Spinal Block with 10 mg of Hyperbaric Bupivacaine Associated with 5 μg of Sufentanil For Cesarean Section. Study of Different Volumes

• Published in: Revista brasileira de anestesiologia 2010-03, Vol.60 (2), p.121-129
• Main Authors: Braga, Angélica de Fátima de Assunção, Frias, José Aristeu Fachini, Braga, Franklin Sarmento da Silva, Pinto, Daniela Roncoletta da Silva
• Format: Article
• Language: English
• Subjects: ANESTHETIC TECHNIQUE, Regional: subarachnoid; ANESTHETIC, Local: hyperbaric bupivacaine; ANESTÉSICO, Local: bupivacaína hiperbárica; CIRURGIA, Obstétrica: cesariana; SURGERY, Obstetric: cesarean section; TÉCNICAS ANESTÉSICAS, Regional: subaracnóidea
• ISSN: 0034-7094; 1806-907X
• DOI: 10.1016/S0034-7094(10)70016-7

Several factors affect the cephalad dispersion of the anesthetic solution in the subarachnoid space; among them, physiological changes of pregnancy and the dose and volume of the local anesthetics should be mentioned. The objective of this study was to assess the effectivity and side effects of different volumes of the subarachnoid administration of the association of hyperbaric bupivacaine and sufentanil in cesarean sections. Forty patients, ASA I and II, undergoing elective cesarean section under spinal block were divided in two groups, according to the volume of the anesthetic solution: Group I (4 mL) and Group II (3 mL). The association of hyperbaric bupivacaine (10 mg-2 mL) and sufentanil (5 μg-1 mL) was used in both groups. In Group I, 1 mL of NS was added to the solution to achieve the volume of 4 mL. The following parameters were evaluated: latency of the blockade; upper limit of the sensorial blockade; degree of motor blockade; time for regression of the motor blockade; total duration of analgesia; maternal side effects; and neonatal repercussions. Latency, the upper limit of the sensorial blockade, and the degree and time for regression of the motor blockade were similar in both groups; duration of analgesia was greater in Group I than in Group II, which was statistically significant. The incidence of side effects was similar in both groups. Maternal cardiocirculatory changes and neonatal repercussions were not observed. Four milliliter of anesthetic solution composed of hyperbaric bupivacaine, 10 mg, associated with 5 μg of sufentanil was more effective than 3 mL of the same solution, providing better intra- and postoperative analgesia without maternal-fetal repercussions. Diversos fatores influenciam na dispersão cefálica da solução anestésica no espaço subaracnóideo, entre os quais destacam-se as alterações fisiológicas inerentes à gravidez, baricidade, dose e volume do anestésico local. O objetivo deste estudo foi avaliar em cesarianas a efetividade e os efeitos colaterais de diferentes volumes da associação de bupivacaína hiperbárica e sufentanil por via subaracnóidea. Quarenta pacientes, ASA I e II, submetidas à cesariana eletiva sob raquianestesia distribuídas em dois grupos, de acordo com o volume da solução anestésica empregada: Grupo I (4 mL) e Grupo II (3 mL). Nos dois grupos o anestésico local empregado foi a bupivacaína hiperbárica (10 mg-2 mL) associada ao sufentanil (5 μg-1 mL). No Grupo I, para obtenção do volume de 4 mL, foi adic