Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000300006
Brazilian Journal of Anesthesiology
Scientific Article

Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho

Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee

Víctor A. Contreras-Domínguez; Paulina E. Carbonell-Bellolio; Álvaro C. Ojeda-Greciet; Edgardo S. Sanzana

http://dx.doi.org/10.1590/S0034-70942007000300006 Braz J Anesthesiol, vol.57, n3, p.280-288, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (3-em-1) é usado para a analgesia pós-operatória de artroplastia de quadril e joelho com bons resultados, apresentando vantagens sobre outras técnicas de analgesia locorregional ou sistêmica e com baixa incidência de complicações. O objetivo deste estudo foi avaliar clinicamente a utilidade do bloqueio femoral contínuo em comparação com a analgesia por via venosa na reconstrução do ligamento cruzado anterior. MÉTODO: Foi realizado um estudo prospectivo, controlado, com 60 pacientes com estado físico ASA I. Os paciente foram divididos em dois grupos: Grupo 1 (n = 30): bloqueio femoral contínuo com infusão de bupivacaína e clonidina; Grupo 2 (n = 30): infusão por via venosa de cetoprofeno. A intervenção cirúrgica foi realizada sob raquianestesia e sedação. O tratamento da dor pós-operatória foi feito com analgesia controlada pelo paciente (PCA) usando morfina. A dor pós-operatória foi registrada 2, 4, 6, 24 e 36 horas após a intervenção cirúrgica usando a Escala Visual Analógica (VAS). O consumo de morfina, a satisfação dos pacientes e as complicações também foram registradas. RESULTADOS: No Grupo 1, o VAS pós-operatório entre 4 e 48 horas após a intervenção cirúrgica foi de 21 mm ± 2 e no Grupo 2 foi de 45 mm ± 4 (p < 0,001). O uso de morfina no período de 4 a 48 horas no Grupo 1 foi de 4,5 mg ± 1,5 e no Grupo 2 foi de 25,5 mg ± 3 (p < 0,001). No Grupo 1, 6,7% dos pacientes apresentaram náusea ou vômito no pós-operatório (NVPO) comparado com 20% no Grupo 2. CONCLUSÕES: O bloqueio 3-em-1 com bupivacaína e clonidina em infusão contínua forneceu analgesia mais eficaz, maior satisfação do paciente, reduziu o consumo de morfina por via venosa e apresentou menor incidência de NVPO do que a analgesia sistêmica.

Palavras-chave

ANALGESIA, Regional, CIRURGIA, Ortopédica

Abstract

BACKGROUND AND OBJECTIVES: Continuous femoral block (three-in-one) is used for postoperative analgesia in hip and knee replacements with good results, with advantages over other locoregional analgesic or intravenous techniques having low incidence of complications. The aim of this study was to clinically evaluate the utility of continuous femoral block compared with intravenous analgesia in reconstruction of anterior cruciate ligament. METHODS: Controlled prospective study of 60 patients ASA I. Patients were divided into two groups: Group 1 (n = 30): continuous femoral block with an infusion of bupivacaine and clonidine; and Group 2 (n = 30): intravenous ketoprofen infusion. Surgery was performed under spinal anesthesia and sedation. Postoperative pain management with morphine patient controlled analgesia (PCA). Postoperative pain recorded at 2, 4, 6, 24 and 36 hours after surgery using Visual Analog Scale (VAS). Morphine consumption, satisfaction's score and complications are registered. RESULTS: In Group 1 postoperative VAS between 4 and 48 hours was 21 mm ± 2 and in Group 2 was 45 mm ± 4 (p < 0.001). Morphine consumption between 4 and 48 hours in Group 1 was 4.5 mg ± 1.5 and in Group 2 was 25.5 mg ± 3 (p < 0.001). In Group 1, 6.7% of patients presented postoperative nausea or vomiting (PONV) compared to 20% in Group 2. CONCLUSION: The three-in-one block with bupivacaine and clonidine in continuous infusion provides more efficient analgesia, patient satisfaction and less consumption of intravenous morphine and PONV than intravenous analgesia.

Keywords

ANALGESIA, Regional, SURGERY, Orthopedic

References

Singelyn FJ, Vanderest PE, Gouverneur JM. Extended femoral nerve sheath block after total hip arthroplasty: continuous versus patient-controlled techniques. Anesth Analg. 2001;92:455-459.

Singelyn FJ, Deyaert M, Joris D. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88-92.

Enneking FK, Wedel DJ. The art and science of peripheral nerve blocks. Anesth Analg. 2000;90:1-2.

Cuignet O, Pirson J, Boughrouph J. The efficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting procedures. Anesth Analg. 2004;98:1077-1081.

Singelyn FJ, Contreras V, Gouverneur JM. Epidural anesthesia complicating continuous 3-in-1 lumbar plexus block. Anesthesiology. 1995;83:217-220.

Adam F, Jaziri S, Chauvin M. Psoas abscess complicating femoral nerve block catheter. Anesthesiology. 2003;99:230-231.

Chelly JE, Greger J, Gebhard R. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001;16:436-45.

Auroy Y, Benhamou D, Bargues L. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97:1274-1280.

Chelly JE. Complications of Continuous Peripheral Nerve Blocks. Continuous Peripheral Nerve Block Techniques. 2001:21-5.

Ben-David B, Chelly JE. Continuous peripheral neural blockade for postoperative analgesia: practical advantages. Anesth Analg. 2003;96:1537-1538.

Brown DW, Curry CM, Ruterbories LM. Evaluation of pain after arthroscopically assisted anterior cruciate ligament reconstruction. Am J Sports Med. 1997;25:182-186.

Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technique of lumbar plexus anesthesia: the "3-in-1" block. Anesth Analg. 1973;52:989-996.

Menigaux C, Fletcher D, Dupont X. The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg. 2000;90:129-135.

Menigaux C, Guignard B, Fletcher D. Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy. Anesth Analg. 2001;93:606-612.

Chew HF, Evans NA, Stanish WD. Patient-controlled bupivacaine infusion into the infrapatellar fat pad after anterior cruciate ligament reconstruction. Arthroscopy. 2003;19:500-505.

Brandsson S, Karlsson J, Morberg P. Intraarticular morphine after arthroscopic ACL reconstruction: a double-blind placebo controlled study of 40 patients. Acta Orthop Scand. ;71:2000.

Anker-Moller E, Spangsberg N, Dahl JB. Continuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma concentrations and analgesic effect of bupivacaine 0.250% and 0.125%. Acta Anaesthesiol Scand. 1990;34:468-472.

Singelyn FJ, Gouverneur JM. Extended three-in-one block after total knee arthroplasty: continuous versus patient-controlled techniques. Anesth Analg. 2000;91:176-180.

Esteve M, Veillette Y, Ecoffey C. Continuous block of the femoral nerve after surgery of the knee: pharmacokinetics of bupivacaine. Ann Fr Anesth Réanim. 1990;9:322-325.

Edkin BS, Spindler KP, Flanagan JF. Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. Arthroscopy. 1995;11:404-409.

Williams BA, Kentor ML, Vogt MT. Femoral-sciatic nerve blocks for complex outpatient knee surgery are associated with less postoperative pain before same-day discharge: a review of 1,200 consecutive cases from the period 1996-1999. Anesthesiology. ;98:1206-1213.

Williams BA, Kentor ML, Vogt MT. Economics of nerve block pain management after anterior cruciate ligament reconstruction. Potential hospital cost savings via associated postanesthesia care unit bypass and same day discharge. Anesthesiology. 2004;100:697-706.

Cuvillon P, Ripart J, Lalourcey L. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg. 2001;93:1045-1049.

Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth. 1989;63:189-195.

Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg. 1996;83:1046-1050.

Sia S, Lepri A. Clonidine administered as an axillary block does not affect postoperative pain when gives as the sole analgesic. Anesth Analg. 1999;88:1109-12.

Langer SZ, Duval N, Massingham R. Pharmacologic and therapeutics significance of alpha-adrenoreceptor subtypes. J Cardiovasc Pharmacol. 1985;7(^s8):s1-8.

Starke K, Wagner J, Schümann HJ. Adrenergic neuron blockade by clonidine: comparison with guanethidine and local anesthetics. Arch Int Pharmacodyn Ther. 1972;195:291-308.

Gaumann DM, Brunet PC, Jirounek P. Clonidine enhances the effects of lidocaine on c-fiber action potential. Anesth Analg. 1992;74:719-725.

Mannion S, Hayes I, Loughnane F. Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery. Anesth Analg. 2005;100:873-878.

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