Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000600006
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação da eficácia de bupivacaína embebida em Gelfoam® no local do enxerto ósseo de crista ilíaca

Evaluation of the efficacy of bupivacaine soaked in Gelfoam® at the iliac crest bone graft site

Mehmet Gamli; Ali Dalgic; Dilsen Ornek; Eyüp Horasanli; Oya Kilci; Canan Un; Bayazit Dikmen

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Resumo

JUSTIFICATIVA E OBJETIVOS: Um número considerável de pacientes relata dor após coleta de enxerto da crista ilíaca anterior. Este estudo avaliou a eficácia da aplicação de bupivacaína embebida em uma esponja de gelatina absorvível (Gelfoam®) no local doador de osso e do uso parenteral de opioides no controle da dor pós-operatória. MÉTODO: Estudo prospectivo, duplo-cego, randomizado e controlado por placebo comparando a infiltração no período intraoperatório de 20 mL de bupivacaína (tratamento, grupo B) versus soro fisiológico (placebo) com Gelfoam embebida no local de coleta óssea da crista ilíaca em pacientes submetidos à cirurgia eletiva de coluna cervical. No período pós-operatório, a administração de cloridrato de hidromorfona (na sala de recuperação pós-anestésica e analgesia controlada pelo paciente) foi padronizada. Um escore de dor com base em escala visual analógica (EVA) com pontuação de zero a 10 foi usado para avaliar a intensidade da dor associada ao local doador. Os escores de dor e uso/frequência de narcóticos foram registrados 24 e 48 horas após a operação. Os médicos, pacientes, a equipe de enfermagem e os estatísticos desconheciam o tratamento usado. RESULTADOS: Os grupos eram semelhantes em idade, gênero e comorbidades. Não houve diferença significativa entre os grupos nos escores da EVA. As doses de narcótico foram significativamente menores no grupo B nos tempos de 24 e 48 horas (p < 0,05). CONCLUSÃO: Este estudo demonstrou que bupivacaína embebida em esponja de gelatina absorvível no local de coleta do enxerto ósseo de crista ilíaca (EOCI) reduziu o uso parenteral de opioides no pós-operatório.

Palavras-chave

ANESTÉSICOS, Local, bupivacaína, CIRURGIA, Transplante, Ortópedica, discotomia, Técnicas Hemostáticas

Abstract

BACKGROUND AND OBJECTIVE: A substantial number of patients report pain after graft harvest from the anterior iliac crest. This study examined the efficacy of local application of bupivacaine soaked in a Gelfoam® at the bone donor site in controlling postoperative pain and parenteral opioid use. METHOD: We performed a prospective, double-blind, randomized, placebo-controlled study comparing intraoperative infiltration of 20 mililiters of bupivacaine (treatment, group B) versus saline (placebo), with Gelfoam® soaked into the iliac crest harvest site for patients undergoing elective cervical spinal surgery. Postoperative administration of dihydromorphinone hydrochloride (post anesthesia care unit and patient-controlled analgesia) was standardized. A pain score based on a 10-point visual analog scale (VAS). was used to assess the severity of pain associated with donor site. Pain scores and narcotic use/frequency were recorded at the twenty-four and forty-eighth hour after the operation. Physicians, patients, nursing staff, and statisticians were blinded to the treatment. RESULTS: The groups were similar in baseline age, gender, and comorbidities. There was no significant difference between groups in VAS scores. Narcotic dosage, were significantly less in the Group B at 24 and 48 hours (p < 0.05). CONCLUSION: This study has demonstrated that bupivacaine soaked in gelfoam at the iliac bone graft harvest site reduced postoperative parenteral opioid usage.

Keywords

Bupivacaine, Bone Transplantation, Diskectomy, Gelatin Sponge, Absorbable

References

Singh K, Samartzis D, Strom J, Manning D, Campbell-Hupp M, Wetzel FT, Gupta P, Phillips FM. A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis. Spine. 2005;30(22):2477-2483.

Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C. Persistent iliac crest donor site pain: Independent outcome assessment. Neurosurgery. 2002;50:510-517.

Wai EK, Sathiaseelan S, O'Neil J, Simchison BL. Local administration of morphine for analgesia after autogenous anterior or posterior iliac crest bone graft harvest for spinal fusion: a prospective, randomized, double-blind, placebo-controlled study. Anesth Analg. 2010;110(3):928-933.

Estebe JP, Le Corre P, Le Naoures A. Local anaesthetic use for the iliac crest-donor site: pharmacokinetic and pharmacodynamic evaluations. Acta Anaesthesiol Belg. 2009;60(1):39-45.

Singh K, Phillips FM, Kuo E, Campbell M. A prospective, randomized, double-blind study of the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after posterior spinal arthrodesis: a minimum of 4-year follow-up. . .

Silber JS, Anderson DG, Daffner SD. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine. 2003;28:134-139.

Wang MY, Levi AD, Shah S, Green BA. Polylactic acid mesh reconstruction of the anterior iliac crest after bone harvesting reduces early postoperative pain after anterior cervical fusion surgery. Neurosurgery. 2002;51:413-416.

Cowan N, Young J, Murphy D. Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain. J Neurosci Nurs. 2002;34:205-210.

Gunzburg Robert, Szpalski Marek. Management of haemostasis in spine surgery. European Musculoskeletal Review. 2008;3(2):53-57.

Gundes H, Kilickan L, Gurkan Y. Short- and long-term effects of regional application of morphine and bupivacaine on the iliac crest donor site. Acta Orthop Belg. 2000;66:341-344.

Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005;101:1343-1348.

Oh YS, Kim DW, Chun HJ, Yi HJ. Incidence and risk factors of acute postoperative delirium in geriatric neurosurgical patients. J Korean Neurosurg Soc. 2008;43(3):143-148.

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