Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000500006
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia analgésica do uso da dextrocetamina intra-articular em pacientes submetidos a artroplastia total do joelho

Analgesic efficacy of the intra-articular administration of S(+)- ketamine in patients undergoing total knee arthroplasty

Hireno Guará Sobrinho; João Batista Santos Garcia; José Wanderley Vasconcelos; José Carlos Amaral Sousa; Letácio Santos Garcia Ferro

http://dx.doi.org/10.1590/S0034-70942012000500006 Braz J Anesthesiol, vol.62, n5, p.670-675, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ) é associada a significativa dor pós-operatória. Muitos agentes de uso intra-articular (IA) têm sido empregados para analgesia pós-operatória com resultados inconsistentes. O enantiômetro cetamina S(+), a dextrocetamina, foi recentemente lançado comercialmente, com maior potência analgésica e menos efeitos indesejáveis do que a forma racêmica. Estudo prospectivo, experimental, aleatório e duplamente encoberto foi conduzido com o objetivo de avaliar a eficácia analgésica do uso da dextrocetamina por via intra-articular em pacientes submetidos à ATJ primária. MÉTODO: Foram avaliados 56 pacientes, alocados em três grupos: Grupo A (n = 19), que recebeu 0,25 mg.kg-1 de peso de dextrocetamina, diluído em 20 mL de solução fisiológica a 0,9%; Grupo B (n = 17), 0,5 mg.kg-1 de peso diluído da mesma forma; e Grupo C (n = 20), somente 20 mL de solução fisiológica a 0,9%, intra-articular, logo após o fim do procedimento e a colocação do dreno. Todos os pacientes tiveram acesso à terapia analgésica de resgate, sendo usada somente morfina endovenosa. Foram feitas avaliações 2, 6, 12 e 24 horas de pós-operatório, com mensuração da intensidade da dor pela Escala Analógica Visual (EAV), o uso da medicação de resgate pela avaliação do tempo decorrido entre a injeção intra-articular da solução e a primeira dose de resgate, o seu consumo total nas 24 horas e os efeitos adversos. RESULTADOS: Os grupos dextrocetamina obtiveram menores escores de dor quando comparados com a solução salina. A menor dose de dextrocetamina intra-articular (Grupo A: 0,25 mg.kg-1) usada resultou em melhores escores de dor e menos analgésico de resgate, com tempo de espera maior para sua solicitação. Os efeitos adversos foram infrequentes. Os resultados com menores escores de dor nos grupos que usaram a dextrocetamina são uma tend&eci+rc;ncia, pois não houve significância estatística entre os grupos. CONCLUSÃO: Neste estudo, com essa amostra, o efeito analgésico da dextrocetamina IA não foi superior à solução salina no período pós-operatório da ATJ.

Palavras-chave

ANALGESIA, Pós-operatório, intra-articular, ANALGÉSICO, Cetamina, CIRURGIA, Ortopédica, artroplastia de joelho, FARMACOLOGIA, Isomeria

Abstract

BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) is associated with significant postoperative pain. Many intra-articular (IA) agents have been used for postoperative analgesia with inconsistent outcomes. Ketamine's enantiomer S(+), S(+)- ketamine, was recently introduced commercially, with higher analgesic potency and less side effects than the racemic form. An experimental prospective randomized double-blind study was conducted to evaluate the analgesic efficacy of intra-articular S(+)- ketamine in patients undergoing primary TKA. METHOD: In total, 56 patients were evaluated and allocated into three groups: Group A (n = 19) received 0.25 mg.kg-1 of S(+)- ketamine diluted in 20 mL of saline solution 0.9%; Group B (n = 17) received 0.5 mg.kg-1 of S(+)- ketamine diluted in the same way; and Group C (n = 20) received only 20 mL of intra-articular saline 0.9%, immediately after surgery and drain placement. All patients had access to rescue analgesic therapy, with the use of intravenous morphine alone. Evaluations were made 2, 6, 12, and 24 hours postoperatively, with measurement of pain intensity by Visual Analogue Scale (VAS), use of rescue medication by the evaluation of the time elapsed between the intra-articular injection of the solution and first dose of rescue, total consumption within 24 hours, and adverse effects. RESULTS: The S(+)- ketamine groups had lower pain scores compared with the saline group. The lowest dose of intra-articular S(+)- ketamine (Group A: 0.25 mg.kg-1) resulted in better pain scores and less rescue analgesia, with longer time to first request. Adverse effects were infrequent. The results with lower pain scores in groups using S(+)- ketamine are a trend, as there was no statistical significance between groups. CONCLUSION: In this study, with this sample, the analgesic effect of IA S(+)- ketamine was not superior to saline solution in the postoperative period of TKA.

Keywords

Analgesia, Injections, Intra-articular, Ketamine, Isomerism, Arthroplasty, Replacement, Knee

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