Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril

Leonardo Teixeira Domingues Duarte; Paulo Sérgio Siebra Beraldo; Renato Ângelo Saraiva

doi:10.1590/S0034-70942009000500002

Scientific Article

Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril

Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

Leonardo Teixeira Domingues Duarte; Paulo Sérgio Siebra Beraldo; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942009000500002 Braz J Anesthesiol, vol.59, n5, p.531-544, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: A dor após artroplastia total do quadril (ATQ) é intensa e agravada pelas mobilizações, o que demanda técnica analgésica eficaz e que permita mobilidade precoce, participação nas atividades de reabilitação e rápida recuperação funcional. O objetivo do estudo foi comparar os efeitos das técnicas de analgesia controlada pelo paciente (ACP) pelas vias peridural e perineural do plexo lombar sobre a reabilitação funcional em pacientes submetidos à ATQ. MÉTODO: Pacientes estado físico ASA I a III foram alocados aleatoriamente nos grupos Peridural e Lombar. Para a ATQ, foi realizada anestesia peridural lombar contínua com ropivacaína a 0,5% (Peridural) ou bloqueio contínuo do plexo lombar com ropivacaína a 0,5% (Lombar). Na sala de recuperação, iniciou-se ACP com infusão de ropivacaína a 0,2% (Lombar) ou ropivacaína a 0,2% + fentanil 3 µg.mL-1 (Peridural). A eficácia da analgesia nas primeiras 48 horas após a ATQ (escores de dor, consumo de morfina de resgate e de bolos da bomba de ACP) foi comparada entre os grupos. Diferentes parâmetros da reabilitação pós-operatória foram estudados. RESULTADOS: Quarenta e um pacientes foram submetidos à análise estatística. Os escores de dor em repouso foram semelhantes nos dois grupos. Apesar do controle mais efetivo da dor dinâmica no grupo Peridural e o uso de morfina ter sido maior, mais frequente e mais precoce no grupo Lombar, não houve diferença entre os grupos em nenhum dos parâmetros estudados de reabilitação. As técnicas de analgesia não influenciaram as falhas no processo de reabilitação. CONCLUSÕES: A maior efetividade da analgesia peridural não se traduziu em melhora no processo de reabilitação, nem reduziu o tempo necessário para alcançar os desfechos estudados.

Palavras-chave

ANALGESIA, Pós-operatória, ANALGESIA, Pós-operatória, ANALGESIA, Pós-operatória, CIRURGIA, Ortopédica, RECUPERAÇÃO PÓS-OPERATÓRIA

Abstract

BAKGROUND AND OBJECTIVES: Pain after total hip arthroplasty (THA) is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation in rehabilitation activities, and fast functional recovery. The objective of this study was to compare the effects of epidural and perineural patient-controlled analgesia (PCA) of the lumbar plexus on functional rehabilitation of patients undergoing THA. METHODS: Patients classified as physical status ASA I to III were randomly divided into two groups: Epidural and Lumbar. For THA, patients underwent continuous epidural lumbar block with 0.5% ropivacaine (Epidural) or continuous lumbar plexus block with 0.5% ropivacaine (Lumbar). In the recovery room, PCA with infusion of 0.2% ropivacaine (Lumbar) or 0.2% ropivacaine + fentanyl 3 µg.mL-1 (Epidural) was instituted. Analgesic efficacy in the first 48 hours after THA (pain scores, rescue morphine consumption, and bolus of the PCA pump) was compared between both groups. Different postoperative rehabilitation parameters were analyzed. RESULTS: Forty-one patients underwent statistical analysis. Resting pain scores were similar in both groups. Despite more effective control of dynamic pain in the Epidural group and the greater, more frequent, and earlier morphine consumption in the Lumbar group, rehabilitation parameters evaluated did not differ in both groups. Analgesia techniques did not affect rehabilitation failures. CONCLUSIONS: The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals.

Keywords

ANALGESIA, Postoperative, ANALGESIA, Postoperative, ANALGESIA, Postoperative, POSTOPERATIVE RECOVERY, SURGERY, Orthopedic

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Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril

Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

Leonardo Teixeira Domingues Duarte; Paulo Sérgio Siebra Beraldo; Renato Ângelo Saraiva

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