Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000200003
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação do efeito da cetamina associada à remifentanila na dor pós-operatória

Assessment of the effect of ketamine in combination with remifentanil on postoperative pain

Plínio Cunha Leal; Rioko Kimiko Sakata; Reinaldo Salomão; Eduardo Jun Sadatsune; Adriana Machado Issy

http://dx.doi.org/10.1590/S0034-70942013000200003 Braz J Anesthesiol, vol.63, n2, p.178-182, 2013
PDF Português
PDF English
Downloads: 1
Views: 1157

Resumo

JUSTIFICATIVA E OBJETIVOS: A associação de cetamina com remifentanila parece estar relacionada à analgesia de melhor qualidade e duração. O objetivo deste estudo foi avaliar se a cetamina associada à remifentanila promove melhora da analgesia pós-operatória. MÉTODO: Estudo prospectivo, aleatório, duplo encoberto em 40 pacientes submetidos à colecistectomia videolaparoscópica. A anestesia foi feita com remifentanila, propofol, atracúrio, 50% de oxigênio. Os pacientes do G1 receberam remifentanila (0,4 mcg.kg-1.min-1) e cetamina (5 mcg.kg-1.min-1); os do G2, remifentanila (0,4 mcg.kg-1.min-1) e solução salina. Foi administrado 0,1 mg.kg-1 de morfina no final da operação e a dor pós-operatória foi tratada com morfina, através de analgesia controlada pelo paciente (PCA). A intensidade da dor pós-operatória foi avaliada pela escala numérica de 0 a 10, durante 24 horas. Foram anotados o tempo para primeira complementação analgésica, a quantidade de morfina usada durante 24 horas e os efeitos adversos. RESULTADOS: Ocorreu diminuição da intensidade da dor entre a desintubação e os outros momentos avaliados no G1 e no G2. Não foi observada diferença significante na intensidade da dor entre os grupos. Não houve diferença entre G1 (22 ± 24,9 min) e G2 (21,5 ± 28,1 min) no tempo para a primeira dose de morfina e dose complementar de morfina consumida no G1 (29 ± 18,4 mg) e no G2 (25,1 ± 13,3 mg). CONCLUSÕES: A associação de cetamina (5 mcg.kg-1.min-1) a remifentanila (0,4 mcg.kg-1.min-1) para colecistectomia não alterou a intensidade da dor pós-operatória, o tempo para primeira complementação ou a dose de morfina em 24 horas.

Palavras-chave

ANALGESIA, Pós-operatório, ANALGÉSICOS, Cetamina, Opioides, remifentanil, CIRURGIA, Abdominal

Abstract

BACKGROUND AND OBJECTIVES: The combination of ketamine and remifentanil seems to be associated with better analgesia and duration. The aim of this study was to evaluate whether a ketamineremifentanil combination promotes improved postoperative analgesia. METHODS: Prospective, randomized, double blind study of 40 patients undergoing video laparoscopic cholecystectomy. Anesthesia was performed with remifentanil, propofol, atracurium, and 50% oxygen. Group 1 (GI) patients received remifentanil (0.4 mcg.kg-1.min-1) and ketamine (5 mcg.kg-1.min-1) and Group 2 (G2) received remifentanil (0.4 mcg.kg-1.min-1) and saline solution. Morphine 0.1 mg.kg-1 was administered at the end of the procedure, and postoperative pain was treated with morphine via PCA. We evaluated the severity of postoperative pain by a numerical scale from zero to 10 during 24 hours. We registered the time to the first analgesic supplementation, amount of morphine used in the first 24 hours, and adverse effects. RESULTS: There was a decrease in pain severity between extubation and other times evaluated in G1 and G2. There was no significant difference in pain intensity between the groups. There was no difference between G1 (22 ± 24.9 min) and G2 (21.5 ± 28.1 min) regarding time to first dose of morphine and dose supplement of morphine consumed in G1 (29 ± 18.4 mg) and G2 (25.1 ± 13.3 mg). CONCLUSION: The combination of ketamine (5 mcg.kg-1.min-1) and remifentanil (0.4 mcg.kg-1.min-1) for cholecystectomy did not alter the severity of postoperative pain, time to first analgesic supplementation or dose of morphine in 24 hours.

Keywords

Analgesia; Postoperative Period, Ketamine, Cholecystectomy, Piperidines

References

Coluzzi F, Savoia G, Paoletti F. Postoperative pain survey in Italy (POPSI): a snapshot of current national practices. Min Anesthesiol. 2009;75(11):622-631.

Vickers A, Bali S, Baxter A. Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach. Curr Med Res Opin. 2009;25(10):2557-2569.

Apfelbaum JL, Chen C, Mehta SS. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534-540.

Davis PJ, Stiller RL, Wilson AS. In vitro remifentanil metabolism: the effects of whole blood constituents and plasma butyrilcholinesterase. Anesth Analg. 2002;95(5):1305-1307.

Battershill AJ, Keating GM. Spotlight on remifentanil: its analgesic and sedative use in the intensive care unit. CNS Drugs. 2006;20(6):519-522.

Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS Drugs. 2004;18(15):1085-1104.

Joly V, Richebe P, Guignard B. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005;103(1):147-155.

Koppert W, Schmelz M. The impact of opioid-induced hyperalgesia for postoperative pain. Best Pract Res Clin Anaesthesiol. 2007;21:65-83.

