Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial
Comparação entre morfina subaracnóidea e bloqueio do nervo femoral para analgesia após reconstrução ligamentar de joelho: estudo clínico randomizado
Joana Zulian Fiorentin, Alexandre Vieira Martins, Juan Manuel Vélez Cañola, Linda Cecilia Gutierrez, Fábio Perches, Thiago Mamôru Sakae, Sérgio Bernardo Tenório
Abstract
Background and objectives
: There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia.
Method
Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100 μg) or Femoral Nerve Block (BNF) with 25 mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24 hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated.
Results
Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24 hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0 %), with statistical significance (p < 0.05).
Conclusion
There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.
Keywords
Resumo
Justificativa e objetivos
: Não há consenso sobre qual a técnica ideal para prover analgesia em reconstruções ligamentares de joelho. Objetivou-se comparar a intensidade da dor pós-operatória destes pacientes sob diferentes modalidades de analgesia.
Método
Ensaio clínico randomizado e controlado de pacientes submetidos à reconstrução do Ligamento Cruzado Anterior (LCA) com tendões flexores entre Dezembro de 2013 e 2014. Todos os pacientes foram submetidos à raquianestesia e analgesia de resgate com tramadol. Comparou-se os grupos C, M, R0,375 e R0,25, aos quais ofertou-se apenas a técnica anteriormente descrita, morfina subaracnóidea (100 µg) ou Bloqueio de Nervo Femoral (BNF) com 25 mL de ropivacaína 0,375% e 0,25%, respectivamente. Avaliou-se intensidade da dor em 6, 12 e 24 horas, idade, sexo, analgesia de resgate, reações adversas e satisfação.
Resultados
Dentre os 83 pacientes elegíveis, observou-se predomínio do sexo masculino (85,7%), entre 28 e 31 anos. O grupo C solicitou mais opioide (27,3%) do que os demais grupos, sem significância quando comparados. Não houve diferenças significativa na intensidade da dor em 6, 12 e 24 horas. Houve maior incidência de retenção urinária no grupo M (23,8%) do que no R0,375(0%) e de bloqueio motor prolongado do quadríceps no grupo R0,375 (30%) do que nos grupos M e C (0%), com significância estatística (p < 0,05).
Conclusão
Não houve diferença na intensidade da dor pós-operatória nos pacientes submetidos à reconstrução de LCA com tendões flexores sob as modalidades analgésicas avaliadas, apesar do predomínio de retenção urinária no grupo M e bloqueio motor no grupo R0,375.
Palavras-chave
References
1 A Pinheiro, CV Sousa Lesão do ligamento cruzado anterior: apresentação clínica, diagnóstico e tratamento Rev Port Ortop Traum, 23 (2015), pp. 320-329
2 B.K.Y. Law, P.S.H. Yung, E.P.Y. Ho, et al. Review of knee arthroscopy performed under local anesthesia Sports Med Arthrosc Rehabil Ther Technol, 1 (2009), pp. 1-3
3 H. Sehmbi, R. Brull, U.J. Shah, et al. Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament reconstruction: Part II: Adductor Canal Nerve Block-A Systematic Review and Meta-analysis Anesth Analg, 128 (2019), pp. 223-238
4 N.M. Fonseca, R.A. Ruzi, F.X. Ferreira, et al. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1) com ropivacaína e analgesia subaracnoidea com morfina Rev Bras Anestesiol, 53 (2003), pp. 188-197
5 B.M. Bujedo, S.G. Santos, A.U. Aspiazu A review of epidural and intrathecal opioids used in the management of postoperative pain J Opioid Manag, 8 (2012), pp. 177-192
6 U.B.P. Guirro, E.M. Tambara, F.R. Munhoz Femoral nerve block: assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction Rev Bras Anestesiol., 63 (2013), pp. 483-491
7 M.V.M. Luzo, C.E.S. Franciozi, Fc Resende, et al. Ligamento cruzado anterior – artigo de atualização Rev Bras Ortop, 51 (2016), pp. 385-395
8 M.P. Leathers, A. Merz, J. Wong, et al. Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States J Knee Surg, 28 (2015), pp. 390-394
9 M.W. Harbell, J.M. Cohen, K. Kolodzie, et al. Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial J Clin Anesth, 33 (2016), pp. 68-74
10 K.R. Swank, A.C. Di Bartola, J.S. Everhart, et al. The effect of femoral nerve block on quadriceps strength in anterior cruciate ligament reconstruction: a systematic review Arthroscopy, 33 (2017), pp. 1082-1091
11 S. Frost, S. Grossfeld, A. Kirkley, et al. The efficacy of femoral nerve block in pain reduction for outpatient hamstring anterior cruciate ligament reconstruction: a double-blind, prospective, randomized trial Arthroscopy, 16 (2000), pp. 243-248
12 P. Faun, B. Lund, S.E. Christiansen, et al. Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: a prospective randomized trial Arthroscopy, 31 (2015), pp. 63-68
13 N. Lefevre, S. Klouche, O. Pamphilis, et al. Peri-articular local infiltration analgesia versus femoral nerve block for postoperative pain control following anterior cruciate ligament reconstruction: Prospective, comparative, non-inferiority study Orthop Traumatol Surg Res, 102 (2016), pp. 873-877
14 P.K. Kristensen, M. Pfeiffer-Jensen, J.O. Storm, et al. Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial Knee Surg Sports Traumatol Arthrosc, 22 (2014), pp. 317-323
15 SJ Dolin, JN Cashman Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data Br J Anaesth, 95 (2005), pp. 584-591
16 L.E. Imbelloni, L. Beato Comparação entre raquianestesia, bloqueio combinado raqui-peridural e raquianestesia contínua para cirurgias de quadril em pacientes idosos. Estudo retrospectivo Rev Bras Anestesiol, 52 (2002), pp. 316-325
17 G. Kuthiala, G. Chaudhary Ropivacaine: A review of its pharmacology and clinical use Indian J Anaesth, 55 (2011), pp. 104-110
18 T.D. Luo, A. Ashraf, D.L. Dahm, et al. Femoral nerve block is associated with persistent strength deficits at 6 months after anterior cruciate ligament reconstruction in pediatric and adolescent patients Am J Sports Med, 43 (2014), pp. 331-336
19 A. Krych, G. Arutyunyan, S. Kuzma, et al. Adverse effect of femoral nerve blockade on quadriceps strength and function after ACL reconstruction J Knee Surg, 28 (2015), pp. 83-88
20 F.W. Abdallah, D.B. Whelan, V.W. Chan, et al. Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction Anesthesiology, 124 (2016), pp. 1053-1064
21 AS Oliveira, HP Torres O papel dos bloqueios anestésicos no tratamento da dor de origem cancerosa Rev Bras Anestesiol., 53 (2003), pp. 654-662
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email