Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000200003
Brazilian Journal of Anesthesiology
Scientific Article

Incidência de tremor em anestesia peridural com ou sem fentanil: estudo comparativo

Shivering during epidural anesthesia with and without fentanyl: comparative study

Múcio Paranhos de Abreu; João Lopes Vieira; Marcelo Negrão Lutti; Emily Santos Montarroyos; Randal de Tarso Rossi; Rodrigo Moraes

http://dx.doi.org/10.1590/S0034-70942004000200003 Braz J Anesthesiol, vol.54, n2, p.153-161, 2004
PDF Português
PDF English
Downloads: 0
Views: 1177

Resumo

JUSTIFICATIVA E OBJETIVOS: A maioria dos trabalhos encontrados na literatura, relacionando a influência dos opióides administrados por via peridural com o tremor intra e pós-operatório, foram realizados com grupos de pacientes obstétricas, nas quais a resposta do centro termorregulador pode ser diferente das pacientes não grávidas. O objetivo deste trabalho foi comparar o bloqueio peridural com e sem fentanil, quanto à incidência de tremores e outras complicações no intra e pós-operatório em pacientes submetidos à cirurgia de varizes sob anestesia peridural com bupivacaína a 0,5% com adrenalina a 1:200.000. MÉTODO: Trinta e quatro pacientes, estado físico ASA I e II, submetidos à cirurgia para tratamento de varizes de membros inferiores, foram divididos aleatoriamente em 2 grupos (n = 17), e receberam midazolam (0,05 mg.kg-1), por via venosa seguido de anestesia peridural lombar, utilizando-se no grupo S, 20 ml bupivacaína a 0,5% (com vasoconstritor) associado a 2 ml de solução fisiológica a 0,9% e no grupo F, 20 ml de bupivacaína a 0,5% (com vasoconstritor) associada ao fentanil (100 µg). Foram estudados: incidência de tremor, temperatura dos pacientes, necessidade do uso de meperidina, e a incidência de náuseas e vômitos nos seguintes momentos: M1 - admissão do paciente na sala de operação; M2 - imediatamente antes da anestesia; M3 - 30 minutos após o término da injeção do anestésico local; M4 - 60 minutos após o término da injeção do anestésico local; M5 - 90 minutos após o término da injeção do anestésico local; M6 - final da anestesia; M7 - antecedendo a alta da sala de recuperação pós-anestésica. RESULTADOS: Quanto aos dados antropométricos, estado físico, tempo médio de duração da anestesia e cirurgia, temperatura dos pacientes e da sala de operação e incidência de náuseas e vômitos não houve diferença estatística entre os grupos. Houve diferença estatística aos 60 minutos (M4) e 90 minutos (M5) após o bloqueio peridural, com maior incidência de tremor no Grupo S que no Grupo F. Houve maior necessidade de utilização de meperidina nos pacientes submetidos ao bloqueio peridural não associado ao fentanil. CONCLUSÕES: Nas condições deste estudo, a adição de 100 µg de fentanil ao anestésico local, por via peridural, mostrou que o opióide não tem a propriedade de abolir o tremor, mas de reduzir sua incidência e a intensidade, sem aumentar a incidência de náuseas e vômitos.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, COMPLICAÇÕES, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Most studies in the literature correlating epidural opioids to postoperative shivering were carried out with obstetric patients whose thermoregulation center response might be different from non-pregnant patients. Our study aimed at comparing intra and postoperative shivering and other complications of epidural block with and without fentanyl in patients submitted to varicose vein surgery under epidural anesthesia with 0.5% bupivacaine and 1:200,000 epinephrine. METHODS: Participated in this study 34 patients, physical status ASA I and II, submitted to lower limbs varicose vein surgery, who were randomly distributed in 2 groups (n = 17) and received intravenous midazolam (0.05 mg.kg-1) followed by lumbar epidural anesthesia. Group S received 20 mL of 0.5% bupivacaine (with epinephrine) associated to 2 mL of 0.9% saline solution, and Group F received 20 mL of 0.5% bupivacaine (with epinephrine) associated to fentanyl (100 µg). Shivering, temperature, meperidine need, nausea and vomiting were evaluated in the following moments: M1 - admission to the operating room; M2 - immediately before anesthesia; M3 - 30 minutes after local anesthetic injection; M4 - 60 minutes after local anesthetic injection; M5 - 90 minutes after local anesthetic injection; M6 - end of anesthesia; M7 - immediately before PACU discharge. RESULTS: There have been no statistically significant differences between groups in demographics, physical status, mean anesthesia and surgery duration, patients and operating room temperature, and the incidence of nausea and vomiting. There have been statistically significant differences in shivering occurrence at 60 (M4) and 90 minutes (M5) after epidural block, with higher incidence of shivering in Group S as compared to Group F. A greater demand for meperidine was observed in patients submitted to epidural block without fentanyl. CONCLUSIONS: In the conditions of our study, 100 µg fentanyl associated to epidural local anesthetics did not abolish shivering but is able to decrease its incidence without increasing the incidence of nausea and vomiting.

