Evaluación de esquemas de asociación de bupivacaína pesada con fentanil, para anestesia raquídea en parto por cesárea, Hospital Regional 2 IESS Dr. Teodoro Maldonado Carbo, 2012-2013
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2015
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes: La cesárea se ha constituido en la intervención de elección de hasta el 60% de nacimientos. La anestesia raquídea se ha convertido en el método de elección para la realización de esta cirugía. El uso de un anestésico local con un opioide es la combinación farmacológica más empleada. Una dosis de bupivacaína con fentanil se utiliza en el Hospital “Teodoro Maldonado” pero no se ha estandarizado dicha dosis. Objetivos: Determinar la dosis más adecuada de bupivacaína pesada 0.5% en combinación con una dosis estándar de fentanil de 25 mcg. en anestesia raquídea para la realización de cesárea. Metodología: Se realizó un estudio observacional, analítico, longitudinal, prospectivo en el Área Materno-Infantil del Hospital “Dr. Teodoro Maldonado Carbo” en el que se incorporaron aleatoriamente 81 pacientes indicadas para cesárea, distribuidos así: 10 pacientes con dosis de 10 mg, 19 pacientes a dosis de 12,5 mg y 52 pacientes con dosis de 15 mg de bupivacaína en una combinación con dosis estándar 25 mcg de fentanil. Resultados: Complicaciones trasnquirúrgicas: se informó dolor leve en el 5,3% de casos Grupo 12.6 mg y 1.9% en el grupo de 15 mg. (P > 0.05). Náuseas/vómito 10% en el grupo 10 mg y 1.9%, 15 mg (P>0.05). En el postquirúrgico, complicaciones atribuibles a la anestesia se informó en el 5.3% de casos con 12.5 mg y en el 1.9% con 15 mg (P > 0.05). Dolor leve postquirúrgico 10.0% grupo 10 mg, 10.5% grupo de 12.5 mg, 11.5% grupo de 15 mg (P > 0.005). Conclusiones: No existen diferencias en los efectos anestésicos ni en los efectos colaterales y adversos entre las diferentes dosis de bupivacaína empleadas en combinación con una dosis estándar de fentanil, por lo que se recomienda que se emplee de manera sistemática la dosis de 10 mg de bupivacaína 0.5% pesada combinada con 25 mcg de fentanil para la realización de cesáreas en la institución.
Background: The cesarean section has become the procedure of choice of up to 60% of births. Spinal anesthesia has become the method of choice to perform this surgery. The use of opioid anesthetic is most commonly used drug combination. A dose of bupivacaine with fentanyl is used in the Teodoro Maldonado hospital but has not been standardized dose. Objective: To determine the most appropriate dose of heavy bupivacaine 0.5% in combination with a standard dose of fentanyl 25 mcg. in spinal anesthesia for cesarean section. Methods: An observational, analytical, longitudinal, prospective study was conducted at the Maternal/Child Care - Teodoro Maldonado Hospital in which 81 patients were included randomly given for cesarean section, distributed as follows: 10 patients with doses of 10 mg, 19 patients at doses of 12.5 mg and 52 patients with doses of 15 mg of bupivacaine in combination with 25 mcg fentanyl. Results: Complications trasnquirúrgicas: mild pain was reported in 5.3% of cases Group 12.6 mg and 1.9% in the 15 mg. (P> 0.05). Nausea / vomiting 10% in the 10 mg group and 1.9%, 15 mg (P> 0.05). In the postoperative attributable to anesthesia complications were reported in 5.3% of cases with 12.5 mg and 1.9% with 15 mg (P> 0.05). Mild postoperative pain 10 mg group 10.0% 10.5% 12.5 mg group, 11.5% of 15 mg group (P> 0.005). Conclusions: There are no differences in anesthetic or side effects and adverse effects between different doses of bupivacaine used in combination with a standard dose of bupivacaine, which is recommended to be used systematically dose of 10 mg combined with 25 mcg of fentanyl to perform caesarean sections in the institution.
Background: The cesarean section has become the procedure of choice of up to 60% of births. Spinal anesthesia has become the method of choice to perform this surgery. The use of opioid anesthetic is most commonly used drug combination. A dose of bupivacaine with fentanyl is used in the Teodoro Maldonado hospital but has not been standardized dose. Objective: To determine the most appropriate dose of heavy bupivacaine 0.5% in combination with a standard dose of fentanyl 25 mcg. in spinal anesthesia for cesarean section. Methods: An observational, analytical, longitudinal, prospective study was conducted at the Maternal/Child Care - Teodoro Maldonado Hospital in which 81 patients were included randomly given for cesarean section, distributed as follows: 10 patients with doses of 10 mg, 19 patients at doses of 12.5 mg and 52 patients with doses of 15 mg of bupivacaine in combination with 25 mcg fentanyl. Results: Complications trasnquirúrgicas: mild pain was reported in 5.3% of cases Group 12.6 mg and 1.9% in the 15 mg. (P> 0.05). Nausea / vomiting 10% in the 10 mg group and 1.9%, 15 mg (P> 0.05). In the postoperative attributable to anesthesia complications were reported in 5.3% of cases with 12.5 mg and 1.9% with 15 mg (P> 0.05). Mild postoperative pain 10 mg group 10.0% 10.5% 12.5 mg group, 11.5% of 15 mg group (P> 0.005). Conclusions: There are no differences in anesthetic or side effects and adverse effects between different doses of bupivacaine used in combination with a standard dose of bupivacaine, which is recommended to be used systematically dose of 10 mg combined with 25 mcg of fentanyl to perform caesarean sections in the institution.
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Cesárea, Anestesia raquídea, Bupivacaína, Fentanilo, Epidemiologia analítica, Estudios prospectivos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador