Eficacia del bloqueo nervioso con Levobupivacaina en comparación a Bupivacaina / Effectiveness of nerve blocking with levobupivacaina in comparasion to bupivacaina

RESUMEN

Pregunta de Investigación.- ¿Sera la eficacia clínica de levobupivacaina mejor que la producida por Bupivacaina ?. Objetivos.- Evaluar en el campo de la clínica anestesiológica la eficacia de la levobupivacaina en espacio peridural y raquídeo en comparación a Bupivacaina. 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 4 grupos y nueve subgrupos. Primer grupo (subgrupo ABC) con levobupivacaina 0,5 y 0,75 por ciento y Bupivacaina 0,5 por ciento. Segundo grupo (subgrupo D y E) con levobupivacaina y bupivacaina al 0,5 por ciento. Tercer grupo (subgrupos F y G) con levobupivacaina y Bupivacaina al 0,375 por ciento. Cuarto grupo (subgrupo H e I) con levobupivacaina pesada al 0,75 por ciento y Bupivacaina pesada al 0,5 por ciento . En cirugías de periné, cesárea, abdomen y extremidades inferiores.

ABSTRACT

Research questionWill 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. DesignA 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.