[New therapeutics alternative in severe preeclampsia].
BACKGROUND
Vasoconstriction is a major pathophysiologic finding in preeclampsia due to hyperactivity of the sympathetic nervous system and a consequent increase in concentration of plasmatic catecholamine. Thus, vasodilatation produced by secondary sympathetic block to lumbar epidural blockade favors control of high blood pressure in patients with severe preeclampsia.


OBJECTIVE
Our objective was to evaluate whether lumbar epidural blockade with bupivacaine 0.25% decreases high blood pressure of patients with severe preeclampsia within a lapse of 6 h in comparison with customary antihypertensive treatment.


METHODS
An open, randomized, controlled trial was carried out in 24 pregnant patients with 30 weeks of gestational age or more and diagnosis of severe preeclampsia who entered the Intensive Care Uni of the IMEIM Hospital of Gynecology and Obstetrics for hemodynamic stabilization and resolution of pregnancy. Group 1 (n = 12) was managed with customary antihypertensive treatment and group 2 (n = 12), with lumbar epidural blockade and bupivacaine 0.25%: 10 mg in bolus and 5 mg/h continuous epidural infusion. Patients were monitored non-invasively and with continuous clinical monitoring with MAP, SAP, and DAP during 6 h. Statistical analysis employed consisted of ANOVA measurement repeats.


RESULTS
In MAP and SAP, there were no significant differences between the two groups; DAP in first and second h of treatment had significant differences between the two groups (p value of < or = 0.05).


CONCLUSIONS
Lumbar epidural blockade with bupivacaine 0.25% can be used as a therapeutic alternative in high blood pressure control in patients with severe preeclampsia during the the first 6 h of hemodynamic stabilization.
Unidad de Investigación en Preeclampsia-Eclampsia, Instituto Materno-Infantil del Estado de México, Toluca.
Rosa Virgen
RV
Pardo-Morales
Socorro
S
Romero-Figueroa
Gilberto Felipe
GF
Vázquez-de Anda
Jesús Carlos
JC
Briones-Garduño
Javier Edmundo
JE
Herrera-Villalobos
Angel
A
González-Vargas
D000328:Adult; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001795:Blood Pressure Determination; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
D000779:Anesthetics, Local; D002045:Bupivacaine