Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000400003
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia controlada pelo paciente reduz consumo de bupivacaína no bloqueio femoral no tratamento da dor pós-operatória após reconstrução do ligamento cruzado anterior do joelho

Patient controlled analgesia reduces the consumption of bupivacaine in femoral nerve block for the treatment of postoperative pain after reconstruction of anterior cruciate ligament of the knee

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

http://dx.doi.org/10.1590/S0034-70942007000400003 Braz J Anesthesiol, vol.57, n4, p.356-365, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (BFC) é utilizado na analgesia pós-operatória das substituições articulares de quadril e joelho com bom resultado. O objetivo deste estudo foi avaliar a utilidade do BFC, comparando três esquemas de administração de bupivacaína após reconstrução do ligamento cruzado anterior (LCA) do joelho por artroscopia. MÉTODO: Estudo prospectivo controlado de 90 pacientes estado físico ASA I e II. Os pacientes foram divididos em três grupos: Grupo 1 (n = 30): 10 mL.h-1 em infusão contínua (IC) de bupivacaína 0,125% + clonidina 1µg.mL-1 (B + C); Grupo 2 (n = 30): 5 mL.h-1 em IC + 2,5 mL de B + C em PCA a cada 30 min; Grupo 3 (n = 30): 5 mL.h-1 de B + C em PCA cada 30 min. A anestesia foi por via subaracnóidea. A dor pós-operatório foi registrada às 2, 4, 6, 24 e 48 horas após a operação avaliada pela Escala Analógica Visual (VAS). Anotou-se também consumo de bupivacaína e morfina. RESULTADOS: Não foram registradas diferenças nas variáveis demográficas entre ambos os grupos. O VAS pós-operatório entre 2 e 48 horas não mostrou diferenças. O consumo de morfina entre 4 e 48 horas foi similar nos três grupos (p = 0,07). No grupo em que só foi utilizado o modo PCA, o consumo de bupivacaína foi significativamente menor (p < 0,001). CONCLUSÕES: O bloqueio femoral contínuo foi uma técnica útil para o manuseio da dor pós-operatória na reconstrução de LCA do joelho. Um débito de apenas 5 mL.h-1 em IC ou em bolos PCA assegurou uma excelente analgesia pós-operatória.

Palavras-chave

ANALGESIA, Pós-operatória, ANESTÉSICOS, Local, CIRURGIA, Ortopédica

Abstract

BACKGROUND AND OBJECTIVES: Continuous femoral nerve block (CFNB) is used in postoperative analgesia of hip and knee replacement surgeries with good results. The objective of this study was to evaluate the usefulness of CFNB, comparing 3 administration schedules of bupivacaine in the arthroscopic anterior cruciate ligament (ACL) repair of the knee. METHODS: A prospective, controlled study with 90 stable patients, physical status ASA I and II was undertaken. Patients were divided in three groups: Group 1 (n = 30): continuous infusion (CI) at a rate of 10 mL.h-1 of 0.125% bupivacaine + clonidine 1 µg.ml-1 (B+C); Group 2 (n = 30): CI at a rate of 5 mL.h-1 + PCA with 2.5 ml of B+C every 30 minutes; Group 3 (n = 30): PCA with 5 mL.h-1 of B+C every 30 minutes. Patients underwent spinal anesthesia. Postoperative pain at 2, 4, 6, 24, and 48 hours, using the Visual Analogue Scale (VAS), and consumption of morphine and bupivacaine were recorded. RESULTS: There were no statistically significant differences regarding the demographic data in both groups. The postoperative VAS between 2 and 48 hours did not show any differences. Morphine consumption between 4 and 48 hours was similar in all 3 groups (p = 0.07). The consumption of bupivacaine was significantly lower in the group that used only PCA (p < 0.001). CONCLUSIONS: Continuous femoral nerve block is a useful technique to manage postoperative pain after ACL repair. A rate of 5 mL.h-1 in CI or PCA boluses assures excellent postoperative analgesia.

Keywords

ANALGESIA, Postoperative, ANESTHETICS, Local, SURGERY, Orthopedic

References

Ho ST, Wang TJ, Tang JS. Pain relief after arthroscopic knee surgery: intravenous morphine, epidural morphine, and intra-articular morphine. Clin J Pain. 2000;16:105-109.

Joshi GP, McCarroll SM, Cooney CM. Intra-articular morphine for pain relief after knee arthroscopy. J Bone Joint Surg Br. 1992;74:749-751.

Moiniche S, Mikkelsen S, Wetterslev J. A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesth Pain Med. 1999;24:430-437.

Boden BP, Fassler S, Cooper S. Analgesic effect of intraarticular morphine, bupivacaine and morphine/bupivacaine after arthroscopic knee surgery. Arthroscopy. 1994;10:104-107.

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

Singelyn FJ, Deyaert M, Joris D. Effects of intravenous patient-controlled analgesia with morphine, contínuous epidural analgesia, and contínuous 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 blockade. 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, Gebhrard R. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001;16:436-445.

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, Casati A, Fanelli G. Complications in Continuous Peripheral Nerve Block Techniques. 2001:21-25.

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

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

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;90:129-139.

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.

Rosaeg OP, Krepski B, Cicutti N. Effect of preemptive multimodal analgesia for arthroscopic knee ligament repair. Reg Anesth Pain Med. 2001;26:125-130.

Brandsson S, Karlsson J, Morberg P. Intraarticular morphine after arthroscopic ACL reconstruction: a double-blind placebo controlled study of 40 patients. Acta Orthop Scand. 2000;71:280-285.

Vintar N, Rawal N, Veselko M. Intraarticular patient-controlled regional anesthesia after arthroscopically assisted anterior ligament reconstruction: ropivacaine/morphine/ketoroloac versus ropivacaine/morphine. Anesth Analg. 2005;101:573-578.

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 outpatients 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. 2003;98:1206-1213.

Williams BA, Kentor ML, Vogt MT. Reduction of verbal pain scores after anterior cruciate ligament reconstruction with 2-day continuous femoral nerve block: a randomized clinical trial. Anesthesiology. 2006;104:315-327.

Gan T, Sloan F, Dear G. How much are patients willing to pay to avoid postoperative nausea and vomiting?. Anesth Analg. 2001;92:393-400.

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