Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000400004
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia da N-butilescopolamina e dipirona sódica associadas ao cetoprofeno no alívio da dor pós-operatória de pacientes submetidas a duas técnicas diferentes de laqueadura por laparoscopia

Efficacy of N-butylscopolamine and sodium dipirone associated to ketoprofen for postoperative pain relief of patients submitted to two different laparoscopic sterilization techniques

Eliana Marisa Ganem; Isabel C F Salem; Fernanda B Fukushima; Giane Nakamura; Rogério Dias; André L Fontana; Nilton J Leite

http://dx.doi.org/10.1590/S0034-70942005000400004 Braz J Anesthesiol, vol.55, n4, p.397-404, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: A laqueadura laparoscópica (LL) é um dos procedimentos mais dolorosos e a intensidade da dor varia com a técnica selecionada, sendo mais intensa com a técnica de oclusão das tubas uterinas com anel. As pacientes submetidas à LL referem dor em cólica no período PO e a N-butilescopolamina e a dipirona sódica, por suas propriedades anti-espasmódicas e analgésicas, associadas às propriedades antiinflamatórias do cetoprofeno, podem ser opção para profilaxia e tratamento de dor. O objetivo deste foi estudar a eficácia da N-butilescopolamina e da dipirona sódica associadas ao cetoprofeno, na prevenção de dor PO em pacientes submetidas à LL, com duas técnicas diferentes - diatermia e pinçamento com anel. MÉTODO: Participaram do estudo 50 pacientes, estado físico ASA I e II, com idade entre 23 e 47 anos. As pacientes foram distribuídas aleatoriamente em dois grupos: G1 - oclusão das tubas uterinas com anéis, G2 - oclusão das tubas uterinas com diatermia. Todas as pacientes receberam N-butilescopolamina (20 mg) e dipirona sódica (2500 mg) e cetoprofeno (100 mg), por via venosa, imediatamente antes da indução da anestesia. A dor foi avaliada pelo critério de escala numérica verbal, variando de 0 a 10, sendo 0 ausência de dor e 10 o máximo de dor, a cada 10 minutos na primeira hora, na sala de recuperação pós-anestésica (SRPA) e na 1ª, 2ª, 3ª e 4ª horas após a alta da SRPA. Dor com intensidade maior que 3 era tratada com tramadol (100 mg), por via venosa. A avaliação da dor foi realizada sem que se soubesse a que grupo pertencia a paciente. Para análise estatística, testes t de Student, Mann-Whitney e Friedman. RESULTADOS: Ambos os grupos foram idênticos com relação à idade, ao peso, à altura, à duração da cirurgia e anestesia. As pacientes do G1 apresentaram maior escore de dor que as do G2, em todos os momentos do estudo. Valores estatisticamente significativos: 80% das pacientes de G1 e 16% de G2 necessitaram de tramadol em algum momento do estudo. CONCLUSÕES: A N-butilescopolamina e a dipirona sódica associadas ao cetoprofeno mostraram ser alternativa de analgesia pós-operatória quando a laqueadura é realizada com a técnica de diatermia.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, DOR, DOR, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Laparoscopic sterilization (LS) is one of the most painful procedures and pain severity varies with the selected technique, being more severe when tubes are occluded with rings. Patients submitted to LS refer PO colic pain and N-butylscopolamine and sodium dipirone, for their anti-spasmodic and analgesic properties, associated to ketoprofen with anti-inflammatory properties, may be the option for pain prevention and relief. This study aimed at evaluating the efficacy of N-butylscopolamine and sodium dipirone associated to ketoprofen to prevent PO pain in patients submitted to LS by two different techniques - diathermy and tubal ring. METHODS: Participated in this study 50 patients, physical status ASA I and II, aged 23 to 47 years. Patients were randomly distributed in two groups: G1 - tubal ring; G2 - diathermy. All patients received intravenous N-butylscopolamine (20 mg) and sodium dipirone (2500 mg) and ketoprofen (100 mg) immediately before anesthetic induction. Pain was evaluated by verbal numeric scale varying from 0 to 10, being 0 no pain and 10 the worst possible pain, every 10 minutes in the first PACU hour and 1, 2, 3 and 4 hours after PACU discharge. Pain above 3 was treated with intravenous tramadol (100 mg). Pain was evaluated without knowing the group to which the patient belonged. Student's t, Mann-Whitney and Friedman tests were used for statistical analysis. RESULTS: Both groups were similar in age, weight, height and length of surgery and anesthesia. G1 patients had higher pain scores as compared to G2, in all studied moments. Statistically significant values were: 80% of G1 and 16% of G2 patients needed tramadol at some point of the study. CONCLUSIONS: N-butylscopolamine and sodium dipirone associated to ketoprofen are a postoperative analgesic alternative when sterilization is performed through diathermy technique.

Keywords

ANALGESICS, ANALGESICS, ANALGESICS, DRUGS, PAIN, PAIN

References

Skacel M, Sengupta P, Plantevin OM. Morbidity after day case laparoscopy: A comparison of two techniques of tracheal anaesthesia. Anaesthesia. 1986;41:537-541.

Collins KM, Plantevin OM, Docherty PW. Comparison of atracurium and alcuronium in day- case gynaecological surgery. Anaesthesia. 1984;39:1130-1134.

