Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942006000500002
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo de midazolam com cetamina S(+) versus midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina

Comparative study of midazolam with ketamine S(+) versus midazolam with uterine paracervical block for manual intrauterine aspiration

Vonaldo Torres de Almeida; Aurélio Molina

http://dx.doi.org/10.1590/S0034-70942006000500002 Braz J Anesthesiol, vol.56, n5, p.443-453, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: Avaliar a efetividade, a analgesia pós-operatória e o grau de satisfação e recomendação das pacientes submetidas à aspiração manual intra-uterina por meio da comparação de duas técnicas anestésicas. MÉTODO: Foram estudadas, prospectivamente, 80 pacientes distribuídas aleatoriamente em dois grupos. Todas receberam midazolam, por via venosa. Em seguida, o Grupo MC recebeu cetamina S(+) por via venosa e o Grupo MP, bloqueio paracervical uterino. Na sala de cirurgia a eficácia da técnica foi avaliada por três observadores (o pesquisador, o obstetra e o residente de obstetrícia) e, após uma hora, foi avaliada por um observador que desconhecia a técnica realizada, a analgesia pós-operatória, os graus de satisfação de recomendação da paciente mediante escala verbal. RESULTADOS: As técnicas mostraram-se eficientes em 95% das pacientes do Grupo MC e 76,7% das pacientes do Grupo MP (p = 0,04). Entre as pacientes do Grupo MC, 67% não apresentaram dor após uma hora, enquanto no grupo MP a porcentagem de pacientes sem dor foi de 33,3% (p < 0,01 e um risco relativo = 2). Ambos os grupos tiveram 90% de satisfação e de recomendação da técnica. CONCLUSÕES: Neste estudo concluiu-se que a anestesia com midazolam e cetamina S(+) foi superior à associação de midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina, tanto com relação à eficácia quanto à analgesia pós-operatória, sob o ponto de vista dos observadores. Na opinião das pacientes o índice de satisfação foi alto com as duas técnicas.

Palavras-chave

ANALGÉSICOS, CIRURGIA, Ginecológica, HIPNÓTICOS, Benzodiazepínicos, TÉCNICAS ANESTÉSICAS, Regional, ANALGESICS, ANESTHETIC TECHNIQUES, Regional, HYPNOTICS, Benzodiazepines, SURGERY, Gynecologic

Abstract

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy, postoperative analgesia, the degree of satisfaction of the patients submitted to manual intrauterine aspiration, and whether the patient would recommend the technique, by comparing two anesthetic techniques. METHODS: A prospective study was done with 80 patients divided, randomized, in two groups. All of them received IV midazolam. Afterwards, the MC Group received IV Ketamaine S(+) and the MP Group underwent paracervical uterine block. In the operating room, the efficacy of the technique was evaluated by 3 observers (the researcher, the obstetrician, and the obstetrics resident) and, after one hour, an observer, who did not know which technique had been used, evaluated the postoperative analgesia, and the degree of satisfaction and whether or not the patient would recommend the technique, using a verbal scale. RESULTS: The techniques were effective in 95% of the patients in the MC group and 76.7% of the patients in the MP group (p = 0.04). Among the patients in the MC group, 67% did not experience pain after 1 hour, while in the MP group the percentage of pain free patients was 33.3% (p < 0.01, and a relative risk = 2). Both groups had a 90% satisfaction rate and 90% would recommend the technique. CONCLUSIONS: We concluded that anesthesia with midazolam and ketamine S(+) was better than the association of midazolam with uterine paracervical block for manual intrauterine aspiration, regarding both efficacy and postoperative analgesia. The index of satisfaction was very high for both techniques.

References

de Poncheville L, Marret H, Perrotin F. Spontaneous abortions of first trimester pregnancy: is uterine aspiration still in line?. Gynecol Obstet Fertil. 2002;30:799-806.

Hemlin J, Moller B. Manual vacuum aspiration, a safe and effective alternative in early pregnancy termination. Acta Obstet Gynecol Scand. 2001;80:563-567.

