O papel dos bloqueios anestésicos no tratamento da dor de origem cancerosa

Amaury Sanchez Oliveira; Henrique de Paiva Torres

doi:10.1590/S0034-70942003000500013

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O papel dos bloqueios anestésicos no tratamento da dor de origem cancerosa

Anesthetic blocks to treat cancer pain

Amaury Sanchez Oliveira; Henrique de Paiva Torres

http://dx.doi.org/10.1590/S0034-70942003000500013 Braz J Anesthesiol, vol.53, n5, p.654-662, 2003

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Resumo

JUSTIFICATIVA E OBJETIVOS: Tradicionalmente os anestesiologistas desenvolveram as técnicas de anestesia regional que hoje dominam. Para participarem do tratamento dos pacientes com dores crônicas, necessitam transferir os conhecimentos adquiridos, além das indicações cirúrgicas, indicando-os no momento correto, tornando-os úteis e eficazes, num atendimento que deve ser multidisciplinar. O objetivo deste trabalho é mostrar aos anestesiologistas que os bloqueios anestésicos, no tratamento da dor crônica de origem cancerosa, para serem úteis e eficazes, devem ser indicados no momento correto inserindo-os como parte de um tratamento sistêmico, do qual deve-se participar ativamente. CONTEÚDO: O uso correto do protocolo da Organização Mundial da Saúde proporciona diretriz para o controle da dor na maioria dos pacientes com moléstia cancerosa avançada. A eficácia desta abordagem é demonstrada nos seus três primeiros passos, com pequeno número de complicações. Contudo, há pacientes que experimentam efeitos colaterais indesejáveis aos medicamentos opióides sistêmicos e a presença de metástases ósseas e as neuropatias podem determinar efeitos deletéricos nesses pacientes. Técnicas invasivas são raramente indicadas, mas podem resultar em analgesia no tratamento das dores resistentes aos opióides quando usados adequadamente. CONCLUSÕES: Bloqueios com agentes neurolíticos que exigiam alto grau de perícia dos anestesiologistas são as últimas opções de tratamento quando as drogas sistêmicas não mantêm o efeito desejado ou produzem efeitos colaterais de difícil tratamento. Bloqueios anestésicos e injeção de drogas opióides por via subaracnóidea, têm lugar de destaque no tratamento da dor de origem cancerosa e devem ser considerados em situações específicas como parte de um tratamento multidisciplinar.

Palavras-chave

ANESTESIA, DOR, DOR

Abstract

BACKGROUND AND OBJECTIVES: Anesthesiologists have traditionally developed and mastered regional anesthetic techniques over the years. To help treating chronic pain, they need to transfer acquired know-how in addition to surgical indications, recommending procedures at the right time in a multidisciplinary approach. This research aimed at showing anesthesiologists that for anesthetic blocks to be useful and effective in treating chronic cancer pain, they have to be indicated in a timely manner, as part of a systemic approach where they need to play an active role. CONTENTS: WHO guidelines provide adequate pain control to most patients with advanced cancer disease. Its first three steps confirm the efficacy of this approach, with a low incidence of complications. There are however patients who experience undesirable side effects of systemic opioids, and the presence of bone metastases and neuropathies may determine noxious effects on those patients. Invasive techniques are seldom indicated, but they may provide analgesia in the treatment of opioid-resistant pain when adequately indicated. CONCLUSIONS: Neurolytic agent blocks, which require anesthesiologist skills, are the last treatment options when systemic drugs are unable to maintain desired effects or produce untreatable side effects. Anesthetic blocks and spinal opioids play an important role in the treatment of cancer pain and should be considered in specific situations as part of a multidisciplinary approach.

Keywords

ANESTHESIA, PAIN, PAIN

References

Bonica J, Ventafrida V, Twycross RG. Cancer Pain. The Management of Pain. 1990:400-460.

Ventafrida V, Tamburini M, Carecni A. A validation study of the WHO method for cancer pain relief. Cancer. 1987;59:850-856.

Stjernswärd J. WHO cancer pain relief programmed: Word Health Organization, Geneve, Switzerland. Cancer Surv. 1998;7:195-208.

Zech DF, Grond S, Lynch J. Validation of Word Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain. 1995;63:65-76.

Mercadante S. Problems of long-term spinal opioid treatment in advanced cancer patients. Pain. 1999;79:1-13.

Twycross RG, Fairfield S. Pain in far - advanced cancer. Pain. 1982;14:303-310.

Grond S, Zech D, Diefenbach C. Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain. 1996;64:107-114.

Mercadante S, Casuccio A, Agnello A. The analgesic effect of non steroidal anti-inflammatory drugs (NSAIDs) in cancer pain due to somatic and visceral mechanism. J Pain Symptom Manage. 1999;17:351-356.

Schug SA, Zech D, Grond S. A long-term survey of morphine in cancer pain patients. J Pain Symptom Manage. 1992;7:259-266.

Mercadante S, Genovese G, Kargar JA. Home palliative care: results in 1991 versus 1988. J Pain Symptom Manage. 1992;7:414-418.

Teixeira MJ, Valle LBS. Tratamento Farmacológico da Dor. Dor: Epidemiologia, Fisiopatogenia, Avaliação, Síndromes Dolorosas e Tratamento. 2001:93-130.

Boisvert M, Cohen SR. Opioid use in advanced malignant disease: why do different centers use vastly different doses? A plea for standardized reporting. J Pain Symptom Manage. 1995;10:632-638.

Mercadante S. Malignant bone pain: path physiology and treatment. Pain. 1997;69:1-18.

Mercadante S, Sapio M, Villari P. Supra scapular nerve block by catheter for breakthrough shoulder cancer pain. Reg Anesth. 1995;20:151-155.

Cooper MG, Keneally JP, Kinchington D. Continuous brachial plexus neural blockade in a child with intratavel cancer pain. J Pain Symptom Manage. 1994;9:277-281.

Sato S, Yamashita S, Iwain M. Continuous interescalene block for cancer pain. Reg Anesth. 1994;19:73-75.

Sanchez CA, Oliveira AS. Sistema Nervoso Autônomo e Síndromes Dolorosas. Dor: Diagnóstico e Tratamento. 2001:171-182.

Oliveira AS, Sanchez CA. Bloqueio do plexo celíaco. Rev Bras Anestesiol. 1995;45(^s20):57-61.

Krames ES. The chronic intraspinal use of opioid and anesthetic mixtures for the relief of intractable pain: when all else fails. Pain. 1993;55:1-4.

Oliveira AS, Pavani NJ, Miyahira SA. Tratamento ambulatorial da dor de origem cancerosa com morfina peridural: estudo retrospectivo. Rev Bras Anestesiol. 1990;40(^s12):CBA130.

Plummer JL, Cherry DA, Cousins MJ. Long-term spinal administration of morphine in cancer and non-cancer pain: a retrospective study. Pain. 1991;44:215-220.

Yang CY, Wong CS, Chang JY. intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain. Cancer J Anaesth. 1996;43:379-383.

Eisenach JC, Pen DUS, Dubois M. Epidural clonidine analgesia for intractable cancer pain. Pain. 1995;61:391-399.

Rocha APC, Lemonica L, Barros GAM. Uso de medicações por via subaracnóidea no tratamento da dor crônica. Rev Bras Anestesiol. 2002;52:628-643.

Nitescu P, Sgoberg M, Appelgren L. Complications of intrathecal opioids and bupivacaine in the treatment of "refractory" cancer pain. Clin J Pain. 1995;11:45-62.

Nitescu P, Appelgren L, Linder LE. Epidural versus intrathecal morphine - bupivacaine: assessment of consecutive treatments in advanced cancer pain. J Pain Symptom Manage. 1990;5:18-26.

Cherry DA, Gourlay GK. CT contrast evidence of injectate encapsulation after long-term epidural administration. Pain. 1992;49:369-377.

Crul BJ, Delhaas EM. Technical complications during long-term subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases. Reg Anesth. 1991;16:209-213.

O papel dos bloqueios anestésicos no tratamento da dor de origem cancerosa

Anesthetic blocks to treat cancer pain

Amaury Sanchez Oliveira; Henrique de Paiva Torres

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