Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000200002
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos do bloqueio pudendo, peridural e subaracnóideo sobre a coagulação sangüínea de gestantes

Effects of pudendal nerve, epidural and subarachnoid block on coagulation of pregnant women

Alberto Vasconcelos; Lígia Andrade da Silva Telles Mathias

http://dx.doi.org/10.1590/S0034-70942008000200002 Braz J Anesthesiol, vol.58, n2, p.95-105, 2008
PDF Português
PDF English
Downloads: 0
Views: 1046

Resumo

JUSTIFICATIVA E OBJETIVOS: Tem sido atribuída à anestesia regional diminuição significativa das complicações tromboembólicas no pós-operatório, provavelmente por sua ação atenuadora sobre a resposta neuroendócrino-metabólica. As gestantes, que apresentam aumento importante da coagulabilidade sangüínea, podem, teoricamente, beneficiar-se desse efeito por ocasião do parto. O objetivo deste estudo foi verificar o efeito da anestesia regional sobre a coagulação sangüínea em gestantes. MÉTODO: Foram estudadas 30 pacientes no terceiro trimestre de gestação, sendo dez submetidas à anestesia peridural para cesariana, com 150 mg de bupivacaína a 0,5% sem epinefrina e 2 mg de morfina (grupo PD); dez à anestesia subaracnóidea para cesariana com 15 mg de bupivacaína hiperbárica a 0,5% e 0,2 mg de morfina (grupo SA); e dez a bloqueio de pudendo para parto vaginal, com doses de até 100 mg de bupivacaína a 0,5% sem epinefrina (grupo BP). A coagulação sangüínea foi avaliada por meio de coagulograma (tempo de protrombina, tempo de trombina, tempo de tromboplastina parcial ativada) e de tromboelastograma (tempo r, tempo k, tempo r + k, ângulo alfa e amplitude máxima) nos seguintes momentos: antes e após a anestesia, após o nascimento do feto e 24 horas após a anestesia nos grupos PD e SA. No grupo BP a avaliação foi realizada antes da anestesia, após o nascimento do feto e 24 horas após a anestesia. RESULTADOS: Os resultados mostraram que nenhuma das técnicas anestésicas utilizadas teve influência na coagulação sangüínea das gestantes. Demonstraram, também, que durante o trabalho de parto tem início um processo de ativação da coagulação que é responsável pelas alterações encontradas nos três grupos estudados. CONCLUSÕES: Nas condições do presente estudo o bloqueio simpático e o anestésico local não influíram sobre a coagulação em gestantes de termo submetidas à anestesia peridural, subaracnóidea ou bloqueio pudendo.

Palavras-chave

ANESTESIA, Obstétrica, ANESTÉSICOS, Local, SANGUE, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The significant reduction in postoperative thromboembolic complications has been attributed to the use of regional block, probably due to attenuation of the neuroendocrine-metabolic response. Pregnant women, who demonstrate important hypercoagulability, can in theory benefit from this effect during labor. The objective of this study was to determine the effects of regional block on coagulation of pregnant women. METHODS: Thirty patients in the 3rd trimester were enrolled; ten patients underwent epidural block for cesarean section with 150 mg of 0.5% bupivacaine without epinephrine and 2 mg of morphine (PD group); ten underwent subarachnoid block for cesarean section with 15 mg of 0.5% hyperbaric bupivacaine and 0,2 mg of morphine (SA group); and ten, pudendal block for vaginal delivery with up to 100 mg of 0.5% bupivacaine without epinephrine (BP group). Coagulation tests (prothrombin time, thrombin time, activated partial thromboplastin time) and thromboelastography (r-time, k-time, r+k-time, alpha-angle, maximum amplitude) were performed in the following moments: before and after the blockade, after delivery, and 24 hours after the blockade in PD and SA groups. In the BP group, the evaluation was done before the blockade, after delivery, and 24 hours after the blockade. RESULTS: The results indicate that the anesthetic technique did not influence coagulation of pregnant women. They also demonstrate that coagulation is activated during labor, which is responsible for the changes seen in all the study groups. CONCLUSIONS: In the conditions of the present study, the sympathetic blockade and the local anesthetic did not have any influence on the coagulation of pregnant women at term undergoing epidural, subarachnoid, or pudendal nerve block.

Keywords

ANESTHESIA, Obstetric, ANESTHETICS, Local, ANESTHETIC TECHNIQUE, Regional, ANESTHETIC TECHNIQUE, Regional, ANESTHETIC TECHNIQUE, Regional, BLOOD, MEASUREMENT TECHNIQUE

References

Benzon HT, Wong CA, Wong HY. The effect of low-dose bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography. Anesth Analg. 1994;79:911-917.

Bigeleison PE, Kang YG. Thrombelastography as an aid regional anesthesia: preliminary communication. Reg Anesth. 1991;16:59-61.

Bonnar J, McNicol GP, Douglas AS. Coagulation and fibrinolytic mechanisms during and after normal childbirth. BMJ. 1970;2:200-203.

