Analgesia perioperatória com infusão peridural contínua da combinação de morfina e clonidina em crianças submetidas a procedimentos cirúrgicos abdominais

Jyrson Guilherme Klamt; Magaly Santoni; Luis Vicente Garcia; Renato Mestriner Stocche

doi:10.1590/S0034-70942007000600003

Scientific Article

Analgesia perioperatória com infusão peridural contínua da combinação de morfina e clonidina em crianças submetidas a procedimentos cirúrgicos abdominais

Perioperative analgesia with continuous epidural infusion of morphine combined with clonidine in children undergoing abdominal surgeries

Jyrson Guilherme Klamt; Magaly Santoni; Luis Vicente Garcia; Renato Mestriner Stocche

http://dx.doi.org/10.1590/S0034-70942007000600003 Braz J Anesthesiol, vol.57, n6, p.606-617, 2007

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JUSTIFICATIVA E OBJETIVOS: O presente estudo foi desenvolvido para avaliar o efeito analgésico da combinação de morfina e clonidina administrada por via peridural, cuja eficácia foi demonstrada em pacientes adultos, sobre o consumo de isoflurano e o consumo de medicação analgésica no período pós-operatório em crianças. MÉTODO: Vinte e seis crianças escaladas para operações intra-abdominais foram alocadas de forma aleatória em dois grupos. Os dois grupos receberam, por via peridural, bolus de morfina (8 µg.kg-1) e de clonidina (0,8 µg.kg-1) antes do início da intervenção cirúrgica, seguidos de infusão contínua de clonidina (0,12 µg.kg-1.h-1) mais morfina (1,2 µg.kg-1.h-1) no Grupo I e o dobro dessas doses no Grupo II, durante 24 horas. Foram medidas as concentrações inspiratórias de isoflurano durante a operação e o número de doses (1 mg.kg-1) de tramadol durante 24 horas no pós-operatório. RESULTADOS: As concentrações de isoflurano foram significativamente menores em relação aos valores observados antes da incisão cirúrgica após 60 e 90 minutos nos Grupos II e I, respectivamente, porém não houve diferença entre os dois grupos. O consumo de tramadol foi muito menor no Grupo II, e sete (53,8%) não necessitaram analgesia de resgate, porém foram observadas maior sedação e hipotensão arterial. Não foi observada depressão respiratória nos dois grupos. CONCLUSÕES: A infusão peridural da combinação de baixas doses de clonidina e morfina promoveu redução da necessidade de isoflurano no período intra-operatório e analgesia pós-operatória de boa qualidade.

Palavras-chave

ANALGESIA, Regional, ANALGÉSICOS, CIRURGIA, Pediátrica

Abstract

BACKGROUND AND OBJECTIVES: The present study was developed to evaluate the analgesic effects of the epidural administration of a combination of morphine and clonidine, whose efficacy has been demonstrated in adults, on the consumption of isoflurane and postoperative consumption of analgesics in children. METHODS: Twenty-six children scheduled for intra-abdominal surgeries were randomly divided in two groups. Both groups received an epidural bolus of morphine (8 µg.kg-1) and clonidine (0.8 µg.kg-1) before the surgery, followed by the continuous infusion of clonidine (0.12 µg.kg-1.h-1) plus morphine (1.2 µg.kg-1.h-1) in Group I, and twice those dosages in Group II, during 24 hours. Inspiratory concentrations of isoflurane were measured during the surgery, as well as the number of doses (1 mg.kg-1) of tramadol during 24 hours in the postoperative period. RESULTS: The concentrations of isoflurane were significantly smaller after 60 and 90 minutes than the concentrations before the incision in Groups II and I, respectively, but those differences were not statistically significant. The consumption of tramadol was significantly lower in Group II, and 7 (53.8%) patients in this group did not need rescue analgesia, but we observed an increase in the incidence of sedation and hypotension. Respiratory depression was not observed in either group. CONCLUSIONS: Epidural infusion of low doses of clonidine combined with morphine reduced the intraoperative need of isoflurane and postoperative analgesia.

Keywords

ANALGESIA, Regional, ANALGESICS, SURGERY, pediatrics

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Analgesia perioperatória com infusão peridural contínua da combinação de morfina e clonidina em crianças submetidas a procedimentos cirúrgicos abdominais

Perioperative analgesia with continuous epidural infusion of morphine combined with clonidine in children undergoing abdominal surgeries

Jyrson Guilherme Klamt; Magaly Santoni; Luis Vicente Garcia; Renato Mestriner Stocche

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