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ISSN 2007-3194 (Print)
Órgano de difusión oficial del Instituto Materno Infantil del Estado de México

2014, Number 1

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Arch Inv Mat Inf 2014; 6 (1)

Estudio comparativo de la analgesia obstétrica peridural con ropivacaína al 2% + sufentanilo 0.4 µg/ mL vs ropivacaína al 2% + sufentanilo 0.2 µg/mL

Flores CGA, Ramos VA, Pardo MRV

Language: Spanish
References: 25
Page: 31-37
PDF size: 168.57 Kb.


ABSTRACT

Introduction: Pain relief in labor has occupied a prominent place and is a challenge for modern anesthesia, with the search for drugs that provide obstetrical analgesia with adequate pain control without side effects and/or adverse effects to both mother and the product. To use of sufentanyl been shown effective analgesia in combination with ropivacaine after epidural administration in patients with labor. Material and methods: We randomly divided into two groups of 75 patients in labor Maternal Child Institute of the State of Mexico in the period covered November 2010 to February 2011. In group one (control) s administered 2% ropivacaine with 0.4 µg/mL sufentanyl, 12 mL volume; group two (case) was administered 2% ropivacaine with 0.2 µg/mL sufentanyl in a volume of 12 mL, graduated both with 0.9% saline, epidural. We evaluated the hemodynamic stability with mean noninvasive arterial pressure, heart rate, respiratory rate. The patient’s pain was measured by visual analog scale (VAS), the degree of motor block was measured with the Bromage scale, and adverse effects of nausea, vomiting, pruritus and sedation. The measurements were taken at time zero, five and 20 minutes. Results: We performed descriptive statistics measures of central tendency and dispersion. Statistically significant differences were found between the two groups with a χ2 of 5.79 and p = 0.031 for pruritus; hemodynamic stability was preserved in both groups; the observed adverse effects were minimal and easily controlled. There were no significant differences between groups for pain measurement (VAS). Conclusions: Obstetric epidural analgesia with ropivacaine 2% plus 0.2 µg/mL sufentanyl proved to be equally effective as ropivacaine 2% plus 0.4 µg/mL sufentanyl, with the benefit of reducing the incidence of pruritus, providing good pain control with minimal adverse effects.


REFERENCES

  1. Wong CA. Advances in labor analgesia, Int J Womens Health 2009; 1: 139-154.

  2. Fernández-Martínez MA, Ros-Mora J, Villalonga-Morales A. Fallos en la analgesia epidural obstétrica y sus causas, Rev Esp Anestesiol Reanim, 2000; 47: 256-265.

  3. Capogna G, Camorcia M, Columb MO. Minimum analgesic doses of fentanyl and sufentanil for epidural analgesia in the first stage of labor, Anesth Analg, 2003; 96: 1178-1182.

  4. Guasch E, Ortega R, Gilsanz F. Analgesia epidural para parto en la gestante obesa, Rev Soc Esp Dolor, 2006; 7: 468-474.

  5. Ostrea EM Jr, Mantaring JB 3rd, Silvestre MA. Drugs that affect the fetus and newborn infant via the placenta or breast milk, Pediat Clin N Am, 2004; 51: 539-579.

  6. Palm S, Gertzen W, Ledowski T, Gleim M, Wulf H. Minimum local analgesic dose of plain ropivacaine vs ropivacaine combined with sufentanil during epidural analgesia for labor, Anaesthesia, 2001; 56: 526-529.

  7. Wong F, Shen X, Guo X, Peng Y, Gu X. Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a five-year randomized controlled trial, Anesthesiology, 2009; 111: 871-880.

  8. Brodner G, Mertes N, Aken HV, Möllhoff T, Zahl M, Wirtz S et al. What concentration of sufentanil should be combined with ropivacaine 0.2% wt/vol for postoperative patient-controlled epidural analgesia? Anesth Analg, 2000; 90: 649-657.

  9. Fisher C, Blanie P, Jaovën E, Vayssiére C, Kaloul I, Coltat JC. Ropivacaine 0.1% plus sufentanil 0.5 mg/mL versus bupivacaine 0.1% plus sufentanil 0.5 mg/mL, using patient-controlled epidural analgesia for labor, Anesthesiology, 2000; 92: 1588-1593.

  10. Kalra S, Saraswat N, Agnihotri GS. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia, Saudi Journal of Anaesthesia, 2010; 4: 178-181.

  11. Bernard JM, Le Roux D, Barthe A, Tourdain O, Vizquel L, Michel C. The dose-range effects of sufentanil added to 0.125% bupivacaine on the quality of patient-controlled epidural analgesia during labor, Anesth Analg, 2001; 92: 184-188.

  12. Boselli E, Debon R, Duflo F, Bryssine B, Allaouchiche B, Chassard D. Ropivacaine 0.15 plus sufentanil 0.5 mg/mL and ropivacaine 0.10% plus sufentanil 0.5 mg/mL are equivalent for patient-controlled epidural analgesia during labor, Anesth Analg, 2003; 96: 1173-1177.

  13. Kaya T, Büyükkoçak U, Basar H, Sagsöz N. Comparison of epidural ropivacaine 0.2% and ropivacaine 0.2% in combination with sufentanil 0.75 microg mL-1 for postcaesarean analgesia, Agri, 2008; 20: 30-37.

  14. Carvalho B, Fuller AJ, Brummel C, Durbin M, Riley ET. Fetal oxygen saturation after combined spinal-epidural labor analgesia: a case series, J Clin Anesth, 2007; 19: 476-478.

  15. Bader AM, Fragneto R, Terui K, Arthur GR, Loferski B, Datta S. Maternal and neonatal fentanyl and bupivacaine concentrations after epidural infusion during labor, Anesth Analg, 1995; 81: 829-832.

  16. Porter JS, Bonello E, Reynolds F. The effect of epidural opioids on maternal oxygenation during labour and delivery, Anaesthesia, 1996; 51: 899-903.

  17. Mardirosoff C, Dumont L, Boulvain M, Tramer MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review, BJOG, 2002; 109: 274-281.

  18. Albright GA, Forster RM. Does combined spinal-epidural analgesia with subarachnoid sufentanil increase the incidence of emergency cesarean delivery? Reg Anesth, 1997; 22: 400-405.

  19. Van de Velde M, Teunkes A, Hanssens M, Vandermeersch E, Verhaeghe J. Intrathecal sufentanil and fetal heart rate abnormalities: a double-blind, double placebo-controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor, Anesth Analg, 2004; 98: 1153-1159.

  20. Soni AK, Miller CG, Pratt SD, Hess PE, Oriol NE, Sarna MC. Low dose intrathecal ropivacaine with or without sufentanil provides effective analgesia and does not impair motor strength during labour: a pilot study, Can J Anaesth, 2001; 48: 677-680.

  21. Broekema AA, Gielen MJM, Hennis PJ. Postoperative analgesia with continuous epidural sufentanil and bupivacaine: a prospective study in 614 patients, Anesth Analg, 1996; 82: 754-9.

  22. Brodner G, Pogatzki E, Wempe H, Van Aken H. Patient-controlled postoperative epidural analgesia. Prospective study of 1799 patients, Anaesthesist, 1997; 46 (Suppl 3): S165-S171.

  23. Amer-Wahlin I, Christoffersson M, Dahlgren N, Rydhstroem H. Epidural analgesia with sufentanil during labor and operative delivery, Acta Obstet Gynecol Scand, 2000; 79: 538-542.

  24. Bornay B, Cuesta MJ, Hernández A, Julián R, Muriel C, Prieto MA, Vaquero LM. Analgesia epidural obstétrica: influencia de dos perfusiones (bupivacaína y ropivacaína a bajas dosis) en la instrumentación del parto. Presentado en el V Congreso de la Sociedad del Dolor (Salamanca 2002). En: http://portal.sedolor.es/index.php?option=com_k2&view=item&layout=item&id=329&Itemid=91

  25. Fernández A, García MB, Moro C, Muriel C, Sánchez E, Valdunciel JJ. Bupivacaína y ropivacaína a bajas concentraciones en la analgesia epidural obstétrica: analgesia y grado de bloqueo motor. Presentado en el VI Congreso de la Sociedad del Dolor (Salamanca 2002). En: http://portal.sedolor.es/index.php?option=com_k2&view=item&layout=item&id=338&Itemid=91




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