[New therapeutics alternative in severe preeclampsia]

Abstract

Introduction: 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.

Material and 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.