Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000600002
Brazilian Journal of Anesthesiology
Scientific Article

Dor crônica pós-cesariana. Influência da técnica anestésico-cirúrgica e da analgesia pós-operatória

Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia

Thais Orrico de Brito Cançado; Maruan Omais; Hazem Adel Ashmawi; Marcelo Luis Abramides Torres

http://dx.doi.org/10.1590/S0034-70942012000600002 Braz J Anesthesiol, vol.62, n6, p.768-774, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: O Brasil ocupa o segundo lugar entre os países com maiores taxas de cesariana no mundo. Pouco se sabe a respeito das consequências futuras desse procedimento sobre a saúde materna. Este estudo investigou a influência da técnica anestésico-cirúrgica e da analgesia pós-operatória no aparecimento de dor crônica após três meses da cesariana. MÉTODO: Este estudo prospectivo randomizado foi feito em 443 pacientes submetidas a cesariana (eletiva e urgente), com diferentes doses de bupivacaína 0,5% hiperbárica e opioides na raquianestesia. Os grupos foram: G1- 8 mg bupivacaína hiperbárica + 2,5 mg sufentanil + 100 mg morfina; G2- 10 mg bupivacaína hiperbárica + 2,5 mg sulfentanil + 100 mg morfina; G3- 12,5 mg bupivacaína hiperbárica + 100 mg morfina; G4- 15 mg bupivacaína hiperbárica + 100 mg morfina; G5- 12,5 mg bupivacaína hiperbárica + 100 mg morfina (sem anti-inflamatório perioperatório). Dor em repouso e em movimento foram avaliadas no pós-operatório imediato. Contato telefônico foi feito, após três meses do procedimento cirúrgico, para identificação das pacientes com dor crônica. RESULTADOS: A incidência de dor crônica nos grupos foi: G1 = 20%; G2 = 13%; G3 = 7,1%; G4 = 2,2% e G5 = 20,3%. Pacientes que referiram escores de dor mais elevados no período pós-operatório tiveram maior incidência de dor crônica (p < 0,05). CONCLUSÃO: A incidência de dor crônica diminui com o emprego de doses maiores de anestésicos locais e uso de anti-inflamatórios não hormonais. Escores mais elevados de dor no período pós-operatório tiveram associação com aparecimento de dor crônica após três meses da cesariana.

Palavras-chave

CIRURGIA, DOR, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Brazil ranks second among countries with the highest rates of cesarean section in the world. Little is known about the future consequences of this procedure on maternal health. This study investigated the influence of anesthetic/surgical technique and postoperative analgesia on the onset of chronic pain after three months of cesarean section. METHOD: This is a prospective randomized study of 443 patients undergoing cesarean section (elective and emergency), with different doses of hyperbaric bupivacaine 0.5% and opioids in spinal anesthesia. Patients were alocated into five groups as follow: G1 received hyperbaric bupivacaine (8 mg), sufentanil (2.5 µg), and morphine (100 µg); G2 received hyperbaric bupivacaine (10 mg), sufentanil (2.5 µg), and morphine (100 µg); G3 received hyperbaric bupivacaine (12.5 mg) and morphine (100 µg); G4 received hyperbaric bupivacaine (15 mg) and morphine (100 µg); G5 received hyperbaric bupivacaine (12.5 mg) and morphine (100 µg), without perioperative anti-inflammatory. Pain at rest and in movement were evaluated in the immediate postoperative period. Phone contact was made after three months of surgery for identification of patients with chronic pain. RESULTS: The incidence of chronic pain in the groups was G1 = 20%; G2 = 13%; G3 = 7.1%; G4 = 2.2%, and G5 = 20.3%. Patients who reported higher pain scores in the postoperative period had a higher incidence of chronic pain (p < 0.05). CONCLUSION: The incidence of chronic pain decreases with higher doses of local anesthetics and use of anti-inflammatory drugs. The higher pain scores in the postoperative period were associated with chronic pain development after three months of cesarean section.

Keywords

Anesthesia, Spinal, Cesarean Section, Chronic Pain, Pain, Postoperative

Referências

Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87:88-98.

Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1-S226.

Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. Anesthesiology. 2000;93:1123-1133.

. 2010.

Lavand'homme P. Post cesarean analgesia: effective strategies and association with chronic pain. Curr Opin Anaesthesiol. 2006;19:244-248.

Power I. Recent advances in postoperative pain therapy. Br J Anaesth. 2005;95:43-51.

Kehlet H, Jensen TS, Woolf C. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618-1625.

Pogatzki-Zahn EM, Zahn PK. From preemptive to preventive analgesia. Curr Opin Anaesthesiol. 2006;19:551-555.

Torres MLA, Carlos RV. Condutas analgésicas em cirurgia obstétrica, dor pós-operatória. 2004:289-307.

True Random Number Service. .

Neter J, Kutner MH, Nachtsheim CJ. Applied linear statistical models. 1996.

Nikolajsen L, Sorensen HC, Jensen TS. Chronic pain following caesarean section. Acta Anaesthesiol Scand. 2004;48:111-116.

Luijendijk RW, Jeekel J, Storm RK. The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment. Ann Surg. 1997;225:365-369.

Rafique Z, Shibli KU, Russell IF. A randomized controlled trial of the closure or non closure of peritoneum at caesarean section; effect on postoperative pain. Br Obstet Gynaecol. 2002;109:694-698.

Eisenach JC, Pan PH, Smiley R. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008;140(1):87-94.

Sng BL, Sia AHT, Quek K. Incidence and risk factor for chronic pain after caesarean section under spinal anaesthesia. Anaesth Intensive Care. 2009;37:748-752.

Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. B J Anaesth. 2005;95:69-76.

Poleshuck EL, Katz J, Andrus CH. Risk factors for chronic pain following breast cancer surgery: a prospective study. Pain. 2006;7:626-634.

Nikolajsen L, Brandsborg B, Lucht U. Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand. 2006;50:495-500.

Kainu JP, Sarvela J, Tiippana E. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth. 2010;19(1):4-9.

Castro LFL, Serafim MM, Côrtes CAF. Avaliação do estado ácido-básico materno com o uso de sufentanil por via subaracnóidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos. Rev Bras Anestesiol. 2003;53(1):17-24.

Wang LZ, Zhang YF, Tang BL. Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section. Br J Anaesth. 2007;98:792-796.

Parpaglioni R, Baldassini B, Barbati G. Adding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required. Acta Anaesthesiol Scand. 2009;53:1214-1220.

Culebras X, Savoldelli GL, Gessel EV. Low-dose sufentanil does not potentiate intrathecal morphine for perioperative analgesia after major colorectal surgery. Can J Anesth. 2007;54(10):811-817.

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