Avaliação do efeito preemptivo da s(+)-cetamina por via peridural para histerectomia: concentrações plasmáticas de interleucinas

Elismar Paulo Azevedo Silva; Rioko Kimiko Sakata; João Batista Santos Garcia; Reinaldo Salomão; Adriana Machado Issy

doi:10.1590/S0034-70942012000100002

Scientific Article

Avaliação do efeito preemptivo da s(+)-cetamina por via peridural para histerectomia: concentrações plasmáticas de interleucinas

Evaluation of preemptive effect of epidural s(+)-ketamine for hysterectomy: plasmatic concentrations of interleukins

Elismar Paulo Azevedo Silva; Rioko Kimiko Sakata; João Batista Santos Garcia; Reinaldo Salomão; Adriana Machado Issy

http://dx.doi.org/10.1590/S0034-70942012000100002 Braz J Anesthesiol, vol.62, n1, p.6-9, 2012

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Alguns estudos demonstraram que a cetamina inibe a produção de citocinas. O objetivo deste estudo foi avaliar o efeito analgésico preemptivo e citocinas plasmáticas (IL-6, TNF-α e IL-10) de S(+)-cetamina por via peridural em histerectomia. MÉTODO: Foi realizado estudo duplo-encoberto em 29 pacientes. Pacientes do Grupo 1 receberam 13 mL de bupivacaína a 0,25% com 25 mg de S(+)-cetamina 30 minutos antes da incisão cirúrgica, e 15 mL de solução salina fisiológica, 30 minutos após, por via peridural. Pacientes do Grupo 2 receberam 15 mL de salina 30 minutos antes da incisão cirúrgica, seguido por 13 mL de bupivacaína 0,25%, mais 25 mg de S (+)-cetamina 30 minutos após. A analgesia pós-operatória foi feita com bupivacaína e fentanil por via peridural. Quando necessário, foi utilizado 1 g de dipirona. Foram avaliados: concentração de citocinas, intensidade da dor, o tempo da primeira solicitação de analgésico e a quantidade total de analgésico utilizado. RESULTADOS: O tempo para a primeira solicitação de analgésico foi de 61,5 minutos no Grupo 1 e 69,0 no Grupo 2, sem diferença entre os grupos. Não houve diferença entre os grupos para a dose total de fentanil usada no Grupo 1 (221,4 µg) e Grupo 2 (223,3 µg). Foi obtido efeito analgésico semelhante nos grupos, exceto em T12 (Grupo 1 = 2,4 ± 3,2; Grupo 2 = 5,5 ± 3,4). Não foi observada diferença entre os grupos na concentração de citocinas. CONCLUSÕES: A injeção de 25 mg de S(+)-cetamina por via peridural antes da incisão reduziu a intensidade da dor apenas 12 horas após a incisão cirúrgica e não alterou a concentração de citocinas.

Palavras-chave

ANALGESIA, ANALGÉSICOS, CIRURGIA, FARMACOLOGIA, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Some studies showed that ketamine inhibits the production of cytokines. The objective of this study was to evaluate the preemptive analgesic effect of epidural S(+)-ketamine in hysterectomy and plasmatic cytokines (IL-6, TNF-α and IL-10). METHOD: A double-blinded study with 29 patients was conducted. Patients in Group 1 received 13 mL of 0.25% bupivacaine with 25 mg of S(+)ketamine 30 minutes before surgical incision and 15 mL of saline solution via the epidural route 30 minutes after. Patients in Group 2 received 15 mL of saline solution 30 minutes before the surgical incision, followed by 13 mL of 0.25% bupivacaine with 25 mg of S(+)-ketamine 30 minutes after. Postoperative analgesia was made with epidural bupivacaine and fentanyl. Dipyrone 1 g was used whenever required. The following paramenters were evaluated: concentration of cytokines, intensity of pain, time of first request of analgesic and total quantity of analgesic used. RESULTS: Time for the first request for analgesics was 61.5 minutes in Group 1 and 69.0 in Group 2, without difference between these groups. There was no difference for total dose of fentanyl used in Group 1 (221.4 µg) and Group 2 (223.3 µg). A similar analgesic effect was obtained in both groups, except in T12 (Group 1 = 2.4 ± 3.2; Group 2 = 5.5 ± 3.4). No differences in concentration of cytokines were observed. CONCLUSIONS: The epidural injection of 25 mg S(+)-ketamine before incision reduced the pain intensity only 12 hours after surgical incision and did not alter concentration of cytokines

Keywords

Ketamine, Analgesia, Anesthesia, Cytokines, Hysterectomy

Referencias

Rocha APC, Kraychete DC, Lemonica L. Dor: aspectos atuais da sensibilização periférica e central. Rev Bras Anestesiol. 2007;57(1):94-105.

Watkins LR, Maier SF, Goehler LE. Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain. 1995;63:289-302.

Wang SZ, Chen Y, Lin HY. Comparison of surgical stress response to laparoscopic and open radical cystectomy. World J Urol. 2010;28(4):451-455.

Watkins LR, Milligan ED, Maier SF. Glial proinflammatory cytokines mediate exaggerated pain states: implications for clinical pain. Adv Exp Med Biol. 2003;521:1-21.

Celerier E, Rivat C, Jun Y. Long-lasting hyperalgesia induced by fentanyl in rats: preventive effect of ketamine. Anesthesiology. 2000;92(2):465-472.

Warncke T, Stubhaug A, Jørum E. Preinjury treatment with morphine or ketamine inhibits the development of experimentally induced secondary hyperalgesia in man. Pain. 2000;86:293-303.

Kissin I, Bright CA, Bradley EL Jr. The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations?. Anesth Analg. 2000;91:1483-1488.

Laulin JP, Maurette P, Corcuff JB. The role of ketamine in preventing fentanyl-induced hyperalgesia and subsequent acute morphine tolerance. Anesth Analg. 2002;94:1263-1269.

Joly V, Richebe P, Guignard B. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005;103(1):147-155.

Yamakura T, Sakimura K, Shimoji K. The stereoselective effects of ketamine isomers on heteromeric N-methyl-D-aspartate receptor channel. Anesth Analg. 2000;91:225-229.

Lahtinen P, Kokki H, Hakala T. S(+)-ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery. Anesth Analg. 2004;99(5):1295-1301.

Almenrader N, Passariello M, D'Amico G. Caudal additives for postoperative pain management in children: S(+)-ketamine and neostigmine. Paediatr Anaesth. 2005;15(2):143-147.

Kuiken SD, van den Berg SJ, Tytgat GN. Oral S(+)-ketamine does not change visceral perception in health. Dig Dis Sci. 2004;49(1112):1745-1751.

Ryu HG, Lee CJ, Kim YT. Preemptive low-dose epidural ketamine for preventing chronic postthoracotomy pain: a prospective, double-blinded, randomized, clinical trial. Clin J Pain. 2011;27(4):304-308.

Bong CL, Samuel M, Ng JM. Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2005;19(6):786-793.

Lavandhomme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology. 2005;103:681-683.

Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief. Anesthesiology. 2002;96:725-741.

Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth. 2001;48:105-114.

Kissin I. Study design to demonstrate clinical value of preemptive analgesia: is the commonly used approach valid?. Reg Anesth Pain Med. 2002;27:242-244.

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

Lahtinen P, Kokki H, Hakala T. S(+)-ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery. Anesth Analg. 2004;99(5):1295 -1301.

Jaksch W, Lang S, Reichhalter R. Perioperative small-dose S(+)-ketamine has no incremental beneficial effects on postoperative pain when standard-practice opioid infusions are used. Anesth Analg. 2002;94:981-986.

Castro FE, Garcia JBS. Analgesia preemptiva com S (+)cetamina e bupivacaína peridural em histerectomia abdominal. Rev Bras Anestesiol. 2005;55(1):28-39.

Lin E, Calvano SE, Lowry SF. Inflammatory cytokines and cell response in surgery. Surgery. 2000;127(2):117-126.

Kawasaki C, Kawasaki T, Ogata M. Ketamine isomers suppress superantigen-induced proinflammatory cytokine in human whole blood. Can J Anaesth. 2001;48:819-823.

Naito Y, Tamai S, Shingu K. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology. 1992;77:426-431.

Avaliação do efeito preemptivo da s(+)-cetamina por via peridural para histerectomia: concentrações plasmáticas de interleucinas

Evaluation of preemptive effect of epidural s(+)-ketamine for hysterectomy: plasmatic concentrations of interleukins

Elismar Paulo Azevedo Silva; Rioko Kimiko Sakata; João Batista Santos Garcia; Reinaldo Salomão; Adriana Machado Issy

Resumo

Palavras-chave

Abstract

Keywords

Referencias

Links

compartir

Braz J Anesthesiol