Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjan.2013.04.002
Brazilian Journal of Anesthesiology
Scientific Article

Bloqueio do nervo femoral: avaliação da analgesia pós-operatória na operação de reconstrução artroscópica do ligamento cruzado anterior

Femoral nerve block: assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction

Úrsula Bueno do Prado Guirro; Elizabeth Milla Tambara; Fernanda Reinaldi Munhoz

http://dx.doi.org/10.1016/j.bjan.2013.04.002 Braz J Anesthesiol, vol.63, n6, p.483-491, 2013
PDF Português
PDF English
Downloads: 0
Views: 931

Resumo

JUSTIFICATIVA E OBJETIVOS: A operação de reconstrução do ligamento cruzado anterior do joelho (RLCA) pode ter pós-operatório doloroso. O objetivo principal deste estudo foi avaliar se o emprego do bloqueio do nervo femoral (BNF) associado à raquianestesia melhoraria o tratamento da dor pós-operatória na RLCA; os objetivos secundários foram avaliar solicitação do tramadol e eventos adversos. MÉTODO: 53 pacientes foram divididos aleatoriamente nos grupos A e B. No Grupo A, 26 receberam raquianestesia e no Grupo B, 27 receberam raquianestesia e BNF. Todos receberam analgesia multimodal e poderiam solicitar analgésico de resgate a qualquer momento. As avaliações ocorreram em 6, 12 e 24 horas. RESULTADOS: Os grupos não apresentaram diferenças quanto às variáveis demográficas e clínico-cirúrgicas. A intensidade da dor não mostrou diferença entre os grupos. Escores médios de dor foram mais elevados 12 horas no Grupo A e não houve variação no Grupo B; 55,6% relataram dor moderada no Grupo A e 53,8% dor leve no Grupo B. Não houve diferença na solicitação de tramadol. Os eventos adversos não foram graves: 80,8% dos pacientes do Grupo B apresentaram bloqueio motor da coxa e dois caíram. CONCLUSÕES: A analgesia foi mais efetiva com a associação de raquianestesia e BNF, que permitiu melhor controle da dor pós-operatória na avaliação em 12 horas após a anestesia. Não houve diferença na solicitação do tramadol. Os eventos adversos apresentados pelos pacientes neste estudo não foram graves, porém deve-se estar atento à paralisia motora e à possibilidade de queda dos pacientes quando o BNF for feito.

Palavras-chave

Analgesia pós-operatória, Bloqueio do nervo femoral, Reconstrução do ligamento cruzado anterior, Raquianestesia, Tramadol, Evento adverso

Abstract

BACKGROUND AND OBJECTIVES: Knee anterior cruciate ligament reconstruction (ACLR) may be painful in the postoperative period. The primary objective of this study was to evaluate whether the use of femoral nerve block (FNB) associated with spinal anesthesia would improve the postoperative pain treatment in ACLR and the secondary objectives were to evaluate tramadol request and adverse events. METHOD: 53 patients were randomly divided into two groups: GA (n =26) received spinal anesthesia and GB (n = 27) received spinal anesthesia and FNB. All patients received multimodal analgesia and rescue analgesics could be requested anytime. Assessments were performed at 6, 12 and 24 hours. RESULTS: There was no difference between both groups regarding demographic and clinical-surgical variables. There was no difference between groups regarding pain intensity. Mean pain scores were higher at 12 hours in GA and there was no change in GB; 55.6% of patients reported moderate pain in GA and 53.8% mild pain in GB. There was no difference regarding tramadol request. There were no serious adverse events: 80.8% of patients in GB had motor block of the thigh and two fell. CONCLUSIONS: Analgesia was more effective with the combination of spinal and FNB, which allowed better control of postoperative pain, assessed 12 hours after anesthesia. There was no difference in tramadol request. Patients in this study had no serious adverse events; however, one must be attentive to motor paralysis and the possibility of falling when FNB is performed.

Keywords

Postoperative analgesia, Femoral nerve block, Anterior cruciate ligament reconstruction, Spinal anesthesia, Tramadol, Adverse event

References

Souza RL, Correa CH, Henriques MD. Single-injection femoral nerve block with 0.25% ropivacaine ou 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament repair. J Clin Anesth. 2008;20:521-7.

Mall NA, Wright RW. Femoral nerve block use in anterior cruciate ligament reconstruction surgery. Arthroscopy. 2010;26:404-16.

Frost S, Grossfeld S, Kirkley B. The efficacy of femoral nerve block in pain reduction for outpatient hamstring anterior cruciate ligament reconstruction: a double-blind, prospective, randomized trial. Arthroscopy. 2000;16:243-8.