Borg T, Modig J. Potential anti-thrombotic effects of local anesthetics due to their inhibition of platelet aggregation. Acta Anaesthesiol Scand. 1985;29:739-742.

Carvalho JCA, Mathias RS, Senra WG. Farmacocinética da bupivacaína em anestesia peridural para cesariana: II. Solução a 0,5% com e sem epinefrina. Rev Bras Anestesiol. 1986;36:273-278.

Christopherson R, Beattie C, Frank SM. Perioperative morbidity in randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology. 1993;79:422-434.

Condie RG. A serial study of coagulation factors Xll, Xl and X in plasma in normal pregnancy and in pregnancy complicated by pre-eclampsia. Br J Obstet Gynecol. 1976;83:636-639.

Corash L. Laboratory Evaluation of Hemostasis. Blood Disorders in Pregnancy. 1986:125-149.

Simon L, Santi TM, Sacquin P. Pre-anesthetic assessment of coagulation abnormalities in obstetric patients: usefulness, timing and clinical implications. Br J Anaesth. 1997;78:678-683.

Corral FS, Rozas A, Rajo P. Tromboelastografia en el embarazo, parto y puerperio. Rev Clin Inst Matern. 1967;18:205-211.

Davis FM, McDermott E, Hickton C. Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty. Br J Anaesth. 1987;59:561-571.

De Nicola P, Mazzetti GM. Evaluation of thrombelastography. Am J Clin Pathol. 1955;25:447-451.

Feinstein MB, Fiekers J, Fraser C. An analysis of the mechanism of local anesthetic inhibition of platelet aggregation and secretion. J Pharmacol Exp Ther. 1976;197:215-228.

Gibbs NM, Crawford GPM, Michalopoulos N. The effect of epidural blockade on postoperative hypercoagulability following abdominal aortic bypass surgery. Anaesth Intensive Care. 1992;20:487-490.

Chamone DAF, Gomes OM, Langer B. Alterações da Coagulação Sangüínea durante a Gravidez e Puerpério. Coagulação e Cirurgia. 1974:17-22.

Greenburg AG. Indications for Transfusion. Emergency Care. 1989:1-19.

Hellgren M, Blombäck M. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium: I Normal condition. Gynecol Obstet Invest. 1981;12:141-154.

Henny CP, Odoom JA, Cate HT. Effects of extradural bupivacaine on the haemostatic system. Br J Anaesth. 1986;58:301-305.

Kang YG, Abouleish E. Thrombelastography in obstetrics. Anesthesiology. 1981;55(^s3A):A304.

Kang YG. Monitoring and Treatment of Coagulation. Hepatic Transplantation. 1986:151-173.

Markarian M, Jackson J. Comparison of the kinetics of clot formation, fibrinogen, fibrinolysis and hematocrit in pregnant women and adults. Am J Clin Obstet Gynecol. 1968;101:593-602.

Mathias LAST. Efeitos da bupivacaína por via peridural sobre a coagulação sangüínea: estudo experimental no cão. 1992.

Modig J, Borg T, Karlström G. Thromboembolism after total hip replacement: Role of epidural and general anesthesia. Anesth Analg. 1983;62:174-180.

Modig J, Hjelmstedt A, Sahlstedt B. Comparative influences of epidural and general anaesthesia on deep venous thrombosis and pulmonary embolism after total hip replacement. Acta Chir Scand. 1981;147:125-130.

Modig J. Thromboembolism and blood loss: Continuous epidural block versus general anesthesia with controlled ventilation. Reg Anesth. 1982;7:S84-88.

Montella KR. Hypercoagulable States in Pregnancy. Current Obstetric Medicine. 1993:141-162.

Pechet L, Alexander B. Increased clotting factors in pregnancy. N Engl J Med. 1961;265:1093-1096.

Rem J, Feddersen C, Brandt MR. Postoperative changes in coagulation and fibrinolysis independent of neurogenic stimuli and adrenal hormones. Br J Surg. 1981;68:229-233.

Steer PL, Krantz H. Thrombelastography and sonoclot analysis in the parturient. Poster exhibit abstracts. :57.6.

Stirling Y, Woolf L, North WRS. Haemostasis in normal pregnancy. Thromb Haemost. 1984;52:176-182.

Tuman KJ, McCarthy RJ, March RJ. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg. 1991;73:696-704.

Tuman KJ, Spiess BD, Mccarthy RJ. Effects of progressive blood loss on coagulation as measured by thrombelastography. Anesth Analg. 1987;66:856-863.

Ueland K. Maternal cardiovascular dynamics: VII. Intrapartum blood volume changes. Am J Obstet Gynecol. 1976;126:671-677.

Yeager MP, Glass DD, Neff RK. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:729-736.

Yoshimura T, Ito M, Nakamura T. The influence of labor on thrombotic and fibrinolytic systems. Eur J Obstet Gynecol Reprod Biol. 1992;44:195-199.

5dd6c6970e8825203c13f288 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections