Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942012000100003
Brazilian Journal of Anesthesiology
Scientific Article

Controle da dor por bloqueio peridural e incidência de disritmias cardíacas no pós-operatório de procedimentos cirúrgicos torácicos e abdominais altos: estudo comparativo

Control of pain trough epidural block and incidence of cardiac dysrhythmias in postoperative period of thoracic and major abdominal surgical procedures: a comparative study

Rohnelt Machado de Oliveira; Sérgio Bernardo Tenório; Pedro Paulo Tanaka; Dalton Precoma

http://dx.doi.org/10.1590/S0034-70942012000100003 Braz J Anesthesiol, vol.62, n1, p.14-18, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: Operações no abdome superior e tórax provocam intensa dor. Entre as principais complicações da dor pós-operatória estão as complicações cardiocirculatórias. O objetivo deste trabalho foi testar a hipótese de que a analgesia pós-operatória com o emprego de anestésicos locais mais opioides espinhais pode reduzir a incidência de complicações cardiovasculares no pós-operatório de pacientes nessas condições, comparando-se a métodos clássicos de analgesia pós-operatória, opioides e AINES, administrados segundo demanda do paciente. MÉTODO: Oitenta pacientes adultos ASA I e II, sem alterações ECG, alocados em dois grupos de 40: Grupo A, sob anestesia geral com propofol, cisatracúrio e isoflurano, associado à anestesia peridural, com cateter e controle da analgesia pós-operatória com bupivacaína e morfina peridural; e Grupo B, sob anestesia geral com as mesmas drogas e doses que o Grupo A, mais analgesia pós-operatória realizada com AINES e morfina endovenosa no final da operação e em intervalos regulares. Em ambos foi aplicado Holter por 24 horas. A avaliação da dor foi realizada pela escala analógica visual. RESULTADOS: Na avaliação da dor observou-se no Grupo A evidente predomínio do escore 0 (p < 0,001) e também houve redução dos níveis de pressão arterial no pós-operatório de forma mais acentuada. As disritmias ventriculares e supraventriculares foram cinco vezes mais frequentes no Grupo B (p = 0,00001), em que também detectou-se tendência a maior frequência de extrassístoles ventriculares em idade > 50 anos (22,2% versus 0,0%. p = 0,26). Não se observou diferença significativa da frequência cardíaca entre os grupos (p > 0,05). CONCLUSÕES: A melhor qualidade da analgesia no pós-operatório, realizada nos pacientes do Grupo A, reduziu a incidência de complicações cardiovasculares

Palavras-chave

ANALGESIA, COMPLICAÇÕES, DOR, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Upper abdomen and thorax surgeries cause intense pain. Some of postoperative pain main complications are cardiocirculatory complications. The objective of this study was to test the hypothesis that postoperative analgesia with employment of local anesthetics plus spinal opioids may reduce the incidence of cardiovascular complications in postoperative period of patients in these conditions, comparing with classical methods of postoperative analgesia, opioids and NSAIDs, administered upon patient's demand. METHOD: Eighty adult patients, ASA I and II, without ECG alterations, were allocated into two groups of 40: Group A, patients under general anesthesia with propofol, cisatracurium and isoflurane, associated with epidural anesthesia with catheter and control of postoperative analgesia with bupivacaine and epidural morphine; and Group B, patients under general anesthesia with the same drugs and doses of A, plus postoperative analgesia carried out with NSAIDs and intravenous morphine at the end of surgery and in regular intervals. In both groups Holter was applied for 24 hours. Pain evaluation was carried out through visual analog scale. RESULTS: In pain evaluation, an evident predominance of 0 score (p < 0.001) was observed in Group A and there was also reduction of blood pressure levels in postoperative period in a more accentuated way. Ventricular and supraventricular dysrhythmias were five times more frequent in Group B (p = 0.00001), in which a tendency to a higher frequency of ventricular extrasystoles in age > 50 years (22.2% versus 0.0%. p = 0.26) was also detected. No significative difference of heart rate among groups (p > 0.05) was observed. CONCLUSIONS: The best quality of analgesia in postoperative period, carried out in Group A, reduced the incidence of cardiovascular complications

Keywords

Anesthesia, Pain, Analgesia, Arrhythmias

References

Ogilvy AJ, Smith G. The gastrointestinal tract after anaesthesia. Eur J Anaesthesiol. 1995;12(^s10):35-42.

Ng A, Smith G. Anesthesia and the gastrointestinal tract. J Anesth. 2002;16(1):51-64.

Hendolin H, Lahtinen J, Lansimies E. The effect of thoracic epidural analgesia on postoperative stress and morbidity. Annals Chirurg Gynaecol. 1987;76(4):234-240.

Raj PP. The problem of postoperative pain: an epidemiologic perspective. Postoperative Pain Management T. 1993:1-17.

Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand. 1990;34(2):144-155.

Davis D. Diagnosis and management of cardiac arrhythmias in the postoperative period. Surg Clin North Am. 1983;63(5):1091-1102.

Asamura H, Naruke T, Tsuchiya R. What are the risk factors for arrhythmias after thoracic operations?: A retrospective multivariate analysis of 267 consecutive thoracic operations. J Thorac Cardiovasc Surg. 1993;106(6):1104-1110.

Rodgers A, Walker N, Schug S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000;321:1493-1497.

Burstal R, Wegener F, Hayes C. Epidural analgesia: prospective audit of 1062 patients. Anaesth Int Care. 1998;26(2):165-172.

Ready LB, Loper KA, Nessly M. Postoperative epidural morphine is safe on surgical wards. Anesthesiol. 1991;75(3):452-456.

Hollenberg MS, Dellinger PR. Noncardiac surgery: Postoperative arrhythmias. Crit Care Med. 2000;28:146-150.

Borgeat A, Biollaz J, Kappenberger L. Prevention of arrhythmias by flecainide after noncardiac thoracic surgery. Annals Thorac Surg. 1989;48(2):232-234.

Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1(3):277-299.

Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117-126.

Smith G. Management of post-operative pain. Can J Anaesth. 1989;36:1-4.

Rawal N. Postoperative pain and its management. Practical management of pain. 1992.

Heller PH, Perry F, Naifeh K. Cardiovascular autonomic response during preoperative stress and postoperative pain. Pain. 1984;18(1):33-40.

Moltner A, Holzl R, Strian F. Heart rate changes as an autonomic component of the pain response. Pain. 1990;43(1):81-89.

Giroban L, Dolinski SY, Zvara DA. Thoracid epidural analgesia: its role in posthoracotomy atrial arrhythmias. J Cardoth Vasc Anest. 2000;14:662-665.

Borgeat A, Biollaz J, Bayer-berger M. Prevention of arrhythmias by flecainide after noncardiac thoracic surgery. Ann Thorac Surg. 1989;48(2):232-234.

Hollenberg MS, Dellinger PR. Noncardiac surgery: postoperative arrhythmias. Crit Care Med. 2000;28:146-150.

Yeager MP, Glass DD, Neff RK. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiol. 1987;66:729-736.

Blomberg S, Emanuelsson H, Kvist H. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiol. 1990;73(5):840-847.

Kastor J. Arrhythmias. 1994:20-59.

Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990:153-184.

Raby KE, Goldman L, Creager MA. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Eng J Med. 1989;321(19):1296-1300.

Takeshima R, Dohi S. Circulatory responses to baroreflexes, vasalva maneuver, coughing, swallowing and nasal stimulation during acute cardiac sympathectomy by epidural blockade in awake humans. Anesthesiol. 1985;63:500-508.

Hopf HB, Shyschally A, Heusch G. Low-frequency spectral power of heart rate variability is not a specific marker of cardiac sympathetic modulation. Anesthesiol. 1995;82:609-619.

Bromage PR. Continuous epidural analgesia. Epidural analgesia. 1978.

Liu , Carpenter RL, Mackey DC. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiol. 1995;83:757-765.

Ready LB, Loper KA, Nessly M. Postoperative epidural morphine is safe on surgical wards. Anesthesiol. 1991;75(3):452-6.

Yukioka H, Bogod DG, Rosen M. Recovery of bowel motility after surgery: Detection of time of first flatus from carbon dioxide concentration and patient estimate after nalbuphine and placebo. Br J Anaesth. 1987;59(5):581-584.

Ferrante M, Timothy R, Vadeboncouer R. Epidural analgesia with combination of local anesthetics and opioid. Postoperative Pain Management. 1993;306.

Dahl JB, Rosenberg J, Hansen BD. Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery. Anesth Analg. 1992;74:362-365.

De Leon-Casasola AO, Lema MJ. Postoperative epidural opioid analgesia: the choices?. Anest Analg. 1996;83:867-875.

Jeffrey HM, Charlton P, Mellor DJ. Analgesia after intracranial surgery: a double-blind, prospective comparison of codeine and tramadol. Br J Anaesth. 1999;83:245-249.

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