Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso

Durval Campos Kraychete; Ana Cristina Guimarães; Maria Goreth Carvalho; Edgar Marcelino de Carvalho

doi:10.1590/S0034-70942003000600010

Informação Clínica

Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso

Intravenous lidocaine to treat scleroderma pain: case report

Durval Campos Kraychete; Ana Cristina Guimarães; Maria Goreth Carvalho; Edgar Marcelino de Carvalho

http://dx.doi.org/10.1590/S0034-70942003000600010 Braz J Anesthesiol, vol.53, n6, p.797-801, 2003

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Resumo

JUSTIFICATIVA E OBJETIVOS: A esclerodermia ou esclerose sistêmica progressiva é uma doença sistêmica do tecido conjuntivo, de causa desconhecida, que costuma cursar com microangiopatia, isquemia de extremidades e dor intensa. O objetivo deste relato é descrever um caso do emprego de lidocaína por via venosa no tratamento da dor no curso de isquemia e enfatizar a possível ação antiinflamatória dos anestésicos locais nos pacientes com esclerodermia. RELATO DO CASO: Paciente do sexo feminino, 34 anos, auxiliar de enfermagem, portadora de esclerodermia há aproximadamente 8 anos, apresentava dor de elevada intensidade (escala numérica =10) nos membros superiores e inferiores, contínua, diária, acompanhada de alterações tróficas, da cor e da temperatura e pequenas úlceras nas extremidades. A paciente foi submetida a uma sessão semanal de lidocaína a 2% (400 mg) sem vasoconstritor por via venosa durante 10 semanas com alívio da dor, do turgor, da elasticidade da pele e da perfusão periférica. CONCLUSÕES: O alívio da dor e de outros sintomas após a administração de lidocaína por via venosa sugere que os anestésicos locais podem modular a resposta inflamatória em vários estágios da esclerodermia.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, DOENÇAS, DOR

Abstract

BACKGROUND AND OBJECTIVES: Scleroderma or progressive systemic sclerosis is a systemic connective tissue disease of unknown origin, which normally courses with microangiopathy, extremities ischemia and severe pain. This report aimed at describing a case of intravenous lidocaine to treat ischemic pain and at emphasizing potential anti-inflammatory action of local anesthetics in scleroderma patients. CASE REPORT: Female patient, clear mulatto 34 years old, nursing assistant, with scleroderma for approximately 8 years, presented with severe continuous, daily pain (numeric scale = 10) in upper and lower limbs, followed by trophic, color and temperature changes, and small ulcers on extremities. Patient was submitted to 1 weekly session of intravenous 2% lidocaine (400 mg) without vasoconstrictor for 10 weeks with pain, turgor, skin elasticity and peripheral perfusion improvement. CONCLUSIONS: Pain and other symptoms relief after intravenous lidocaine suggests that local anesthetics are able to modulate inflammatory response in different scleroderma stages.

Keywords

ANESTHETICS, ANESTHETICS, DISEASES, PAIN

Referências

Lundborg C, Nitescu P, Appelgren L. Progressive systemic sclerosis: intrathecal pain management. Reg Anesth Pain Med. 1999;24:89-93.

Ward WA, Van Morre Charlotte NC. Management of finger ulcers in scleroderma. J Hand Surg. 1995;20:868-872.

Vayssairat M. Les phénomènes de Raynaud avec troubles trophiques. J Mal Vasc. 1992;17:127-131.

Sapadin NA, Fleischmajer R. Treatment of scleroderma. Arch Dermatol. 2002;138:99-105.

Di Trapani G, Tulli A, La Cara A. Peripheral neuropathy in course of progressive systemic sclerosis: Light and ultrastructural study. Acta Neuropathol. 1986;72:103-110.

Leighton C. Drug treatment of scleroderma. Drugs. 2001;61:419-427.

Biasi G, Giordanengo F, Pignoli P. 25 ani di esperienza nel trattamento della malattia di Raynaud e delle sindromi Raynaud-simili. Minerva Chir. 1980;35:663-667.

Broggi G, Servello D, Franzini A. Epidural stimulation for peripheral vascular disease: 10 years of experience. Ital J Neurol Sci. 1993;14:317-320.

Dahm P, Nitescu P, Appelgren L. Efficacy and technical complications of long-term continuous intraspinal infusions of opioid and/or bupivacaine in refractory nonmalignant pain: a comparison between the epidural and the intrathecal approach with externalized or implanted catheters and infusion pumps. Clin J Pain. 1998;14:4-16.

Ferrante FM, Paggioli J, Cherukuri S. The analgesic response to intravenous lidocaine in the treatment of neuropathic pain. Reg Anesth. 1996;82:91-97.

Krause KH, Demaurex N, Jaconi M. Ion channels and receptor-mediated Ca2+ influx in neutrophil granulocytes. Blood Cells. 1993;19:165-173.

Mikawa K, Maekawa N, Nishina K. Effect of lidocaine pretreatment on endotoxin-induced lung injury in rabbits. Anesthesiology. 1994;81:689-699.

Schmidt W, Schmidt H, Bauer H. Influence of lidocaine on endotoxin-induced leukocyte-endothelial cell adhesion and macromolecular leakage in vivo. Anesthesiology. 1997;87:617-624.

Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication?. Anesthesiology. 2000;93:858-875.

Nellgard P, Jonsson A, Bojo L. Small-bowel obstruction and the effects of lidocaine, atropine and hexamethonium on inflammation and fluid losses. Acta Anaesthesiol Scand. 1996;40:287-292.

Rimback G, Cassut J, Faxen A. Effects of intra-abdominal bupivacaine instillation on postoperative colonic motility. Gut. 1986;27:170-175.

Martinsson T, Oda T, Fernivk E. Ropivacaine inhibits leukocyte rolling, adhesion and CD11b/CD18 expression. J Pharmacol Exp Ther. 1997;283:59-65.

Hattori M, Dohi S, Nozaki M et al. The inhibitory effects of local anesthetics on superoxide generation of neutrophils correlate with their partition coefficients. Anesth Analg. 1997;84:405-412.

Wallace MS, Laitan S, Licht D. Concentration-effect Relations for Intravenous lidocaine Infusions in human volunteers: effects on acute sensory thresholds and capsaicin-evoked hyperpathia. Anesthesiology. 1997;86:1262-1272.

Tsai P, Buerkle H, Huang LT. Lidocaine concentrations in plasma and cerebrospinal fluid after systemic bolus administration in humans. Reg Anesth. 1998;87:601-604.

Swanton BJ, Shorten G. Anti-inflammatory effects of local anesthetic agents. Int Anesthesiol Clin. 2003;41:1-19.

Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso

Intravenous lidocaine to treat scleroderma pain: case report

Durval Campos Kraychete; Ana Cristina Guimarães; Maria Goreth Carvalho; Edgar Marcelino de Carvalho

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