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

Artigo Científico

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

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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

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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

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