Ganem EM, Castiglia YMM, Módolo NSP. Laparoscopia ginecológica: estudo retrospectivo de complicações intra e pós-operatórias. Rev Bras Anestesiol. 1995;45:165-172.

Collins KM, Docherty PW, Plantevin OM. Postoperative morbidity following gynaecological outpatient laparoscopy: A reappraisal of the service. Anaesthesia. 1984;39:819-822.

Dobbs FF, Kumar V, Alexander JI. Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynaecol. 1987;94:262-266.

Tool Al, Kammerer-Doak DN, Nguyen CM. Postoperative pain relief following laparoscopic tubal sterilization with silastic bands. Obstet Gynecol. 1997;90:731-734.

Budd J, Whyte J, Wilson M. A comparison of tramadol with morphine for postoperative analgesia following day case laparoscopic sterilization. Eur J Anaesthesiol. 2000;17:A34.

Wheatley SA, Millar JM, Jadad AR. Reduction of pain after laparoscopic sterilisation with local bupivacaine: a randomised, parellel, double-blind trial. Br J Obstet Gynaecol. 1994;101:443-446.

Buggy DJ, Wall C, Carton EG. Preoperative or postoperative diclofenac for laparoscopic tubal ligation. Br J Anaesth. 1994;73:767-770.

Chui PT, Gin T. A comparison between ketorolac and diclofenac in laparoscopic sterelization. Eur J Anaesthesiol. 1995;12:597-601.

Putland AJ, McCluskey A. The analgesic efficacy of tramadol verus ketorolac in day-case laparoscopic sterilisation. Anaesthesia. 1999;54:382-385.

Alexander JI. Pain after laparoscopy. Br J Anaesth. 1997;79:369-378.

Wilson CM, Lillywhite N, Matta B. Intravenous buscopan for analgesia following laparoscopic sterilisation. Anaesthesia. 1999;54:389-392.

Habib A, Anderson S, Francis S. Buscopan for the treatment of pain after laparoscopic sterilisation. Anaesthesia. 2001;56:174-176.

Edwards ND, Barclay K, Catling SJ. Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac. Anaesthesia. 1991;46:1077-1080.

Davis A, Millar JM. Postoperative pain: a comparison of laparoscopic sterilisation and diagnostic laparoscopy. Anaesthesia. 1988;43:796-797.

Chi IC, Cole LP. Incidence of pain among women undergoing laparoscopic sterilization by electrocoagulation, the spring-loaded clip, and the tubal ring. Am J Obstet Gynecol. 1979;135:397-401.

Lawson S, Cole RA, Templeton AA. The effect of laparoscopic sterilisation by diathermy or silastic bands on post-operative pain, menstrual symptoms and sexuality. Br J Obstet Gynaecol. 1979;86:659-663.

Smith BE, MacPherson GH, de Jonge M. Rectus sheath and mesosalpinx block for laparoscopic sterilization. Anaesthesia. 1991;46:875-877.

Guard BC, Wiltshire SJ. The effect of glycopyrrolate on postoperative pain and analgesic requirements following laparoscopic sterilisation. Anaesthesia. 1996;51:1173-1175.

Hupscher DN, Dommerholt O. Action and side effects of small doses of buscopan in gastroduodenal radiography: A prospective study in 300 patients. Diagn Imaging Clin Med. 1984;53:77-86.

Finnerup NB, Sindrup SH, Jensen TS. Anticonvulsant analgesics in peripheral and central neuropathic pain. Pain Med Pal Care. 2004;3:42-52.

Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77:362-379.

Likar R, Krumpholz R, Pipam W. Randomized, double-blind study with ketoprofen in gynecologic patients. Preemptive analgesia study following the Brevik-Stubhaug design. Anaesthesist. 1998;47:303-310.

Likar R, Krumpholz R, Mathiaschitz K. The preemptive action of ketoprofen: Randomized, double-blind study with gynecologic operations. Anaesthesist. ;46:186-190.

Wnek W, Zajaczkowska R, Wordliczek J. Influence of pre-operative ketoprofen administration (preemptive analgesia) on analgesic requirement and the level of prostaglandins in the early postoperative period. Pol J Pharmacol. 2004;56:547-552.

Wu C, Yu J, Yeh C. Preincisional dextromethorphan treatment decreases postoperative pain and opioid requirement after laparoscopic cholecystectomy. Anesth Analg. 1999;88:1331-1334.

Helmy SA, Bali A. The effect of the preemptive use of the NMDA receptor antagonist dextromethorphan on postoperative analgesic requirements. Anesth Analg. 2001;92:739-744.

Fu ES, Miguel R, Scharf JE. Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anesth Analg. 1997;84:1086-1090.

Suto Y, Yamaguchi H, Sato S. Preoperative Ketamine augments postoperative pain relief by epidural morphine in patients undergoing gynecological surgeries. Anesth Analg. 1998;86(2^sSuppl):319S.

Birch PJ, Grossman CJ, Hayes AG. Kynurenic acid antagonises responses to NMDA via an action at the strychnine-insensitive glycine receptor. Eur J Pharmacol. 1988;154:85-87.

McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994;47(5^sSuppl):28-47.

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