1 Revista da Associação Médica Brasileira 2008 Vol: 54(2):. DOI: 10.1590/S0104-42302008000200011

Efeito sinérgico entre a dexmedetomidina e a ropivacaína 0,75% na anestesia peridural

BACKGROUND: This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. METHODS: Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg), plus dexmedetomidine, 1 mg.kg-1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia and incidence of side-effects. RESULTS: Epidural dexmedetomidine did not affect onset time or upper level of anesthesia (p > 0.05) however it prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and also resulted in a more intense motor block, l (p < 0.05). Values of bispectral index were lower in Dexmedetomidine Group (p < 0.05). There was no difference in incidence of hypotension and bradycardia (p > 0.05). Occurrence of side-effects (shivering, vomiting and SpO2 < 90%) was low and similar between groups (p > 0.05). CONCLUSION: There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.

Figure 1
  1. Aantaa R, Jaakola ML, Kallio A, Kanto J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology.86 , 1055-60 (1997) .
  2. Jalonen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology.86 , 331-45 (1997) .
  3. Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol.22 , 386-91 (2005) .
  4. Meert TF, De Kock M. Potentiation of the analgesic properties of fentanyl-like opioids with alpha2-adrenoceptor agonists in rats. Anesthesiology.81 , 677-88 (1994) .
  5. Asano T, Dohi S, Ohta, Shimonaka H, Iida H. Antinociception by epidural and systemic alpha(2)-adrenoceptor agonists and their binding affinity in rat spinal cord and brain. Anesth Analg.90 , 400-7 (2000) .
  6. Fukushima K, Nishimi Y, Mori K, Kaneko I, Fukushima Y. Postoperative analgesic action and plasma concentration of epidural administered dexmedetomidine. Anesthesiology.87(Suppl):744 , (1997) .
  7. Klimscha W, Chiari A, Krafft P, Plattner O, Taslimi R, Mayer N, et al. Hemodynamic and analgesic effects of clonidine added repetitively to continuous epidural and spinal blocks. Anesth Analg.80 , 322-7 (1995) .
  8. Alves TCA, Braz JRC. Efeitos da associação da clonidina à ropivacaína na anestesia peridural. Rev Bras Anestesiol.52 , 410-9 (2002) .
  9. Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand.16 , 55-69 (1965) .
  10. Lima OS, Neto DSC, Araújo Jr GS, Benevides AM. Estudo comparativo de anestesia peridural com ropivacaína a 1% associada a clonidina ou a dexmedetomidina. Rev Bras Anestesiol.53(supl):A013 , (2003) .
  11. Nishikawa T, Dohi S. Clinical evaluation of clonidine added to lidocaine solution for epidural anesthesia. Anesthesiology.73 , 853-9 (1990) .
  12. Milligan KR, Convery PN, Weir P, Quinn P, Connolly D. The efficacy and safety of epidural infusions of levobupivacaine with and without clonidine for postoperative pain relief in patients undergoing total hip replacement. Anesth Analg.91 , 393-7 (2000) .
  13. Landau R, Schiffer E, Morales M, Savoldelli G, Kern C. The dose-sparing effect of clonidine added to ropivacaine for labor epidural analgesia. Anesth Analg.95 , 728-34 (2002) .
  14. Curatolo M, Schnider TW, Petersen-Felix S, Weiss S, Signer C, Scaramozzino P, et al. A direct search procedure to optimize combinations of epidural bupivacaine, fentanyl, and clonidine for postoperative analgesia. Anesthesiology.92 , 325-37 (2000) .
  15. Paech MJ, Pavy TJ, Orlikowski CE, Lim W, Evans SF. Postoperative epidural infusion: a randomized, double-blind, dose-finding trial of clonidine in combination with bupivacaine and fentanyl. Anesth Analg.84 , 1323-8 (1997) .
  16. Walker SM, Howard RF, Keay KA, Fitzgerald M. Developmental age influences the effect of epidural dexmedetomidine on inflammatory hyperalgesia in rat pups. Anesthesiology.102 , 1226-34 (2005) .
  17. Muguruma T, Sakura S, Saito Y. Dexmedetomidine and bupivacaine have synergistic antinociceptive interaction in rats. Anesthesiology. 105(Suppl):A308 , (2006) .
  18. Silva MV, Araújo JHL, Baldiotti LAS. Dexmedetomidina com bupivacaína em peridural para histerectomia. Rev Bras Anestesiol.52(supl):B014 , (2002) .
  19. Eisenach JC, Shafer SL, Bucklin BA, Jackson C, Kallio A. Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep. Anesthesiology.80 , 1349-59 (1994) .
  20. Ala-Kokko TI, Pienimaki P, Lampela E, Hollmen AI, Pelkonen O, Vahakangas K. Transfer of clonidine and dexmedetomidine across the isolated perfused human placenta. Acta Anaesthesiol Scand.41 , 313-9 (1997) .
  21. Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-. Anesthesiology. 1996 85, 655-74 (1995) .
  22. Sabbe MB, Penning JP, Ozaki GT, Yaksh TL. Spinal and systemic action of the alpha 2 receptor agonist dexmedetomidine in dogs. Antinociception and carbon dioxide response. Anesthesiology.80 , 1057-72 (1994) .
  23. Maroof M, Khan SA, Jain D, Khan RM, Maroof SM. Evaluation of effect of dexmedetomidine in reducing shivering following epidural anesthesia. Anesthesiology.101(supl):A495 , (2004) .
  24. Rauck RL, Eisenach JC, Jackson K, Young LD, Southern J. Epidural clonidine treatment for refractory reflex sympathetic dystrophy. Anesthesiology.79 , 1163-9 (1993) .
  25. Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology.87 , 835-41 (1997) .
  26. Doufas AG, Lin CM, Suleman MI, Liem EB, Lenhardt R, Morioka N, et al. Dexmedetomidine and meperidine additively reduce the shivering threshold in humans. Stroke.34 , 1218-23 (2003) .