Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000500007
Brazilian Journal of Anesthesiology
Scientific Article

Efeito analgésico intra-operatório da cetamina, clonidina ou dexmedetomidina, administradas por via peridural, em cirurgia de abdômen superior

Intraoperative analgesic effect of epidural ketamine, clonidine or dexmedetomidine for upper abdominal surgery

Taylor Brandão Schnaider; Antonio Mauro Vieira; Antonio Carlos Aguiar Brandão; Marcos Vinicius Tonante Lobo

http://dx.doi.org/10.1590/S0034-70942005000500007 Braz J Anesthesiol, vol.55, n5, p.525-531, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: A cetamina reduz a nocicepção, bloqueando os canais dos receptores NMDA, em doses sub-anestésicas. A ativação dos receptores alfa2-adrenérgicos induz intensa resposta analgésica. O objetivo desta pesquisa foi avaliar os efeitos da cetamina, clonidina e dexmedetomidina, por via peridural, em pacientes submetidos à cirurgia do abdômen superior. MÉTODO: Participaram deste estudo aleatório e duplamente encoberto, 70 pacientes, de ambos os gêneros, com idade entre 18 e 50 anos, estado físico ASA I e II, submetidos a colecistectomia por via subcostal, sob anestesia geral associada à peridural lombar. Na anestesia peridural foram administrados, aleatoriamente, 20 mL de ropivacaína a 0,75% e 1 mL de cloreto de sódio a 0,9% no grupo Controle (n = 10); 20 mL de ropivacaína a 0,75% e 0,5 mg.kg-1 de cetamina no grupo Cetamina (n = 20); 20 mL de ropivacaína a 0,75% e 1 mL de clonidina (150 µg) no grupo Clonidina (n = 20) ou 20 mL de ropivacaína a 0,75% e 2 µg.kg-1 de dexmedetomidina no grupo Dexmedetomidina (n = 20). A indução anestésica foi realizada com etomidato, alfentanil e rocurônio, sendo a manutenção obtida pela administração de isoflurano e alfentanil. A analgesia foi observada por meio dos sinais clínicos e a concentração inspirada do agente inalatório por meio do analisador de gases ins e expirados, durante o ato operatório. RESULTADOS: Nos pacientes em que foi administrada cetamina, clonidina ou dexmedetomidina, ocorreu diminuição da freqüência cardíaca e da pressão arterial sistêmica, e não houve necessidade de complementação analgésica peri-operatória. Com relação à concentração inspirada do isoflurano, as necessidades variaram entre 0,5vol% e 1vol%, não se observando sinais clínicos ou respostas que sugerissem níveis inadequados de anestesia. CONCLUSÕES: A administração de cetamina, clonidina ou dexmedetomidina, por via peridural, reduz o consumo de alfentanil e a concentração inspirada de isoflurano, no intra-operatório de cirurgia de abdômen superior.

Palavras-chave

ANALGESIA, ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS

Abstract

BACKGROUND AND OBJECTIVES: Low dose ketamine decreases nociception by blocking NMDA receptor channels. Alpha2-adrenergic receptor activation triggers intense analgesic response. This study aimed at evaluating the effects of epidural ketamine, clonidine and dexmedetomidine, in patients undergoing upper abdominal surgery. METHODS: Participated in this randomized double-blind study 70 patients of both genders, aged 18 to 50 years, physical status ASA I or II, submitted to subcostal cholecystectomy under general anesthesia associated to lumbar epidural anesthesia. Lumbar epidural anesthesia was randomly induced as follows: Control group: 20 mL of 0.75% ropivacaine and 1 mL of 0.9% saline solution (n = 10); Ketamine group: 20 mL of 0.75% ropivacaine and 0.5 mg.kg-1 ketamine (n = 20); Clonidine group: 20 mL of 0.75% ropivacaine and 1 mL clonidine (150 µg) (n = 20); Dexmedetomidine group: 20 mL of 0.75% ropivacaine and 2 µg.kg-1 dexmedetomidine (n = 20). Anesthesia was induced with etomidate, alfentanil and rocuronium and was maintained with isoflurane and alfentanil. Analgesia was evaluated by clinical signs and inhalational anesthetic inspired concentration was evaluated by anesthetic gases analysis during surgery. RESULTS: All patients receiving ketamine, clonidine or dexmedetomidine had heart rate and systemic blood pressure decrease and have not required perioperative analgesic complementation. For the same patients, isoflurane inspired concentration varied from 0.5vol% to 1vol% and there were no clinical signs or responses suggesting inadequate anesthetic levels. CONCLUSIONS: Epidural ketamine, clonidine or dexmedetomidine decreases alfentanil consumption and isoflurane inspired concentration in the intraoperative period of upper abdominal surgery.

Keywords

ANALGESIA, ANALGESICS, ANALGESICS, ANALGESICS, ANALGESICS, ANALGESICS, ANESTHETICS, ANESTHETICS, ANESTHETICS, ANESTHETICS, ANESTHETICS

References

Choe H, Choi YS, Kim YH. Epidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration. Anesth Analg. 1997;84:560-563.

Dickenson AH. Spinal cord pharmacology of pain. Br J Anaesth. 1995;75:193-200.

Bagatini A, Gomes CR, Masella MZ. Dexmedetomidina: farmacologia e uso clínico. Rev Bras Anestesiol. 2002;52:606-617.

Alves TCA, Braz JRC, Vianna PTG. Alfa2-agonistas em Anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. 2000;50:396-404.

Hayashi Y, Maze M. Alpha-2 adrenoreceptor agonist and anesthesia. Br J Anaesth. 1993;71:108-118.

Guignard B, Coste C, Costes H. Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. Anesth Analg. 2002;95:103-108.

De Kock M, Wiederkher P, Laghmiche A. Epidural clonidine used as the sole analgesic agent during and after abdominal surgery. A dose response study. Anesthesiology. 1997;86:285-292.

Hager H, Marhofer P, Sitzwohl C. Caudal clonidine prolongs analgesia from caudal S(+)ketamine in children. Anesth Analg. 2002;94:1169-1172.

Ozyalcin NS, Yucel A, Camlica H. Effect of pré-emptive ketamine on sensory changes and postoperative pain after thoracotomy: comparison of epidural and intramuscular routes. Br J Anaesth. 2004;93:356-361.

Jankovic Z, Stamenkovic D, Milosavljevic S. Epidural analgesia in total gastrectomy - combination of bupivacaine with ketamine or fentanyl. Acta Chir Iugosl. 1999;46:47-52.

Fanelli G, Casati A, Berti M. Incidence of hypotension and bradycardia during integrated epidural/general anaesthesia: An epidemiologic observational study on 1200 consecutive patients. Italian Study Group on Integrated Anaesthesia. Minerva Anestesiol. 1998;64:313-319.

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