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

References

Snyder SH. Opiate receptors and internal opiates. Sci Am. 1977:44-56.

Benzon HT. Epidural steriod injections for low back pain and lumbosacral radiculopathy: reviews. Pain. 1971;24:277-295.

Houmes RJ, Vofts MA, Verkaaik A. Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression.. Anesth Analg. 1992:510-514.

Preston KL, Jasinski D, Tosta M. Abuse potencial and pharmacological comparison of tramadol and morphine.. Drug Alcohol Depend. 1991;27:7-17.

Vickers MD, O'Flaherty D, Szekely SM. Tramadol: pain relief by an opioid without depression of respiration.. Anaesthesia. 1992:291-296.

Etches RC, Sandler AN, Daley MD. Respiratory depression and spinal opioids.. Can J Anaesth. 1989:165-185.

Brennum J, Petersen Kl, Horn A. Quantitative sensory examination of epidural anaesthesia and analgesia in man- combination of morphine and bupivacaine.. Pain. 1994;56:327-337.

Tejwani GA, Rattan AK, Mcdonald JS. Role of spinal opioid receptors in the antinociceptive intrathecal morphine and bupivacaine.. J Bone Jt Surg. 1992:726-734.

Penning Rk, Yaksh PL. Interaction of intratecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology. 1992;77:1186-1200.

Dilke FW, Burry HC, Grahame R. Epidural corticosteroid injection in management of lumbar nerve root compression.. Br Med J. 1973;2:635-637.

Haddox JD. Lumbar and cervical epidural steroid therapy. Anaesth Clin Nosth Am. 1992;1:179-203.

Irwin RP, Rogawski MA, Purdy RH. Steroid potentiation and inhibition of N-Methil-D-Aspartato receptor-mediated intracelular Ca++ responses: struture-activity studies. J Pharmacol Exp Ther. 1994:677-682.

Mathis C, Paul SM, Crawley JN. The neurosteroid pregnenolone sulfate blocks NMDA antagonist-induced deficits in a passive avoidance memory task. Psychopharmacology. 1994;116:201-206.

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