Crawford MW, Hickey C, Zaarour C. Development of acute opioid tolerance during infusion of remifentanil for pediatric scoliosis surgery. Anesth Analg. 2006;102:1662-1667.

Koppert W, Sittl R, Scheuber K, Alsheimer M, Schmelz M, Schüttler J. Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. Anesthesiology. 2003;99(1):152-159.

Angst MS, Clark JD. Opioid-induced hyperalgesia: a quantitative systematic review. Anesthesiol. 2006;104(3):570-587.

Dupen A, Sben D, Ersek M. Mechanisms of opioid-induced tolerance and hyperalgesia. Pain Mange Nurs. 2007;8(3):113-121.

Mao J. Opioid-induced abnormal pain sensitivity: implications in clinical opioid therapy. Pain. 2002;100:213-217.

Leal PC, Clivatti J, Garcia JBS. Hiperalgesia induzida por opioides. Rev Bras Anestesiol. 2010;60(6):639-747.

Jaksch W, Lang S, Reichhalter R. Perioperative smalldose S(+)-ketamine has no incremental beneficial effects on postoperative pain when standard-practice opioid infusions are used. Anesth Analg. 2002;94(4):981-986.

Guignard B, Menigaux C, Dupont X. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg. 2000;90(1):161-167.

Hong BH, Lee WY, Kim YH, Yoon SH, Lee WH. Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia. Korean J Anesthesiol. 2011;61(3):238-243.

Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005;102(1):211-220.

Estivalet FF, Bagatini A, Gomes CR. Remifentanil associado ao propofol ou sevoflurano para colecistectomia videolaparoscópica: Estudo comparativo. Rev Bras Anestesiol. 2002;52(4):385-393.

Imbelloni LE, Fornsani M, Fialho JC. Anestesia geral versus raquianestesia para colecistectomia videolaparoscópica. Rev Bras Anestesiol. 2010;60(3):217-227.

Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-996.

Cirillo DJ, Wallace RB, Rodabough RJ. Effect of estrogen therapy on gallbladder disease. JAMA. 2005;293(3):330-339.

Tsai CJ, Leitzmann MF, Willet WC. Prospective study of abdominal adiposity and gallstone disease in us men. Am J Clin Nutr. 2004;80(1):38-44.

Egan TD, Huizinga B, Gupta SK. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998;89(3):562-573.

Camu F, Royston D. Inpatient experience with remifentanil. Anesth Analg. 1999;89(4):15-21.

Ma JF, Huang ZL, Li J. Cohort study of remifentanilinduced hyperalgesia in postoperative patients. Zhonghua Yi Xue Za Zhi. 2011;91(14):977-979.

Jo HR, Chae YK, Kim YH. Remifentanil-induced pronociceptive effect and its prevention with pregabalin. Korean J Anesthesiol. 2011;60(3):198-204.

Guignard B, Coste C, Costes H. Supplementing desflurane- remifentanil anesthesia with small dose ketamine reduce perioperative opioid analgesia requeriments. Anesth Analg. 2002;95(1):103-108.

Engelhardt T, Zaarour C, Naser B. Intraoperative low-dose ketamine does not prevent a remifentanil-induced increase in morphine requirement after pediatric scoliosis surgery. Anesth Analg. 2008;107(4):1170-1175.

Ganne O, Abisseror M, Menault P. Low-dose ketamine failed to spare morphine after a remifentanil-based anesthesia for ear, nose and throat surgery. Eur J Anesthesiol. 2005;22:426-430.

De Kock MF, Lavand'homme PM. The clinical role of NMDA receptor antagonist for the treatment of postoperative pain. Best Pract Res Clin Anaesthesiol. 2007;21(1):85-98.

Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg. 2004;99(2):482-495.

Aveline C, Gautier JF, Vautier P. Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam. Eur J Pain. 2009;13(6):613-619.

Parikh B, Maliwad J, Shah VR. Preventive analgesia: effect of small dose of ketamine on morphine requirement after renal surgery. J Anaesthesiol Clin Pharmacol. 2011;27(4):485-488.

Albrecht S, Fechner J, Geisslinger G. Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery. Anaesthesia. 2000;55(4):315-322.

Kochs E, Cote D, Deruyck L. Postoperative pain management and recovery after remifentanil-based anaesthesia with isoflurane or propofol for major abdominal surgery. Br J Anaesth. 2000;84(2):169-173.

Munoz HR, Guerrero ME, Brandes V. Effect of timing of morphine administration during remifentanil: based anaesthesia on early recovery from anaesthesia and postoperative pain. Br J Anaesth. 2002;88(6):814-818.

Joshi GP, Warner DS, Twersky RS. A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. J Clin Anesth. 2002;14(7):494-499.

Fujii Y. Management of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2011;25(3):691-695.

Rüsch D, Eberhart LH, Wallenborn J. Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment. Dtsch Arztebl Int. 2010;107(42):733-741.

Rüsch D, Becke K, Eberhart LH. Postoperative nausea and vomiting (PONV): Recommendations for risk assessment, prophylaxis and therapy - Results of an expert panel meeting. Anasthesiol Intensivmed Notfallmed Schmerzther. 2011;46(3):158-170.

5dd42a990e8825c527c63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections