Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000100002
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação do efeito preemptivo da s(+)-cetamina por via peridural para histerectomia: concentrações plasmáticas de interleucinas

Evaluation of preemptive effect of epidural s(+)-ketamine for hysterectomy: plasmatic concentrations of interleukins

Elismar Paulo Azevedo Silva; Rioko Kimiko Sakata; João Batista Santos Garcia; Reinaldo Salomão; Adriana Machado Issy

http://dx.doi.org/10.1590/S0034-70942012000100002 Braz J Anesthesiol, vol.62, n1, p.6-9, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: Alguns estudos demonstraram que a cetamina inibe a produção de citocinas. O objetivo deste estudo foi avaliar o efeito analgésico preemptivo e citocinas plasmáticas (IL-6, TNF-α e IL-10) de S(+)-cetamina por via peridural em histerectomia. MÉTODO: Foi realizado estudo duplo-encoberto em 29 pacientes. Pacientes do Grupo 1 receberam 13 mL de bupivacaína a 0,25% com 25 mg de S(+)-cetamina 30 minutos antes da incisão cirúrgica, e 15 mL de solução salina fisiológica, 30 minutos após, por via peridural. Pacientes do Grupo 2 receberam 15 mL de salina 30 minutos antes da incisão cirúrgica, seguido por 13 mL de bupivacaína 0,25%, mais 25 mg de S (+)-cetamina 30 minutos após. A analgesia pós-operatória foi feita com bupivacaína e fentanil por via peridural. Quando necessário, foi utilizado 1 g de dipirona. Foram avaliados: concentração de citocinas, intensidade da dor, o tempo da primeira solicitação de analgésico e a quantidade total de analgésico utilizado. RESULTADOS: O tempo para a primeira solicitação de analgésico foi de 61,5 minutos no Grupo 1 e 69,0 no Grupo 2, sem diferença entre os grupos. Não houve diferença entre os grupos para a dose total de fentanil usada no Grupo 1 (221,4 µg) e Grupo 2 (223,3 µg). Foi obtido efeito analgésico semelhante nos grupos, exceto em T12 (Grupo 1 = 2,4 ± 3,2; Grupo 2 = 5,5 ± 3,4). Não foi observada diferença entre os grupos na concentração de citocinas. CONCLUSÕES: A injeção de 25 mg de S(+)-cetamina por via peridural antes da incisão reduziu a intensidade da dor apenas 12 horas após a incisão cirúrgica e não alterou a concentração de citocinas.

Palavras-chave

ANALGESIA, ANALGÉSICOS, CIRURGIA, FARMACOLOGIA, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Some studies showed that ketamine inhibits the production of cytokines. The objective of this study was to evaluate the preemptive analgesic effect of epidural S(+)-ketamine in hysterectomy and plasmatic cytokines (IL-6, TNF-α and IL-10). METHOD: A double-blinded study with 29 patients was conducted. Patients in Group 1 received 13 mL of 0.25% bupivacaine with 25 mg of S(+)ketamine 30 minutes before surgical incision and 15 mL of saline solution via the epidural route 30 minutes after. Patients in Group 2 received 15 mL of saline solution 30 minutes before the surgical incision, followed by 13 mL of 0.25% bupivacaine with 25 mg of S(+)-ketamine 30 minutes after. Postoperative analgesia was made with epidural bupivacaine and fentanyl. Dipyrone 1 g was used whenever required. The following paramenters were evaluated: concentration of cytokines, intensity of pain, time of first request of analgesic and total quantity of analgesic used. RESULTS: Time for the first request for analgesics was 61.5 minutes in Group 1 and 69.0 in Group 2, without difference between these groups. There was no difference for total dose of fentanyl used in Group 1 (221.4 µg) and Group 2 (223.3 µg). A similar analgesic effect was obtained in both groups, except in T12 (Group 1 = 2.4 ± 3.2; Group 2 = 5.5 ± 3.4). No differences in concentration of cytokines were observed. CONCLUSIONS: The epidural injection of 25 mg S(+)-ketamine before incision reduced the pain intensity only 12 hours after surgical incision and did not alter concentration of cytokines

Keywords

Ketamine, Analgesia, Anesthesia, Cytokines, Hysterectomy

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