Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000400004
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia do emprego da metadona ou da clonidina no intraoperatório para controle da dor pós-operatória imediata após uso de remifentanil

Efficacy of intraoperative methadone and clonidine in pain control in the immediate postoperative period after the use of remifentanil

Ricardo Francisco Simoni; Luiz Marciano Cangiani; Antônio Márcio Sanfim Arantes Pereira; Múcio Paranhos Abreu; Luis Henrique Cangiani; Guilherme Zemi

http://dx.doi.org/10.1590/S0034-70942009000400004 Braz J Anesthesiol, vol.59, n4, p.421-430, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: Por suas características farmacocinéticas, o remifentanil não promove efeito analgésico residual no pós-operatório imediato. O objetivo deste estudo foi comparar a eficácia da metadona e da clonidina no controle da dor pós-operatória de intervenções cirúrgicas videolaparoscópicas sob anestesia venosa total com infusão alvo-controlada de remifentanil. MÉTODO: Participaram deste estudo aleatório, duplamente encoberto e placebo-controlado, 126 pacientes com idade entre 18 e 65 anos, ASA PS 1 e 2 de ambos os sexos, que estavam previamente programados para a realização de intervenções cirúrgicas laparoscópicas. Após venopunção, os pacientes receberam por via venosa cetoprofeno e dipirona. A indução e manutenção da anestesia foram realizadas com infusão alvo-controlada de remifentanil e propofol. Antes do início da operação, os pacientes recebiam por via venosa a solução contendo metadona 0,1 mg.kg-1 (grupo metadona), clonidina 2,0 ¼g.kg-1 (grupo clonidina) ou solução fisiológica a 0,9% (grupo placebo). Na sala de recuperação pós-anestésica, a dor pós-operatória foi avaliada através da escala numérica verbal (ENV). Foi considerado paciente sem dor quando a ENV < 2 e paciente com dor quando > 3. RESULTADOS: A incidência de dor no grupo metadona foi significativamente menor em relação ao grupo clonidina e grupo placebo (11, 21 e 23, respectivamente; p < 0,02). Não houve diferença significativa na incidência de dor entre pacientes do grupo clonidina e placebo. CONCLUSÕES: Em relação ao controle da dor pós-operatória de intervenções cirúrgicas videolaparoscópicas sob anestesia venosa total com uso de remifentanil, o emprego da metadona foi mais eficaz que a clonidina; e usar clonidina não foi melhor que não usar.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, DOR

Abstract

BACKGROUND AND OBJECTIVES: Due to its pharmacokinetic characteristics, remifentanil does not promote residual analgesia in the immediate postoperative period. The objective of this study was to compare the efficacy of methadone and clonidine in the control of postoperative pain of videolaparoscopic surgeries under total intravenous anesthesia with target-controlled remifentanil infusion. METHODS: One hundred and twenty-six patients, ages 18 to 65 years, ASA I and II, of both genders, scheduled for laparoscopic surgeries, participated in this randomized, double- blind, placebo-controlled study. After venipuncture, intravenous ketoprofen and dypirone were administered. Target-controlled infusion of remifentanil and propofol was used for induction and maintenance of anesthesia. Before beginning the procedure, an intravenous solution containing 0.1 mg.kg-1 of methadone (methadone group), 2.0 ¼g.kg-1 of clonidine (clonidine group), or NS (placebo group) was administered. In the post-anesthetic care unit, postoperative pain was evaluated by the Verbal Numeric Scale (VNS). Absence of pain was defined as a score < 2, and pain as a score of > 3. RESULTS: The incidence of pain in the methadone group was significantly lower than in the clonidine and placebo groups (11, 21, and 23, respectively; p < 0.02). Significant differences in the incidence of pain in the placebo and clonidine groups were not observed. CONCLUSIONS: Methadone was more effective than clonidine in the control of postoperative pain in videolaparoscopic surgeries under total intravenous anesthesia with remifentanil; and using clonidine was not better than not using it.

Keywords

ANALGESICS, ANALGESICS, PAIN

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