Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000600002
Brazilian Journal of Anesthesiology
Scientific Article

Diclofenaco por via muscular ou retal associado com baixas doses de morfina subaracnóidea para analgesia pós-operatória em cesarianas

Intramuscular versus rectal diclofenac associated with low dose spinal morphine for post-cesarean analgesia

Mônica Maria Siaulys Capel Cardoso; José Carlos Almeida Carvalho; Silvia Maria Machado Tahamtani

http://dx.doi.org/10.1590/S0034-70942002000600002 Braz J Anesthesiol, vol.52, n6, p.666-672, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: O diclofenaco tem sido utilizado em combinação com opióides por via subaracnóidea no controle da dor pós-operatória; entretanto, a melhor forma de sua administração não é conhecida. Este estudo avaliou a qualidade da analgesia pós-operatória de diferentes esquemas de administração de diclofenaco, em pacientes submetidas à cesariana sob raquianestesia com bupivacaína e morfina. MÉTODO: Após o final da cirurgia, as pacientes foram distribuídas aleatoriamente em três grupos que receberam diclofenaco como se segue: G50VR (n=62), 50 mg por via retal; G50IM (n=62), 50 mg por via muscular e G75IM (n=62), 75 mg por via muscular. A dor foi avaliada com uma escala analógica visual de 0-10 cm (EAV) a cada 30 minutos nas primeiras seis horas e meperidina, via venosa, foi administrada como medicação de resgate sempre que a EAV fosse igual ou maior que 3 cm. RESULTADOS: No intervalo entre 30 e 150 minutos após a administração do diclofenaco, a média da intensidade de dor no grupo G50VR (0,9 ± 1,4; 1,4 ± 1,4; 1,3 ± 1,5; 1,3 ± 1,2 e 1,5 ± 3,3 cm) foi maior quando comparada com as do G50IM (0,4 ± 0,8; 0,5 ± 0,8; 0,7 ± 1,0; 0,7 ± 1,1 e 0,7 ± 1,1 cm) e G75IM (0,4 ± 0,8; 0,7 ± 1,3; 0,7 ± 1,1; 0,8 ± 1,2 e 0,7 ± 1,0 cm). A necessidade de meperidina de resgate (43,5%) e o consumo total de meperidina (21,3 ± 28,9 mg) foram maiores no G50VR, quando comparados com G50IM (21% e 8,2 ± 18,2 mg) e G75IM (19,4% e 6,8 ± 16,7 mg). CONCLUSÕES: Quando combinada com baixas doses de morfina subaracnóidea, a administração do diclofenaco por via muscular promove melhor analgesia pós-operatória que por via retal. Além disso, parece haver um efeito teto para esta droga, já que não se observam vantagens com doses superiores a 50 mg por via muscular.

Palavras-chave

ANALGESIA, CIRURGIA, CIRURGIA, DROGAS, DROGAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Diclofenac has been used in combination with spinal opioids to control postoperative pain; however, the best regimen of its administration is not known. This study evaluated the quality of postoperative analgesia of different regimens of diclofenac administration, in patients submitted to Cesarean section under spinal anesthesia with bupivacaine and morphine. METHODS: After the end of surgery, patients were randomly allocated into three groups that received diclofenac as follows: G50VR(n=62), 50 mg rectally; G50IM(n=62), 50 mg intramuscularly and G75IM (n=62), 75 mg intramuscularly. Pain was evaluated with a 0-10 cm visual analog scale (VAS) every 30 minutes for six hours and rescue intravenous (iv) meperidine was administered whenever VAS ≥ 3 cm. RESULTS: In the interval between 30 and 150 min after diclofenac administration, mean pain scores in G50VR (0.9 ± 1.4; 1.4 ± 1.4; 1.3 ± 1.5; 1.3 ± 1.2 and 1.5 ± 3.3 cm) were higher as compared to G50IM (0.4 ± 0.8; 0.5 ± 0.8; 0.7 ± 1.0; 0.7 ± 1.1 and 0.7 ± 1.1cm) and G75IM (0.4 ± 0.8; 0.7 ± 1.3; 0.7 ± 1.1; 0.8 ± 1.2 and 0.7 ± 1.0 cm). The need for rescue meperidine (43.5%) and total meperidine consumption (21.3 ± 28.9 mg) were higher in G50VR as compared to G50IM (21% and 8.2 ± 18.2 mg) and G75IM (19.4% and 6.8 ± 16.7 mg) respectively. CONCLUSIONS: When associated with low doses of spinal morphine, intramuscular diclofenac offers better postoperative analgesia than the rectal route. Additionally, a ceiling effect is probably present for this drug, as no advantages were observed with doses larger than 50 mg intramuscularly.

Keywords

ANALGESIA, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, DRUGS, DRUGS, SURGERY, SURGERY

References

Luthman J, Kay NH, White JB. The morphine sparing effect of diclofenac sodium following cesarean section under spinal anesthesia. Int J Obstet Anesth. 1994;3:82-86.

Dennis AR, Leeson-Payne CG, Hobbs GJ. Analgesia after cesarean section: The use of diclofenac as an adjunct to spinal morphine. Anaesthesia. 1995;50:297-299.

Cardoso MMSC, Carvalho JCA, Amaro AR. Small doses of spinal morphine combined with systemic diclofenac for postoperative analgesia after cesarean delivery. Anesth Analg. 1998;86:538-541.

McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994;47:28-45.

Bjorkman R. Central antinociceptive effects of nonsteroidal anti-inflammatory drugs and paracetamol. Acta Anaesthesiol Scand. 1995;39:1-44.

Peloso PM. Strategies and practice for use of nonsteroidal anti-inflammatory drugs. Scand J Rheumatol. 1996;105:29-48.

Ostensen M, Husby G. Antirheumatic drug treatment during pregnancy and lactation. Scand J Rheumatol. 1985;14:1-7.

Campbell WI, Kendrick R, Patterson C. Intravenous diclofenac sodium: Does its administration before operation suppress postoperative pain?. Anaesthesia. 1990;45:763-766.

Jakobson J, Rane K, Davidson S. Intramuscular NSAID reduces postoperative pain after minor outpatient anesthesia. Eur J Anaesth. 1996;13:67-71.

Hyrkas T, Ylipaavalniemi P, Oikarinen VJ. Postoperative pain prevention by a single-dose formulation of diclofenac producing a steady plasma concentration. J Oral Maxillofac Surg. 1992;50:124-127.

Moore AP, Thorpe JA, Mulley BA. Which diclofenac form is best? Post-thoracotomy pain: intramuscular vs rectal administration of diclofenac. Hosp Pharm Pract. 1993:431-432.

Willis JV, Kendall MJ, Flinn RM. The pharmacokinetics of diclofenac sodium following intravenous and oral administration. Eur J Clin Pharmacol. 1979;16:405-410.

O’Hara DA, Fragen RJ, Kinzer M. Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative. Clin Pharmacol Ther. 1987;41:556-561.

Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175-184.

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