Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000200011
Brazilian Journal of Anesthesiology
Miscellaneous

Estudo comparativo entre toxina botulínica e bupivacaína para infiltração de pontos-gatilho em síndrome miofascial crônica

Comparative study between botulin toxin and bupivacaine for triggering-points infiltration in chronic myofascial syndrome

Eduardo Keiichi Unno; Rioko Kimiko Sakata; Adriana Machado Issy

http://dx.doi.org/10.1590/S0034-70942005000200011 Braz J Anesthesiol, vol.55, n2, p.250-255, 2005
PDF Português
PDF English
Downloads: 0
Views: 979

Resumo

JUSTIFICATIVA E OBJETIVOS: Existem controvérsias sobre a eficácia da toxina botulínica em relação ao anestésico local para infiltração de pontos-gatilho. O objetivo deste estudo é comparar o efeito analgésico da toxina botulínica com o da bupivacaína, para infiltração em pontos-gatilho de síndrome miofascial crônica. MÉTODO: Foram avaliados 20 pacientes, divididos em dois grupos. Os pacientes do G1 (n = 10) receberam 25U de toxina botulínica e os do G2 (n = 10), bupivacaína a 0,25%, em um a três pontos-gatilho, sendo 0,5 mL por ponto. Os pacientes foram avaliados semanalmente, durante 8 semanas. Foram associados 35 mg de orfenadrina, e 300 mg de dipirona, a cada 8 horas, e os pacientes foram submetidos à estimulação elétrica transcutânea, duas vezes por semana, durante 1 hora por sessão. A intensidade da dor foi avaliada através da escala numérica verbal e a qualidade da analgesia, pelo paciente, nos momentos zero (antes da injeção), e após 30 minutos, 1, 2, 3, 4, 5, 6, 7 e 8 semanas. Os resultados foram submetidos à análise estatística (Mann-Whitney e Exato de Fisher). RESULTADOS: Após 30 minutos da aplicação e com 1 e 4 semanas, a intensidade da dor no G1 foi menor que no G2. Após 2, 3, 5, 7 e 8 semanas da infiltração, não houve diferença significativa entre os grupos. A qualidade da analgesia foi considerada melhor pelos pacientes do G1 que do G2, exceto após 2 semanas. CONCLUSÕES: O efeito analgésico foi melhor com toxina botulínica (25 U) que com bupivacaína a 0,25% para infiltração de pontos-gatilho.

Palavras-chave

ANESTÉSICOS, Local, DROGAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: There are controversies about the efficacy of botulin toxin as compared to local anesthetics for triggering-points infiltration. This study aimed at comparing the analgesic effect of botulin toxin and bupivacaine for triggering-points infiltration in chronic myofascial syndrome. METHODS: Participated in this study 20 patients divided in two groups. G1 patients (n = 10) received 25U botulin toxin and G2 patients (n = 10) received 0.25% bupivacaine in one to three triggering-points, being 0.5 mL per point. Patients were weekly evaluated for 8 weeks. Orphenadrine (35 mg) and dipirone (300 mg) were associated every 8 hours and patients were submitted to transcutaneous electrical stimulation twice a week during 1 hour. Pain intensity was evaluated through verbal numeric scale and quality of analgesia was evaluated by patients in moments zero (before injection), 30 minutes after, and at 1, 2, 3, 4, 5, 6, 7 and 8 weeks. Results were submitted to statistical analysis (Mann-Whitney and Fisher Exact tests). RESULTS: After 30 minutes, 1 and 4 weeks, pain intensity was lower for G1 as compared to G2. After 2, 3, 5, 7 and 8 weeks, there was no significant difference between groups. Quality of analgesia was considered better by G1 patients as compared to G2, except after 2 weeks. CONCLUSIONS: Analgesic effect was better with botulin toxin (25U) as compared to 0.25% bupivacaine for triggering-points infiltration.

Keywords

ANESTHETICS, Local, DRUGS, ANESTHETIC TECHNIQUES

References

Fischer AA. Pressure threshold measurement for diagnosis of myofascial pain and evaluation of treatment results. Clin J Pain. 1987;2:207-214.

Fricton JR. Myofascial Pain Syndrome: Characteristics and Etiology. Advances in Pain Research and Therapy. 1990:107-127.

Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil. 2000;79:48-52.

O'Brien CF. Clinical application of botulinum toxin: implication for pain management. Pain Digest. 1998;8:342-345.

O'Brien CF. Injection techniques for botulinum toxin using electromyography and electrical stimulation. Muscle Nerve. 1997;6(^sSuppl):S176-S180.

Porta M, Perretti A, Gamba M. The rationale and results of treating muscle spasm and myofascial syndrome with botulinum toxin type A. Pain Digest. 1998;8:346-352.

Porta M, Perretti A, Gamba M. Compartment of botulinum toxin injection for myofascial pain relief. Dolor. 1997;12:42.

Yue SK. Initial experience in the use of botulinum toxin A for the treatment of myofascial related muscle dysfunctions. J Musculoskel Pain. 1995;3:22.

Porta M. A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasms. Pain. 2000;85:101-105.

Brashear A, Lew MF, Dykstra DD. Safety and efficacy of Neurobloc (botulinum toxin type B) in type A: responsive cervical dystonia. Neurology. 1999;53:1439-1446.

Lianza S. Consenso Nacional sobre Espasticidade: Diretrizes para Diagnósticos e Tratamentos. SBMFR. 2001:24-27.

Acquadro MA, Borodic G. Treatment of myofascial pain with botulinum A toxin. Anesthesiology. 1994;80:705-706.

Porta M. L´impiego della tossina bolulinica tipo A nelle síndrome dolorosi miofasciali. La Riabilitazione. 1999;32:49-55.

Childers M, Wilson D, Galate J. Treatment of painful muscle syndroms with botulinum toxin: A review. J Back Musculoskel Rehabil. 1998;10:89-96.

Racz GB. D. A. B. P. M.. Pain Digest. 1998;8:353-356.

Aoki R. The Development of BOTOX® - It´s History and Pharmacology. Pain Digest. 1998;8:337-341.

5dd7d35b0e8825fe3b13f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections