Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942001000500006
Brazilian Journal of Anesthesiology
Scientific Article

Lombociatalgia: comparação da analgesia entre metilprednisolona, fentanil e metilprednisolona com fentanil, associados à bupivacaína, por via peridural

Low back pain: comparison of epidural analgesia with bupivacaine associated to methylprednisolone, fentanyl and methylprednisolone plus fentanyl

Quitéria Maria Wanderley Rocha; Rioko Kimiko Sakata; Adriana Machado Issy

http://dx.doi.org/10.1590/S0034-70942001000500006 Braz J Anesthesiol, vol.51, n5, p.407-413, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os corticosteróides têm sido empregados no espaço peridural, como alternativa de tratamento da lombalgia refratária às medidas conservadoras. Os opióides têm efeito analgésico através da ligação a receptores da medula espinhal e poderiam ter efeito somatório. Este estudo teve como objetivo avaliar a eficácia, os efeitos colaterais e as complicações de opióide e corticosteróide associados ao anestésico local, para tratamento da lombalgia e lombociatalgia aguda, provocadas por hérnia de disco. MÉTODO: Foram avaliados 45 pacientes adultos portadores de hérnia de disco. O grupo G-I recebeu 8 ml de bupivacaína a 0,25% com metilprednisolona (80 mg); o grupo G-II, 8 ml de bupivacaína a 0,25% com fentanil (100 µg) e o grupo G-III, 6 ml de bupivacaína a 0,25% com fentanil (100 µg) e metilprednisolona (80 mg). Havendo necessidade de repetição, nova injeção foi feita após 1 semana e 2 semanas no espaço intervertebral, ou próximo ao da localização da hérnia de disco. O efeito analgésico foi mensurado através de escala verbal. RESULTADOS: Aos 30 minutos, 6, 12 e 24 horas após o procedimento não houve diferença entre os grupos quanto ao alívio da dor. No quarto, sétimo e 14º dias, os grupos GI e GIII mostraram melhor alívio da dor, não havendo diferença estatística entre esses grupos. No grupo GII houve maior necessidade para repetir a injeção no 7º dia (GI= 33,3%; GII= 100% e GIII= 33,3%), e no 14º dia (GI= 6,6%; GII= 86,6% e GIII= 6,6%). A utilização de tramadol foi maior no GII. No GI, houve cefaléia (1 paciente); no GII, sonolência (2 pacientes) e prurido (1 paciente) e no GIII, prurido (1 paciente) e sonolência (1 paciente). CONCLUSÕES: O citrato de fentanil não tem efeito duradouro no controle da dor da hérnia de disco e não melhora o efeito analgésico quando associado a bupivacaína e metilprednisolona por via peridural.

Palavras-chave

ANALGÉSICOS, Opióides, DOR, Aguda, DROGAS, Corticosteróides

Abstract

BACKGROUND AND OBJECTIVES: Epidural steroids are used as an alternative for the treatment of low back pain refractory to conservative measures. Opioids exert their analgesic effect through binding to spinal cord receptors and may have an additive effect. This study aimed at evaluating efficacy, side-effects and complications of opioids and steroids associated to local anesthetics in the treatment of acute low back pain caused by herniated disks. METHODS: Participated in this study 45 adult patients with acute herniated disks. G-I received 8 ml of 0.25% bupivacaine with methylprednisolone acetate (80 mg); G-II received 8 ml of 0.25% bupivacaine with fentanyl (100 µg) and G-III received 6 ml of 0.25% bupivacaine with fentanyl (100 µg) and 80 mg methylprednisolone acetate. When needed, a new injection was administered after 1 week and 2 weeks into the herniated disk interspace or close to it. Analgesic effects were evaluated through a verbal scale. RESULTS: At 30 minutes, 6, 12 and 24 hours there were no differences among groups as to pain relief. In days 4, 7 and 14, groups G-I and G-III had better pain relief without statistical differences between them. Group II needed more repeated injections in days 7 (G-I = 33.3%; G-II = 100% and G-III = 33.3%) and 14 (G-I = 6.6%, G-II=86.6% and G-III = 6.6%). Tramadol was more frequently used in G-II. G-I referred headache (1 patient), G-II somnolence (2 patients) and pruritus (1 patient) and G-III pruritus (1 patient) and somnolence (1 patient). CONCLUSIONS: Fentanyl did not improve analgesia when associated either to epidural bupivacaine plus methylprednisolone or to plain bupivacaine.

Keywords

ANALGESICS, Opioids, DRUGS, Steroids, PAIN, Acute

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