Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000400002
Brazilian Journal of Anesthesiology
Scientific Article

Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25) para analgesia pós-operatória em colecistectomias videolaparoscópicas

Intraperitoneal administration of 50% enantiomeric excess (S75-R25) bupivacaine in postoperative analgesia of laparoscopic cholecystectomy

João Batista Santos Garcia; Antônio M. Alencar Júnior; Carlos Eduardo Claro dos Santos

http://dx.doi.org/10.1590/S0034-70942007000400002 Braz J Anesthesiol, vol.57, n4, p.344-355, 2007
PDF Português
PDF English
Downloads: 0
Views: 966

Resumo

JUSTIFICATIVA E OBJETIVOS: O efeito analgésico de infusões intraperitoneais de anestésicos locais após colecistectomia videolaparoscópica é controverso e os resultados descritos vão de alívio considerável à pequena redução da dor. O objetivo deste estudo foi avaliar a eficácia da administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25) para o alívio da dor no pós-operatório de colecistectomia videolaparoscópica. MÉTODO: Estudo aleatório, placebo-controlado e duplamente encoberto com 40 pacientes submetidos à colecistectomia videolaparoscópica divididos em dois grupos: GI (n = 20) que recebeu 80 mL de solução de bupivacaína S75-R25 a 0,125% intraperitoneal no fim da operação; GII (n = 20) que recebeu 80 mL de solução fisiológica a 0,9%. Ambos os grupos receberam 40 mg de tenoxicam e 30 mg.kg-1 de dipirona, por via venosa, pouco antes do fim da operação. A analgesia no pós-operatório (PO) foi feita com tramadol. Foram avaliados os escores de dor em repouso, ao sentar e à manobra de Valsalva, segundo a escala numérica ao despertar e 2, 4, 8, 12 e 24 horas no PO; a presença de dor no ombro; o tempo para a primeira solicitação do analgésico; e o seu consumo cumulativo. RESULTADOS: Houve diferença estatística significativa entre os escores de dor às 12 horas no PO com o paciente em repouso (GI < GII). O tempo da primeira solicitação de tramadol foi maior no GI e o seu consumo menor neste grupo, porém essas diferenças não foram significativas. CONCLUSÕES: A instilação intraperitoneal de 80 mL de bupivacaína S75-R25 a 0,125% proporcionou baixos escores de dor em repouso de forma significativa somente às 12 horas de PO de colecistectomia videolaparoscópica.

Palavras-chave

ANALGESIA, ANESTÉSICOS, Local, TÉCNICA ANALGÉSICA, CIRURGIA, Abdominal

Abstract

BACKGROUND AND OBJECTIVES: The analgesic effect of intraperitoneal administration of local anesthetics after laparoscopic cholecystectomy is a controversial issue, and the results described vary from considerable pain relief to little reduction in pain. The objective of this study was to evaluate the efficacy of the intraperitoneal administration of 50% enantiomeric excess bupivacaine (S75-R25) for the postoperative pain relief of laparoscopic cholecystectomy. METHODS: A randomized, double blind, placebo controlled study was conducted with 40 patients undergoing laparoscopic cholecystectomy, who were divided in two groups: GI (n = 20) received 80 mL of intraperitoneal 0,125% S75-R25 bupivacaine at the end of the procedure; and GII (n = 20) received 80 mL of intraperitoneal normal saline. Both groups received 40 mg of tenoxicam and 30 mg.kg-1 of intravenous dypirone shortly before the end of the surgery. Tramadol was used for postoperative analgesia (PO). Pain scores were evaluated at rest, sitting up, and during the Valsalva maneuver, according to a numeric scale upon waking up and 2, 4, 8, 12, and 24 hours postoperatively; the presence of shoulder pain was assessed, as well as the length of time until the first request of analgesic and its cumulative consumption. RESULTS: There was a statistically significant difference in resting pain scores at 12 hours PO (GI < GII). The length of time until the first request of tramadol was greater in GI and this group presented smaller consumption of this drug, but these differences were not statistically significant. CONCLUSIONS: The intraperitoneal instillation of 80 mL of 0.125% S75-R25 bupivacaine provided for lower resting pain scores, which was statistically significant only at the 12th postoperative hour.

Keywords

ANALGESIA, ANESTHETICS, Local, ANALGESIC TECHNIQUE, SURGERY, Abdominal

References

Widdison AL. Systematic review of the effectiveness and safety of laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1996;78.

Labaille T, Mazoit JX, Paqueron X. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg. 2002;94:100-105.

Ure BM, Troidl H, Spangenberger W. Pain after laparoscopic cholecystectomy: Intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events. Surg Endosc. 1994;8:90-96.

Zmora O, Stolik-Dollberg O, Bar-Zakai B. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. J Soc Laparosc Surg. 2000:301-304.

Elfberg BA, Sjovall-Mjoberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc Percutan Tech. 2000;10:357-359.

McLeod GA, Burke D. Levobupivacaine. Anaesthesia. 2001;56:331-341.

Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551-579.

Simonetti MPB, Ferreira FMC. Does the D-isomer of bupivacaine contribute to the improvement of efficacy in neural block?. Reg Anesth and Pain Med. 1999;24(^ssuppl).

Macedo EP, Ferrari Jr AP. Litíase Biliar. Atualização Terapêutica 2003. 2003:477-479.

Ng A, Smith G. Intraperitoneal administration of analgesia: is this practice of any utility?. Br J Anaesth. 2002;89:535-537.

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

Moiniche S, Jorgensen H, Wetterslev J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90:899-912.

Elhakim M, Amine H, Kamel S. Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxican on pain relief and bowel recovery after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2000;44:929-933.

Schulte-Steinberg H, Weninger E, Jokisch D. Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology. 1995;82:634-640.

Gonçalves RF, Lauretti GR, Mattos AL. Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural. Rev Bras Anestesiol. 2003;53:169-176.

Tanaka PP, Souza RO, Salvalaggio MFO. Estudo comparativo entre a bupivacaína a 0,5% e a mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural em pacientes submetidos a cirurgia ortopédica de membros inferiores. Rev Bras Anestesiol. 2003;53:331-337.

Cortês CAF, Oliveira AS, Castro LFL. Estudo comparativo entre a bupivacaína a 0,5%, mistura enantiomérica de bupivacaína S75-R25 a 0,5% e ropivacaína a 0,75%, associadas ao fentanil em anestesia peridural para cesarianas. Rev Bras Anestesiol. 2003;53:177-187.

Buck L, Varras MN, Miskry T. Intraperitoneal bupivacaine for the reduction of postoperative pain following operative laparoscopy: a pilot study and review of the literature. J Obstet Gynaecol. 2004;24:448-451.

Mraovi B, Jurisi T, Kogler-Majeric V. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 1997;41:193-196.

Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc. 1996;10:44-48.

Lepner U, Goroshina J, Samarutel J. Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. Scand J Surg. 2003;92:121-124.

Jiranantarat V, Rushatamukayanunt W, Lert-akyamanee N. Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy. J Med Assoc Thai. 2002;85(^ssuppl):897-s903.

Elhakim M, Elkott M, Ali NM. Intraperitoneal lidocaine for postoperative pain after aparoscopy. Acta Anaesthesiol Scand. 2000;44:280-284.

Inan A, Sen M, Dener C. Local anesthesia use for laparoscopic cholecystectomy. World J Surg. 2004;28:741-744.

Fuhrer Y, Charpentier C, Boulanger G. Analgesie pres cholecystectomie par voie coelioscopique par administration intraperitoneale de bupivacaine. Ann Fr Anesth Reanim. 1996;15:128-134.

Hernandez-Palazon J, Tortosa JA, Nuno de la Rosa V. Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Eur J Anaesthesiol. 2003;20:891-896.

Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979;51:285-287.

Huang YF, Pryor ME, Mather LE. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg. 1998;86:797-804.

Bardsley H, Gristwood R, Baker H. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol. 1998;46:245-249.

5dd821c20e8825840313f28b 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