Keywords

ANALGESICS, ANALGESICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, COMPLICATIONS, COMPLICATIONS

Referências

Carvalho MJ, Carvalho JCA, Castellana MEB. Tremores durante anestesia peridural: influência da temperatura do anestésico local e dos líquidos infundidos. Rev Bras Anestesiol. 1989;39:187-190.

Wheelahan JM, Leslie K, Silbert BS. Epidural fentanyl reduces the shivering threshold during epidural lidocaine anesthesia. Anesth Analg. 1998;87:587-590.

Matthews N, Corser G. Epidural fentanyl for shaking in obstetrics. Anaesthesia. 1988;43:783-785.

Ponte J, Sessler DI. Extradurals and shivering: effects of cold and warm extradural saline injections in volunteers. Br J Anaesth. 1990;64:731-733.

Liu WH, Luxton MC. The effect of prophylactic fentanyl on shivering in elective caesarian section under epidural analgesia. Anaesthesia. 1991;46:344-348.

Rolbin SH. Editorial review of four papers on shivering. Obstetric Anesth Digest. 1987;7:64.

Imbelloni LE. Meperidina para controle do tremor transoperatório durante cesariana sob anestesia peridural. Rev Bras Anestesiol. 1989;39:343-347.

Shehabi Y, Gatt S, Buckman T. Effect of adrenaline, fentanyl and warming of injectate on shivering following extradural analgesia in labour. Anaesth Intensive Care. 1990;18:31-37.

Cousins MJ, Veering BT. Epidural Neural Blockade. Bridenbaugh - Neural Blockade in Clinical Anesthesia and Management of Pain. 1998;8:243-320.

Glosten B, Hynson J, Sessler DI et al. Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg. 1993;77:488-493.

Hynson JM, Sessler DI, Glosten B et al. Thermal balance and tremor patterns during epidural anesthesia. Anesthesiology. 1991;74:680-690.

Sessler DI, Ponte J. Shivering during epidural anesthesia. Anesthesiology. 1990;72:816-821.

Silva ED, Quinto D. Controle da Hipotermia Acidental. Atualização em Anestesiologia. 1999:111-129.

Sessler DI, McGuire J, Moayeri A. Isoflurane-Induced vasodilation on minimally increases cutaneous heat loss. Anesthesiology. 1991;74:226-232.

Sessler DI, Hynson J, Moayeri A. Thermoregulatory vasoconstriction decreases cutaneous heat loss. Anesthesiology. 1990;73:656-660.

Frank SM, Beattie C, Christopherson R. Unintentional hypothermia is associated with postoperative myocardial ischemia: The perioperative ischemia randomized anesthesia trial study group. Anesthesiology. 1993;78:468-476.

Frank SM, Fleisher LA, Breslow MJ. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinic trial. JAMA. 1997;277:1127-1134.

Morris RH. Operating room temperature and anesthetized, paralyzed patient. Arch Surg. 1971;102:95-97.

Kurz A, Sessler D, Narzt E. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth. 1995;7:359-366.

Sharkey A, Lipton JM, Murphy MT. Inhibition of postanaesthetic shivering with radiant heat. Anesthesiology. 1987;66:249-252.

Imrie MM, Hall GM. Body temperature and anaesthesia. Br J Anaesth. 1990;64:346-354.

Kurz A, Go JC, Sessler DI. Alfentanil slightly increases the sweating threshold and markedly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1995;83:293-299.

Kurz A, Ikeda T, Sessler DI. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology. 1997;86:1046-1054.

Shehabi Y, Gatt S, Buckman T. Effect of adrenaline, fentanyl and warming of injectate on shivering following extradural analgesia in labour. Anaesth Intensive Care. 1990;18:31-37.

Cousins M, Cherry D, Gourlay G. Acute and Chronic Pain: Use of Spinal Opioids. Neural Blockade and Clinical Anesthesia and Pain Management. 1988:955-1025.

Justins DM, Knott C, Lythman J. Epidural versus intramuscular fentanil: Analgesia and pharmacokinetics in labour. Anaesthesia. 1983;38:937-942.

5dd7f05a0e88255e0213f288 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections