Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000400004
Brazilian Journal of Anesthesiology
Artigo Científico

Influência da morfina peridural na função pulmonar de pacientes submetidos à colecistectomia aberta

The influence of epidural morphine in the pulmonary function of patients undergoing open cholecystectomy

Gilson Cassem Ramos; Edísio Pereira; Salustiano Gabriel Neto; Ênio Chaves de Oliveira; Roberto Helôu Rassi; Sílvio Pinheiro de Lemos Neto

http://dx.doi.org/10.1590/S0034-70942007000400004 Braz J Anesthesiol, vol.57, n4, p.366-381, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: Operações de abdome superior podem causar, no pós-operatório, disfunções ventilatórias. O objetivo do presente estudo foi avaliar a função pulmonar após colecistectomias laparoscópicas e abertas, com e sem morfina peridural. MÉTODO: Em estudo do tipo ensaio clínico duplamente encoberto e aleatório, 45 pacientes foram distribuídas em três grupos, GL, GA e GAM, de 15 componentes submetidas a colecistectomias. O grupo GL foi operado pela via laparoscópica; enquanto GA e GAM, pela via aberta, sendo que este último recebeu morfina peridural. As pacientes realizaram espirometrias e gasometrias no pré- e no pós-operatório. A hipótese de igualdade de médias entre os grupos foi verificada utilizando-se a ANOVA. Quando os resultados apresentaram diferença estatística significativa, realizava-se o teste de Tukey. A hipótese de igualdade de médias entre um mesmo grupo foi verificada por meio do teste t de Student emparelhado. O valor de p < 0,05 foi considerado significativo. RESULTADOS: As variáveis espirométricas no pré- e no pós-operatório imediato: a) para capacidade vital forçada (CVF) GL versus GA (p = 0.000) e GL versus GAM (p = 0.000); para redução percentual da CVF GA versus GAM (p = 0,001); b) mesmos grupos entre si: GL para CVF (p = 0,020) e volume expiratório forçado em 1 segundo (VEF1) (p = 0,022); GA para CVF (p < 0,001) e VEF1 (p < 0,001); e GAM para CVF (p = 0,007) e VEF1 (p = 0,001). A pressão arterial de oxigênio (PaO2) reduziu em todos os grupos. CONCLUSÕES: Pode-se concluir que as menores disfunções ventilatórias ocorreram nas pacientes operadas pela via laparoscópica e que a morfina peridural reverteu, parcialmente, o distúrbio ventilatório pós-operatório de colecistectomia aberta.

Palavras-chave

ANALGESIA, Pós-operatória, CIRURGIA, Abdominal, COMPLICAÇÕES, Pós-operatória

Abstract

BACKGROUND AND OBJECTIVES: Upper abdominal surgeries may cause postoperative respiratory dysfunction. The objective of this study was to evaluate the pulmonary function after laparoscopic and open cholecystectomies, with and without epidural morphine. METHODS: In this randomized, double-blind clinical trial, 45 patients undergoing cholecystectomies were divided in three groups: GL, GA, and GAM, composed of 15 patients each. The GL group underwent laparoscopic surgery, while GA and GAM underwent open cholecystectomy, but the former received epidural morphine. Pre- and postoperative spirometry and arterial blood gases were performed. ANOVA was used to verify the hypothesis of equality of the means among the groups. When results were statistically significant, the Tukey test was performed. Paired test t Student was used to verify the hypothesis of equality within a group. A p < 0.05 was considered significant. RESULTS: The pre and immediately postoperative spirometry results were used to determine: a) forced vital capacity (FVC) in GL versus GA (p = 0.000) and GL versus GAM (p = 0.000); percentage of the reduction of FVC in GA versus GAM (p = 0.001); b) within each group: in GL, FVC (p = 0.020) and forced expiratory volume in 1 second (FEV1) (p = 0.022); in GA, FVC (p < 0.001) and FEV1 (p < 0.001); and in GAM, FVC (p = 0.007) and FEV1 (p = 0.001). The arterial oxygen pressure (PaO2) was reduced in all three groups. CONCLUSIONS: One can conclude that respiratory dysfunction was less severe in patients operated by laparoscopy and that epidural morphine reversed, partially, the postoperative ventilatory disturbances of open cholecystectomy.

Keywords

ANALGESIA, Postoperative, COMPLICATIONS, postoperative, SURGERY, Abdominal

Referências

Aboussouan LS, Stoller JK. Perioperative Pulmonary Care. Homma I Rehabilitation of Patient with Respiratory Disease. 1999:561-575.

Pecora DV. Predictability of effects of abdominal and thoracic surgery upon pulmonary function. Ann Surg. 1969;170:101-108.

Fairshter RD, Williams JH Jr. Pulmonary physiology in the postoperative period. Crit Care Clin. 1987;3:287-306.

Marshall BE, Wyche MQ Jr. Hypoxemia during and after anesthesia. Anesthesiology. 1972;37:178-209.

Dureuil B, Cantineau JP, Desmonts JM. Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth. 1987;59:1230-1235.

Kostreva DR, Hopp FA, Zuperku EJ. Respiratory inhibition with sympathetic afferent stimulation in the canine and primate. J Appl Physiol. 1978;44:718-724.

Prabhakar NR, Marek W, Loeschcke HH. Altered breathing pattern elicited by stimulation of abdominal visceral afferents. J Appl Physiol. 1985;58:1755-1760.

Ali J, Weisel RD, Layug AB. Consequences of postoperative alterations in respiratory mechanics. Am J Surg. 1974;128:376-382.

Schauer PR, Luna J, Ghiatas AA. Pulmonary function after laparoscopic cholecystectomy. Surgery. 1993;114:389-399.

Buttner J, Klose R. Alkalinization of mepivacaine for axillary plexus anesthesia using a catheter. Reg Anaesth. 1991;14:17-24.

I Consenso Brasileiro sobre Espirometria. J Pneumol. 1996;22:-128.

Thomas HM, Garrett RC. Interpretation of spirometry: A graphic and computational approach. Chest. 1984;86:129-131.

I Consenso Brasileiro sobre Espirometria. J Pneumol. 1996;22:145-146.

Mahul P, Burgard G, Costes F. Fonction respiratoire postopertative et cholecystectomie par voie coelioscopique. Ann Fr Anesth Reanim. 1993;12:273-277.

Hasuki S, Mesic D, Dizdarevi E. Pulmonary function after laparoscopic and open cholecystectomy. Surg Endosc. 2002;16:163-165.

Barnett RB, Clement GS, Drizin GS. Pulmonary changes after laparoscopic cholecystectomy. Surg Laparosc Endosc. 1992;2:125-127.

Simonneau G, Vivien A, Sartene R. Diaphragm dysfunction induced by upper abdominal surgery: Role of postoperative pain. Am Rev Respir Dis. 1983;128:899-903.

Sprung J, Cheng EY, Nimphius N. Diaphragm dysfunction and respiratory insufficiency after upper abdominal surgery. Plucne Bolesti. 1991;43:5-12.

Erice F, Fox GS, Salib YM. Diaphragmatic function before and after laparoscopic cholecystectomy. Anesthesiology. 1993;79:966-975.

Joris J, Kaba A, Lamy M. Postoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures. Br J Anaesth. 1997;79:422-426.

Dureuil B, Viires N, Cantineau JP. Diaphragmatic contractility after upper abdominal surgery. J Appl Physiol. 1986;61:1775 -1780.

de La Pena M, Togores B, Bosch M. Recuperación de la function pulmonar trás colecistectomia laparoscopica: papel de l dolor postoperatorio. Arch Bronconeumol. 2002;38:72-76.

Egbert LD, Laver MB. The effect of site of operation and type of anesthesia upon the ability to cough in the postoperative period. Surg Gynecol Obstet. 1962;115:-298.

Wong DH, Weber EC, Schell MJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 1995;80:276-284.

Ravimohan SM, Kaman L, Jindal R. Postoperative pulmonary function in laparoscopic versus open cholecystectomy: prospective, comparative study. Indian J Gastroenterol. 2005;24:6-8.

Frazee RC, Roberts JW, Okenson GC. Open versus laparoscopic cholecystectomy: A comparison of postoperative pulmonary function. Ann Surg. 1991;213:651-653.

Simpson T, Wahl G, DeTraglia M. A pilot study of pain, analgesia use, and pulmonary function after colectomy with or without a preoperative bolus of epidural morphine. Heart Lung. 1993;22:316-327.

Guyton AC. Ventilação Pulmonar. Tratado de Fisiologia Médica. 1986.

Kroenke K, Lawrence VA, Theroux JF. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med. 1992;152:967-971.

Latimer RG, Dickman M, Day WC. Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis. Am J Surg. 1971;122:622-632.

Knudsen J. Duration of hypoxaemia after uncomplicated upper abdominal and thoraco-abdominal operations. Anaesthesia. 1970;25:372-377.

Alexander JI, Horton PW, Millar WT. Lung volume changes in relation to airway closure in the postoperative period: a possible mechanism of postoperative hypoxaemia. Br J Anaesth. 1971;43:1196-1197.

Lindberg P, Gunnarsson L, Tokics L. Atelectasis and lung function in the postoperative period. Acta Anaesthesiol Scand. 1992;36:546-553.

Eriksen J, Andersen J, Rasmussen JP. Postoperative pulmonary function in obese patients after upper abdominal surgery. Acta Anaesthesiol Scand. 1977;21:336-341.

Meyers JR, Lembeck L, O'Kane H. Changes in functional residual capacity of the lung after operation. Arch Surg. 1975;110:576-583.

Tarhan S, Moffitt EA, Sessler AD. Risk of anesthesia and surgery in patients with chronic bronchitis and chronic obstructive pulmonary disease. Surgery. 1973;74:720-726.

Gardner E. Fígado, Vias Biliares, Pâncreas e Baço. Anatomia. 1985.

Mimica Z, Biocic M, Bacic A. Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function. Respiration. 2000;67:153-158.

Rosen MA, Hughes SC, Shnider SM. Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg. 1983;62:666-672.

Eriksson-Mjoberg M, Svensson JO, Almkvist O. Extradural morphine gives better pain relief than patient-controlled i.v. morphine after hysterectomy. Br J Anaesth. 1997;78:10-16.

Nguyen NT, Lee SL, Goldman C. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Coll Surg. 2001;192:469-476.

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