Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide?
Autor(a) principal: | |
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Data de Publicação: | 1998 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://www.sba.com.br/arquivos/revista/rba/nov98455.pdf http://hdl.handle.net/11449/65554 |
Resumo: | Background and Objectives: - The effects of associating lipophilic opioids to local anesthetics in epidural anesthesia are not well defined. There are still questions and controversies about opioid doses to be used and their major effects in the epidural block. This study aimed at evaluating the epidural block effects in humans of the association of different fentanyl and sufentanil doses to bupivacaine with 1:200.000 epinephrine. Methods: - A double-blind randomized study was performed in 94 patients of both genders, physical status ASA I, aged between 18 and 60 years, submitted to lower abdomen, perineal or lower limb surgery. Patients without preanesthetic medication were epidurally injected with 100 mg (20 ml) 0.5% bupivacaine, 0.1 mg (0.1 ml) 1%o epinephrine plus a combination of the following drugs: BUPI Group (15 patients): 2 ml of 0.9% saline solution (SS); FENT50 Group (19 patients): 50 μg (1 ml) fentanyl + 1 ml SS; FENT100 Group (20 patients): 100 μg (2 ml) fentanyl; SUF30 Group (20 patients): 30 μg (0.6 ml) sufentanil + SS (1.4 ml); SUF100 Group (20 patients): 50 μg (1 ml) sufentanil + SS (1 ml). The following parameters were studied: onset of sensory block, analgesic block (onset time) in T12, T10 and T8, analgesic block duration in T10 and T12, motor block degree, consciousness degree, need for supplemental perioperative sedation and analgesia, hypotension, bradycardia and peri and post operative side-effects, analgesia duration, proportion of patients needing supplemental analgesia and evaluation of postoperative pain (pain analog visual scale). Results: Groups were demographically uniform. The addition of fentanyl or sufentanil did not alter major characteristics of perioperative epidural block and has not significantly increased postoperative analgesia duration as compared to the use of bupivacaine only. However, the addition of lipophilic opioids has increased the quality of perioperative anesthetic block, translated into a lesser need for supplemental analgesia (p < 0.02). The increased dose of fentanyl and especially of sufentanil has increased the incidence of perioperative drowsiness (p < 0.001) without significant increase in other side effects. Conclusions: In the conditions and doses used, the addition of lipophilic opioids to bupivacaine and the increased dose of lipophilic opioids have improved anesthetic block quality without changes in the epidural block characteristics or a significant increase in side effects, with the exception of drowsiness mainly caused by sufentanil. However, they were not able to provide a significant increase in postoperative analgesia duration. |
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Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide?Association of lipophilic opioids and bupivacaine in epidural anesthesia. Would an increased opioid dose be advantageous?Analgesics, opioids: fentanyl, sufentanilAnesthetic techniques, regional: epiduralAnesthetics, local: bupivacaineadrenalinbupivacainefentanyllocal anesthetic agentopiatesufentaniladultanesthesia inductionbradycardiaclinical trialconsciousnesscontrolled clinical trialdose time effect relationdouble blind proceduredrowsinessepidural anesthesiaepidural drug administrationfemalehumanhypotensionlipophilicitymajor clinical studymalepostoperative analgesiapostoperative painrandomized controlled trialsedationBackground and Objectives: - The effects of associating lipophilic opioids to local anesthetics in epidural anesthesia are not well defined. There are still questions and controversies about opioid doses to be used and their major effects in the epidural block. This study aimed at evaluating the epidural block effects in humans of the association of different fentanyl and sufentanil doses to bupivacaine with 1:200.000 epinephrine. Methods: - A double-blind randomized study was performed in 94 patients of both genders, physical status ASA I, aged between 18 and 60 years, submitted to lower abdomen, perineal or lower limb surgery. Patients without preanesthetic medication were epidurally injected with 100 mg (20 ml) 0.5% bupivacaine, 0.1 mg (0.1 ml) 1%o epinephrine plus a combination of the following drugs: BUPI Group (15 patients): 2 ml of 0.9% saline solution (SS); FENT50 Group (19 patients): 50 μg (1 ml) fentanyl + 1 ml SS; FENT100 Group (20 patients): 100 μg (2 ml) fentanyl; SUF30 Group (20 