Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

Esra Mercanoğ; lu; Zekeriyya Alanoğ; lu; Perihan Ekmekçi; Sacide Demiralp; Neslihan Alkı; ş

doi:10.1590/S0034-70942013000200010

Scientific Article

Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique

Esra Mercanoğ; lu; Zekeriyya Alanoğ; lu; Perihan Ekmekçi; Sacide Demiralp; Neslihan Alkı; ş;

http://dx.doi.org/10.1590/S0034-70942013000200010 Braz J Anesthesiol, vol.63, n2, p.213-219, 2013

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JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo randomizado, duplo-cego e prospectivo foi determinar a eficácia e os efeitos colaterais da administração por via intravenosa ou epidural de morfina, bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia. MÉTODOS: Sessenta pacientes submetidos a procedimentos de toracotomia eletiva foram randomicamente alocados em quatro grupos com o uso da técnica de envelopes lacrados. Os grupos MIV, ME, MEB e MER receberam morfina controlada pelo paciente por via intravenosa, e morfina, morfina-bupivacaína e morfina- ropivacaína epidural, respectivamente. Frequência cardíaca, pressão arterial e saturação de oxigênio perioperatórias e dor pós-operatória em repouso e durante a tosse, efeitos colaterais e necessidade de analgésicos de resgate foram registrados aos 30 e 60 minutos e em duas, quatro, seis, 12, 24, 36, 48 e 72 horas. RESULTADOS: A necessidade de sódio diclofenaco durante o estudo foi menor no grupo ME. A área sob a curva de tempo na VAS foi menor no grupo ME em comparação com o Grupo MIV, mas similar aos Grupos MEB e MER. Os escores de dor em repouso foram maiores nos tempos 12, 24, 36 e 48 horas no Grupo MIV em comparação com o Grupo ME. Os escores de dor em repouso foram maiores aos 30 e 60 minutos nos Grupos ME e MIV em comparação com o Grupo MEB. Os escores de dor durante a tosse aos 30 minutos foram maiores no grupo ME em comparação com o Grupo MEB. Não houve diferença entre os Grupos MIV e MER. CONCLUSÕES: Morfina administrada por via epidural foi mais eficaz do que por via intravenosa. A eficácia foi maior no grupo EM no período pós-operatório tardio e no Grupo MEB no período pós-operatório inicial. Concluímos que morfina administrada por via epidural foi a mais eficaz e preferida.

Palavras-chave

ANALGÉSICOS, Opióides, Morfina, ANESTÉSICOS LOCAIS, Ropivacaína, bupivacaína, CIRURGIA, Torácica, TÉCNICAS DE ANALGESIA, PCA, Analgesia Controlada pelo Paciente

Abstract

BACKGROUND AND OBJECTIVEs: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. METHODS: Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphineropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30th and 60th minutes and the 2nd, 4th, 6th, 12th, 24th, 36th, 48th, and 72nd hour. RESULTS: Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48th hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30th and 60th minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30th minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. CONCLUSIONS: Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

Keywords

Analgesia, Patient Controlled, Morphine, Amides/ropivacaine, Bupivacaine, Pain Management, Thoracotomy, Infusions, Intravenous, Analgesia, Epidural.

References

Andreas M, Zollinger A, De Lorenzi D. Pospective, randomized comparison of extrapleural versus epidural analgesia for postthoracotomy pain.. Ann Thorac Surg. 1998;66:367-372.

Casati A, Alessandrini P, Nuzzi M. A prospective randomized blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery.. Eur J Anaesthesiol. 2006;23(12):999-1004.

Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery.. Anesthesiology. 1994;81:737-759.

Smith AJ, Haynes TK, Roberts DE, Harmer M. A comparison of opioid solutions for patient-controlled epidural analgesia.. Anesthesia. 2008;51(11):1013-1017.

Macias A. A randomized double-blinded comparison of thoracic epidural ropivacaine, ropivacaine/fentanyl, or bupivacaine/ fentanyl for postthoracotomy analgesia.. Anesth Analg. 2002;95:1344-1350.

Owen MD, D'Angelo R, Gerancher JC. 0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patientcontrolled epidural infusion.. Anesth Analg. 1998;86:527-531.

Cousini MJ, Bernadette TV. Epidural blockade. Neural blockade. 1998:243-322.

Soto RG, Fu ES. Acute pain management for patients undergoing thoracotomy.. Ann Thorac Surg. 2003;75(4):1349-1357.

Takamori S, Yoshida S, Hayashi A, Matsuo T, Mitsuoka M, Shirouzu K. Intraoperative intercostal nerve blockade for postthoracotomy pain.. Ann Thorac Surg. 2002;74:338-341.

Bloch MB, Dyer RA, Heijke SA, James MF. Tramadol infusion for postthoracotomy pain relief: a placebo-controlled comparison with epidural morphine.. Anesth Analg. 2002;94:523-528.

Sentürk M. Acute and chronic pain after thoracotomies.. Curr Opin Anaesthesiol. 2005;18:1-4.

Glass PSA, Estok P, Ginsberg B, Goldberg JS, Sladen RN. Use of patient: Controlled analgesia to compare the efficacy of epidural to intravenous fentanil administration. Anesth Analg. 1992:345-351.

Ferrante FM, Timothy RV. Opioids and PCA.. Postoperative pain management. 1993:107-277.

Bozkurt P. The analgesic efficacy and neuroendocrine response in paediatric patients treated with two analgesic techniques: using morphine-epidural and patient-controlled analgesia.. Paediatr Anaesth. 2002;12:248-254.

White PF. Use of patient-controlled analgesia: an update on its use in the treatment in the treatment of postoperative pain. Anesth Clin N Am. 1989;7:63-78.

Chaney MA. Side effects of intratechal and epidural opioids.. Can J Anaesth. 1995;42(10):891-904..

Lee CR, McTavish D, Sorkin EM. Tramadol a preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in acute and chronic pain states. Drugs. 1993;46(2):313-340.

Rawal N. Epidural and spinal agents for postoperative analgesia.. Surg Clin North Am. 1999;79:313-344.

Veering BT, Cousins MJ. Cardiovascular and pulmonary effects of epidural anaesthesia.. Anaesth Intens Care. 2000;28:620-635.

Wu CL, Cohen SR, Richman JM. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesth. 2005;103(5):1079-1088.

Azad SC, Groh J, Beyer A. Continuos peridural analgesia vs patient-controlled intravenous analgesia for pain therapy after thoracotomy. Anaesthesist. 2000;49(1):9-17.

Scott DA. Ropivacaine for postoperative epidural analgesia. Techniques in Regional Anesthesia Pain Management. 2001;5(2):64-69.

Macias A, Monedero P, Adame P. A randomized, double-blinded comparison of thoracic epidural ropivacaine, ropivacain-fentanyl or bupivacaine-fentanyl for post-thoracotomy analgesia.. Anesth Analg. 2002;95:1344-1350.

Cassady JF, Lederhaas G, Cancel DD, Cummings RJ, Loveless EA. A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents.. Reg Anesth Pain Med. 2000:3246-3253.

Savage C, McQuitty C, Wang D. Postthoracotomy pain management. Chest Surg Clin N Am. 2002;12(2):251-263.

Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique

Esra Mercanoğ; lu; Zekeriyya Alanoğ; lu; Perihan Ekmekçi; Sacide Demiralp; Neslihan Alkı; ş;

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