Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000400007
Brazilian Journal of Anesthesiology
Scientific Article

Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas

Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

Karl Otto Geier

http://dx.doi.org/10.1590/S0034-70942004000400007 Braz J Anesthesiol, vol.54, n4, p.506-517, 2004
PDF Português
PDF English
Downloads: 0
Views: 914

Resumo

JUSTIFICATIVA E OBJETIVOS: Não obstante o bloqueio pleural ter sido convertido quase numa panacéia analgésica, resultados contraditórios foram publicados. O objetivo deste estudo foi observar o desempenho analgésico e espirométrico das funções pulmonares no pós-operatório imediato de 21 pacientes com o bloqueio pleural bilateral em laparotomias medianas de urgência. MÉTODO: Bloqueio pleural bilateral foi realizado em decúbito dorsal horizontal em 21 pacientes com 20 ml de bupivacaína a 0,375% com adrenalina a 1:400.000 administrados por cateter em cada hemitórax durante o pós-operatório imediato. Soluções aleatórias de bupivacaína e de solução fisiológica foram administradas por residentes ou enfermeiras que desconheciam o conteúdo das seringas, e seus desfechos analgésicos avaliados de acordo com a escala de dor Prince Henry ao comparar os valores pré e pós-bloqueio pleural bilateral. Em função da dor pós-operatória, testes espirométricos das funções pulmonares também foram determinados mediante espirômetro portátil. RESULTADOS: Analgesia pós-operatória, com duração média de 247,75 ± 75 minutos foi constatada em todos os pacientes com a bupivacaína, embora tenha persistido dor residual de menor intensidade na região suprapúbica em cinco pacientes (8%) e em dois pacientes na apófise xifóide (3,2%). Nenhum efeito analgésico foi obtido com solução fisiológica. Face à dor pós-operatória, as funções pulmonares, avaliadas antes e após os bloqueios, registraram melhora com a bupivacaína na CVF (p < 0,0367), e no FEV1 (p < 0,0051), e nenhuma no PEF (p < 0,059) e quociente FEV1/CVF (p < 0,1263). CONCLUSÕES: No presente estudo, o controle da dor pós-operatória pelo bloqueio pleural bilateral em laparotomias medianas de urgência foi considerado nulo com solução fisiológica. No entanto, com a bupivacaína o resultado da analgesia não foi totalmente efetivo em todos os pacientes, durante a movimentação no leito e à respiração profunda. O bloqueio pleural parece não ter o mesmo desfecho analgésico em todos os pacientes.

Palavras-chave

ANALGESIA, CIRURGIA, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, ANALGESIA, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, SURGERY

Abstract

BACKGROUND AND OBJECTIVES: Notwithstanding pleural block having become almost an analgesic panacea, contradictory results have been published. This study aimed at observing analgesic and spirometric behavior of pulmonary function in the immediate postoperative period of 21 patients submitted to urgency median laparotomies under bilateral pleural block. METHODS: Bilateral pleural block was induced in the supine position with 20 mL of 0.375% bupivacaine with 1:400,000 epinephrine administered via catheter in each hemithorax during the immediate postoperative period. Randomized bupivacaine and saline were administered by residents or nurses blind to syringes content, and their analgesic outcomes were evaluated according to Prince Henry's pain score by comparing pre and post bilateral pleural block values. As a function of postoperative pain, spirometric tests of pulmonary function were also applied via a portable spirometer. RESULTS: All bupivacaine patients referred postoperative analgesia with mean duration of 247.75 ± 75 minutes although there has been mild residual pain in the suprapubic region of five patients (8%) and in the xiphoid apophysis in two patients (3.2%). No analgesic effect was obtained with saline. Pulmonary function evaluated pre and post-blockade were improved with bupivacaine in FVC (p < 0.0367) and FEV1 (p < 0.0051). No improvement was seen in EFP (p < 0.059) and FEV1/FVC ratio (p < 0.1263). CONCLUSIONS: In our study, postoperative pain control with bilateral pleural block after urgency median laparotomies was null with saline. With bupivacaine, however, analgesia was not considered fully effective in all patients during movements on bed and deep breathing. Pleural block does not seem to have the same analgesic outcome for all patients.

References

Kvalheim L, Reiestad F. Interpleural catheter in the management of postoperative pain. Anesthesiology. 1984;61(A231).

Murphy DF. Intercostal nerve blockade for fractured ribs and postoperative analgesia: Description of a new technique. Reg Anesth. 1983;8:151-153.

O'Kelly E, Garry B. Continuous pain relief for multiple fractured ribs. Br J Anaesth. 1981;53:989-991.

Murphy DF. Continuous intercostal nerve blockade for pain relief after cholecystectomy. Br J Anaesth. 1983;55:521-524.

Reiestad F, Kvalheim L. Continuous intercostal blocks for postoperative pain relief. Tidsskr Nor Laegetoren. 1984;104:485-487.

McKenzie AG, Mathe S. Interpleural local anaesthesia: anatomical basis for mechanism of action. Br J Anaesth. 1996;76:297-299.

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

Pybus DA, Torda TA. Dose-affect relationships of extradural morphine. Br J Anaesth. 1982;54:1259-1262.

Strömskag KE, Reiestad F, Holmqvist EL. Intrapleural administration of 0.25%, 0.375% and 0.5% bupivacaine with epinephrine after cholecystectomy. Anesth Analg. 1988;67:430-434.

Ferrante FM, Chan VW, Arthur GR. Interpleural analgesia after thoracotomy. Anesth Analg. 1991;72:105-109.

Schneider RF, Villamena PC, Harvey J. Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy. Chest. 1993;103:414-416.

Kambam JR, Hammon J, Parris WC. Intrapleural analgesia for post-horacotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth. 1989;36:106-109.

Kawamata M, Omote K, Namikia A. Bilateral interpleural injection of lidocaine after bilateral lung surgery through median thoracotomy in four patients. Anesth Analg. 1992;75:1046-1049.

El Naggar MA, Bennett B, Raad C. Bilateral intrapleural intercostal nerve block. Anesth Analg. 1988;67(57).

Belzarena SD. Analgesia pós-operatória com bupivacaína intrapleural. Rev Bras Anestesiol. 1990;40(3-6).

KO Geier. Bloqueio pleural para ressutura de parede abdominal: Relato de caso. Rev Bras Anestesiol. 1994;44(211-216).

Vieira AM, Schnaider TB, Brandão ACA. Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas. Rev Bras Anestesiol. 2003;53:346-350.

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

Ramajoli F, De Amici D. Is there a bilateral block of the thoracic sympathetic chain after unilateral intrapleural analgesia?. Anesth Analg. 1998;87:360-367.

Lauder GR. Interpleural analgesia and phrenic nerve paralysis. Anaesthesia. 1993;48:315-316.

Redick LF. Is phrenic nerve block possible with interpleural analgesia?. Reg Anesth. 1990;15:44-45.

Netter FH. Atlas of Human Anatomy. 1997.

Stromskag KE, Hauge O, Steen PA. Distribution of local anesthetics injected into the interpleural space, studied by computerized tomography. Acta Anaesthesiol Scand. 1990;34:323-326.

Reiestad F, Stromskag KE. Intrapleural catheter in the management of postoperative pain: A preliminary report. Reg Anesth. 1986;11:91-93.

Brismar B, Pattersson N, Tokics I. Postoperative analgesia with intrapleural administration of bupivacaine-adrenalina. Acta Anaesthesiol Scand. 1987;31:515-520.

5dd7dd0e0e8825915313f286 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