Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000600001
Brazilian Journal of Anesthesiology
Scientific Article

Metadona e morfina na indução da anestesia em cirurgia cardíaca: repercussão na analgesia pós-operatória e prevalência de náuseas e vômitos

Methadone and morphine during anesthesia induction for cardiac surgery: repercussion in postoperative analgesia and prevalence of nausea and vomiting

Artur Udelsmann; Fernanda Gardini Maciel; Derli Conceição Munhoz Servian; Eder Reis; Teresinha Maria de Azevedo; Marcos De Simone Melo

http://dx.doi.org/10.1590/S0034-70942011000600001 Braz J Anesthesiol, vol.61, n6, p.698-701, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A dor é fator agravante da morbimortalidade pós-operatória, principalmente nas intervenções de grande porte. Métodos para combatê-la eficazmente esbarram em custo elevado e por isso não são acessíveis em todos os serviços. A opção seria a utilização de um opioide com meia-vida longa como a metadona. O objetivo deste trabalho foi comparar a demanda de analgesia pós-operatória em pacientes que receberam, na indução de anestesia, metadona ou morfina, ou ainda placebo, além da prevalência de náuseas e vômitos no pós-operatório. MÉTODO: 55 pacientes programados para cirurgia cardíaca foram divididos em três grupos que receberam, na indução da anestesia, 20 mg de metadona, ou 20 mg de morfina, ou ainda placebo. Ao término, eram encaminhados à UTI, onde foram avaliados os seguintes fatores: duração da anestesia, tempo até a extubação, tempo até a necessidade do primeiro analgésico, número de doses necessárias em 24 horas, avaliação da analgesia pelo paciente e prevalência de náuseas/vômitos. RESULTADOS: Não houve diferença na duração da anestesia e no prazo até a extubação. A primeira dose de analgésico naqueles que receberam metadona foi administrada mais tarde que nos outros dois grupos. A necessidade de analgésicos no grupo metadona foi menor, a qualidade da analgesia foi melhor e a prevalência de náuseas e vômitos, também menor. CONCLUSÕES: A metadona na indução da anestesia mostrou-se eficiente para a analgesia em cirurgias de grande porte. Houve menor incidência de náuseas e vômitos, tratando-se, portanto, de uma opção de baixo custo, disponível em nosso meio e que deve ser estimulada.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES, DOR

Abstract

BACKGROUND AND OBJECTIVES: Pain is an aggravating factor in postoperative morbidity and mortality especially in large size surgeries. Methods to effectively fend pain collide with elevated costs and for this reason they are not accessible in every service. The option would be the use of an opioid with long half-life, such as methadone. The objective of the present study was to compare the requirements of postoperative analgesia in patients who received methadone, morphine, or placebo during anesthetic induction, besides the prevalence of postoperative nausea and vomiting. METHODS: Fifty-five patients scheduled for cardiac surgery were divided into three groups and they received during anesthetic induction 20 mg of methadone, 20 mg of morphine, or placebo. At the end of surgery, patients were transferred to the ICU where the following parameters were evaluated: duration of anesthesia, time until extubation, time until the need of the first analgesic, number of doses required in 24 hours, assessment of analgesia by the patient, and prevalence of nausea/vomiting. RESULTS: Differences in the duration of anesthesia and time until extubation were not observed. The first dose of analgesic in patients who received methadone was administered later than in patients in the other two groups. The need of analgesics in the methadone group was lower, quality of analgesia was better, and prevalence of nausea and vomiting was also lower. CONCLUSIONS: Methadone during anesthetic induction was effective for analgesia in large size surgeries. Lower incidence of nausea and vomiting was observed in the methadone group and therefore it is a low cost option available among us that should be stimulated.

Keywords

Methadone, Morphine, Pain, Thoracic Surgery, Postoperative Nausea and Vomiting

References

Toombs JD, Kral LA. Methadone treatment for pain states. Am Fam Physician. 2005;71:1353-1358.

Fishman SM, Wilsey B, Mahajan G, Molina P. Methadone reincarnated: nouvel clinical applications with related concerns. Pain Med. 2002;3:339-348.

Bruera E, Sweeney C. Methadone use in cancer patients with pain: a review. J Palliat Med. 2002;5:127-138.

Gourlay GK, Wilson PR, Glynn CJ. Methadone produces prolonged postoperative analgesia. Br Med J. 1982;284:630-631.

Berde CB, Beyer JE, Bournaki MC, Levin CR, Sethna NF. Comparison of morphine and methadone for prevention of postoperative pain in 3- to 7- year old children. J Pediatr. 1991;119:136-41.

Simoni RF, Cangiani LM, Pereira AMSA, Abreu MP, Cangiani LH. ZemiG - Eficácia do emprego da metadona ou da clonidina no intraoperatório para controle da dor pós-operatória imediata após uso de remifentanil. Rev Bras Anestesiol. 2009;59:421-430.

Broadman L. Blocks and other techniques pediatric surgeons can emply to reduce postoperative pain in pediatric patients. Semin Pediatr Surgery. 1999;8:30-33.

Shaiova L, Berger A, Blinderman CD. Consensus guideline on parenteral methadone use in pain and palliative care. Palliat Support Care. 2008;6:165-176.

Gourlay GK, Willis RJ, Lamberty J. A double-blind comparison of the efficacy of methadone and morphine in postoperative pain control. Anesthesiology. 1986;64:322-327.

Richlin DM, Reuben SS. Postoperative pain control with methadone following lower abdominal surgery. J Clin Anesth. 1991;3:112-116.

Gottschalk A, Durieux ME, Nemergut EC. Intraoperative methadone improves postoperative pain control in patients undergoing complex spinal surgery. Anesth Analg. 2011;112:218-223.

Jordan B, Devi LA. Molecular mechanisms of opioid receptor signal transduction. Br J Anaesth. 1998;81:12-19.

Peng PWH, Tumber OS, Gourlay D. Review article: Perioperative pain management of patients on methadone therapy. Can J Anesth. 2005;52:513-523.

Stringer J, Welsh C, Tomasello A. Metahdone-associated Q-T interval prolongation and torsades de pointes. Am J Health-Syst Pharm. 2009;66:825-833.

Hum A, Faisinger RL, Bielech M. Subcutaneous methadone: an issue revisited. J Pain Symptom Manage. 2007;34:573-575.

Davis MP, Walsh D. Methadone for relief of cancer pain: a review of pharmacokinetics, pharmacodynamics, drug interactions and protocols of administration. Support Care Cancer. 2001;9:73-83.

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