Bloqueo motor y sensitivo en anestesia epidural con l-bupivacaína vs Bupivacaína en cesáreas. Hospital Vicente Corral Moscoso. Cuenca 2013

Abstract

ABSTRACT Introduction: When considering the use of a local anesthetic, it is important to think about the physiological effects, indications and contraindications of various anesthetic techniques for cesarean section. Whatever the technical and drug used, it must strive to preserve the maternal-fetal homeostasis. Objective: To compare the intensity of motor block and the duration of sensory block produced by L-bupivacaine + fentanyl vs bupivacaine + fentanyl in epidural anesthesia for cesarean sections. Material and methods: We conducted a controlled clinical study randomized single-blind study with 236 maternal divided into two equal groups. Group A (n = 118) received L-bupivacaine + 150 µg of fentanyl, group B (n = 118) received bupivacaine + 150 µg of fentanyl. Was compared in both groups immediately after surgery, the intensity of motor block with the Bromage scale in the recovery room until discharge of patients to the floor of gynecology for about two hours and duration of sensory block every ten minutes until this absence. The incidence of nausea, vomiting, hypotension and hemodynamic changes that occurred in the two groups was quantified. Expected Results: The motor block according to Bromage scale is lower with L-bupivacaine, p = 0.000; no cases of motor block 2 or 3, which was observed when 3.4% bupivacaine. A sensitive lock 5.5 hours in the group of l-bupivacaine compared with 3.8 hours in the bupivacaine group, p = 0.000 was obtained. No major differences in the two groups regarding the heart rate and side effects were observed p = 0.624. The percentage of patients who achieved a level of sensitive blockade with L-T4 bupivacaine is 72.9% compared to 54.2% in the bupivacaine group. (p = 0.011). The frequency of hypotension in the group with l-bupivacaine is 34.7% compared to 63.6% of bupivacaine group (p = 0.028). Conclusions: the use of l-bupivacaine presents better clinical indicators compared with bupivacaine for cesarean section