Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000400003
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia controlada pelo paciente reduz consumo de bupivacaína no bloqueio femoral no tratamento da dor pós-operatória após reconstrução do ligamento cruzado anterior do joelho

Patient controlled analgesia reduces the consumption of bupivacaine in femoral nerve block for the treatment of postoperative pain after reconstruction of anterior cruciate ligament of the knee

Victor A. Contreras-Domínguez; Paulina E. Carbonell-Bellolio; Álvaro C. Ojeda-Greciet; Edgardo S. Sanzana

http://dx.doi.org/10.1590/S0034-70942007000400003 Braz J Anesthesiol, vol.57, n4, p.356-365, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (BFC) é utilizado na analgesia pós-operatória das substituições articulares de quadril e joelho com bom resultado. O objetivo deste estudo foi avaliar a utilidade do BFC, comparando três esquemas de administração de bupivacaína após reconstrução do ligamento cruzado anterior (LCA) do joelho por artroscopia. MÉTODO: Estudo prospectivo controlado de 90 pacientes estado físico ASA I e II. Os pacientes foram divididos em três grupos: Grupo 1 (n = 30): 10 mL.h-1 em infusão contínua (IC) de bupivacaína 0,125% + clonidina 1µg.mL-1 (B + C); Grupo 2 (n = 30): 5 mL.h-1 em IC + 2,5 mL de B + C em PCA a cada 30 min; Grupo 3 (n = 30): 5 mL.h-1 de B + C em PCA cada 30 min. A anestesia foi por via subaracnóidea. A dor pós-operatório foi registrada às 2, 4, 6, 24 e 48 horas após a operação avaliada pela Escala Analógica Visual (VAS). Anotou-se também consumo de bupivacaína e morfina. RESULTADOS: Não foram registradas diferenças nas variáveis demográficas entre ambos os grupos. O VAS pós-operatório entre 2 e 48 horas não mostrou diferenças. O consumo de morfina entre 4 e 48 horas foi similar nos três grupos (p = 0,07). No grupo em que só foi utilizado o modo PCA, o consumo de bupivacaína foi significativamente menor (p < 0,001). CONCLUSÕES: O bloqueio femoral contínuo foi uma técnica útil para o manuseio da dor pós-operatória na reconstrução de LCA do joelho. Um débito de apenas 5 mL.h-1 em IC ou em bolos PCA assegurou uma excelente analgesia pós-operatória.

Palavras-chave

ANALGESIA, Pós-operatória, ANESTÉSICOS, Local, CIRURGIA, Ortopédica

Abstract

BACKGROUND AND OBJECTIVES: Continuous femoral nerve block (CFNB) is used in postoperative analgesia of hip and knee replacement surgeries with good results. The objective of this study was to evaluate the usefulness of CFNB, comparing 3 administration schedules of bupivacaine in the arthroscopic anterior cruciate ligament (ACL) repair of the knee. METHODS: A prospective, controlled study with 90 stable patients, physical status ASA I and II was undertaken. Patients were divided in three groups: Group 1 (n = 30): continuous infusion (CI) at a rate of 10 mL.h-1 of 0.125% bupivacaine + clonidine 1 µg.ml-1 (B+C); Group 2 (n = 30): CI at a rate of 5 mL.h-1 + PCA with 2.5 ml of B+C every 30 minutes; Group 3 (n = 30): PCA with 5 mL.h-1 of B+C every 30 minutes. Patients underwent spinal anesthesia. Postoperative pain at 2, 4, 6, 24, and 48 hours, using the Visual Analogue Scale (VAS), and consumption of morphine and bupivacaine were recorded. RESULTS: There were no statistically significant differences regarding the demographic data in both groups. The postoperative VAS between 2 and 48 hours did not show any differences. Morphine consumption between 4 and 48 hours was similar in all 3 groups (p = 0.07). The consumption of bupivacaine was significantly lower in the group that used only PCA (p < 0.001). CONCLUSIONS: Continuous femoral nerve block is a useful technique to manage postoperative pain after ACL repair. A rate of 5 mL.h-1 in CI or PCA boluses assures excellent postoperative analgesia.

Keywords

ANALGESIA, Postoperative, ANESTHETICS, Local, SURGERY, Orthopedic

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