Bloqueio analgésico peridural lombar para tratamento de lombociatalgia discogênica: estudo clínico comparativo entre metilprednisolona e metilprednisolona associada à levobupivacaína

Fátima Aparecida Emm Faleiros Sousa; Orlando Carlos Gomes Colhado

doi:10.1590/S0034-70942011000500004

Scientific Article

Bloqueio analgésico peridural lombar para tratamento de lombociatalgia discogênica: estudo clínico comparativo entre metilprednisolona e metilprednisolona associada à levobupivacaína

Lumbar epidural anesthesia in the treatment of discal lombosciatalgia: a comparative clinical study between methylprednisolone and methylprednisolone with levobupivacaine

Fátima Aparecida Emm Faleiros Sousa; Orlando Carlos Gomes Colhado

http://dx.doi.org/10.1590/S0034-70942011000500004 Braz J Anesthesiol, vol.61, n5, p.549-555, 2011

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Resumo

JUSTIFICATIVA E OBJETIVOS: A técnica peridural lombar tem sido utilizada no tratamento da lombociatalgia desde 1953. Na maioria das vezes, emprega-se metilprednisolona adicionada a um anestésico local e não se sabe se seu uso isolado tem a mesma eficácia no alívio dos sintomas. O objetivo deste estudo foi comparar a eficácia de duas soluções diferentes - metilprednisolona com soro fisiológico e metilprednisolona com levobupivacaína -, injetadas no espaço peridural para tratar lombociatalgia devido à hérnia discal lombar. MÉTODO: Participaram deste estudo 60 indivíduos, ASA I e II, no período de um ano, submetidos à técnica analgésica peridural lombar interlaminar para tratamento da lombociatalgia sem controle radioscópico, de ambos os sexos, com idade entre 18 e 65 anos, divididos em dois grupos: G-M (metilprednisolona + solução fisiológica a 0,9%) e G-M + L (metilprednisolona + levobupivacaína + solução fisiológica a 0,9%), ambos em um volume de 10 mL. O diagnóstico se baseou na história, no exame físico e em exame por imagem (ressonância magnética nuclear). O trabalho foi conduzido de forma duplo-encoberta, com seleção aleatória dos participantes. Foi aplicada a Escala Analógica Visual (EAV) em um total de dois bloqueios, um a cada 15 dias. RESULTADOS: Houve redução mais significativa da intensidade da dor para o grupo metilprednisolona + levobupivacaína, porém sem significância estatística. CONCLUSÕES: A solução do G-M + L demonstrou eficácia analgésica superior à solução do G-M para o tratamento da lombociatalgia discogênica no que diz respeito ao menor tempo para início da analgesia, mas não de forma significativa, no momento da alta, sendo as duas soluções eficazes no tratamento da lombociatalgia radicular discogênica.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, DOR, TÉCNICAS DE ANALGESIA, TÉCNICAS DE ANALGESIA

Abstract

BACKGROUND AND OBJECTIVES: Lumbar epidural technique has been used in the treatment of lombosciatalgia since 1953. In most cases, methylprednisolone is used along with a local anesthetic, and it is not known whether the isolated use of methylprednisolone is equally effective in relieving symptoms. The objective of this study was to compare the efficacy of two different solutions - methylprednisolone with saline and methylprednisolone with levobupivacaine injected in the epidural space to heal lombosciatalgia secondary to lumbar herniated disk. METHODS: Sixty individuals ASA I and II, of both genders, ages 18 to 65 years participated in this randomized, double-blind study over a period of one year. They underwent interlaminar lumbar epidural analgesia without radioscopic control to heal a lombosciatalgia and they were divided into two groups: G-M (methylprednisolone + saline) and G-M + L (methylprednisolone + levobupivacaine + saline) both at a volume of 10 mL. Diagnosis was based on history, physical exam, and imaging exam (MRI). The Visual Analogue Scale (VAS) was applied in a total of two blockades, 15 days apart. RESULTS: A reduction in pain severity was observed in the methylprednisolone-levobupivacaine group, but without statistical significance. CONCLUSIONS: The analgesic efficacy of the G-M + L solution was superior to that of the G-M solution in the treatment of discal lombosciatalgia regarding the shorter time to onset of analgesia, but this was not significant at the time of discharge, and both solutions were effective in the treatment of discal lombosciatalgia.

Keywords

Sciatica, Intervertebral Disk Displacement, Methylprednisolone, Anesthetics, Local, Analgesia, Epidural

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Bloqueio analgésico peridural lombar para tratamento de lombociatalgia discogênica: estudo clínico comparativo entre metilprednisolona e metilprednisolona associada à levobupivacaína

Lumbar epidural anesthesia in the treatment of discal lombosciatalgia: a comparative clinical study between methylprednisolone and methylprednisolone with levobupivacaine

Fátima Aparecida Emm Faleiros Sousa; Orlando Carlos Gomes Colhado

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