Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000600001
Brazilian Journal of Anesthesiology
Artigo Científico

Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína

Comparison among three techniques of postoperative regional analgesia with ropivacaine in children

Ana Maria Menezes Caetano; Gilliatt Hanois Falbo; Luciana Cavalcanti Lima

http://dx.doi.org/10.1590/S0034-70942006000600001 Braz J Anesthesiol, vol.56, n6, p.561-570, 2006
PDF Português
PDF English
Downloads: 0
Views: 1011

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória acarreta um aumento nos gastos e gera insatisfação dos pais com relação à prescrição analgésica para os seus filhos. A ropivacaína apresenta larga margem de segurança em anestesia regional em pediatria. O objetivo deste estudo foi comparar a anestesia peridural sacra (PS) com o bloqueio dos nervos ileoinguinal/ileohipogástrico (BIHII) e com a infiltração da ferida operatória (IFO) utilizando a ropivacaína para a analgesia pós-operatória em crianças. MÉTODO: Foram estudadas 87 crianças do sexo masculino, com idade entre 1 e 5 anos, submetidas a herniorrafias inguinais eletivas unilaterais. As crianças receberam de forma aleatória a PS, o BIHII ou a IFO. Pesquisou-se a necessidade de analgésico no pós-operatório, o tempo necessário para a sua 1ª dose, a intensidade da dor e o grau de bloqueio motor. RESULTADOS: No Grupo da IFO observou-se maior necessidade de analgésicos, e maior intensidade de dor nas primeiras duas horas, quando comparada com a PS e com o BIHII. Apenas crianças submetidas a PS apresentaram bloqueio motor de grau leve. O tempo médio da necessidade da 1ª dose de analgésico foi semelhante entre os grupos. CONCLUSÕES: O BIHII apresentou superioridade sobre a IFO, sobretudo nas primeiras duas horas de pós-operatório. As três técnicas anestésicas podem ser utilizadas com segurança e eficácia no controle da dor pós-operatória de herniorrafia inguinal em crianças.

Palavras-chave

ANALGESIA, Pós-operatória, ANESTÉSICOS, Local, CIRURGIA, Pediátrica, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Postoperative pain increases cost and generates dissatisfaction among parents regarding to the analgesics prescribed to their children. Ropivacaine has a broad safety margin to be used for regional block in pediatric patients. The aim of this study was to compare caudal epidural block (CE) with ilioinguinal/iliohypogastric nerve block (IINB) and infiltration of surgical wound (ISW) with ropivacaine for postoperative analgesia in children. METHODS: Eighty-seven children, all males, ages 1 to 5, who underwent elective unilateral inguinal herniorrhaphy participated in this study. Children were randomly assigned to receive CE, IINB, or ISW. The need for postoperative analgesia, length of time until the first dose, severity of pain, and degree of the motor blockade were evaluated. RESULTS: The need for analgesia and pain severity in the first two hours were greater for the ISW Group when compared with the CE and IINB Groups. Only the children in the CE Group presented a mild motor blockade. The mean length of time until de 1st dose of analgesic was similar in all groups. CONCLUSIONS: Ilioinguinal/iliohypogastric nerve block was superior to ISW, especially in the first two hours after the surgery. The three anesthetic techniques can be safely and effectively used to control postoperative pain in inguinal herniorrhaphy in children.

Keywords

ANALGESIA, Postoperative, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETICS, Local, SURGERY, Pediatric

Referências

Morton NS. Prevention and control of pain in children. Br J Anaesth. 1999;83:118-129.

Hannallah RS. Postoperative analgesia in the paediatric patient. Can J Anaesth. 1992;39:641.

Sinatra RS. Neural Blockade in Clinical Anesthesia and Management of Pain. 2001.

Morton NS. Pain assessment in children. Paediatr Anaesth. 1997;7:267-272.

Norden J, Hannallah R, Getson P. Concurrent validation of an objective pain scale for infants and children. Anesthesiology. 1991;75:A934.

Norden J, Hannallah R, Getson P. Reliability of an objective pain scale in children. Anesth Analg. 1991;72:S199.

Yaster M, Maxwell LG. Pediatric regional anesthesia. Anesthesiology. 1989;70:324-338.

Kehlet H. Epidural analgesia and the endocrine-metabolic response to surgery-updates and perspectives. Acta Anaesthesiol Scand. 1984;28:125-127.

Bell C, Kain ZN, Hughes C. Acute Pediatric Pain Management. The Pediatric Anesthesia Handbook. 1997:453-484.

Berde CB, Kain ZN. Pain Management in Infants and Children. Anesthesia for Infants and Children. 1996:385-402.

Cook B, Grubb DJ, Aldrige LA. Comparison of the effects of adrenaline, clonidine and Ketamine on the duration of caudal anaesthesia produced by bupivacaine in children. Br J Anaesth. 1995;75:698-701.

Wolf AR, Hobbs AJ, Wade A. Postoperative analgesia after orchidopexy: evaluation of a bupivacaine/morphine mixture. Br J Anaesth. 1990;64:430-435.

Wolf AR, Hughes D, Hobbs AJ. Combined morphine/bupivacaine caudals for reconstructive penile surgery in children: systemic absorption of morphine and postoperative analgesia. Anaesth Intensive Care. 1991;19:17-21.

Dalens B, Ecoffey C, Joly A. Pharmacokinetics and analgesic effect of ropivacaine following-ilioinguinal/iliohypogastric nerve block in children. Paediatr Anaesth. 2001;11:415-420.

Moiniche S, Mikkelsen S, Wetterslev J. A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations. Br J Anaesth. 1998;81:377-383.

Suresh S. Practical pediatric regional anesthesia. ASA Refresher Courses in Anesthesiology. 2003;31:177-188.

Martin J. Postoperative pain management in infants and children: new developments. Curr Opin Anesth. 2000;13:285-289.

Wilson G, Doyle E. Validation of three peadiatric pain scores for use by parents. Anaesthesia. 1996;51:1005-1007.

Suraseranivongse S, Santawat U, Kraiprasit K. Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth. 2001;87:400-405.

Turner G, Blake D, Buckland M. Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery. Br J Anaesth. 1996;76:606-610.

Hannallah RS, Broadman LM, Belman AB. Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology. 1987;66:832-834.

Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg. 1989;68:654-672.

Uguralp S, Mutus M, Koroglu A. Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: experience in 1554 children. J Pediatr Surg. 2002;37:610-613.

Tverskoy M, Cozacov C, Ayache M. Postoperative pain after inguinal herniorrhaphy with different types of anesthesia. Anesth Analg. :1990.

Johansson B, Glise H, Hallerback B. Preoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy. Anesth Analg. 1994;78:210-214.

Trotter C, Martin P, Youngson G. A comparison between ilioinguinal-iliohypogastric nerve block performed by anaesthetist or surgeon for postoperative analgesia following groin surgery in children. . 1995;5:363-367.

Dalens B, Ecoffey C, Jol A. Pharmacokinetics and analgesic effect of ropivacaine following ilioinguinal/iliohypogastric nerve block in children. Paediatr Anaesth. 2001;11:415-420.

Rice LJ. Practical postoperative pain management for children. ASA Refresher Courses in Anesthesiology. 2002;30:159-168.

Conceição MJ, Coelho L. Caudal anaesthesia with 0.375% ropivacaine or 0.375% bupivacaine in paediatric patients. Br J Anaesth. 1998;80:507-508.

Conceição MJ, Coelho L, Khalil M. Ropivacaine 0.25% compared with bupivacaine 0.25% by caudal route. Paediatr Anaesth. 1999;9:229-233.

Ivani G, Mereto N, Lampugnani E. Ropivacaine in paediatric surgery: preliminary results. Paediatr Anaesth. 1998;8:127-129.

Luz G, Innerhofer P, Haussler B. Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single-shot caudal anaesthesia in children. Paediatr Anaesth. 2000;10:499-504.

Ivani G, Negri PD, Conio A. Comparison of racemic bupivacaine, ropivacaine, and levobupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. Reg Anesth Pain Med. 2002;27:157-161.

Keenan RL, Shapiro JH, Kane FR. Bradycardia during anesthesia in infants: an epidemiologic study. Anesthesiology. 1994;80:976-982.

Conceição MJ, Costa JSMB. Incidência de complicações em anestesia pediátrica. Rev Bras Anestesiol. 1995;45:337-343.

Meneghini L, Zadra N, Zanette G. The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children. Paediatr Anaesth. 1998;8:11-15.

Armendi AJ, Todres D. Postanesthesia Care Unit. A Practice of Anesthesia for Infants and Children. 2001:704-708.

Baines D. Postoperative nausea and vomiting in children. Paediatr Anaesth. 1996;6:7-14.

Conran AM, Hannallah RS. Pediatric outpatient anesthesia and perioperative care. Curr Opin Anesthesiol. 1997;10:205-208.

Brennan LJ. Modern day-case anaesthesia for children. Br J Anaesth. 1999;83:91-103.

5dd2fc610e8825867dc63494 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