Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000600005
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia pós-operatória plexular contínua: estudo dos efeitos colaterais e do risco de infecção dos cateteres

Postoperative continuous plexular analgesia. A study on the side effects and risk factors of catheter infection

Juliano Rodrigues Gasparini; Sérgio Silva de Mello; Ronaldo Soares Marques; Renato Ângelo Saraiva

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Resumo

JUSTIFICATIVA E OBJETIVOS: A analgesia pós-operatória foi muito valorizada nos últimos anos. Os cateteres plexulares são boa opção para analgesia de qualidade com a mínima repercussão sistêmica. O presente estudo visou a avaliar a ocorrência de efeitos colaterais e complicações em analgesia pós-operatória com cateteres plexulares e identificar fatores de risco para colonização bacteriana nos cateteres. MÉTODO: Pacientes submetidos a operações ortopédicas entre março de 2005 e janeiro de 2007 receberam analgesia por cateteres de plexo. Foi avaliada a ocorrência de efeitos colaterais e de complicações com o uso da técnica. Em parte dos casos foi feita cultura da ponta do cateter. RESULTADOS: Foram estudados 433 pacientes. As incidências de retenção urinária e náuseas/vômitos foram de 1,3% e 16,6%, respectivamente. Houve colonização em 8,6% dos 280 cateteres examinados. Não houve infecções, lesões nervosas nem repercussões sistêmicas. CONCLUSÕES: O uso pré-operatório de antibióticos e o tipo de agulha utilizado foram fatores de risco para colonização dos cateteres.

Palavras-chave

ANESTESIA, Regional, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The importance of postoperative analgesia has increased over the years. Plexular catheters represent a good option for high quality analgesia with reduced systemic repercussions. The objective of the present study was to evaluate the incidence of side effects and complications in postoperative analgesia with plexular catheters and identify risk factors for bacterial colonization of the catheters.
METHODS: Patients undergoing orthopedic surgeries between March of 2005 and January of 2007 received analgesia via plexular catheters. The incidence of side effects and complications of this technique were evaluated. In some of the cases, the catheter tip was cultured.
RESULTS: Four hundred and thirty-three patients were evaluated. Urinary retention and nausea/vomiting had an incidence of 1.3 and 16.6%, respectively. Of 280 catheters examined, 8.6% were colonized. Infections, nerve lesions, or systemic repercussion were not observed.
CONCLUSIONS: The use of antibiotics preoperatively and the type of needle were the risk factors of infection identified.

Keywords

ANESTHESIA, Regional; ANESTHETIC TECHNIQUES, Regional: peripheral blocks; COMPLICATIONS: infection.

References

Trindade EMV. Uma perspectiva histórica do sofrimento humano: considerações éticas no âmbito da saúde. Rev Saúde Dist. Fed. 2004;15:9-18.

Arredondo CMS. Analgesia postoperatória. Fármacos. 2003;16:21-29.

Wu CL, Rowlingson AJ, Partin AW. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med. 2005;30:516-22.

Hammond EJ, Veltman MG, Turner GA. The development of a performance indicator to objectively monitor the quality of care provided by an acute pain team. Anaesth Intensive Care. 2000;28:293-299.

Calvin A, Becker H, Biering P. Measuring patient opinion of pain management. J Pain Symptom Manage. 1999;18:17-26.

Borgeat A, Tewes E, Biasca N. Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA. Br J Anaesth. 1998;81:603-605.

Borgeat A, Schappi B, Biasca N. Patient-controlled analgesia after major shoulder surgery: Patient-controlled interscalene analgesia versus patient controlled analgesia. Anesthesiology. 1997;87:1343-1347.

Capdevila X, Barthelet Y, Biboulet P. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8-15.

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.

Zaric D, Boysen K, Christiansen C. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg. 2006;102:1240-1246.

Wilson JL, Brown DL, Wong GY. Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique. Anesth Analg. 1998;87:870-873.

Whiffler K. Coracoid block, a safe and easy technique. Br J Anaesth. 1981;53:845-848.

Mello SS, Saraiva RA, Marques RS. Posterior lumbar plexus block in children: a new anatomical landmark. Reg Anesth Pain Med. 2007;522-527.

Pandin P, Vandesteene A, dHollander A. Sciatic nerve blockade in the supine position: a novel approach. Le blocage du nerf sciatique en décubitus dorsal: une nouvelle approche. Can J Anesth. 2003;50:52-56.

Zetlaoui PJ, Bouaziz H. Lateral approach to the sciatic nerve in the popliteal fossa. Anesth Analg. 1998;87:79-82.

Capdevila X, Pirat P, Bringuier S. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery. Anesthesiology. 2005;103:1035-1045.

Borgeat A, Dullenkopf A, Ekatodramis G. Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Anesthesiology. 2003;99:436-442.

Singelyn FJ, Gouverneur JM. Postoperative analgesia after total hip arthroplasty: i.v. PCA with morphine, patient-controlled epidural analgesia, or continuous "3-in-1" block? A prospective evaluation by our acute pain service in more than 1,300 patients. J Clin Anesth. 1999;11:550-554.

Jeffrey MR, Spencer SL, Genevieve C. Does continuous peripheral nerve block provide superior pain control to opioids?: A meta-analysis. Anesth Analg. 2006;102:248-257.

Duarte LTD, Fernandes MCCB, Fernandes MJ. Analgesia peridural contínua: análise da efeitos adversos e fatores de risco para ocorrência de complicações. Rev Bras Anestesiol. 2004;54:371-390.

Capdevila X, Dadure C, Bringuier S. Effect of patient-controlled perineural analgesia onrehabilitation and pain after ambulatory orthopedic surgery. Anesthesiology. 2006;105:566-573.

Grossia P, Allegri M. Continuous peripheral nerve blocks: state of the art. Curr Opin Anaesthesiol. 2005;18:522-526.

Dickson MA, Doyle E. The intravascular migration of an epidural catheter. Paediatr Anaesth. 1999;9:273-275.

Jaeger JM, Madsen ML. Delayed subarachnoid migration of an epidural Arrow FlexTip Plus catheter. Anesthesiology. 1997;87:718-719.

Wang LP, Hauerberg J, Schmidt JR. Incidence of spinal epidural abscess after epidural analgesia. Anesthesiology. 1999;91:1928-1936.

Bubeck J, Boos K, Krause H. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters. Anesth Analg. 2004;99:689-693.

Yentur EA, Luleci N, Topcu I. Is skin disinfection with 10% povidone iodine sufficient to prevent epidural needle and catheter contamination?. Reg Anesth Pain Med. 2003;28:389-393.

Morin AM, Klerwat KM, Klotz MK. Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiology. 2005;5(1).

Adams D, Quayum M, Worthington T. Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. J Hosp Infect. 2005;61:287-290.

Keblish DJ, Zurakowski D, Wilson MG. Preoperative skin preparation of the foot and ankle: bristles and alcohol are better. J Bone Joint Surg Am. 2005;87:986-992.

Grabsch EA, Mitchell DJ, Hooper J. In-use efficacy of a chlorhexidine in alcohol surgical rub: a comparative study. ANZ J Surg. 2004;74:769-772.

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