| Comparación entre ropivacaína al 0.75% vs ropivacaína 0.75% más fentanilo en cesárea. |
Dr. Heberto Hernández-Miranda, Dr. Eliseo Martínez-Ortiz, Dr. Marco A Calderón-Yáñez, Dr. Bernardo Soto-Rivera
Revista Mexicana de Anestesiología Vol. 34. No. 3 Julio-Septiembre 2011, pp 176-180
RESUMEN
El presente trabajo es un estudio de tipo longitudinal, prospectivo, comparativo y abierto realizado en una población de 50 pacientes embarazadas programadas para operación cesárea, entre 18 y 45 años de edad, sin sufrimiento fetal agudo, clasifi cadas con ASA I-II, con peso no mayor de 90 kilos, escolaridad mínima de secundaria, cumpliendo ayuno mínimo de 8 horas. En forma aleatoria se determinó la división de los dos grupos de estudio, definiendo como grupo (A) a las pacientes que recibieron ropivacaína al 0.75% 13 mL más fentanilo (2 mL) peridural y como grupo (B) a las pacientes que recibieron sólo ropivacaína al 0.75% 15 mL. Se estudiaron 50 pacientes: edad promedio de 28.5 años, peso promedio de 75.5 kilos. Se valoró el período de latencia en ambos grupos encontrando un tiempo de latencia menor en el grupo A en relación al grupo B con p = .000 con U de Mann-Whitney. En relación a la calidad de la anestesia en ambos grupos fue buena. Respecto al dolor postoperatorio éste se presentó más tardíamente en el grupo A p = .000 medido con U de Mann-Whitney. La frecuencia cardíaca y la presión arterial disminuyen en ambos grupos p = .000. Conclusión: La combinación de ropivacaína 0.75% más fentanilo peridural en la operación cesárea disminuye el período de latencia, da buena calidad anestésica y prolonga el tiempo de analgesia postoperatoria.
Palabras clave: Ropivacaína, fentanilo, cesárea, latencia, anestesia, analgesia postoperatoria, escala visual análoga.
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| Dosis mínima efectiva de anestésico local de ropivacaína y bupivacaína hiperbáricas intratecales 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. gengzhiyu_2005@yahoo.com.cn
Chin Med J (Engl). 2011 Feb;124(4):509-13.
Abstract
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.
http://www.cmj.org/Periodical/PDF/201121855768630.pdf
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| Efectos del fentanil peridural sobre la velocidad y la calidad del bloqueo para cesárea urgente en la extensión de la analgesia epidural de trabajo de parto utilizando ropivacaína y fentanil. |
Effects of epidural fentanyl on speed and quality of block for emergency cesarean section in extending continuous epidural labor analgesia using ropivacaine and fentanyl. Hong JY, Jee YS, Jeong HJ, Song Y, Kil HK. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. J Korean Med Sci. 2010 Feb;25(2):287-92. Epub 2010 Jan 19.Abstract We performed a prospective, randomized, and double-blind study comparing the top-up effects of 2% lidocaine/100 microg fentanyl/epinephrine (n=31) and 2% lidocaine/saline/epinephrine (n=30) when extending an epidural labor analgesia using low-dose ropivacaine and fentanyl. Survival analysis for the sensory blocks to the T4 level showed no statistically significant differences in onset time to T4 between the 2 groups. Onset times (min) to T4-sensory blocks for cold and pinprick were not different between the two groups. However, median maximum sensory level in the lidocaine-fentanyl group (T1 for cold and T2 for pinprick) was significantly higher than that in the lidocaine-saline group (T3 and T4, respectively). The lidocaine-fentanyl group exhibited less visceral pain (6.5% vs. 36.7%), less supplementation of lidocaine (6.5% vs. 43.3%), and less nausea (6.5% vs. 26.7%) compared with the lidocaine-saline group during the intraoperative period. It is concluded that adding fentanyl to 2% lidocaine does not speed up the onset of the block when the onset is tested with cold or sharp pinprick but improves the quality of analgesia with fewer side effects in emergency top-up for cesarean section. http://www.jkms.org/Synapse/Data/PDFData/0063JKMS/jkms-25-287.pdf |
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