Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000400001
Brazilian Journal of Anesthesiology
Scientific Article

Comparação da concentração máxima plasmática da mistura com excesso enantiomérico de 50% (S75/R25) de bupivacaína a 0,5% com epinefrina 1: 200.000 entre os acessos parassacral e infraglúteo do bloqueio do nervo isquiático

Comparison of the plasma levels of 50% enantiomeric excess (S75/R25) 0.5% bupivacaine combined with 1: 200,000 epinephrine between the parasacral and infragluteal sciatic nerve blocks

Pablo Escovedo Helayel; André Roberto Bussman; Diogo Brüggemann da Conceição; Getúlio Rodrigues de Oliveira Filho

http://dx.doi.org/10.1590/S0034-70942008000400001 Braz J Anesthesiol, vol.58, n4, p.323-329, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: Anestésicos locais (AL) são fármacos seguros se administrados em dose e localização corretas. A velocidade de absorção do anestésico local depende de sua massa e vascularização do local de injeção. O objetivo deste estudo foi analisar a concentração sérica da mistura com excesso enantiomérico de 50% (S75/R25) de bupivacaína 0,5% com epinefrina 1:200.000, utilizada para bloqueio do nervo isquiático (BNI) nas vias parassacral (PS) e infraglútea (IG). MÉTODO: Vinte e oito pacientes agendados para operações no tornozelo e pé foram, aleatoriamente, distribuídos em dois grupos de maneira prospectiva. No Grupo 1, foi realizado BNI com neuroestimulação por via IG, enquanto no Grupo 2 foi utilizada a via PS. Nos dois grupos foram injetados 30 mL de bupivacaína (S75/R25) a 0,5% com adrenalina 1:200.000. Foram coletadas amostras de 5 mL de sangue arterial com 0, 15, 30, 60 e 90 minutos após injeção do AL. A análise da concentração sérica foi realizada pela cromatografia líquida de alto desempenho. Dados demográficos foram comparados, entre grupos, pelo teste t de Student para amostras independentes e pelo teste Exato de Fisher. Dados referentes às concentrações plasmáticas foram submetidos à Análise de Variância bifatorial para amostras repetidas. RESULTADOS: Os Grupos 1 e 2 não apresentaram diferenças demográficas significativas. A concentração máxima (Cmáx.) do Grupo 1 (308 ± 91 ng.mL-1) foi obtida nas amostras 5 (90 minutos), enquanto no Grupo 2 (425 ± 280 ng.mL-1) esta ocorreu nas amostras 2 (15 minutos). Nenhum paciente apresentou toxicidade sistêmica. CONCLUSÕES: A Cmáx. da bupivacaína (S75/R25) a 0,5% com adrenalina 1:200.000 no acesso parassacral foi superior, quando comparado com o acesso infraglúteo do BNI.

Palavras-chave

ANESTESIA, Regional, ANESTÉSICOS, local, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Local anesthetics (LA) are safe drugs when the proper dose and localization are used. The rate of absorption of the local anesthetic depends on its mass and blood flow at the site of the injection. The objective of this study was to analyze the plasma concentration of 50% enantiomeric excess (S75R25) 0.5% bupivacaine combined with 1:200,000 epinephrine in the parasacral (PS) and infragluteal (IG) sciatic nerve block (SNB). METHODS: Twenty-eight patients scheduled for ankle and foot surgeries were randomly divided into two groups in this prospective study. In Group 1, SNB was performed with IG neurostimulation, while in Group 2 the PS method was used. Both groups received 30 mL of 0.5% bupivacaine (S75/R25) with 1:200,000 epinephrine. Arterial blood samples, 5 mL, were drawn at 0, 15, 30, 60, and 90 minutes after the administration of the LA. High-performance liquid chromatography was used to analyze the serum concentrations. Demographic data of both groups were compared using the Student t test for independent samples and Fisher's Exact test. Bifactorial Analysis of Variance for repeated samples was used for the data concerning the plasma concentrations. RESULTS: Groups 1 and 2 showed no significant demographic differences. The maximal concentration (Cmax) in Group 1 (308 ± 91 ng.mL-1) was obtained in samples number 5 (90 minutes), while in Group 2 (425 ± 280 ng.mL-1) it was obtained in samples number 2 (15 minutes). Cases of systemic toxicity were not observed. CONCLUSIONS: Cmax of 0.5 % bupivacaine (S75/R25) with 1:200,000 in the parasacral approach was higher when compared with the infragluteal SNB.

Keywords

ANESTHESIA, Regional, ANESTHETICS, local, ANESTHETIC TECHNIQUES, Regional

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