RESUMEN
INTRODUCCIÓN: Una de las ventajas de utilizar bolos epidurales es que se ejerce mayor presión de inyección y por tanto más difusión produciendo un mayor bloqueo sensitivo. Por tanto si a mayor velocidad de administración del bolo más presión se ejerce cabe esperar que el nivel sensitivo alcanzado sea mayor. OBJETIVO: Nuestro objetivo fue comparar el nivel sensitivo alcanzado con el set de alto flujo y el de flujo estándar a velocidades máximas. MATERIAL Y MÉTODOS: Se incluyeron setenta y tres gestantes primíparas que solicitaron analgesia epidural utilizando bolos epidurales intermitentes programados a 10ml cada 60 min de ropivacaína al 0,1% con fentanilo 2ug/ml más analgesia epidural controlada por la paciente. Dichos bolos se administraron con set de infusión estándar a 250ml/h o de alto flujo a 500ml/h según la práctica clínica habitual de cada anestesiólogo. El objetivo primario fue evaluar el nivel sensitivo alcanzado. Los objetivos secundarios fueron la escala visual analógica, la escala modificada de Bromage y el consumo anestésico en términos de analgesia de rescate (analgesia epidural controlada por la paciente y bolos administrados por el anestesiólogo). RESULTADOS: La mediana del nivel sensitivo máximo fue T9 en el grupo de alto flujo y T7 en el de flujo estándar, siendo dicha diferencia significativa estadísticamente (P=0,0002). No hubo diferencias significativas en la escala visual analógica, Bromage o analgesia de rescate. CONCLUSIÓN: El set de alto flujo no ofrece beneficios en cuanto a los resultados analizados por lo que hay que valorar su uso ya que conlleva un coste adicional
INTRODUCTION: The higher injection pressure obtained with epidural boluses give greater anaesthetic spread, and therefore better sensory block. Therefore, it stands to reason that anaesthetic administered at greater injection pressure and a higher flow rate would spread to a higher sensory level. OBJECTIVE: Our aim was to compare the sensory level reached with the high flow. and standard flow set at maximum rates. MATERIAL AND METHODS: We included 73 primiparous women who requested epidural analgesia for labour using programmed intermittent epidural boluses of 0.1% ropivacaine at a flow rate of 10ml/h and 2 ug/ml fentanyl plus patient-controlled epidural analgesia. The boluses were administered with a standard (250ml/h) or high-flow (500ml/h) infusion set, according to the usual clinical practice of each anaesthesiologist. The primary objective was to evaluate the sensory level reached. Secondary objectives were pain on a visual analogue scale, motor block measured on the modified Bromage scale, and anaesthesia consumption in terms of rescue analgesia (patient-controlled epidural analgesia) and anaesthesiologist-administered boluses. RESULTS: The median maximum sensory level reached was T9 in the high flow group and T7 in the standard flow group; this difference was statistically significant (p=.0002). There were no significant differences in visual analogue scale, Bromage or rescue analgesia between groups. CONCLUSION: Our results show that the high flow set does not offer benefits. The use of such sets need to be evaluated due to their higher cost
Asunto(s)
Humanos , Femenino , Embarazo , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locales , Anestésicos Locales/administración & dosificación , Dolor de Parto/tratamiento farmacológico , Ropivacaína/administración & dosificación , Fentanilo/administración & dosificación , Infusión Espinal/métodos , Escala Visual Analógica , Manejo del Dolor , Estudios ProspectivosRESUMEN
INTRODUCTION: The higher injection pressure obtained with epidural boluses give greater anaesthetic spread, and therefore better sensory block. Therefore, it stands to reason that anaesthetic administered at greater injection pressure and a higher flow rate would spread to a higher sensory level. OBJECTIVE: Our aim was to compare the sensory level reached with the high flow. and standard flow set at maximum rates. MATERIAL AND METHODS: We included 73 primiparous women who requested epidural analgesia for labour using programmed intermittent epidural boluses of 0.1% ropivacaine at a flow rate of 10ml/h and 2 ug/ml fentanyl plus patient-controlled epidural analgesia. The boluses were administered with a standard (250ml/h) or high-flow (500ml/h) infusion set, according to the usual clinical practice of each anaesthesiologist. The primary objective was to evaluate the sensory level reached. Secondary objectives were pain on a visual analogue scale, motor block measured on the modified Bromage scale, and anaesthesia consumption in terms of rescue analgesia (patient-controlled epidural analgesia) and anaesthesiologist-administered boluses. RESULTS: The median maximum sensory level reached was T9 in the high flow group and T7 in the standard flow group; this difference was statistically significant (p=.0002). There were no significant differences in visual analogue scale, Bromage or rescue analgesia between groups. CONCLUSION: Our results show that the high flow set does not offer benefits. The use of such sets need to be evaluated due to their higher cost.