Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000400004
Brazilian Journal of Anesthesiology
Scientific Article

Incidência de síndrome dolorosa regional após cirurgia para descompressão do túnel do carpo: existe correlação com a técnica anestésica realizada?

Incidence of regional pain syndrome after carpal tunnel release: is there a correlation with the anesthetic technique?

Veronica Vieira da Costa; Sandro Barbosa de Oliveira; Maria do Carmo Barreto Fernandes; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942011000400004 Braz J Anesthesiol, vol.61, n4, p.429-433, 2011
PDF Português
PDF English
Downloads: 0
Views: 1012

Resumo

JUSTIFICATIVA E OBJETIVOS: A síndrome dolorosa complexa regional (SDCR), anteriormente conhecida como distrofia simpático-reflexa, descreve um conjunto de sinais e sintomas que incluem dor, sudorese e instabilidade vasomotora. A dor geralmente é desencadeada por estímulo nocivo em um nervo periférico e se mostra desproporcional ao estímulo desencadeante. Seu aparecimento após cirurgia não é incomum, variando com a intervenção. Após descompressão do túnel do carpo (DTC), descreve-se incidência de 2,1% a 5%. O bloqueio simpático pode prevenir o aparecimento de SDCR, mas nenhum estudo validou essa técnica como prevenção da SCR após cirurgia para DTC. O objetivo do estudo foi definir a incidência de SDCR após cirurgia de DTC e sua relação com quatro técnicas de anestesia. MÉTODO: Os pacientes foram distribuídos aleatoriamente e receberam uma das técnicas: anestesia geral, anestesia venosa regional com lidocaína, anestesia venosa regional com lidocaína e clonidina ou bloqueio de plexo axilar. No pós-operatório, foram acompanhados por uma enfermeira que desconhecia a técnica utilizada, fazendo-se o seguimento pelo prontuário eletrônico até 6 meses depois da anestesia. Nesse período, foram pesquisados sinais e sintomas típicos de SDCR e, em caso positivo, instituiu-se o tratamento. Foi realizada avaliação descritiva, empregando-se o Qui-quadrado. RESULTADOS: Foram estudados 301 pacientes. Destes, 25 desenvolveram SDCR configurando uma incidência de 8,3%. Não houve predominância entre as técnicas de anestesia. Foram pesquisados outros fatores como: tabagismo, profissão e outras doenças concomitantes e nenhum mostrou relação com o desenvolvimento de SDCR após DTC. CONCLUSÕES: A incidência de SDCR após cirurgia para DTC é de 8,3% sem relação com as técnicas anestésicas estudadas.

Palavras-chave

TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVE: Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy refers to a set of signs and symptoms that include pain, increased sweating, and vasomotor instability. Pain is usually triggered by a noxious stimulus in a peripheral nerve, which is disproportionate to the triggering stimulus. Its development after surgery is not uncommon varying with the type of intervention. An incidence of 2.1 to 5% has been reported after carpal tunnel release (CTR). Sympathetic blockade may prevent the onset of CRPS. However, there is no study validating this technique to prevent CRPS after CTR. The objective of the present study was to define the incidence of CRPS after CTR and its relationship with four anesthetic techniques. METHODS: Patients were randomly distributed to undergo one of the following techniques: general anesthesia, regional intravenous anesthesia with lidocaine, regional intravenous anesthesia with lidocaine and clonidine, or axillary plexus block. Postoperatively, they were followed-up by a nurse who was unaware of the anesthetic technique used, and follow-up was done through electronic patient records for up to 6 months after the anesthesia. During this period signs and symptoms typical of CRPS were investigated and, if positive, treatment was instituted. A descriptive evaluation using the chi-square test was performed. RESULTS: Three-hundred and one patients were investigated. Twenty-five of them developed CRPS, an incidence of 8.3%. Predominance was not observed among the anesthetic techniques used. Other factors such as smoking, profession, and other concomitant diseases were also investigated, and none showed a relationship with the development of post-CTR CRPS. CONCLUSIONS: Complex regional pain syndrome has an incidence of 8.3% after CTR surgery without association with the anesthetic techniques investigated.

Keywords

Complex Regional Pain Syndromes, Carpal Tunnel Syndrome, Anesthesia, Nerve Block, Brachial Plexus, Clonidine

Referencias

Cordon FCO, Lemonica L. Síndrome dolorosa complexa regional: epidemiologia, fisiopatologia, manifestações clínicas, testes diagnósticos e propostasterapêuticas. Rev Bras Anestesiol. 2002;52:618-627.

Raja SN, Grabow TS. Complex regional pain syndrome I (reflex sympathetic dystrophy). Anesthesiology. 2002;96:1254-1260.

Shinya K, Lanzetta M, Conolly WB. Risk and complications in endoscopic carpal tunnel release. J Hand Surg Br. 1995;20:222-227.

Veldman PA, Reynen HM, Artz IE. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet. 1993;342:1012-1016.

Viel EJ, Pelissier J, Eledjam JJ. Sympathetically maintained pain after surgery may be prevented by regional anesthesia. Anesthesiology. 1994;81:265-266.

Reuben SS. Sympathetically maintained pain and the use of regional anesthesia. Anesthesiology. 1994;81.

ReisJunior A. Anestesia Regional Intravenosa. Tratado de Anestesiologia. 2006:1295-1315.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 1988.

Faul F, Erdfelder E, Lang AG. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. ;39:175-191.

Reuben SS. Preventing the development of complex regional pain syndrome after surgery. Anesthesiology. 2004;101:1215-1224.

Gulati A, Whitaker IS, Jaggard M. Carpal tunnel decompression: The impact of tourniquet, anaesthesia type, and aperating team on patient satisfaction scores. Br J Plast Surg. 2005;58:116-119.

Reuben SS, Pristas R, Dixon D. The incidence of complex regional pain syndrome after fasciectomy for Dupuytren's contracture: a prospective observational study of four anesthetic techniques. Anesth Analg. 2006;102:499-503.

Reuben SS, Rosenthal EA, Steinberg RB. Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: the use of intravenous regional anesthesia with clonidine. J Clin Anesth. 2004;16:517-522.

5dd6bbc70e8825860d13f286 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections