Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

Affonso H. Zugliani; Nubia Verçosa; José Luiz Gomes do Amaral; Louis Barrucand; Cátia Salgado; Márcia Borges Hage Karam

doi:10.1590/S0034-70942007000500006

Scientific Article

Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

Control of postoperative pain following total knee arthroplasty: is it necessary to associate sciatic nerve block to femoral nerve block?

Affonso H. Zugliani; Nubia Verçosa; José Luiz Gomes do Amaral; Louis Barrucand; Cátia Salgado; Márcia Borges Hage Karam

http://dx.doi.org/10.1590/S0034-70942007000500006 Braz J Anesthesiol, vol.57, n5, p.514-524, 2007

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Resumo

JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ) promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO: Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9) foi realizado bloqueio do nervo femoral e no Grupo B (n = 8), bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1). RESULTADOS: A mediana do tempo de analgesia (M1) no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001). Não foram observadas complicações atribuíveis às técnicas utilizadas. CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.

Palavras-chave

ANALGESIA, CIRURGIA, Ortopédica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) causes severe tissue trauma, leading to severe postoperative pain. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy in the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block. METHODS: Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9), femoral nerve block was performed, while in Group B (n = 8), femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1) was also evaluated. RESULTS: The median of the duration of analgesia (M1) in Group A was 110 min, while in Group B it was 1285 min (p = 0.0001). There were no complications related to the technique used. CONCLUSIONS: Sciatic nerve block, when associated with femoral nerve block, under the conditions of the present study, improved significantly the quality of postoperative analgesia in TKA.

Keywords

ANALGESIA, ANESTHETIC TECHNIQUES, Regional, SURGERY, Orthopedic

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Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

Control of postoperative pain following total knee arthroplasty: is it necessary to associate sciatic nerve block to femoral nerve block?

Affonso H. Zugliani; Nubia Verçosa; José Luiz Gomes do Amaral; Louis Barrucand; Cátia Salgado; Márcia Borges Hage Karam

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