Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos?

Domingos Dias Cicarelli; Renata Veloso Silva; Elke Frerichs; Marcelo Lacava Pagnocca

doi:10.1590/S0034-70942007000300005

Scientific Article

Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos?

Combined spinal-epidural for labor analgesia: does the addition of sufentanil to the local anesthetic influence apgar scores of the newborns?

Domingos Dias Cicarelli; Renata Veloso Silva; Elke Frerichs; Marcelo Lacava Pagnocca

http://dx.doi.org/10.1590/S0034-70942007000300005 Braz J Anesthesiol, vol.57, n3, p.272-279, 2007

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado (BC) é uma técnica muito utilizada em anestesia obstétrica. Porém não há na literatura padronização com relação à técnica, doses e anestésicos utilizados, além da controvérsia sobre a possibilidade da adição do opióide ao anestésico local causar bradicardia fetal e alteração de sua vitalidade. O objetivo deste estudo foi identificar as técnicas e anestésicos utilizados no Serviço de Anestesiologia do Hospital Universitário da Universidade de São Paulo (USP) e avaliar se a utilização de sufentanil associado ao anestésico local no BC altera o Apgar dos recém-nascidos. MÉTODO: Foram analisadas as fichas de anestesia em que foram realizados BC para analgesia de parto durante 12 meses no Hospital Universitário da USP. Foram registrados o uso e dose de sufentanil, a via de parto utilizada e os escores de Apgar do 1°, 5° e 10° minutos dos recém-nascidos. RESULTADOS: Dos 635 BC avaliados, 307 utilizaram sufentanil e anestésico local (Grupo SUF) e 328, só anestésico local (Grupo AL). Cento e vinte e sete (20%) foram realizados através da técnica de agulha por dentro de agulha e os outros 508 (80%) foram realizados pela técnica de duas punções. Não foi verificada diferença entre o Apgar dos grupos estudados no 1°, 5° e 10° minutos. CONCLUSÕES: O sufentanil utilizado no bloqueio combinado não alterou o Apgar dos recém-nascidos.

Palavras-chave

ANALGESIA, Obstétrica, ANALGÉSICOS, Opióide, AVALIAÇÃO RECÉM-NASCIDO, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) is a very common obstetric technique. However, the literature does not present a standardization regarding the technique, doses, and anesthetics used, besides there is also the controversy about the possibility that the addition of opioids to the local anesthetic causes fetal bradycardia and affects its vitality. The aim of this study was to identify the techniques and anesthetics used in the Anesthesiology Service of the Hospital Universitário of Universidade de São Paulo (USP) and determine whether the use of sufentanil associated with the local anesthetic affects Apgar scores of newborns. METHODS: The anesthesiology charts of patients submitted to CSE for labor analgesia over a 12-month period at the Hospital Universitário of USP were analyzed. The use and dose of sufentanil, the type of delivery, and Apgar scores in the 1st, 5th, and 10th minutes were recorded. RESULTS: Of the 635 CSE analyzed, 307 used sufentanil and local anesthetic (SUF Group) and 328 only local anesthetic (LA Group). One hundred and twenty-seven (20%) were done using the needle through the needle technique and the other 508 (80%) used the double puncture technique. There were no differences in the Apgar scores in the 1st, 5th, and 10th minutes between both groups. CONCLUSIONS: The use of sufentanil in the combined spinal-epidural did not change Apgar scores of the newborns.

Keywords

ANALGESIA, Obstetric, ANALGESICS, Opioids, NEWBORN EVALUATION, ANESTHETIC TECHNIQUES, Regional

Referencias

Cook TM. Combined spinal-epidural techniques. Anaesthesia. 2000;55:42-64.

Shaw IC, Birks RJS. A case of extensive block with the combined spinal-epidural technique during labour. Anaesthesia. 2001;56:346-349.

Tsen LC, Thue B, Datta S. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?. Anesthesiology. 1999;91:920-925.

Collis RE, Baxandall ML, Srikantharajah ID. Combined spinal epidural (CSE) analgesia: technique, management and outcome of 300 mothers. Int J Obst Anesth. 1994;3:75-81.

Lo WK, Chong JL, Chen LH. Combined spinal epidural for labour analgesia - duration, efficacy and side effects of adding sufentanil or fentanyl to bupivacaine intrathecally vs plain bupivacaine. Singapore Med J. 1999;40:639-643.

Abouleish A, Abouleish E, Camann W. Combined spinal-epidural analgesia in advanced labour. Can J Anaesth. 1994;41:575-578.

Westmore MD. Epidural opioids in obstetrics - a review. Anaesth Intens Care. 1990;18:292-300.

Clarke VT, Smiley RM, Finster M. Uterine hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia?. Anesthesiology. 1994;81:1083.

Greenberg RS, Daniels SR, Flanders WD. Medical Epidemiology. 2001:146-162.

Van De Velde M, Vercauteren M, Vandermeersch E. Fetal heart rate abnormalities after regional analgesia for labor pain: the effect of intrathecal opioids. Reg Anesth Pain Med. 2001;26:257-262.

Nageotte MP, Larson D, Rumney PJ. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Engl J Med. 1997;337:1715-1719.

Vertommen JD. Opioids in combination with local anesthetics for epidural analgesia during labor. Eur J Obstetr Gynaecol Reprod Biol. 1995:35-S38.

Scherer R, Holzgreve W. Influence of epidural analgesia on fetal and neonatal well-being. Eur J Obstetr Gynaecol Reprod Biol. 1995;59:S17-S29.

Wong CA, Scavone BM, Peaceman AM. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med. 2005;352:655-665.

Van De Velde M, Teukens A, Vandermeersch E. Regional anesthesia and analgesia for labor and delivery. N Engl J Med. 2003;348:1818-1820.

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

D'Angelo R, Eisenach JC. Severe maternal hypotension and fetal bradycardia after a combined spinal epidural anesthetic. Anesthesiology. 1997;87:166-168.

Norris MC, Fogel ST, Conway-Long C. Combined spinal-epidural versus epidural labor analgesia. . 2001;95:913-920.

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

Wee M, Morgan BM, Collis RE. Meningitis after combined spinal-extradural anaesthesia in obstetrics. Br J Anaesth. 1995;74:351-353.

Oliveira AS, Côrtes CAF. Meningite após técnica combinada para analgesia de parto. Relato de caso. Rev Bras Anestesiol. 2002;52:515-516.

Harding SA, Collis RE, Morgan BM. Meningitis after combined spinal-extradural anaesthesia in obstetrics. Br J Anaesth. 1994;73:545-547.

Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos?

Combined spinal-epidural for labor analgesia: does the addition of sufentanil to the local anesthetic influence apgar scores of the newborns?

Domingos Dias Cicarelli; Renata Veloso Silva; Elke Frerichs; Marcelo Lacava Pagnocca

Resumo

Palavras-chave

Abstract

Keywords

Referencias

Links

compartir

Braz J Anesthesiol