Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5%

Leonardo Teixeira Domingues Duarte; Franklin Cespedes Paes; Maria do Carmo Barreto C. Fernandes; Renato Ângelo Saraiva

doi:10.1590/S0034-70942009000300002

Scientific Article

Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5%

Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

Leonardo Teixeira Domingues Duarte; Franklin Cespedes Paes; Maria do Carmo Barreto C. Fernandes; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942009000300002 Braz J Anesthesiol, vol.59, n3, p.273-285, 2009

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JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pela via posterior promove analgesia pós-operatória efetiva na artroplastia total do quadril. Ropivacaína e bupivacaína não apresentaram qualquer diferença na eficácia analgésica em diferentes bloqueios de nervos periféricos. O objetivo deste estudo foi comparar a eficácia da analgesia pós-operatória resultante da administração em dose única da bupivacaína a 0,5% ou da ropivacaína a 0,5% no bloqueio do plexo lombar pela via posterior na artroplastia total do quadril. MÉTODO: Trinta e sete pacientes foram alocados aleatoriamente em dois grupos, segundo o anestésico local utilizado no bloqueio: Grupo B - bupivacaína a 0,5% com epinefrina 1:200.000 ou Grupo R - ropivacaína a 0,5%. Durante o período pós-operatório, os escores de dor e o consumo de morfina na analgesia controlada pelo paciente foram comparados entre os grupos. O sangramento durante a operação e a incidência de efeitos adversos e de complicações também foram comparados. RESULTADOS: Apesar dos escores de dor terem sido menores no Grupo R 8, 12 e 24 horas após o bloqueio, essas diferenças não foram clinicamente significativas. Regressão linear múltipla não identificou o anestésico local como variável independente. Não houve diferença no consumo de morfina, no sangramento intraoperatório e na incidência de complicações e efeitos adversos entre os dois grupos. CONCLUSÕES: A bupivacaína a 0,5% e a ropivacaína a 0,5% produziram alívio eficaz e prolongado da dor pós-operatória após artroplastia total do quadril, sem diferença clínica, quando doses equivalentes foram administradas no bloqueio do plexo lombar pela via posterior.

Palavras-chave

ANALGESIA, Pós-operatória, ANESTÉSICOS, Local, ANESTÉSICOS, Local, CIRURGIA, Ortopédica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in posterior lumbar plexus block for total hip arthroplasty. METHODS: Thirty-seven patients were randomly divided in two groups according to the local anesthetic used: Group B - 0.5% bupivacaine with 1:200,000 epinephrine; or group R - 0.5% ropivacaine. During the postoperative period, pain scores and morphine consumption in patient controlled analgesia were compared between groups. Bleeding during surgery and the incidence of side effects and complications were also compared. RESULTS: Although pain scores were lower in Group R 8 hours, 12 hours, and 24 hours after the blockade, these differences were not clinically significant. Multiple linear regression identified the local anesthetic as an independent variable. Differences in morphine consumption, intraoperative bleeding, and the incidence of complications and side effects were not observed between both groups. CONCLUSIONS: 0.5% Bupivacaine and 0.5% ropivacaine produced effective and prolonged postoperative pain relief after total hip arthroplasty, without clinical differences, when equivalent doses were administered for posterior lumbar plexus block.

Keywords

ANALGESIA, Postoperative, ANESTHETICS, Local, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, SURGERY, Orthopedic

Referências

Fischer HB, Simanski CJ. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia. 2005;60:1189-1202.

Singelyn FJ, Ferrant T, Malisse MF. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Reg Anesth Pain Med. 2005;30:452-457.

Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921-1928.

Lattermann R, Belohlavek G, Wittmann S. The anticatabolic effect of neuraxial blockade after hip surgery. Anesth Analg. 2005;101:1202-1208.

Kampe S, Randebrock G, Kiencke P. Comparison of continuous epidural infusion of ropivacaine and sufentanil with intravenous patient-controlled analgesia after total hip replacement. Anaesthesia. 2001;56:1189-1193.

Souron V, Delaunay L, Schifrine P. Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty. Can J Anaesth. 2003;50:574-579.

Kampe S, Weigand C, Kaufmann J. Postoperative analgesia with no motor block by continuous epidural infusion of ropivacaine 0.1% and sufentanil after total hip replacement. Anesth Analg. 1999;89:395-398.

Capdevila X, Macaire P, Dadure C. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606-1613.

Stevens RD, Van Gessel E, Flory N. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology. 2000;93:115-121.

Biboulet P, Morau D, Aubas P. Postoperative analgesia after total-hip arthroplasty: comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block, a prospective, randomized, double-blind study. Reg Anesth Pain Med. 2004;29:102-109.

Mannion S, O'Callaghan S, Walsh M. In with the new, out with the old?: Comparison of two approaches for psoas compartment block. Anesth Analg. 2005;101:259-264.

Aya AG, de la Coussaye JE, Robert E. Comparison of the effects of racemic bupivacaine, levobupivacaine, and ropivacaine on ventricular conduction, refractoriness, and wavelength: an epicardial mapping study. Anesthesiology. 2002;96:641-650.

Knudsen K, Beckman Suurkula M, Blomberg S. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-514.

Wienzek H, Freise H, Giesler I. Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine. Reg Anesth Pain Med. 2007;32:233-239.

Polley LS, Columb MO, Naughton NN. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology. 1999;90:944-950.

Casati A, Putzu M. Bupivacaine, levobupivacaine and ropivacaine: are they clinically different?. Best Pract Res Clin Anaesthesiol. 2005;19:247-268.

Klein SM, Greengrass RA, Steele SM. A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg. 1998;87:1316-1319.

Greengrass RA, Klein SM, D'Ercole FJ. Lumbar plexus and sciatic nerve block for knee arthroplasty: comparison of ropivacaine and bupivacaine. Can J Anaesth. 1998;45:1094-1096.

Casati A, Fanelli G, Magistris L. Minimum local anesthetic volume blocking the femoral nerve in 50% of cases: a double-blinded comparison between 0.5% ropivacaine and 0.5% bupivacaine. Anesth Analg. 2001;92:205-208.

Connolly C, Coventry DM, Wildsmith JA. Double-blind comparison of ropivacaine 7.5 mg ml-1 with bupivacaine 5 mg ml-1 for sciatic nerve block. Br J Anaesth. 2001;86:674-677.

Ng HP, Cheong KF, Lim A. Intraoperative single-shot "3-in-1" femoral nerve block with ropivacaine 0.25%, ropivacaine 0.5% or bupivacaine 0.25% provides comparable 48-hr analgesia after unilateral total knee replacement. Can J Anaesth. 2001;48:1102-1108.

McNamee DA, Convery PN, Milligan KR. Total knee replacement: a comparison of ropivacaine and bupivacaine in combined femoral and sciatic block. Acta Anaesthesiol Scand. 2001;45:477-481.

Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18:205-207.

Duarte LTD, Saraiva RA. Raquianestesia total após bloqueio do plexo lombar por via posterior: Relato de caso. Rev Bras Anestesiol. 2006;56:518-523.

De Biasi P, Lupescu R, Burgun G. Continuous lumbar plexus block: use of radiography to determine catheter tip location. Reg Anesth Pain Med. 2003;28:135-139.

Bogdanov A, Loveland R. Is there a place for interscalene block performed after induction of general anaesthesia?. Eur J Anaesthesiol. 2005;22:107-110.

Candido KD, Sukhani R, Doty Jr R. Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and clinical course. Anesth Analg. 2005;100:1489-1495.

Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5%

Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

Leonardo Teixeira Domingues Duarte; Franklin Cespedes Paes; Maria do Carmo Barreto C. Fernandes; Renato Ângelo Saraiva

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