Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000300005
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas

Comparative study of intercostal and interpleural block for post-cholecystectomy analgesia

Antonio Mauro Vieira; Taylor Brandão Schnaider; Antonio Carlos Aguiar Brandão; João Pires Campos Neto

http://dx.doi.org/10.1590/S0034-70942003000300005 Braz J Anesthesiol, vol.53, n3, p.346-350, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A analgesia no pós-operatório é desejada pelos pacientes e tem sido praticada pela maioria dos anestesiologistas. Além dos opióides, os anestésicos locais têm sido utilizados nos bloqueios periféricos e centrais para se obter a analgesia pós-operatória. O objetivo deste estudo foi comparar duas técnicas de bloqueio dos nervos intercostais para analgesia pós-operatória em colecistectomias abertas. MÉTODO: Sessenta pacientes foram submetidos a colecistectomias abertas com incisão subcostal e receberam bloqueio intercostal (Grupo IC, n=30) ou bloqueio interpleural (Grupo IP, n=30), ambos com 100 mg de bupivacaína a 0,5% com adrenalina, para analgesia pós-operatória. Foram avaliados os tempos de analgesia e as queixas relatadas pelos pacientes. RESULTADOS: A qualidade da analgesia foi considerada boa para ambas as técnicas. A duração média de analgesia foi de 505 minutos no grupo IP e 620 minutos no grupo IC, não havendo diferença estatística entre eles. Náuseas, vômitos e dor abdominal leve foram as queixas pós-operatórias mais freqüentes. Não se constatou qualquer complicação pós-operatória associada exclusivamente aos bloqueios, assim como não foi evidenciado nenhum caso de pneumotórax. CONCLUSÕES: Concluiu-se que as técnicas promoveram analgesia satisfatória após colecistectomia, sendo que o bloqueio interpleural apresentou maior facilidade de execução.

Palavras-chave

ANALGESIA, ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Postoperative analgesia is a wish of all surgical patients and has been used by most anesthesiologists. In addition to opioids, local anesthetic agents have been employed for peripheral and central blocks. The purpose of this study was to evaluate and to compare intercostal and interpleural blocks for post-cholecystectomy analgesia. METHODS: Sixty patients undergoing open cholecystectomy with subcostal incision, received either intercostal block (Group IC, n = 30) or interpleural block (Group IP, n = 30), for postoperative analgesia, both with 0.5% bupivacaine (100 mg) with epinephrine. Analgesia duration and patients’ complaints were evaluated. RESULTS: Analgesia was considered satisfactory for both groups. Mean analgesia duration was 505 minutes for Group IP and 620 minutes for Group IC, with no statistical significant difference. Nausea, vomiting and mild abdominal pain were the most frequent postoperative complaints. There was no postoperative complication related to blockade and no pneumothorax was detected. CONCLUSIONS: We concluded that both techniques were effective in promoting post-cholecystectomy analgesia, but interpleural block was easier to perform.

Keywords

ANALGESIA, ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Reiestad F, Strömskag KE. Interpleural catheter in the management of postoperative pain: A preliminary report. Reg Anaesth. 1986;11:89-91.

Covino BG. Interpleural regional analgesia. Anesth Analg. 1988;67:427-429.

Strömskag KE, Reiestad F, Holmqvist ELO. Intrapleural administration of 0.25%, 0.375% and 0,5% bupivacaine with epinephrine after cholecystectomy. Anesth Analg. 1988;67:430-434.

Kastrissios H, Mogg GAG, Triggs EJ. Interpleural bupivacaine infusion compared with intravenous pethidine infusion after cholecystectomy. Anaesth Intensive Care. 1991;19:539-545.

Laurito CE, Kirz LI, Vadeboncouer TR. Continuous infusion of interpleural bupivacaine maintains effective analgesia after cholecystectomy. Anesth Analg. 1991;72:516-521.

Strömskag KE, Minor BG, Lindeberg A. Comparison of 40 milliliters of 0.25% intrapleural bupivacaine with epinephrine with 20 milliliters of 0.5% intrapleural bupivacaine with epinephrine after cholecystectomy. Anesth Analg. 1991;73:397-400.

Stayer AS, Pasquarillo CA. The safety of continuous pleural lignocaine after thoracotomy in children and adolescents. Paediatr Anaesth. 1995;5:307-310.

Catalá E, Casas JI, Queraltó JM. Bloqueo paravertebral torácico: efectividad analgésica postoperatoria y concentraciones plasmáticas de bupivacaína. Rev Esp Anestesiol Reanim. 1993;40:125-128.

Johnson MD, Micker T, Arthur GR. Bupivacaine with and without epinephrine for intercostal nerve block. J Cardiothorac Anesth. 1990;4:200-203.

Kambam JR, Hsmmon J, Parris WCV. Intrapleural analgesia for posthoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth. 1989;36:106-109.

Pond WW, Somerville GM, Thong SH. Pain of delayed traumatic splenc rupture masked by intrapleural lidocaine. Anesthesiology. 1988;70:154-155.

Geier KO. Bloqueio pleural. Rev Bras Anestesiol. 2001;51:160-175.

Durrani Z, Winnie AP, Ikkuta P. Interpleural catheter for pancreatic pain. Anesth Analg. 1988;67:479-481.

Cangiani LM. Bloqueio intercostal na linha axilar média (BILAM). Rev Bras Anestesiol. 1995;45(^s20):71-73.

Steinberg HS, Weninger E, Jokisch D. Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology. 1985;62:634-640.

Abrão J. Bloqueio intercostal posterior com injeção única. Rev Bras Anestesiol. 1995;45(^s20):74-75.

Ahlburg P, Molgaard J, Rasmussen BS. Intrapleural administration of 0.5% plain bupivacaine compared to 0.5% epinephrine: a hemodynamic and ventilatory study. Reg Anesth. 1991;16:257-261.

Iwama H, Tase C, Kawamae K. Catheter location and patient position affect spread of interpleural regional analgesia. Anesthesiology. 1993;79:1154.

Seltzer JL, Larijani GE, Goldberg ME. Intrapleural bupivacaine: a kinetic and dynamic evaluation. Anesthesiology. 1987;67:798-800.

Effa E, Vaghadia H, Jenkins LC. The effect of continuous interpleural analgesia on pain and pulmonary function after cholecystectomy. Can J Anaesth. 1989:S74-S75.

Symreng T, Gomez MN, Johnson B. Intrapleural bupivacaine: technical considerations and intraoperative use. J Cardiothorac Anesth. 1989;3:139-143.

Scott PV. Interpleural regional analgesia: detection of the interpleural space by saline infusion. Br J Anaesth. 1991;66:131-133.

Kastrissios H, Triggs EJ, Mogg GA. Steady-state pharmacokinetics of interpleural bupivacaine in patients after cholecystectomy. Anaesth Intensive Care. 1990;18:200-204.

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