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espanolIntroduccion: Los principales adyuvantes de la bupivacaina son los opioides y la clonidina; el primer opioide usado por via epidural fue la morfina, que desde 1979 se ha demostrado el beneficio de su uso tanto por via intratecal como extradural, para el manejo de dolor cronico y postoperatorio. Objetivo: Determinar la efectividad analgesica de clonidina vs. morfina como coadyuvantes de la anestesia espinal con bupivacaina hiperbarica en pacientes sometidas a cesarea. Metodo: Ensayo clinico correlacional cuasi experimental de campo. 60 pacientes con embarazo a termino y feto unico programadas para cesarea, con anestesia espinal, distribuidas en dos grupos. Grupo BC (n = 30): bupivacaina hiperbarica 10 mg mas clonidina 75 µg; grupo BM (n = 30): bupivacaina hiperbarica 10 mg mas morfina 100 µg. Resultados: Se evidencian diferencias estadisticamente significativas, p = 0,02, entre el tiempo de 14,5 ± 2,1 horas desde la administracion de la anestesia hasta la solicitud de la primera dosis de analgesia adicional en el grupo morfina vs. clonidina con 8,18 ± 2,91 horas. El dolor en el momento de la solicitud de analgesia fue superior para clonidina con 6,4 ± 1,0 puntos de EVA con relacion a la morfina con 0,93 ± 2,4 puntos, p = 0,001. Los valores de EVA tambien fueron significativamente mayores para clonidina con relacion a la morfina a las 6, 12 y 18 horas. No se presentaron cambios hemodinamicos ni respiratorios significativos en ninguno de los dos grupos. Para la morfina el efecto adverso mas frecuente fue prurito en 66,7 % de las pacientes. El nivel de sedacion fue el mismo para clonidina y morfina en la totalidad de las pacientes. Conclusiones: Adicionar 100 μg de morfina a la bupivacaina hiperbarica en anestesia espinal, prolonga y mejora significativamente el tiempo y la calidad analgesica en el periodo postquirurgico en mayor grado que 75 μg de clonidina. El efecto secundario mas frecuente es el prurito. EnglishIntroduction: The main adjuvants of bupivacaine are opioids and clonidine; the first opioid used by the epidural route was morphine, which since 1979 has demonstrated benefit of its intrathecal and extradural use, for the management of chronic and postoperative pain. Objective: Determine the analgesic effectiveness of morphine vs. clonidine added to spinal anesthesia with hyperbaric bupivacaine in patients undergoing cesarean section. Method: A quasi-experimental correlational clinical trial. 60 parturients, carrying a singleton fetus at term, scheduled to undergo cesarean section under spinal anesthesia were randomized in one of the two groups. Group BC (n = 30) received 10 mg hyperbaric bupivacaine and 75 μg clonidine; Group BM (n = 30) 10 mg hyperbaric bupivacaine and 100 μg morphine. Results: Statistically significant difference, p = 0.02, were found between the time of 14.5 ± 2.1 hours since the administration of anesthesia to the application of the first dose of additional analgesia in morphine group vs. clonidine group 8.18 ± 2.91 hours. Pain at the time of the application of postoperative analgesia was superior in clonidine group with 6.4 ± 1.0 points in AVE vs. morphine with 0.93 ± 2.4 points. p = 0.001. AVE values were also significantly higher for clonidine in relation to morphine at 6, 12 and 18 hours. No significant hemodynamic and respiratory changes occurred in either group. For morphine the most frequent side effect was itching in 66.7 % of patients. The level of sedation was the same for clonidine and morphine in all the patients. Conclusions: Add 100 μg of morphine to hyperbaric bupivacaine for spinal anesthesia prolongs the time and significantly improves quality of the postoperative analgesic period greater than 75 μg of clonidine. The most common side effect is itching.

Efectividad analgésica de clonidina vs morfina como coadyuvantes de la anestesia espinal con bupivacaina hiperbárica en pacientes sometidas a cesárea