Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000500007
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia intra-articular com morfina, bupivacaína ou fentanil após operação de joelho por videoartroscopia

Intra-articular analgesia with morphine, bupivacaine or fentanyl after knee video-arthroscopy surgery

Rogério Helcias de Souza; Adriana Machado Issy; Rioko Kimiko Sakata

http://dx.doi.org/10.1590/S0034-70942002000500007 Braz J Anesthesiol, vol.52, n5, p.570-580, 2002
PDF
Downloads: 0
Views: 937

Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de métodos que promovam analgesia para dor do joelho sem prejudicar a função motora tem sido bastante pesquisado. O objetivo do presente estudo foi comparar o efeito analgésico da morfina, da bupivacaína e do fentanil, com a solução fisiológica, injetada por via intra-articular após operação de joelho por videoartroscopia. MÉTODO: Sessenta pacientes foram divididos de forma aleatória, em quatro grupos: GI (n=15) - 10 ml de solução fisiológica; GII (n = 15) - 2 mg de morfina diluídos para 10 ml de solução fisiológica; GIII (n = 15) - 10 ml de bupivacaína a 0,25%; GIV (n = 15) - 100 µg de fentanil diluídos para 10 ml de solução fisiológica, injetados ao término da operação. Todos os pacientes foram submetidos à anestesia subaracnóidea com 15 mg de bupivacaína hiperbárica. A intensidade da dor foi avaliada pela escala analógica visual (imediatamente após o término da operação e após 6, 12, 18 e 24 horas), bem como a necessidade de complementação analgésica (dipirona 1 g por via venosa). Foram anotados os possíveis efeitos colaterais. RESULTADOS: Não houve diferença significativa na intensidade da dor entre os grupos, na quase totalidade dos tempos estudados. Houve diferença estatística até seis horas, quando o grupo fentanil apresentou intensidade da dor significativamente menor. O grupo morfina necessitou de maior número de complementações com dipirona. Os efeitos colaterais foram mínimos, sem significância estatística. CONCLUSÕES: Não houve diferença significativa entre a analgesia promovida pelas soluções estudadas na maioria dos tempos investigados.

Palavras-chave

ANALGESIA, ANALGESIA, ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, CIRURGIA

Abstract

BACKGROUND AND OBJECTIVES: Methods to promote knee pain analgesia without impairing motor function have been widely researched. This study aimed at comparing intra-articular morphine, bupivacaine, and fentanyl analgesic effects (as compared to saline solution), after knee video-arthroscopy. METHODS: Participated in this study 60 patients who were randomly distributed in four groups: GI (n = 15) 10 ml saline solution; GII (n = 15) 2 mg morphine diluted in 10 ml saline solution; GIII (n = 15) 10 ml of 0.25% bupivacaine; GIV (n = 15) 100 µg fentanyl diluted in 10 ml saline solution, injected at surgery completion. All patients received spinal anesthesia with 15 mg hyperbaric bupivacaine. Pain intensity was evaluated by a visual analog scale (VAS) (at surgery completion, and 6, 12, 18 and 24 hours later). The need for analgesic complementation (1 g intravenous dipirone) was also evaluated. Side effects were recorded. RESULTS: There were no statistical differences in pain intensity among groups in almost all moments studied. There was a statistic difference up to 6 hours, when the fentanyl group had significantly lower pain. The morphine group needed more dipirone complementation. Side effects were minor, without statistical significance. CONCLUSIONS: There were no statistical differences among solutions’ analgesic effects in almost all moments studied.

Keywords

ANALGESIA, ANALGESIA, ANALGESICS, ANALGESICS, ANALGESICS, SURGERY

References

Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg. 1993;76:182-191.

Huskisson EC. Measurement of pain. Lancet. 1974:1127-1131.

Maxwell DL, Satake E. Research and Statistical Methods in Communication Disorders. 1997:183-189.

Butterworth JF, Carnes RS, Samuel MP. Effect of adrenaline on plasma concentrations of bupivacaine following intra-articular injection of bupivacaine for knee arthroscopy. Br J Anaesth. 1990;65:537-539.

Aasbo V, Raeder JC, Grogaard B. No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy. Acta Anaesthesiol Scand. 1996;40:585-588.

Hughes DG. Intra-articular bupivacaine for pain relief in arthroscopic surgery. Anaesthesia. 1985;40:821.

Patel NJ, Flashburg MH, Paskin S. A regional anesthetic technique compared to general anesthesia for outpatient knee arthroscopy. Anesth Analg. 1986;65:185-187.

Milligan KA, Mowbray MJ, Mulrooney L. Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients. Anaesthesia. 1988;43:563-564.

Kaeding CC, Hill JA, Katz J. Bupivacaine use after knee arthroscopy: pharmacokinetics and pain control study. Arthroscopy. 1990;6:33-39.

Chirwa SS, Macleod BA, Day B. Intra-particular bupivacaine (Marcaine) after meniscectomy: a randomized double-mind controlled study. Arthroscopy. 1989:33-35.

Henderson RC, Campion ER, Demasi RA. Postarthroscopy analgesia with bupivacaine: A prospective, randomized, blinded evaluation. Am J Sports Med. 1990;18:614-617.

Shaw A, Mobs PJ, Haines JF. Analgesic effect of intra-articular bupivacaine or diamorphine after arthroscopic surgery of the knee joint in day-case patients. Eur J Anaesthesiol. 1997;14:635-641.

De Andrés J, Valia JC, Barrera I. Intra-articular analgesia after arthroscopic knee surgery: comparison of three different regimens. Eur J Anaesth. 1998;15:10-15.

Björnson A, Gupta A, Vegfors M. Intra-articular morphine for postoperative analgesia following knee arthroscopy. Reg Anesth. 1994;19:104-108.

Dalsgaard J, Felsby S, Juelsgaard P. Low dose intra-articular morphine analgesia in day case knee arthroscopy: a randomized double-mind prospective study. . 1994;56:151-154.

Dickstein R, Raja SN, Johnson C. Comparison of intra-articular bupivacaine and morphine for analgesia following arthroscopy knee surgery. Anesthesiology. 1991;75:767.

Raja SN, Dickstein RE, Johnson CA. Comparison of postoperative analgesic effects of intra-articular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology. 1992;77:1143-1147.

Katayama M, Laurito GM, Severino MAF. Comparação entre anestesia geral e bloqueio subaracnóideo para artroscopia de joelho em regime ambulatorial. Rev Bras Anestesiol. 1991;41:91-97.

Heard SO, Edwards WT, Ferrari D. Analgesic effect of intra-articular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study. Anesth Analg. 1992;74:822-826.

De Andrés J, Bellver J, Barrera I. A comparative study of analgesia after knee surgery with intra-articular bupivacaine, intra-articular morphine, and lumbar plexus block. Anesth Analg. 1993;77:727-730.

Lopes MB, Sousa LR, Porsani DF. Associação de bupivacaína e morfina intra-articular para analgesia pós- operatória em cirurgia artroscópica de joelho. Rev Bras Anestesiol. 1999;49:165-168.

Niemi L, Pitkänen M, Tuominen M. Intra-articular morphine for pain relief after knee arthroscopy performed under regional anaesthesia. Acta Anaesthesiol Scand. 1994;38:402-405.

Khoury GF, Chen AC, Garland DE. Intra-articular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology. 1992;77:263-266.

Allen GC, St. Amand MA, Lui ACP. Postarthroscopy analgesia with intra-articular bupivacaine/morphine. Anesthesiology. 1993;79:475-480.

Joshi GP, McCarrol SM, O’Brien TM. Intra-articular analgesia following knee arthroscopy. Anesth Analg. 1993;76:333-336.

Haynes TK, Appadurai JR, Power J. Intra-articular morphine and bupivacaine analgesia after arthoscopic knee surgery. Anaesthesia. 1994;49:54-56.

Heine MF, Tillet ED, Tsueda K. Intra-articular morphine after arthroscopic knee operation. Br J Anaesth. 1994;73:413-415.

Lyons B, Lohan D, Flynn CG. Intra-articular analgesia for arthroscopic meniscectomy. Br J Anaesth. 1995;75:552-555.

Laurent SC, Nolan JP, Pozo JL. Addition of morphine to intra-articular bupivacaine does not improve analgesia after day-case arthroscopy. Br J Anaesth. 1994;72:170-173.

Whitford A, Healy M, Joshi GP. The effect of tourniquet release time on the analgesic efficacy of intra-articular morphine after arthroscopic knee surgery. Anesth Analg. 1997;84:791-793.

Klinken C. Effects of tourniquet time in knee arthroscopy patients receiving intra-articular morphine combined with bupivacaine. CRNA. 1995;6:37-42.

Söderlund A, Westman l, Ersmark H. Analgesia following arthroscopy - a comparison of intra-articular morphine, pethidine and fentanyl. Acta Anaesthesiol Scand. 1997;41(^s1):6-11.

Yang IC, Chen LM, Wang CJ. Postoperative analgesia by intra-articular neostigmine in patients undergoing knee arthroscopy. Anesthesiology. 1998;88:334-339.

Dahl MR, Dasta JF, Zuelzer W. Lidocaine local anesthesia for arthroscopic knee surgery. Anesth Analg. 1990;71:670-674.

Gentili M, Houssel P, Osman M. Intra-articular morphine and clonidine produce comparable analgesia but the combination is not more effective. Br J Anaesth. 1997;79:660-661.

Reuben SS, Connely NR. Postoperative for outpatient arthroscopic knee surgery with intra-articular clonidine. Anesth Analg. 1999;88:729-733.

McSwiney MM, Joshi GP, Kenny P. Analgesia following arthroscopic knee surgery: A controlled study of intra-articular morphine, bupivacaine or both combined. Anaesth Intensive Care. 1993;21:201-203.

Ruwe PA, Klein J, Shields CL. The effect of intra-articular Injection of morphine and bupivacaine on postarthroscopic pain control. Am J Sports Med. 1995;23:59-64.

5dd5817b0e8825b523c8fca7 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections