Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000500003
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo entre fentanil por vias peridural e venosa para analgesia de operações ortopédicas

Comparative study of epidural and intravenous fentanyl for postoperative analgesia of orthopedic surgeries

Marcelo Soares Privado; Rioko Kimiko Sakata; Adriana Machado Issy; João Batista Santos Garcia

http://dx.doi.org/10.1590/S0034-70942004000500003 Braz J Anesthesiol, vol.54, n5, p.634-639, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: Existem controvérsias sobre o local de ação de opióides lipofílicos após injeção peridural, e alguns autores acreditam que esses fármacos agem no nível supra-espinhal, enquanto outros acham que ocorre ação espinhal. Para tentar esclarecer essa dúvida foi feito estudo comparativo da aplicação de fentanil por vias peridural e venosa após operações ortopédicas de membro inferior. MÉTODO: O estudo foi aleatório e duplamente encoberto. Quando apresentavam dor pós-operatória, os pacientes do G1 (n = 14) receberam 5 ml de solução (100 µg de fentanil em solução fisiológica a 0,9%) por via peridural e 2 ml de solução fisiológica a 0,9% por via venosa, os do G2 (n = 15) receberam 5 ml de solução fisiológica a 0,9%, por via peridural e 2 ml de fentanil (100 µg) por via venosa. Foi avaliada a necessidade de complementação analgésica com tenoxicam (40 mg) por via venosa e com bupivacaína a 0,25% (5 ml) por via peridural (quando não havia alívio com tenoxicam). A intensidade da dor foi avaliada pelas escalas numérica e verbal nos momentos M30, M120 e M240 minutos. RESULTADOS: O número de pacientes que necessitaram de complementação analgésica, tanto com o tenoxicam (G1 = 10 e G2 = 15 pacientes) quanto com a bupivacaína (G1 = 2 e G2 = 8 pacientes) foi maior no G2. Não houve diferença estatística na intensidade da dor entre os grupos nos tempos avaliados. CONCLUSÕES: Nas condições deste estudo o efeito analgésico do fentanil peridural é melhor que por via venosa.

Palavras-chave

ANALGESIA, ANALGÉSICOS, ANALGÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: There are controversies about the action site of lipophylic opioids after epidural injection. Some authors believe that these drugs act at supraspinal level, while others propose a spinal action. This comparative study aimed at answering this question by comparing epidural and intravenous fentanyl for postoperative analgesia of lower limb orthopedic procedures. METHODS: This was a randomized double-blind study. At postoperative pain complaint, G1 patients (n = 14) received 5 mL epidural solution (100 µg fentanyl in 0.9% saline) and 2 mL of intravenous 0.9% saline; G2 patients (n = 15) received 5 mL epidural 0.9% saline and 2 mL intravenous fentanyl (100 µg). Analgesic complementation with intravenous tenoxicam (40 mg) and epidural 0.25% bupivacaine (5 mL) (when there was no relief with tenoxicam) has been evaluated. Pain intensity was evaluated by numeric and verbal scales in moments M30, M120 and M240 minutes. RESULTS: Number of patients needing analgesic complementation both with tenoxicam (G1 = 10 and G2 = 15 patients) and bupivacaine (G1 = 2 and G2 = 8 patients) has been higher in G2. There have been no statistical differences in pain intensity between groups in all studied moments. CONCLUSIONS: In the conditions of our study, effects of epidural fentanyl were better as compared to intravenous fentanyl.

Keywords

ANALGESIA, ANALGESICS, ANALGESICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50:149-151.

Sandler AN, Stringer D, Panos L. A randomized, double-blind comparison of lumbar epidural and intravenous fentanyl infusions for postthoracotomy pain relief: Analgesic, pharmacokinetic, and respiratory effects. Anesthesiology. 1992;77:626-634.

Coda BA, Brown MC, Schaffer R. Pharmacology of epidural fentanyl, alfentanil, and sufentanil in volunteers. Anesthesiology. 1994;81:1149-1161.

D’Angelo R, Gerancher JC, Eisenach JC. Epidural fentanyl produces labor analgesia by a spinal mechanism. Anesthesiology. 1998;88:1519-1523.

Gourlay GK, Kowalski SR, Plummer JL. Fentanyl blood concentration-analgesic response relationship in the treatment of postoperative pain. Anesth Analg. 1988;67:329-337.

de Leon-Casasola OA, Lema MJ. Postoperative epidural opioid analgesia: what are the choices?. Anesth Analg,. 1996;83:867-875.

Thomson CA, Becker DR, Messick Jr JM. Analgesia after thoracotomy: effects of epidural fentanyl concentration/ infusion rate. Anesth Analg. 1995;81:973-981.

Justins DM, Francis D, Houlton PG. A controlled trial of extradural fentanyl in labour. Br J Anaesth. 1982;54:409-414.

Reynolds F, O`Sullivan G. Epidural fentanyl and perineal pain in labour. Anaesthesia. 1989;44:341-344.

Renaud B, Brichant JF, Clergue F. Ventilatory effects of continuous epidural infusion of fentanyl. Anesth Analg. 1988;67:971-975.

Ellis DJ, Millar WL, Reisner LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. Anesthesiology. 1990;72:981-986.

Loper KA, Ready LB, Downey MP. Epidural and intravenous fentanyl infusions are clinically equivalent following knee surgery. Anesth Analg. 1990;70:72-75.

Salomaki TE, Laitinen JO, Nuutinen LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology. 1991;75:790-795.

Welchew EA, Thornton JA. Continuous thoracic epidural fentanyl: A comparison of epidural fentanyl with intramuscular papaveretum for postoperative pain. Anaesthesia. 1982;37:309-316.

Guinard J, Mavrocordatos P, Chiolero R. A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology. 1992;77:1108-1115.

Baxter AD, Laganiere S, Samson B. A comparison of lumbar epidural and intravenous fentanyl infusions for post-thoracotomy analgesia. Can J Anaesth. 1994;41:184-191.

Cooper DW, Ryall DM, Desira WR. Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action?. Br J Anaesth. 1995;74:184-187.

Harukuni I, Yamaguchi H, Sato S. The comparison of epidural fentanyl, epidural lidocaine, and intravenous fentanyl in patients undergoing gastrectomy. Anesth Analg. 1995;81:1169-1174.

Liu SS, Gerancher JC, Bainton BG. The effect of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Anesth Analg. 1996;82:98-102.

Lutti MN, Simoni RF, Cangiani LM. Analgesia controlada pelo paciente com morfina ou fentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo. Rev Bras Anestesiol. 2000;50:8-13.

Naulty JS, Datta S, Ostheimer GW. Epidural fentanyl for postcesarean delivery pain management. Anesthesiology. 1985;63:694-698.

Birnbach DJ, Johnson MD, Arcario T. Effect of diluent volume on analgesia produced by epidural fentanyl. Anesth Analg. 1989;68:808-810.

Dickenson AH, Sullivan AF, McQuay HJ. Intrathecal etorphine, fentanyl and buprenorphine on spinal neurones in the rat. Pain. 1990;42:227-234.

Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiology. 1992;76:91-99.

Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology. 1992;77:1186-1200.

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