Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000200005
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia pós-operatória em pacientes pediátricos: estudo comparativo entre anestésico local, opióides e antiinflamatório não esteróide

Postoperative analgesia in pediatric patients: comparative study among local anesthetics, opioids and non-steroidal anti-inflammatory drugs

Miriam Seligman Menezes; Judymara Lauzi Gozzani

http://dx.doi.org/10.1590/S0034-70942002000200005 Braz J Anesthesiol, vol.52, n2, p.175-184, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: O tratamento da dor pós-operatória em crianças tem merecido atenção especial nas últimas décadas. O propósito deste estudo foi analisar a analgesia pós-operatória de crianças no que se relaciona à qualidade e à duração da analgesia, à confiabilidade dos métodos de avaliação e à incidência de efeitos colaterais decorrentes das diferentes técnicas de analgesia utilizadas. MÉTODO: Participaram do estudo 100 crianças com idades entre 2 e 12 anos alocadas em 5 grupos de 20 crianças cada, que receberam, logo após a indução da anestesia, os seguintes tratamentos de analgesia: grupo B, bupivacaína a 0,25%, com vasoconstritor, 0,5 a 1 ml.kg-1; grupo F, fentanil, 1,5 µg.kg-1; grupo M, morfina, 30 µg.kg-1, grupo S, sufentanil, 0,3 µg.kg-1, todos por via peridural caudal e o grupo D, que recebeu diclofenaco potássico (1 mg.kg-1) por via retal. A dor foi avaliada por 2 métodos distintos: um predominantemente comportamental, objetivo e o outro de auto-avaliação, subjetivo, durante as primeiras 4 horas e a partir deste momento até a 24ª hora. Efeitos colaterais foram observados e tratados. RESULTADOS: Nas primeiras 4 horas os pacientes dos grupos B, F, M e S apresentaram comportamentos semelhantes, com mínimas necessidades de analgesia complementar. Nas 20 horas restantes o maior tempo de analgesia foi o observado no grupo S, não diferindo dos grupos F e M, mas sendo significativamente superior ao tempo dos grupos B e D. Diclofenaco retal não promoveu alívio efetivo da dor. Maior incidência de efeitos colaterais ocorreu no grupo M que não diferiu do grupo S, mas foi significativamente superior aos grupos F, B e D. Houve correlação positiva e significativa entre os escores das 2 escalas de avaliação de dor. CONCLUSÕES: Os opióides espinhais mostraram-se seguros e efetivos na analgesia pós-operatória em crianças, porém quando comparados à bupivacaína não apresentaram diferenças relevantes e apresentaram maior incidência de efeitos colaterais. O diclofenaco por via retal não se mostrou efetivo como analgésico único quando comparado às outras técnicas.

Palavras-chave

ANALGÉSICOS, Opióides, ANALGÉSICOS, Opióides, ANALGÉSICOS, Opióides, ANALGÉSICOS, Opióides, ANESTESIA, Pediátrica, ANESTÉSICOS, Local, DOR, Aguda, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The treatment of postoperative pain in children has been given special attention in the last decades. This study aimed at analyzing postoperative analgesia in children, considering analgesia quality and duration, evaluation methods reliability and the incidence of side effects resulting from different analgesia techniques. METHODS: Participated in this study 100 children, aged 2 to 12 years, allocated in 5 groups of 20 children each, who received, right after anesthesia, the following analgesics: group B, 0.25% bupivacaine with epinephrine (1:400,000) 0.5 to 1 ml.kg-1; group F, 1.5 µg.kg-1 fentanyl; group M, 30 µg.kg-1 morphine; group S, 0.3 µg.kg-1 sufentanil, all by epidural caudal block and group D, who received rectal diclofenac (1 mg.kg-1). Pain was evaluated by two different methods: one, predominantly behavioral and objective and the other subjective and self-evaluated, during the first 4 hours and then up to the 24th hour. Side effects were observed and treated. RESULTS: In the first 4 hours, groups B, F, M and S patients presented similar behavior, with a minimum need for complementary analgesia. In the remaining 20 hours, the longest analgesia duration was seen in group S, which did not differ from groups F and M, but was significantly longer than for groups B and D. Rectal diclofenac has not promoted effective pain relief. There has been a higher incidence of side-effects in group M, which did not differ from group S, but was significantly higher than for groups F, B and D. There has been a positive and significant correlation between both pain scales. CONCLUSIONS: Spinal opioids are safe and effective for postoperative analgesia in children, but when compared to bupivacaine, there have been no significant differences and a higher incidence of side effects. Rectal diclofenac was not effective as a single analgesic as compared to other techniques.

Keywords

ANALGESICS, Opioids, ANALGESICS, Opioids, ANALGESICS, Opioids, ANALGESICS, Opioids, ANESTHESIA, Pediatric, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, PAIN, Acute

Referencias

Meigner M, Zaouter M, Ricard PH. Analgésie per et postopératoire en chirurgie pédiatrique: expérience d’un an. Chir Pediatr. 1990;31:341-344.

Altimier L, Norwood S, Dick MJ. Postoperative pain management in preverbal children: the prescription and administration in analgesics with and without caudal analgesia. J Pediatr Nurs. 1994;9:226-232.

Berde CB. Pediatric postoperative pain management. Pediatric Clin North Am. 1989;36:921-940.

Ecoffey C, Desparmet J. Analgesia na Cirurgia Pediátrica, em: Bonnet F - A Dor no Meio Cirúrgico. 1993:278-294.

Desparmet JF. Acute Pain Syndromes in Children. Pain Medicine: A Comprehensive Review. 1996:530-536.

McGrath PA. An assessment of children’s pain: a review of behavioral, physiological and direct scaling techniques. Pain. 1987;31:147-176.

Rice LJ, Pudimat MA, Hannallah RS. Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients. Can J Anaesth. 1990;37:429-431.

Lloyd -Thomas AR. Pain management in paediatric patients. Br J Anaesth. 1990;64:85-104.

Goldman A, Lloyd-Thomas AR. Pain management in children. Br Med Bull. 1991;47:676-689.

Tesler MD, Savedra MC, Holzemer WL. The word-graphic rating scale as a measure of children’s and adolescents’ pain intensity. Res Nurs Health. 1991;14:361-371.

Swaford LI, Allan D. Pain relief in the pediatric patient. Med Clin North Am. 1968;52:131-136.

Mather L, Mackie J. The incidence of postoperative pain in children. Pain. 1983;15:271-282.

Dalens B. Regional anesthesia in children. Anesth Analg. 1989;68:654-672.

Choonara IA. Pain relief. Arch Dis Child. 1989;64:1101-1102.

Ecoffey C. Analgésie postopératoire chez l’enfant: techniques. Cah Anesthesiol. 1995;43:305-306.

Soliman MG, Ansara S, Laberge R. Caudal anaesthesia in paediatric patients. Can Anaesth Soc J. 1978;25:226-230.

Kay B. Caudal block for postoperative pain relief in children. Anaesthesia. 1974;29:610-614.

Lunn JN. Postoperative analgesia after circuncision: A randomized comparison between caudal analgesia and intramuscular morphine in boys. Anaesthesia. 1979;34:85-104.

Payne KA, Hedrix MR, Wade WJ. Caudal bupivacaine for postoperative analgesia in pediatric lower limb surgery. J Pediatr Surg. 1993;28:155-157.

Concha M, Gonzáles J, Vergara R. Analgésie postopératoire pour la chirurgie ambulatoire chez l’enfant: comparaison de deux techniques. Cah Anesthesiol. 1994;42:339-342.

Broadman LM, Hannalah RS, Norden JM. Kiddie caudals: experience with 1154 consecutive cares without complications. Anesth Analg. 1987;66(^sSuppl):S18.

Armitage EN. Caudal block in children. Anaesthesia. 1979;34:396.

Wolf AR, Valley RD, Fear DW. Bupivacaine for caudal analgesia in infants and children: the optimal effective concentration. Anesthesiology. 1988;69:102-106.

Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg. 1989;68:654-672.

Warner MA, Kunkel SE, Offord KO. The effects of age, epinephrine, and operative site on duration of caudal analgesia in pediatric patients. Anesth Analg. 1987;66:995-998.

Holthusen H, Eichwede F, Stevens M. Preemptive analgesia: comparison of preoperative with postoperative caudal block on postoperative pain in children. Br J Anaesth. 1994;73:440-442.

Jensen BH. Caudal block for postoperative pain relief in children after genital operations: A comparison between bupivacaine and morphine. Acta Anaesthesiol Scand. 1981;25:373-375.

Krane EJ, Tyler DC, Jacobson LE. The dose response of caudal morphine in children. Anesthesiology. 1989;71:48-52.

Valls JM, Mabrok MM, Teixidor PA. Analgesia postoperatoria con morfina por via caudal en cirurgia pediátrica: estudio aleatorio y a doble ciego comparada con bupivacaina. Rev Esp Anestesiol Reanim. 1989;36:88-92.

Wolf AR, Hughes D, Wade A. Postoperative analgesia after paediatric orchidopexy: evaluation of a bupivacaine - morphine mixture. Br J Anaesth. 1990;64:430-435.

Wolf AR, Hughes D, Hobbs AJ. Combined morphine- bupivacaine caudals for reconstrutive penile surgery in children: systemic absorption of morphine and postoperative analgesia. Anaesth Intensive Care. 1991;19:17-21.

Valley RD, Bailey AG. Caudal morphine for postoperative analgesia in infants and children: a report of 183 cases. Anesth Analg. 1991;72:120-124.

Henneberg SW, Hole P, Hass IM. Epidural morphine for postoperative pain relief in children. Acta Anaesthesiol Scand. 1993;37:664-667.

Irving GA, Butt AD, Vanderveen B. A comparison of caudal morphine given pre or post surgery for postoperative analgesia in children. Pediatr Anaesth. 1993;3:217-221.

Alvarez MAP, Menezes MS, Gozzani JL. Analgesia pós-operatória com uso de fentanil por via peridural sacra em cirurgia pediátrica: Estudo não comparativo multicêntrico. Rev Bras Anestesiol. 1988;38(^sSupl):81.

Campbell FA, Yentis SM, Fear DW. Analgesic efficacy and safety of a caudal bupivacaine-fentanyl mixture in children. Can J Anaesth. 1992;39:661-664.

Benlabed M, Ecoffey C, Levron JC. Analgesia and ventilatory response to CO2 following epidural sufentanil in children. Anesthesiology. 1987;67:948-951.

Moores MA, Wandless JG, Fell D. Paediatric postoperative analgesia: A comparison of rectal diclofenac with caudal bupivacaine after inguinal herniotomy. Anaesthesia. 1990;45:156-158.

Gadiyar V, Gallagher TM, Phil M. The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children. Anaesthesia. 1995;50:820-822.

McGrath PJ, Johnson GG. Pain management in children. Can J Anaesth. 1988;35:107-109.

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