Eficacia del Bloqueo Nervioso con Levobupivacaina en Comparación a Bupivacaina
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Cuad. - Hosp. Clín.
Abstract
Pregunta de investigación ¿Será la eficacia clínica de Levobupivacaína mejor que la producida por Bupivacaína ? Objetivos Evaluar en el campo de la clínica anestesiológica la eficacia de Levobupivacaína en espacio peridural y raquídeo en comparación a Bupivacaína. Diseño Ensayo clínico a doble ciego. Lugar Hospital de Clínicas Universitario, Hospital del Niño, Hospital Militar COSSMIL y Hospital de La Mujer de la ciudad de La Paz, años 2002,2003,2004. Participantes Pacientes ASA 1 y 2 sometidos a cirugía. Métodos: Pacientes divididos en cuatro grupos y nueve subgrupos. Primer grupo (subgrupo A, B, C)con Levobupivacaína 0,5-0,75% y Bupivacaína 0,5%. Segundo grupo (subgrupo D y E) con Levobupivacaína y Bupivacaína al 0,5%. Tercer grupo (subgrupos F y G) con Levobupivacaína y Bupivacaína al 0,375%. Cuarto grupo (subgrupo H e I) con Levobupivacaína pesada al 0,75% y Bupivacaína pesada al 0,5%. En cirugías de periné, cesárea, abdomen y extremidades inferiores. Resultados Total 258 pacientes. El Sub-grupo D y F se obtuvo menor grado de bloqueo motor (grado 1 en 37% y nulo 65%) mayor duración analgésica (7 horas) y mayor calidad de bloqueo sensitivo. En el Sub-grupo H menor tiempo de latencia (22 segundos +10.3). Ningún grupo presentó efectos colaterales de importancia clínica. Los cambios hemodinámicos fueron mínimos en los que recibieron Levobupivacaína. La Reducción del Riesgo Relativo, del Riesgo Atribuible y el Número Necesario a Tratar a favor de Levobupivacaína en anestesia peridural y raquídea. Conclusiones El tiempo promedio de latencia y grado de bloqueo motor fueron menores en los pacientes que recibieron Levobupivacaína. El nivel y calidad de bloqueo sensitivo, la calidad y duración de analgesia posoperatoria fueron mayores con Levobupivacaína en anestesia peridural y raquídea. No se identificaron efectos colaterales de importancia clínica en ninguno de los grupos de estudio. Levobupivacaína ofrece mayor eficacia en comparación a Bupivacaína.
Research question Will the clinical effectiveness of Levobupivacaine be better than the produced one for Bupivacaine? Objectives Evaluate in the field of the clinical anestesiologist the effectiveness of Levobupivacaine in peridural and spinal space in comparison to Bupivacaine. Design A clinical essay to blind double. Place University Hospital of Clinics, Hospital of the Boy, Military Hospital COSSMIL and Woman's Hospital from the city of La Paz, among 2002-2003. Participants Subjected patients ASA 1 and 2 to surgery Methods Patients divided in four groups. First group with Levobupivacaine 0,5-0,75% and Bupivacaine 0,5%. Second group with Levobupivacaine and Bupivacaine to 0,5%. Third group with Levobupivacaine and Bupivacaine to 0,375%. Fourth group with Levobupivacaine weighed 0,75% and Bupivacaine weighed to 0,5%. In perine surgeries, Caesarean operation, abdomen and inferior extremities. Results Total 258 patients. In Sub-group D and F smaller grade of blockade motor was obtained (grade 1 in 37% and null 65%) bigger analgesic duration (7 hours) and bigger quality of sensitive blockade. In the Sub-group H smaller time of latency (22 seconds +10.3). No group presented colateral goods of importance clínica. The hemodynamic changes were minimum in those that received Levobupivacaine. The Reduction of the Relative Risk, of the Attributable Risk and the Necessary Number to Try in favor of Levobupivacaína in peridural and spinal anesthesia. Conclusion The time average of latency and grade of blockade motor were smaller in patients who recived Levobupivacaine. The level and quality of sensitive blockade, the quality and duration of analgesia were bigger with Levobupivacaine in peridural and spinal anesthesia. They were not identified colateral effects of clinical importance in none of the study groups. Levobupivacaine offers bigger effectiveness in comparison to Bupivacaine.
Research question Will the clinical effectiveness of Levobupivacaine be better than the produced one for Bupivacaine? Objectives Evaluate in the field of the clinical anestesiologist the effectiveness of Levobupivacaine in peridural and spinal space in comparison to Bupivacaine. Design A clinical essay to blind double. Place University Hospital of Clinics, Hospital of the Boy, Military Hospital COSSMIL and Woman's Hospital from the city of La Paz, among 2002-2003. Participants Subjected patients ASA 1 and 2 to surgery Methods Patients divided in four groups. First group with Levobupivacaine 0,5-0,75% and Bupivacaine 0,5%. Second group with Levobupivacaine and Bupivacaine to 0,5%. Third group with Levobupivacaine and Bupivacaine to 0,375%. Fourth group with Levobupivacaine weighed 0,75% and Bupivacaine weighed to 0,5%. In perine surgeries, Caesarean operation, abdomen and inferior extremities. Results Total 258 patients. In Sub-group D and F smaller grade of blockade motor was obtained (grade 1 in 37% and null 65%) bigger analgesic duration (7 hours) and bigger quality of sensitive blockade. In the Sub-group H smaller time of latency (22 seconds +10.3). No group presented colateral goods of importance clínica. The hemodynamic changes were minimum in those that received Levobupivacaine. The Reduction of the Relative Risk, of the Attributable Risk and the Necessary Number to Try in favor of Levobupivacaína in peridural and spinal anesthesia. Conclusion The time average of latency and grade of blockade motor were smaller in patients who recived Levobupivacaine. The level and quality of sensitive blockade, the quality and duration of analgesia were bigger with Levobupivacaine in peridural and spinal anesthesia. They were not identified colateral effects of clinical importance in none of the study groups. Levobupivacaine offers bigger effectiveness in comparison to Bupivacaine.
Description
Vol. 51, No. 1