patients): 30 μg (0.6 ml) sufentanil + SS (1.4 ml); SUF100 Group (20 patients): 50 μg (1 ml) sufentanil + SS (1 ml). The following parameters were studied: onset of sensory block, analgesic block (onset time) in T12, T10 and T8, analgesic block duration in T10 and T12, motor block degree, consciousness degree, need for supplemental perioperative sedation and analgesia, hypotension, bradycardia and peri and post operative side-effects, analgesia duration, proportion of patients needing supplemental analgesia and evaluation of postoperative pain (pain analog visual scale). Results: Groups were demographically uniform. The addition of fentanyl or sufentanil did not alter major characteristics of perioperative epidural block and has not significantly increased postoperative analgesia duration as compared to the use of bupivacaine only. However, the addition of lipophilic opioids has increased the quality of perioperative anesthetic block, translated into a lesser need for supplemental analgesia (p < 0.02). The increased dose of fentanyl and especially of sufentanil has increased the incidence of perioperative drowsiness (p < 0.001) without significant increase in other side effects. Conclusions: In the conditions and doses used, the addition of lipophilic opioids to bupivacaine and the increased dose of lipophilic opioids have improved anesthetic block quality without changes in the epidural block characteristics or a significant increase in side effects, with the exception of drowsiness mainly caused by sufentanil. However, they were not able to provide a significant increase in postoperative analgesia duration.Departamento Anestesiologia da FMB UNESP, Rubiao Junior 18618-970 Botucatu, SPDepartamento Anestesiologia da FMB UNESP, Rubiao Junior 18618-970 Botucatu, SPUniversidade Estadual Paulista (Unesp)Braz, José Reinaldo Cerqueira [UNESP]Vanni, S. M D [UNESP]Menezes, J. A. [UNESP]Gorayb, S. B S [UNESP]Módolo, Norma Sueli Pinheiro [UNESP]2014-05-27T11:19:38Z2014-05-27T11:19:38Z1998-11-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article455-467application/pdfhttp://www.sba.com.br/arquivos/revista/rba/nov98455.pdfRevista Brasileira de Anestesiologia, v. 48, n. 6, p. 455-467, 1998.0034-7094http://hdl.handle.net/11449/655542-s2.0-00317891052-s2.0-0031789105.pdf8223546475724058Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPporRevista Brasileira de Anestesiologia0.8500,320info:eu-repo/semantics/openAccess2023-10-06T06:07:54Zoai:repositorio.unesp.br:11449/65554Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-10-06T06:07:54Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? Association of lipophilic opioids and bupivacaine in epidural anesthesia. Would an increased opioid dose be advantageous? |
title |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? |
spellingShingle |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? Braz, José Reinaldo Cerqueira [UNESP] Analgesics, opioids: fentanyl, sufentanil Anesthetic techniques, regional: epidural Anesthetics, local: bupivacaine adrenalin bupivacaine fentanyl local anesthetic agent opiate sufentanil adult anesthesia induction bradycardia clinical trial consciousness controlled clinical trial dose time effect relation double blind procedure drowsiness epidural anesthesia epidural drug administration female human hypotension lipophilicity major clinical study male postoperative analgesia postoperative pain randomized controlled trial sedation |
title_short |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? |
title_full |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? |
title_fullStr |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? |
title_full_unstemmed |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? |
title_sort |
Associacao de opioides lipofilicos a bupivacaina na anestesia peridural. Ha vantagem no aumento da dose do opioide? |
author |
Braz, José Reinaldo Cerqueira [UNESP] |
author_facet |
Braz, José Reinaldo Cerqueira [UNESP] Vanni, S. M D [UNESP] Menezes, J. A. [UNESP] Gorayb, S. B S [UNESP] Módolo, Norma Sueli Pinheiro [UNESP] |
author_role |
author |
author2 |
Vanni, S. M D [UNESP] Menezes, J. A. [UNESP] Gorayb, S. B S [UNESP] Módolo, Norma Sueli Pinheiro [UNESP] |
author2_role |
author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Braz, José Reinaldo Cerqueira [UNESP] Vanni, S. M D [UNESP] Menezes, J. A. [UNESP] Gorayb, S. B S [UNESP] Módolo, Norma Sueli Pinheiro [UNESP] |
dc.subject.por.fl_str_mv |
Analgesics, opioids: fentanyl, sufentanil Anesthetic techniques, regional: epidural Anesthetics, local: bupivacaine adrenalin bupivacaine fentanyl local anesthetic agent opiate sufentanil adult anesthesia induction bradycardia clinical trial consciousness controlled clinical trial dose time effect relation double blind procedure drowsiness epidural anesthesia epidural drug administration female human hypotension lipophilicity major clinical study male postoperative analgesia postoperative pain randomized controlled trial sedation |
topic |
Analgesics, opioids: fentanyl, sufentanil Anesthetic techniques, regional: epidural Anesthetics, local: bupivacaine adrenalin bupivacaine fentanyl local anesthetic agent opiate sufentanil adult anesthesia induction bradycardia clinical trial consciousness controlled clinical trial dose time effect relation double blind procedure drowsiness epidural anesthesia epidural drug administration female human hypotension lipophilicity major clinical study male postoperative analgesia postoperative pain randomized controlled trial sedation |
description |
Background and Objectives: - The effects of associating lipophilic opioids to local anesthetics in epidural anesthesia are not well defined. There are still questions and controversies about opioid doses to be used and their major effects in the epidural block. This study aimed at evaluating the epidural block effects in humans of the association of different fentanyl and sufentanil doses to bupivacaine with 1:200.000 epinephrine. Methods: - A double-blind randomized study was performed in 94 patients of both genders, physical status ASA I, aged between 18 and 60 years, submitted to lower abdomen, perineal or lower limb surgery. Patients without preanesthetic medication were epidurally injected with 100 mg (20 ml) 0.5% bupivacaine, 0.1 mg (0.1 ml) 1%o epinephrine plus a combination of the following drugs: BUPI Group (15 patients): 2 ml of 0.9% saline solution (SS); FENT50 Group (19 patients): 50 μg (1 ml) fentanyl + 1 ml SS; FENT100 Group (20 patients): 100 μg (2 ml) fentanyl; SUF30 Group (20 patients): 30 μg (0.6 ml) sufentanil + SS (1.4 ml); SUF100 Group (20 patients): 50 μg (1 ml) sufentanil + SS (1 ml). The following parameters were studied: onset of sensory block, analgesic block (onset time) in T12, T10 and T8, analgesic block duration in T10 and T12, motor block degree, consciousness degree, need for supplemental perioperative sedation and analgesia, hypotension, bradycardia and peri and post operative side-effects, analgesia duration, proportion of patients needing supplemental analgesia and evaluation of postoperative pain (pain analog visual scale). Results: Groups were demographically uniform. The addition of fentanyl or sufentanil did not alter major characteristics of perioperative epidural block and has not significantly increased postoperative analgesia duration as compared to the use of bupivacaine only. However, the addition of lipophilic opioids has increased the quality of perioperative anesthetic block, translated into a lesser need for supplemental analgesia (p < 0.02). The increased dose of fentanyl and especially of sufentanil has increased the incidence of perioperative drowsiness (p < 0.001) without significant increase in other side effects. Conclusions: In the conditions and doses used, the addition of lipophilic opioids to bupivacaine and the increased dose of lipophilic opioids have improved anesthetic block quality without changes in the epidural block characteristics or a significant increase in side effects, with the exception of drowsiness mainly caused by sufentanil. However, they were not able to provide a significant increase in postoperative analgesia duration. |
publishDate |
1998 |
dc.date.none.fl_str_mv |
1998-11-30 2014-05-27T11:19:38Z 2014-05-27T11:19:38Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://www.sba.com.br/arquivos/revista/rba/nov98455.pdf Revista Brasileira de Anestesiologia, v. 48, n. 6, p. 455-467, 1998. 0034-7094 http://hdl.handle.net/11449/65554 2-s2.0-0031789105 2-s2.0-0031789105.pdf 8223546475724058 |
url |
http://www.sba.com.br/arquivos/revista/rba/nov98455.pdf http://hdl.handle.net/11449/65554 |
identifier_str_mv |
Revista Brasileira de Anestesiologia, v. 48, n. 6, p. 455-467, 1998. 0034-7094 2-s2.0-0031789105 2-s2.0-0031789105.pdf 8223546475724058 |
dc.language.iso.fl_str_mv |
por |
language |
por |
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Revista Brasileira de Anestesiologia 0.850 0,320 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
455-467 application/pdf |
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Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
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UNESP |
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UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
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