Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000600005
Brazilian Journal of Anesthesiology
Scientific Article

Efeito preemptivo da morfina por via venosa na analgesia pós-operatória e na resposta ao trauma cirúrgico

The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response

Levent Kiliçkan

http://dx.doi.org/10.1590/S0034-70942001000600005 Braz J Anesthesiol, vol.51, n6, p.503-510, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: Embora os primeiros estudos sobre analgesia preemptiva tenham demonstrado que o bloqueio pré-operatório com anestésicos locais ou a medicação pré-anestésica com opióides sistêmicos eram mais eficazes no alívio da dor pós-operatória do que qualquer outro tratamento, o resultado de outros estudos comparando os efeitos do tratamento pré operatório ao mesmo tratamento iniciado após a cirurgia, produziram efeitos inconsistentes. As razões para essa falta de consistência não são claras. São poucos os estudos sobre a relação entre analgesia preemptiva e o consumo de analgésicos e a resposta ao trauma cirúrgico. O objetivo deste estudo foi avaliar o efeito preemptivo da morfina por via venosa preemptiva no consumo pós-operatório de analgésicos e na resposta ao trauma cirúrgico. MÉTODO: Participaram deste estudo 60 pacientes, estado físico ASA I ou II, com idades entre 20 e 60 anos, escalados para histerectomia abdominal total e salpingo-ooferectomia bilateral, que foram aleatoriamente distribuídos em três grupos de 20 pacientes. Grupo I (n=20) - 0,15 mg.kg-1 de morfina após a indução anestésica e soro fisiológico durante o fechamento do peritônio. Grupo II (n=20) - soro fisiológico após a indução e 0,15 mg.kg-1 de morfina durante o fechamento do peritônio. Grupo III (n=20) soro fisiológico durante a indução e o fechamento do peritônio. Foram medidos os níveis sangüíneos de cortisol e de glicose e feita a contagem de leucócitos nos períodos pré e pós-operatórios. RESULTADOS: O consumo total de morfina pós-operatória foi significativamente mais baixo no grupo I comparado ao grupo III (p < 0,001). Os níveis de cortisol aumentaram significativamente em todos os grupos 4 horas após a cirurgia, quando comparados aos valores pré-operatórios (p < 0,001). Os níveis de glicose plasmática também aumentaram significativamente em todos os grupos 30 minutos e 8 horas após a cirurgia (p < 0,01). Todos os grupos apresentaram leucocitose pós-operatória e a contagem de leucócitos foi significativamente mais alta no período pós-operatório do que no pré-operatório (p < 0,01). CONCLUSÕES: Morfina preemptiva por via venosa, na dose de 0,15 mg.kg-1 diminuiu o consumo total de morfina mas não conseguiu suprimir a resposta ao trauma cirúrgico.

Palavras-chave

ANALGESIA, Preemptiva, Pós-operatória, ANALGÉSICOS, Opióides

Abstract

BACKGROUNDS AND OBJECTIVES: Although initial studies of preemptive analgesia showed that preoperative blockade with local anaesthetics or pre-operative administration of systemic opioids was more effective in reducing postoperative pain than control conditions involving no treatment, the result of subsequent investigations comparing the effects of pre-operative treatment with the same treatment initiated after surgery have produced inconsistent results.The reasons for the lack of consistency are not clear. Studies about the relationship of preemptive analgesia and both analgesic consumption and surgical stress response are limited. The purpose of this study was to evaluate the effect of preemptive intravenous morphine on both postoperative analgesic consumption and surgical stress response. METHODS: Sixty patients, ASA lor II, aged 20-60, undergoing total abdominal hysterectomy plus bilateral salphingo-opherectomy were randomly assigned to three groups of 20 patients. Group I (n = 20) received 0.15 mg.kg-1 of morphine following induction and placebo saline during peritoneal closure. Group II (n = 20) received placebo saline following induction and 0.15 mg.kg-1 of morphine during peritoneal closure. Group III (n = 20) received placebo salin, both during induction and peritoneal closure. Blood cortisol, glucose levels and leukocyte count were measured in the pre and postoperative period. RESULTS: Postoperative total morphine consumption was significantly lower in group I compared with group III (p < 0.001). In all groups, plasma cortisol levels increased significantly within 4 h of surgery as compared to pre-op values (p < 0.001). Plasma glucose levels also increased significantly in all groups of the postoperative at 30 minutes and 8 hours period (p < 0.001). Postoperative leukocytosis was observed in all groups and the leukocyte count was significantly greater during the postoperative period than preoperative values (p < 0.001). CONCLUSIONS: Preemptive intravenous morphine 0.15 mg.kg-1 has decreased total morphine consumption but has failed to supress the surgical stress response.

Keywords

ANALGESIA, Preemptive, Postoperative, ANALGESICS, Opoids

References

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