Yord L, Leonard AH, Winkler J. Guia de Aspiração Manual Intra-uterina para Médicos. 1994.

Deng XM, Xiao WJ, Luo MP. The use of midazolam and small-dose ketamine for sedation and analgesia during local anesthesia. Anesth Analg. 2001;93:1174-1177.

Gruber RP, Morley B. Ketamine-assisted intravenous sedation with midazolam: benefits and potential problems. Plast Reconstr Surg. 1999;104:1823-1827.

Adams HA, Werner C. From the racemate to the eutomer: (S)-ketamine. Renaissance of a substance?. Anaesthesist. 1997;46:1026-1042.

Mathisen LC, Skjelbred P, Skoglund LA. Effect of ketamine, an NMDA receptor inhibitor, in acute and chronic orofacial pain. Pain. 1995;61:215-220.

Ferreira AA. Anestésicos Locais. Anestesia Ambulatorial. 2001:163-182.

Egziabher TG, Ruminjo JK, Sekadde-kigondu C. Pain relief using paracervical block in patients undergoing manual vacuum aspiration of uterus. East Afr Med J. 2002;79:530-534.

Donati S, Medda E, Proietti S. Reducing pain of first trimester abortion under local anaesthesia. Eur J Obstet Gynecol Reprod Biol. 1996;70:145-149.

de Benedittis G, Massei R, Nobili R, Pieri A. The Italian Pain Questionnaire. Pain. 1988;33:53-62.

Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia. 2001.

Marco AP, Greenwald MK, Higgins MS. A preliminary study of 24-hour post-cesarean patient controlled analgesia: postoperative pain reports and morphine requests/utilization are greater in abstaining smokers than non-smokers. Med Sci Monit. 2005;11:CR255-CR261.

Santos EC, Condeco G. Avaliação do grau de satisfação dos doadores de sangue do Hospital Distrital de Chaves. 2002:11.

Gomez PI, Gaitan H, Nova C. Paracervical block in incomplete abortion using manual vacuum aspiration: randomized clinical trial. Obstet Gynecol. 2004;103:943-951.

Gilger MA, Spearman RS, Dietrich CL. Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy. Gastrointest Endosc. 2004;59:659-663.

Elia N, Tramer MR. Ketamine and postoperative pain - a quantitative systematic review of randomized trials. Pain. 2005;113:61-70.

Strigo IA, Duncan GH, Bushnell MC. The effects of racemic ketamine on painful stimulation of skin and viscera in human subjects. Pain. 2005;113:255-264.

Clements JA, Nimmo WS. Pharmacokinetics and analgesic effect of ketamine in man. Br J Anaesth. 1981;53:27-30.

Idvall J, Ahlgren i, Aronsen KR. Ketamine infusions: pharmacokinetics and clinical effects. Br J Anaesth. 1979;51:1167-1173.

Koinig H, Marhofer P, Krenn CG. Analgesics effects of caudal and intramuscular S(+)-ketamine in children. Anesthesiology. 2000;93:976-980.

Kienbaum P, Heuter T, Pavlakovic G. S (+)-ketamine increases muscle sympathetic activity and maintains the neural response to hypotensive challenges in humans. Anesthesiology. 2001;94:252-258.

Pocock SJ. Clinical Trials: A Practical Approach. 1990.

Godambe SA, Elliot V, Matheny D. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics. 2003;112:116-123.

Seigler RS, Avant MG, Gwyn DR. A comparison of propofol and ketamine/midazolam for intravenous sedation of children. Pediatr Crit Care Med. 2001;2:20-23.

Chudnofsky CR, Weber JE, Stoyanoff PJ. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients. Acad Emerg Med. 2000;7:228-235.

Hustveit O, Maurset A, Oye I. Interaction of the chiral forms of ketamine with opioid, phencyclidine, sigma and muscarinic receptors. Pharmacol Toxicol. 1995;77:355-359.

Finck AD, Ngai SH. Opiate receptor mediation of ketamine analgesia. Anesthesiology. 1982;56:291-297.

Aida S, Baba H, Yamakura T. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesth Analg. 1999;89:711-716.

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