viernes, 10 de junio de 2011

Dosis mínima efectiva de ropivacaína y bupivacaína hiperbárica intratecal para operación cesárea

Dosis mínima efectiva de ropivacaína y bupivacaína hiperbárica intratecal para operación cesárea
Minimum effective local anesthetic dose of intrathecal hyperbaric ropivacaine and bupivacaine for cesarean section.
Geng ZY, Wang DX, Wu XM.
Department of Anesthesiology and Surgical Intensive Care, Peking University First Hospital, Beijing, China.
Chin Med J (Engl). 2011 Feb;124(4):509-13.
BACKGROUND: Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose (MLAD) of intrathecal ropivacaine for non-obstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacaine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio. METHODS: We enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine. The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection. RESULTS: The intrathecal MLAD was 9.45 mg (95%confidence interval (CI), 8.45 - 10.56 mg) for ropivacaine and 7.53 mg (95%CI, 7.00 - 8.10 mg) for bupivacaine. The relative potency ratio was 0.80 (95%CI, 0.74 - 0.85) for ropivacaine/bupivacaine when given intrathecally in cesarean section. CONCLUSION: Ropivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery. 
Comparación de fentanil y sufentanil agregados a bupivacaína 0.5% hiperbárica para anestesia espinal en pacientes de operación cesárea.
Comparison of fentanyl and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section.
Lee JH, Chung KH, Lee JY, Chun DH, Yang HJ, Ko TK, Yun WS.
Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea.
Korean J Anesthesiol. 2011 Feb;60(2):103-8. Epub 2011 Feb 25.
BACKGROUND: Subarachnoid block is widely used for cesarean section due to the rapid induction, the complete analgesia, the low failure rate and the prevention of aspiration pneumonia. The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia & prolong the duration of analgesia. Therefore we compared the effects of fentanyl 20 µg and sufentanil 2.5 µg, which were added to intrathecal hyperbaric bupivacaine. METHODS: SEVENTY TWO HEALTHY TERM PARTURIENTS WERE RANDOMLY DIVIDED INTO THREE GROUPS: Group C (control), Group F (fentanyl 20 µg) and Group S (sufentanil 2.5 µg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen by Harten et al. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS: There were significant differences between the control and the fentanyl 20 µg and sufentanil 2.5 µg groups for the degree of muscle relaxation, the quality of intraoperative analgesia, the maximal sedation level and the duration of effective analgesia. The frequencies of side effects such as nausea and pruritis in the opioid groups were higher than those in the control group. But there were no differences between fentanyl 20 µg and sufentanil 2.5 µg for the frequencies of nausea and pruritis. CONCLUSIONS: The addition of fentanyl 20 µg or sufentanil 2.5 µg for spinal anesthesia provides adequate intraoperative analgesia without significant adverse effects on the mother and neonate 
Dr. Benito Cortes-Blanco 
Anestesiología y Medicina del Dolor
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