Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam

Sérgio D. Belzarena; Mozart T. Alves; Máximo L. D. Cucco; Vanius D. D

doi:10.1590/S0034-70942005000200002

Scientific Article

Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam

Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

Sérgio D. Belzarena; Mozart T. Alves; Máximo L. D. Cucco; Vanius D. D'Ávila

http://dx.doi.org/10.1590/S0034-70942005000200002 Braz J Anesthesiol, vol.55, n2, p.158-164, 2005

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Avaliar as características da analgesia pós-operatória em pacientes submetidas à cirurgia ginecológica videolaparoscópica ambulatorial, comparando o efeito de parecoxib e tenoxicam venoso em um estudo duplamente encoberto. MÉTODO: Foram estudadas, prospectivamente, 60 pacientes divididas aleatoriamente em 2 grupos. Todas receberam sedação pré-operatória com midazolam. Um dos grupos (P) recebeu, antes de iniciar a cirurgia, 40 mg de parecoxib e o outro (T) 20 mg de tenoxicam. Na sala de operação foi feita raquianestesia com bupivacaína e sufentanil. A analgesia pós-operatória foi avaliada mediante a intensidade da dor com escalas verbal e visual, a localização da dor (incisional, visceral, no ombro) e o consumo de analgésicos suplementares. Os efeitos colaterais adversos foram registrados. A satisfação da paciente com a técnica foi pesquisada. RESULTADOS: A qualidade analgésica foi excelente, com 76% das pacientes do grupo P e 83% das pacientes do grupo T sem queixa de dor nem uso de analgésicos no pós-operatório. Não houve diferença entre os grupos em todos os critérios e períodos de avaliação analgésica. A incidência de efeitos adversos foi pequena, embora prurido de intensidade leve e curta duração tenha ocorrido freqüentemente. Todas as pacientes ficaram satisfeitas ou muito satisfeitas com a técnica empregada. CONCLUSÕES: Uma técnica de analgesia multimodal, com um componente de anestésico local e opióide por via subaracnóidea associado a AINE venoso, produz analgesia pós-operatória de excelente qualidade com poucos efeitos colaterais adversos em cirurgia videolaparoscópica ginecológica ambulatorial. A escolha do AINE não parece importante para obter estes resultados.

Palavras-chave

ANALGÉSICOS,, ANALGÉSICOS,, ANESTESIA, CIRURGIA

Abstract

BACKGROUND AND OBJECTIVES: The quality of postoperative analgesia in patients submitted to outpatient videolaparoscopic gynecologic surgery was evaluated by comparing the effects of intravenous parecoxib and tenoxicam in a double-blind study. METHODS: Participated in this prospective study 60 patients who were randomly divided into two groups. All patients were premedicated with midazolam and one group (P) received 40 mg parecoxib before surgery. The other group (T) received 20 mg tenoxicam in the same manner. Spinal anesthesia with bupivacaine and sufentanil was administered for videolaparoscopic gynecologic procedures. Postoperative analgesia was evaluated using verbal and visual scales. Pain site (incisional, visceral or shoulder), supplemental analgesics and side effects were recorded, in addition to patients' satisfaction with the technique. RESULTS: Analgesic quality was excellent with 76% Group P patients and 83% group T patients with no postoperative pain complaint or analgesic request. There were no statistical differences between groups in all evaluated criteria. Pruritus, although brief and mild, was the primary side effect. All patients were satisfied or very satisfied with the technique. CONCLUSIONS: Multimodal analgesia with subarachnoid local anesthetic and opioid associated to intravenous NSAID produces excellent postoperative pain relief with few adverse effects in outpatient videolaparoscopic gynecologic surgery. The choice of the NSAID seems to be of minor importance for such results.

Keywords

ANALGESICS,, ANALGESICS,, ANESTHESIA, SURGERY

References

McCrory CR, Lindahl SG. Cyclooxygenase inhibition for postoperative analgesia. Anesth Analg. 2002;95:169-176.

Gilron I, Milne B, Hong M. Cyclooxigenase-2 inhibitors in postoperative pain management: current evidence and failure directions. Anesthesiology. 2003;99:1198-1208.

Souter AJ, Fredman B, White PF. Controversies in the perioperative use of nonsteroidal antiinflammatory drugs. Anesth Analg. 1994;79:1178-1190.

Desjardins PJ, Grossman EH, Kuss ME. The injectable cyclooxigenase-2- specific inhibitor parecoxib sodium has analgesic efficacy when administered preoperatively. Anesth Analg. 2001;93:721-727.

Tang J, Li S, White PF. Effect of parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, on the postoperative opioid requirement and quality of pain control. Anesthesiology. 2002;96:1305-1309.

Belzarena SD. Tenoxicam venoso para prevenção da dor pós-operatória em cirurgia abdominal superficial. Rev Bras Anestesiol. 1994;44:175-180.

O'Hanlon DM, Thambipillai T, Colbert ST. Timing of pre-emptive tenoxicam is important for postoperative analgesia. Can J Anaesth. 2001;48:162-166.

Gilroy DW, Tomlinson A, Willoughby DA. Differential effects of inhibitors of cyclooxygenase (cyclooxygenase 1 and cyclooxygenase 2) in acute inflammation. Eur J Pharmacol. 1998;355:211-217.

Zhu X, Conklin D, Eisenach JC. Cyclooxigenase-1 in the spinal cord plays an important role in postoperative pain. Pain. 2003;104:15-23.

Jin FL, Chung F. Postoperative pain - a challenge for anaesthetists in ambulatory surgery. Can J Anaesth. 1998;45:293-296.

Dobbs FF, Kumar V, Alexander JI. Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynaecol. 1987;94:262-266.

McKenzie R, Phitayakorn P, Uy NT. Topical etidocaine during laparoscopic tubal occlusion for postoperative pain relief. Obstet Gynecol. 1986;67:447-449.

MacLennan AH, Rodrigues LV, Krutli DR. Post-operative discomfort after ring or clip tubal ligation: is there any difference and do indomethacin suppositories help?. Contraception. 1990;42:309-313.

Chilvers CR, Goodwin A, Vaghadia H. Selective spinal anesthesia for outpatient laparoscopy: V: pharmacoeconomic comparison vs general anesthesia. Can J Anaesth. 2001;48:279-283.

Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606-617.

Brodner G, Pogatzki E, Van Aken H. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg. 1998;86:228-234.

Purhonen S, Kauko M, Koski EM. Comparison of tropisetron, droperidol and saline in the prevention of postoperative nausea and vomiting after gynecologic surgery. Anesth Analg. 1997;84:662-667.

Graczyk SG, McKenzie R, Kallar S. Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery. Anesth Analg. 1997;84:325-330.

Carpenter RL, Liu S, Neal JM. Epidural anesthesia and analgesia: Their role in postoperative outcome. Anesthesiology. 1995;82:1474-1506.

Girod V, Bouvier M, Grelot L. Characterization of lipopolysaccharide - induced emesis in conscious piglets: effects of cervical vagotomy, cyclooxigenase inhibitors and 5-HT(3) receptor antagonism. Neuropharmacology. 2000;39:2329-2335.

Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam

Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

Sérgio D. Belzarena; Mozart T. Alves; Máximo L. D. Cucco; Vanius D. D'Ávila

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol