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Estudo prospectivo, randômico, controlado e de avaliac¸ão cega do desfecho --- infusão peridural intermitente programado em analgesia de parto
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Advisor(s)
Abstract(s)
Justificativa: Há evidências de que a administracão de um bolus epidural intermitente pro gramado (BEIP) comparada com a infusão epidural contínua (IEC) resulta em maior eficácia da analgesia e da satisfac¸ão materna, com reduc¸ão das intervenc¸ões anestésicas. Métodos: Neste estudo, 166 mulheres com gravidezes viáveis foram incluídas. Após uma dose epidural de 10 mL de ropivacaína a 0,16% e adic¸ão de 10 g de sufentanil, as parturientes foram aleatoriamente designadas para um dos três regimes: A - ropivacaína a 0,15% mais soluc¸ão de sufentanil (0,2 g/mL) como infusão peridural contínua (5 mL/h, imediatamente após o bolus inicial); B - ropivacaína a 0,1% mais sufentanil (0,2 g/mL) como bolus epidural intermitente
programado; C - soluc¸ão idêntica à do Grupo A com bolus epidural intermitente programado.Os regimes BEIP foram programados como 10 mL por hora, comec¸aram 60 minutos após o bolus inicial. Bolus de resgate de 5 mL da mesma soluc¸ão foi administrado com bomba de infusão. A satisfac¸ão materna foi avaliada com uma escala numérica verbal de 0 a 10. Também avaliamos os resultados adversos maternais e neonatais. Resultados: Foram avaliadas 130 gestantes (A = 60, B = 33; C = 37). A mediana na escala numé rica verbal para a satisfac¸ão materna foi de 8,8 no grupo A; 8,6 no grupo B e 8,6 no grupo C
(p = 0,83). Encontramos uma taxa mais elevada para parto cesário no grupo A (56,7%; p = 0,02).
Não observamos diferenc¸as no bloqueio motor, taxa de parto instrumental e resultados neona tais.
Conclusões: A manutenc¸ão da analgesia peridural com bolus epidural intermitente progra mado está associada a uma reduc¸ão da incidência de parto cesariano com satisfac¸ão materna igualmente elevada e sem resultados adversos
Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 g, parturient were randomly assigned to one of three regimens: A --- Ropivacaine 0.15% plus Sufentanil 0.2 g/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus); B --- Ropivacaine 0.1% plus Sufentanil 0.2 g/mL as programmed intermittent epidural bolus and C --- Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83). We found a higher caesarean delivery rate in group A (56.7%; p = 0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satis faction and no adverse outcomes
Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 g, parturient were randomly assigned to one of three regimens: A --- Ropivacaine 0.15% plus Sufentanil 0.2 g/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus); B --- Ropivacaine 0.1% plus Sufentanil 0.2 g/mL as programmed intermittent epidural bolus and C --- Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83). We found a higher caesarean delivery rate in group A (56.7%; p = 0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satis faction and no adverse outcomes
Description
Keywords
Analgesia epidural Técnicas de analgesia epidural infusão Analgesia obstétrica Bolus intermitente Região Aiutónoma da Madeira Madeira Island Portugal epidural analgesia techniques
Citation
Rev Bras Anestesiol. 2016;66(5):439---444
Publisher
Sociedade Brasileira de Anestesiologia