Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000200004
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo

Patient controlled analgesia with fentanyl or sufentanil in the postoperative period of knee ligament reconstruction: comparative study

Marcelo Negrão Lutti; João Lopes Vieira; Dante Roberto Eickhoff; Daniel de Carli; Marcelo Antônio de Carvalho

http://dx.doi.org/10.1590/S0034-70942002000200004 Braz J Anesthesiol, vol.52, n2, p.166-174, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os opióides têm sido utilizados por via peridural associados ou não a anestésicos locais para analgesia pós-operatória de forma contínua e/ou em bolus controlado pelo paciente. O objetivo deste estudo foi comparar a analgesia pós-operatória entre o fentanil e sufentanil em infusão contínua e em bolus por via peridural, em pacientes submetidos à reconstrução de ligamento do joelho. MÉTODO: Participaram do estudo 70 pacientes com idades entre 16 e 47 anos, estado físico ASA I e II, divididos aleatoriamente em dois grupos: Grupo F (fentanil) e Grupo S (sufentanil). Todos os pacientes foram submetidos à anestesia peridural com bupivacaína a 0,5% (100 mg) com epinefrina 1:200.000 associada a fentanil (100 mg). Ao final da cirurgia, os pacientes receberam fentanil (Grupo F) ou sufentanil (Grupo S) por via peridural em regime de infusão contínua mais bolus liberados pelo paciente. No Grupo F foi utilizada solução fisiológica (85 ml) contendo fentanil 500 µg (10 ml) e bupivacaína (5 ml a 0,5%). No Grupo S foi utilizada solução fisiológica (92 ml) contendo sufentanil 150 µg (3 ml) e bupivacaína (5 ml a 0,5%). Para os dois grupos a bomba de infusão foi programada inicialmente em 5 ml.h-1, com dose de 2 ml em bolus liberado pelo paciente num intervalo de 15 minutos. Foram comparados os seguintes parâmetros: dor, número de bolus acionados, consumo de opióides, bloqueio motor, sedação e efeitos colaterais. RESULTADOS: Não houve diferença entre os grupos quanto à qualidade da analgesia, sendo a maioria de boa qualidade (EAV 0 a 2). Houve diferença quanto ao número de bolus liberados. No Grupo F solicitou mais bolus que o Grupo S. Não houve diferença quanto ao volume total e tempo de infusão total. Não houve bloqueio motor após a instituição da analgesia controlada pelo paciente. A incidência de vômitos e retenção urinária foi maior no Grupo S e quanto à sedação e ao prurido, não houve diferença entre os grupos. CONCLUSÕES: O fentanil ou o sufentanil contínuos em bolus acionados pelo paciente, por via peridural, nas doses utilizadas neste estudo, apresentaram excelente analgesia pós-operatória. No entanto, o sufentanil apresentou efeitos colaterais mais intensos que o fentanil.

Palavras-chave

ANALGESIA, Pós-operatória, ANALGÉSICOS, Opióides, ANALGÉSICOS, Opióides, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Epidural opioids, associated or not to local anesthetics, have been used for postoperative analgesia in continuous infusion and/or patient controlled boluses. The aim of this study was to compare postoperative analgesia provided by epidural fentanyl or sufentanil, in bolus or continuous infusion, in patients submitted to knee ligament reconstruction. METHODS: Seventy ASA I - II patients, aged 16 to 47 years, were randomly distributed in two groups. All patients were submitted to epidural anesthesia with 0.5% bupivacaine (100 mg) with epinephrine 1:200,000 associated to fentanyl (100 mg). At the end of the procedure, patients received epidural fentanyl (Group F) or sufentanil (Group S) in continuous infusion plus patient controlled boluses. Group F infusion solution was made of saline (85 ml), 500 µg fentanyl (10 ml) and 0.5% bupivacaine (5 ml). Group S solution was made of saline (92 ml), 150 µg sufentanil (3 ml) and 0.5% plain bupivacaine (5 ml). Infusion pump´s flow was initially programmed to 5 ml.h-1, with 2 ml patient controlled bolus doses every 15 minutes at most, for both groups. The following parameters were compared: pain, number of patient controlled boluses, opioid consumption, motor block, sedation and side-effects. RESULTS: There have been no statistically significant difference in analgesia quality between groups, being in most cases rated good (AVS 0 to 2). There has been a significant difference in the number of patient controlled boluses, with Group F needing more boluses than Group S. There has been no difference in total infused solution volume and total infusion time. There has been no motor block after beginning of patient-controlled analgesia. Vomiting and urine retention incidences were higher in Group S and there have been no significant differences in sedation and pruritus between groups. CONCLUSIONS: Epidural fentanyl or sufentanil in continuous epidural infusion and patient-controlled boluses in the doses used in this study have induced excellent postoperative analgesia. However, sufentanil caused more severe side effects than fentanyl.

Keywords

ANALGESIA, Postoperative, ANALGESICS, Opioids, ANALGESICS, Opioids, ANESTHETIC TECHNIQUES, Regional

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