Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjan.2013.01.001
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo entre doses de morfina intratecal para analgesia após cesariana

Comparative study between doses of intrathecal morphine for analgesia after caesarean

Francisco Amaral Egydio de Carvalho; Sérgio B. Tenório

Downloads: 0
Views: 129

Resumo

JUSTIFICATIVA E OBJETIVOS: Analgesia após cesarianas é importante, pois puérperas com dor têm dificuldade na movimentação, o que prejudica o aleitamento. Morfina intratecal proporciona analgesia adequada e duradoura após cesarianas. O objetivo deste estudo foi comparar a qualidade da analgesia proporcionada por duas doses de morfina intratecal e seus efeitos colaterais em pacientes submetidas à cesariana. MÉTODO: Participaram do estudo 123 gestantes, com idade gestacional superior a 38 semanas e plano de cesariana eletiva. As gestantes foram alocadas de maneira aleatória em dois grupos que receberam 50 ou 100 µg de morfina intratecal (Grupo 50/Grupo 100). Todas as pacientes foram anestesiadas com 12 mg de bupivacaína 0,5% hiperbárica via intratecal. As pacientes foram avaliadas entre a 9ª e a 11ª horas e entre a 22ª e a 24ª horas após o bloqueio, em relação à qualidade da analgesia, ao consumo de analgésico, aos efeitos colaterais e à principal causa de desconforto nas primeiras 24 horas após a cirurgia. RESULTADOS: Os grupos foram semelhantes em relação aos dados antropométricos e antecedente obstétrico. Não houve diferença estatística na intensidade dolorosa entre os grupos. Nos dois grupos a dor foi maior nas primeiras 12 horas após a anestesia (p < 0,001). O consumo de cloridrato de tramadol e o intervalo até a primeira dose foram semelhantes nos dois grupos. Prurido foi o efeito colateral mais frequente, com incidência estatisticamente maior no Grupo 100 (p = 0,026). CONCLUSÕES: Morfina intratecal em 50 µg tem a mesma qualidade de analgesia que 100 µg, com menor incidência de efeitos colaterais.

Palavras-chave

Analgesia, Cesariana, Morfina, Intratecal, Efeitos colaterais, Escala visual analógica

Abstract

BACKGROUND AND OBJECTIVES:Analgesia after caesarean section is important because postpartum women with pain have difficulty in mobility, which undermines breastfeeding. Intrathecal morphine provides adequate and prolonged analgesia after cesarean. The aim of this study was to compare the quality of analgesia provided by two doses of intrathecal morphine and its side effects in patients undergoing cesarean section. METHOD: The study included 123 pregnant women with gestational age over 38 weeks and scheduled for cesarean section. The women were randomly allocated into two groups to receive either 50 or 100 µg of intrathecal morphine (Group 50/Group 100). All patients were intrathecally anesthetized with 12 mg of 0.5% hyperbaric bupivacaine. Patients were assessed between the 9th and 11th hour and the 22nd and 24th hour after blockade for quality of analgesia, analgesic consumption, side effects, and main cause of discomfort in the first 24 hours after surgery. RESULTS: There was similarity between groups regarding anthropometric data and obstetric history. There was no statistical difference in pain intensity between groups. In both groups, pain was more intense in the first 12 hours after anesthesia (p < 0.001). Tramadol hydrochloride consumption and time to first dose were similar in both groups. Pruritus was the most common side effect, with statistically higher incidence in Group 100 (p = 0.026). CONCLUSIONS: Intrathecal morphine 50 µg provides the same quality of analgesia as 100 µg, with a lower incidence of side effects.

Keywords

Analgesia, Caesarean section, Morphine, Intrathecal, Side effects, Visual analogue scale

References

Werner MU, Søholm L, Rotbøll-Nielsen P. Does an acute pain service improve postoperative outcome?. Anesth Analg. 2002;95:1361-72.

Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87:62-72.

Carvalhaes MABL, Corrêa CRH. Identificação de dificuldades no início do aleitamento materno mediante aplicação de protocolo. J Pediatr. 2003;79:13-20.

Pérez-Escamilla R, Maulén-Radovan I, Dewey KG. The association between cesarean delivery and breast-feeding outcomes among Mexican women. Am J Public Health. 1996;86:832-6.

Dahl JB, Jeppesen IS, Jørgensen H. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology. 1999;91:1919-27.

Palmer CM, Emerson S, Volgoropolous D. Dose response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology. 1999;90:437-44.

Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesthesia. 1995;7:89-91.

Breivik H, Borchgrevink PC, Allen SM. Assessment of pain. Br J Anaesth. 2008;101:17-24.

Mikuni I, Hirai H, Toyama Y. Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia. J Clin Anesth. 2010;22:268-73.

Paech MJ, Pavy TJ, Orlikowski CE. Postoperative intraspinal opioid analgesia after caesarean section: a randomised comparison of subarachnoid morphine and epidural pethidine. Int J Obstet Anesth. 2000;9:238-45.

Cardoso MM, Carvalho JC, Amaro AR. Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg. 1998;86:538-41.

Ganem EM, Módolo NSP, Ferrari F. Efeitos da associação entre pequenas doses subaracnóideas de morfina e cetoprofeno venoso e oral em pacientes submetidas à cesariana. Rev Bras Anestesiol. 2003;53:431-9.

Girgin NK, Gurbet A, Turker G. Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine. J Clin Anesth. 2008;20:180-5.

Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;3:409-23.

Sarvela J, Halonen P, Soikkeli A. A double-blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery. Anesth Analg. 2002;95:436-40.

Abboud TK, Dror A, Mosaad P. Mini-dose intrathecal morphine for the relief of post-cesarean section pain: safety, efficacy, and ventilatory responses to carbon dioxide. Anesth Analg. 1988;67:137-43.

Uchiyama A, Nakano S, Ueyama H. Low dose intrathecal morphine and pain relief following caesarean section. Int J Obstet Anesth. 1994;3:87-91.

Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64:643-51.

Stoelting RK, Hillier SC. Pharmacology & physiology in anesthetic practice. 2006:90-2.

Liang CC, Chang SD, Wong SY. Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean delivery. J Obstet Gynacol Res. 2010;36:991-5.

Baldini G, Bagry H, Aprikian A. Postoperative urinary retention. Anesthesiology. 2009;110:1139-57.

Kuipers PW, Kamphuis ET, van Venrooij GE. Intrathecal opioids and lower urinary tract function: a urodynamic evaluation. Anesthesiology. 2004;100:1497-503.

5dd3f0220e8825275ac63495 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections