Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000600004
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal

Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

Monica Rossi Rodrigues; Franklin Cêspedes Paes; Leonardo Teixeira Domingues Duarte; Luiz Guilherme Nadal Nunes; Verônica Vieira da Costa; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942009000600004 Braz J Anesthesiol, vol.59, n6, p.684-693, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: O procedimento de correção de pé torto congênito (PTC) cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças. MÉTODO: Estudo randômico, encoberto, em crianças submetidas à intervenção cirúrgica para liberação póstero-medial de PTC, alocadas em 4 grupos conforme a técnica anestésica: Caudal (ACa); Bloqueios isquiático e femoral (IF); Bloqueios isquiático e safeno (IS); Bloqueio isquiático e anestesia local (IL), associados à anestesia geral. Nas primeiras 24 horas os pacientes receberam dipirona e paracetamol via oral e foram avaliados por anestesiologista que desconhecia a técnica empregada. Conforme escores da escala CHIPPS (Children's and infants postoperative pain scale) era administrada morfina via oral (0,19 mg.kg-1 por dia). RESULTADOS: Foram estudadas 118 crianças distribuídas nos grupos ACa (30), IF (32), IS (28) IL (28). O tempo médio entre o bloqueio e a primeira dose de morfina foi 6,16 horas no grupo ACa, 7,05 horas no IF, 7,58 horas no IS e 8,18 horas no IL. O consumo de morfina foi 0,3 mg.kg-1 por dia nos quatro grupos. Não houve diferença significativa entre os grupos. CONCLUSÕES: Os bloqueios nervosos periféricos não promoveram maior tempo de analgesia, tampouco redução no consumo de morfina nas primeiras 24 horas em crianças submetidas à correção de PTC quando comparados ao bloqueio peridural caudal.

Palavras-chave

ANALGESIA, Pós-operatória, CIRURGIA, Ortopédica

Abstract

BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children. METHODS: This is a randomized, double-blind study with children undergoing surgeries for posteromedial release of CCF, who were divided in four groups according to the anesthetic technique: caudal (ACa), sciatic and femoral block (IF), sciatic and saphenous block (IS), and sciatic block and local anesthesia (IL), associated with general anesthesia. In the first 24 hours, patients received oral dypirone and acetaminophen, and they were evaluated by anesthesiologists who were unaware of the technique used. Oral morphine (0.19 mg.kg¹ per day) was administered according to the scores of the CHIPPS (Children's and infants' postoperative pain scale) scale. RESULTS: One hundred and eighteen children separated into four groups: ACa (30), IF (32), IS (28), and IL (28) participated in this study. The mean time between the blockade and the first dose of morphine was 6.16 hours in group ACa, 7.05 hours in group IF, 7.58 in IS, and 8.18 hours in IL. Morphine consumption was 0.3 mg.kg-1 per day in all four groups. Significant differences were not observed among the groups. CONCLUSIONS: peripheral nerve blocks did not promote longer lasting analgesia or a decrease in morphine consumption in the first 24 hours in children undergoing CCF correction when compared to caudal epidural block.

Keywords

ANALGESIA, postoperative, SURGERY, orthopedic

References

Ross AK, Eck JG, Tobias JD. Pediatric regional anesthesia: beyond the caudal. Anesth Analg. 2000;91:16-26.

Dalens B. Some current controversies in paediatric regional anaesthesia. Curr Opin Anaesthesiol. 2006;19:301-308.

Tobias JD. Regional anaesthesia of the lower extremity in infants and children. Paediatr Anaesth. 2003;13:152-163.

Tsui BCH, Berde CB. Caudal analgesia and anesthesia techniques in children. Curr Opin Anaesthesiol. 2005;18:283-288.

Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg. 1996;83:904-912.

Buttner W, Finke W. Analisys of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on several consecutive studies. Paediatr Anaesth. 2000;10:303-318.

Suraseranivongse S, Kaosaard R, Intakong P. A comparison of postoperative pain scales in neonates. Br J Anaesth. 2006;97:540-544.

Zuckerberg AL, Yaster M. Anesthesia for Pediatric Orthopedic Surgery. Smith's Anesthesia for Infants and Children. 2006:737-769.

Bösenberg AT, Ivani G. Regional anaesthesia: children are different. Paediatr Anaesth. 1998;8:447-450.

Costa VV, Rodrigues MR, Fernandes MCBC. Complicações e sequelas da anestesia regional realizada em crianças sob anestesia geral: Um problema real ou casos esporádicos?. Rev Bras Anestesiol. 2006;56:583-590.

Berde C. Regional Anesthesia in children: what have we learned?. Anesth Analg. 1996;83:897-900.

Hu D, Hu R, Berde CB. Absolute volume predicts duration of sciatic blockade better than volume/kilogram in infant and adult rats. Anesthesiology. 1994;81:A1375.

Hu D, Hu R, Berde CB. Neurologic evaluation of infant and adult rats before and after sciatic nerve blockade. Anesthesiology. 1997;86:957-965.

Kohane DS, Sankar WN, Shubina M. Sciatic nerve blockade in infant, adolescent, and adult rats: a comparison of ropivacaine with bupivacaine. Anesthesiology. 1998;89:1199-1208.

Ross AK. Pediatric Regional Anesthesia. Smith's Anesthesia for Infants and Children. 2006:459-506.

Analgesia review. Pediatr Anesth. 2008;18(^sSuppl):64-78.

Kart T, Christrup LL, Rasmussen M. Recommended use of morphine in neonates, infants and children based on a literature review: Part 1 - Pharmacokinetics. Paediatric Anaesth. 1997;7:5-11.

Howard RF. Pain management in infants: systemic analgesics. Br J Anaesth CEPD Rev. 2002;2:37-40.

Lundeberg S, Lonnqvist PA. Update on systemic postoperative analgesia in children. Paediatr Anaesth. 2004;14:394-397.

Kart T, Christrup LL, Rasmussen M. Recommended use of morphine in neonates, infants and children based on a literature review: Part 2 - Clinical use. Paediatric Anaesth. 1997;7:93-101.

Lönnqvist PA, Morton NS. Postoperative analgesia in infants and children. Br J Anaesth. 2005;95:59-68.

Buckenmaier CC 3rd, Bleckner LL. Anaesthetic agents for advanced regional anaesthesia: a North American perspective. Drugs. 2005;65:745-759.

Vanzillotta PP, Barbosa AP. Miscellaneous Techniques. Pediatric Anesthesia: Principles and Practice. 2002:964-981.

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