Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000400004
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia do emprego da metadona ou da clonidina no intraoperatório para controle da dor pós-operatória imediata após uso de remifentanil

Efficacy of intraoperative methadone and clonidine in pain control in the immediate postoperative period after the use of remifentanil

Ricardo Francisco Simoni; Luiz Marciano Cangiani; Antônio Márcio Sanfim Arantes Pereira; Múcio Paranhos Abreu; Luis Henrique Cangiani; Guilherme Zemi

http://dx.doi.org/10.1590/S0034-70942009000400004 Braz J Anesthesiol, vol.59, n4, p.421-430, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: Por suas características farmacocinéticas, o remifentanil não promove efeito analgésico residual no pós-operatório imediato. O objetivo deste estudo foi comparar a eficácia da metadona e da clonidina no controle da dor pós-operatória de intervenções cirúrgicas videolaparoscópicas sob anestesia venosa total com infusão alvo-controlada de remifentanil. MÉTODO: Participaram deste estudo aleatório, duplamente encoberto e placebo-controlado, 126 pacientes com idade entre 18 e 65 anos, ASA PS 1 e 2 de ambos os sexos, que estavam previamente programados para a realização de intervenções cirúrgicas laparoscópicas. Após venopunção, os pacientes receberam por via venosa cetoprofeno e dipirona. A indução e manutenção da anestesia foram realizadas com infusão alvo-controlada de remifentanil e propofol. Antes do início da operação, os pacientes recebiam por via venosa a solução contendo metadona 0,1 mg.kg-1 (grupo metadona), clonidina 2,0 ¼g.kg-1 (grupo clonidina) ou solução fisiológica a 0,9% (grupo placebo). Na sala de recuperação pós-anestésica, a dor pós-operatória foi avaliada através da escala numérica verbal (ENV). Foi considerado paciente sem dor quando a ENV < 2 e paciente com dor quando > 3. RESULTADOS: A incidência de dor no grupo metadona foi significativamente menor em relação ao grupo clonidina e grupo placebo (11, 21 e 23, respectivamente; p < 0,02). Não houve diferença significativa na incidência de dor entre pacientes do grupo clonidina e placebo. CONCLUSÕES: Em relação ao controle da dor pós-operatória de intervenções cirúrgicas videolaparoscópicas sob anestesia venosa total com uso de remifentanil, o emprego da metadona foi mais eficaz que a clonidina; e usar clonidina não foi melhor que não usar.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, DOR

Abstract

BACKGROUND AND OBJECTIVES: Due to its pharmacokinetic characteristics, remifentanil does not promote residual analgesia in the immediate postoperative period. The objective of this study was to compare the efficacy of methadone and clonidine in the control of postoperative pain of videolaparoscopic surgeries under total intravenous anesthesia with target-controlled remifentanil infusion. METHODS: One hundred and twenty-six patients, ages 18 to 65 years, ASA I and II, of both genders, scheduled for laparoscopic surgeries, participated in this randomized, double- blind, placebo-controlled study. After venipuncture, intravenous ketoprofen and dypirone were administered. Target-controlled infusion of remifentanil and propofol was used for induction and maintenance of anesthesia. Before beginning the procedure, an intravenous solution containing 0.1 mg.kg-1 of methadone (methadone group), 2.0 ¼g.kg-1 of clonidine (clonidine group), or NS (placebo group) was administered. In the post-anesthetic care unit, postoperative pain was evaluated by the Verbal Numeric Scale (VNS). Absence of pain was defined as a score < 2, and pain as a score of > 3. RESULTS: The incidence of pain in the methadone group was significantly lower than in the clonidine and placebo groups (11, 21, and 23, respectively; p < 0.02). Significant differences in the incidence of pain in the placebo and clonidine groups were not observed. CONCLUSIONS: Methadone was more effective than clonidine in the control of postoperative pain in videolaparoscopic surgeries under total intravenous anesthesia with remifentanil; and using clonidine was not better than not using it.

Keywords

ANALGESICS, ANALGESICS, PAIN

References

Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology. 2006;104:835-846.

Fredman B, Jedeikin R, Olsfanger D. Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg. 1994;79:152-154.

Egan TD. Remifentanil pharmacokinetics and pharmacodynamics: A preliminary appraisal. Clin Pharmacokinet. 1995;29:80-94.

Guignard B, Bossard AE, Coste C. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology. 2000;93:409-417.

Hood DD, Curry R, Eisenach JC. Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia. Anesth Analg. 2003;97:810-815.

Angst MS, Koppert W, Pahl I. Shot-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdraw. Pain. 2003;106:49-57.

Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104:570-587.

Vinik HR, Kissin I. Rapid development of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg. 1998;86:1307-1311.

Koppert W, Angst MS, Alsheimer M. Naloxone provokes similar pain facilitation as observed after short-term infusion of remifentanil in humans. Pain. 2003;106:91-99.

Wilder-Smith OHG, Arent-Nielsen L. Postoperative hyperalgesia: its clinical importance and relevance. Anesthesiology. 2006;104:601-607.

Koppert W, Sittl R, Scheuber K. Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. Anesthesiology. 2003;99:152-159.

Guignard B, Coste C, Costes H. Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requeriments. Anesth Analg. 2002;95:103-108.

Joly V, Richebe P, Guignard B. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005;103:147-155.

Toombs JD, Kral LA. Methadone treatment for pain states. Am Fam Physician. 2005;71:1353-1358.

Inturrisi CE. Pharmacology of methadone and its isomers. Minerva Anestesiol. 2005;71:435-437.

Hayashi Y, Maze M. Alpha-2 adrenoreceptor agonists and anaesthesia. Br J Anaesth. 1993;71:108-118.

Alves TCA, Braz JRC, Vianna PTG. Alfa-2 agonistas em Anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. 2000;50:396-404.

Marinangeli F, Ciccozzi A, Donatelli F. Clonidine for treatment of postoperative pain: a dose-finding study. Eur J Pain. 2002;6:35-42.

Altan A, Turgut N, Yildiz F. Effects of magnesium sulphate and clonidine on propofol consumption: haemodynamics and postoperative recovery. Br J Anaesth. 2005;94:438-441.

Tryba M, Gehling M. Clonidine: a potent analgesic adjvant. Curr Opin Anaesthesiol. 2002;15:511-517.

Fehr SB, Zalunardo MP, Seifert B. Clonidine decreases propofol requeriments during anaesthesia: effect on bispectral index. Br J Anaesth. 2001;86:627-632.

Spaulding TC, Fielding S, Lal JJ. Antinociceptive activity of clonidine and its potentiation of morphine analgesia. Eur J Pharmacol. 1979;58:19-25.

Stone LS, MacMillan LB, Kitto KF. The alpha-2a adrenergic receptor subtype mediates spinal analgesia evoked by alpha-2 agonists and is necessary for spinal adrenergic-opioid synergy. J Neurosci. 1997;17:7157-7165.

Bernard JM, Hommeril JL, Passuti N. Postoperative analgesia by intravenous clonidine. Anesthesiology. 1991;75:577-582.

Stocche RM, Garcia LV, Klamt JG. Influência da clonidina por via venosa no custo de anestesia com sevoflurano em cirurgias de ouvido médio em regime ambulatorial. Rev Bras Anestesiol. 2004;54:91-98.

De Kock MF, Pichon G, Scholtes JL. Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia. Can J Anaesth. 1992;39:537-544.

Ong CKS, Lirk P, Seymour RA. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100:757-773.

Troster A, Sittl R, Singler B. Modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by parecoxib in humans. Anesthesiology. 2006;105:1016-1023.

Lenz H, Raeder J, Hoymork SC. Administration of fentanyl before remifentanil-based anaesthesia has no influence on post-operative pain or analgesic consumption. Acta Anaesthesiol Scand. 2008;52:149-154.

Imai Y, Mammoto T, Murakami K. The effects of preanesthetic oral clonidine on total requirement of propofol for general anesthesia. J Clin Anesth. 1998;10:660-665.

Goyagi T, Tanaka M, Nishikawa T. Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia. Can J Anaesth. 1999;46:894-896.

Higuchi H, Adachi Y, Arimura S. Oral clonidine premedication reduces the awakening concentration of propofol. Anesth Analg. 2002;94:609-614.

Higuchi H, Adachi Y, Dahan A. The interaction between propofol and clonidine for loss of consciouness. Anesth Analg. 2002;94:886-891.

Higuchi H, Adachi Y, Arimura S. Oral clonidine premedication reduces the EC50 of propofol concentration for laryngeal mask airway insertion in male patients. Acta Anaesthesiol Scand. 2002;46:372-377.

Hirata K, Koyama N, Minami T. The effects of clonidine and tizanidine on responses of nociceptive neurons in nucleus ventralis posterolateralis of the cat thalamus. Anesth Analg. 1995;81:259-264.

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