal sufentanil with bupivacaine in late labour-analgesic quality and obstetric outcome. Eur J Obst Gynecol Reprod Biol. 2003;110:131-135.

Debon R, Bernard A, Duflo F. The analgesic effect of sufentanil combined with ropivacaine 0.2% for labor analgesia: a comparison of three sufentanil doses. Anesth Analg. 2001;92:180-183.

Geller E, Chrubasik J, Graf R. A randomized double-blind comparison of epidural sufentanil versus intravenous sufentanil or epidural fentanyl analgesia after major abdominal surgery. Anesth Analg. 1993;76:1243-1250.

Cohen S, Amar D, Pantuck CB. Postcesarean delivery epidural patient-controlled analgesia. Fentanyl or sufentanil?. Anesthesiology. 1993;78:486-491.

Malan TP. Opioid pharmacology: new insights and clinical relevance. ASA Refresher Course. 2000;28:109-119.

Vertommen JD, Vandermeulen E, Aken HV. The effects of the addition of sufentanil to 0,125% bupivacaine in late quality of analgesic during labor and on the incidence on instrumental deliveries. Anesthesiology. 1991;74:809-814.

Cohen Se, Tan S, White PF. Sufentanil analgesia following cesarean section: epidural versus intravenous administration. Anesthesiology. 1988;66:129-134.

Lee BB, Kee WDN, Lau WM. Epidural infusions for labor analgesia: a comparison of 0.2% ropivacaine, 0.1% ropivacaine, and 0,1% ropivacaine with fentanyl. Reg Anesth Pain Med. 2002;27:31-36.

Chaves IMM, Machado GP, Almeida JR. Estudo comparativo do sufentanil por via peridural, subaracnóidea e venosa em cesarianas. Rev Bras Anestesiol. ;49:1999.

Nelson KE, Rauch T, Terebuh V. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Anesthesiology. 2002;96:1070-1073.

Megarbane B, Gueye P, Baud F. Interactions between benzodiazepines and opioids. Ann Med Interne. 2003;154:64-s72.

Bernards CM. Recent insights into the pharmacokinetics of spinal opioids and relevance to opioid selection. Curr Opin Anaesthesiol. 2004;17:441-447.

Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth. 1995;42:891-903.

D'Angelo R, Gerancher JC, Eisenach JC. Epidural fentanyl produces labor analgesia by a spinal mechanism. Anesthesiology. 1998;88:1519-1525.

Ellis DJ, Millar WL, Reisner LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. Anesthesiology. 1990;72:981-986.

Miguel R, Barlow I, Morrell M. A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions. Anesthesiology. 1994;81:346-352.

Ummenhofer WC, Arends RH, Shen DD. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000;92:739-753.

5dd83daf0e88253d5a13f286 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections