Analgesia regional periférica com lidocaína em paciente queimado: relato de caso

Karl Otto Geier

doi:10.1590/S0034-70942004000200011

Clinical Information

Analgesia regional periférica com lidocaína em paciente queimado: relato de caso

Peripheral regional analgesia with lidocaine in burned patient: case report

Karl Otto Geier

http://dx.doi.org/10.1590/S0034-70942004000200011 Braz J Anesthesiol, vol.54, n2, p.239-246, 2004

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Resumo

JUSTIFICATIVA E OBJETIVOS: A realização de anestesia regional em pacientes queimados é dificultosa pela localização aleatória das lesões térmicas. Elevadas taxas de alfa1 glicoproteína ácida com grande afinidade para drogas alcalinas, especialmente a lidocaína, têm sido observadas nesses pacientes. Este caso relata como o uso intermitente de anestesia e analgesia regional periférica com altas doses de lidocaína podem ser úteis em fornecer efetiva analgesia num paciente com queimaduras de segundo grau nos quatro membros, abrangendo, aproximadamente, 20% de área superficial queimada. RELATO DO CASO: Paciente do sexo masculino, 23 anos, 86 kg, estado físico ASA II, com queimadura superficial da face, segundo grau nos quatro membros e elevada taxa sérica de alfa1 glicoproteína ácida (260 mg.dl-1), teve sua dor controlada com 11,6 mg.kg-1 de lidocaína com adrenalina 1:400.000 administrada por cateteres introduzidos e tunelizados para diversos procedimentos - irrigações e troca de curativos, desbridamentos, fisioterapia, enxertos cutâneos e analgesia diária durante 28 dias. CONCLUSÕES: Em pacientes queimados com injúrias térmicas localizadas nas extremidades, a analgesia regional periférica pode ser útil. As elevadas taxas séricas de alfa1 glicoproteína ácida e o local da injeção podem permitir o emprego de altas doses de lidocaína.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Regional anesthesia is difficult in burned patients due to the randomized location of thermal injuries. High plasma levels of alpha1-acid glycoprotein with major affinity to basic drugs, especially lidocaine, have been observed in these patients. This report shows how intermittent peripheral regional anesthesia and analgesia with high lidocaine doses may be useful in inducing effective analgesia in patient with almost 20% Total Burn Skin Area (TBSA) of partial thickness burn in his four limbs. CASE REPORT: Male patient, 23 years old, 86 kg, physical status ASA II, with superficial facial burn, partial thickness burn on four limbs and increased serum alpha1-acid glycoprotein levels (260 mg.dL-1), who was treated with 11.6 mg.kg-1 lidocaine with 1:400,000 epinephrine through catheters inserted and tunnelized, for several procedures - irrigations and dressing changes, débridements, physical therapy, skin grafting and daily analgesia during 28 days. CONCLUSIONS: Burned patients with thermal injuries on the extremities are suitable for peripheral regional analgesia. High alpha1-acid glycoprotein serum levels and injection site may allow the use of high lidocaine doses.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

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Analgesia regional periférica com lidocaína em paciente queimado: relato de caso

Peripheral regional analgesia with lidocaine in burned patient: case report

Karl Otto Geier

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