Fonseca NM, Ruzi RA, Ferreira FX. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1) com ropivacaína e a analgesia subaracnóidea com morfina. Rev Bras Anestesiol. 2003;53:188-97.

Pavlin JD, Kent CD. Recovery after ambulatory anesthesia. Curr Opin Anesthesiol. 2008;21:729-35.

Paul JE, Arya A, Hurlburt L. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a metanalisys of randomized controlled trials. Anestesiology. 2010;113:1144-62.

Kandasami M, Kinninmonth AW, Saungi M. Femoral nerve block for total knee replacement: A word of caution. Knee. 2009;16:98-100.

Sharma S, Iorio R, Specht LM. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010;468:135-40.

Koh IJ, Chang CB, Seo ES. Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study. Arthroscopy. 2012;28:649-57.

Rosaeg OP, Frepski B, Cicutti N. Effect of preemptive multimodal analgesia for arthoscopic knee ligament repair. Reg Anesth Pain Med. 2001.

McCarty EC, Spindler KP, Tingstad E. Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction?. Am J Sports Med. 2001;29:327-32.

Casati A, Fanelli G, Magistris L. Minimum local anesthetic volume blocking the femoral nerve in 50% of cases: a double-blinded comparision between 0.5% ropivacaine and 0.5% bupivacaine. Anesth Analg. 2001;92:205-8.

Matava MJ, Prickett WD, Khodamoradi S. Femoral nerve blockade as a preemptive anesthetic in patients undergoing anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2009;37:78-86.

Jansen TK, Miller BE, Arretche N. Will the addition of a sciatic nerve block to a femoral nerve block provide better pain control following anterior cruciate ligament repair surgery?. AANA J. 2009;77:213-8.

Charous MT, Madison SJ, Suresh PJ. Continuous femoral nerve block: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block. Anesthesiology. 2011;115:774-81.

Wulf H, Löwe J, Gnutzmann KH. Femoral nerve block with ropivacaine in day case anterior crucial ligament reconstruction. Acta Anaesthesiol Scand. 2010;54:414-20.

Aguirre J, Del Moral A, Cobo I. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:1-20.

Edkin BS, Spindler KP, Flanagan JFK. Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. Arthroscopy. 1995;11:404-9.

Mulroy MF, Larkin KL, Batra MS. Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Reg Anesth Pain Med. 2001;26:24-9.

Alford JW, Fadale PD. Evaluation of postoperative bupivacaine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy. 2003;19:855-61.

Chan MH, Chen WH, Tung YW. Single injection femoral nerve block lacks preemptive effects on postoperative pain and morphine consumption in total knee arthroplasty. Acta Anaesthesiol Taiwan. 2012;50:54-8.

Wiegel M, Gottschaldt U, Hennebach R. Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients. Anesth Analg. 2007;104:1578-82.

Albrecht E, Niederhauser J, Gronchi . Transient femoral neuropathy after knee ligament reconstruction and nerve stimulator-guided continuous femoral nerve block: a case series. Anaesthesia. 2011;66:850-1.

Grosu I, Kock M. New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures. Anesthesiol Clin. 2011;29:311-27.

Gandhi K, Heitz JW, Viscusi ER. Challenges in acute pain management. Anesthesiol Clin. 2011;29:291-309.

Beaupre LA, Johnston DB, Dieleman S. Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: a controlled clinical pilot study. Scientific Word Journal. 2012;2012:1-6.

Sakura S, Hara K, Ota J. Ultrasound-guided peripheral nerve blocks for anterior cruciate ligament reconstruction: effect of obturator nerve block during and after surgery. J Anesth. 2010;24:411-7.

Sakata R, Issy AM. Guias de medicina ambulatorial e hospitalar Unifesp: dor. 2004:127-39.

Posso IP, Romaneck RM, Awade R. Princípios de tratamento da dor aguda. Tratado de anestesiologia da Sociedade de Anestesiologia do Estado de São Paulo. 2011:519-41.

Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798-804.

Daniulaityte R, Falck R, Carlson RG. I'm not afraid of those ones just 'cause they've been prescribed: perceptions of risk among illicit users of pharmaceutical opioids. Int J Drug Policy. 2012;23:374-84.

Rodríguez J, Taboada M, García F. Intraneural hematoma after stimulation-guided femoral block in a patient with factor XI deficiency: case report. J Clin Anesth. 2011;23:234-7.

5dd3eff70e88258c5cc63494 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