Analgesia regional em cuidados intensivos

Luísa Guedes; Helena Rebelo; Raquel Oliveira; Aida Neves

doi:10.1590/S0034-70942012000500011

Review Article

Analgesia regional em cuidados intensivos

Regional analgesia in intensive care

Luísa Guedes; Helena Rebelo; Raquel Oliveira; Aida Neves

http://dx.doi.org/10.1590/S0034-70942012000500011 Braz J Anesthesiol, vol.62, n5, p.724-730, 2012

PDF

Downloads: 2

Resumo

JUSTIFICATIVAS E OBJETIVOS: A analgesia regional desempenha um papel importante na abordagem multimodal da dor no doente crítico e permite amenizar o desconforto do doente e reduzir os estresses fisiológico e psicológico associados. Ao diminuir as doses de opioides sistêmicos, reduz alguns dos seus efeitos colaterais, como a síndrome de abstinência, possíveis alterações psicológicas e disfunção gastrintestinal. Apesar desses benefícios, seu uso é controverso, uma vez que os doentes em unidades de cuidados intensivos apresentam frequentemente contraindicações, como coagulopatia, instabilidade hemodinâmica e dificuldade na avaliação neurológica e na execução da técnica regional. CONTEÚDO: Os autores apresentam uma revisão sobre analgesia regional em cuidados intensivos, com foco nas principais vantagens e limitações de seu uso no doente crítico, e descrevem as técnicas regionais mais usadas e a sua aplicabilidade nesse contexto.

Palavras-chave

ANALGESIA, COMPLICAÇÕES, Generalidades, DOR, TÉCNICAS ANESTÉSICAS, Regional, TERAPIA INTENSIVA

Abstract

JUSTIFICATIONS AND OBJECTIVES: regional analgesia plays an important role in multimodal pain management in critically ill patients, minimizing patient discomfort and reducing the associated physiological and psychological stress. Lower doses of systemic opioids reduce some of its side effects, such as withdrawal syndrome, possible psychological changes, and gastrointestinal dysfunction. Despite these benefits, its use is controversial, as patients in intensive care units often have contraindications, such as coagulopathy, hemodynamic instability, and difficulty in neurological assessment and implementation of regional technique. CONTENT: The authors present a review of regional analgesia in intensive care, focusing on the main advantages and limitations of its use in critically ill patients, and describe the most commonly used regional techniques and its applicability.

Keywords

Analgesia, Anesthesia, Conduction, Pain, Intensive Care

Referencias

Desbiens NA, Wu AW, Broste SK. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment). Crit Care Med. 1996;24(12):1953-61.

Novaes MA, Knobel E, Bork AM. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med. 1999;25(12):1421-1426.

Hall LG, Oyen LJ, Murray MJ. Analgesic agents: Pharmacology and application in critical care. Crit Care Clin. 2001;17(4):899-923.

Schulz-Stübner S, Boezaart A, Hata JS. Regional analgesia in the critically ill. Critical Care Med. 2005;33(6):1400-1407.

Fraser GL, Riker RR. Monitoring sedation, agitation, analgesia, and delirium in critically ill adult patients. Crit Care Clin. 2001;17(4):967-987.

Melzack R, Katz J. Pain measurement in persons in pain. Textbook of pain. 1999:337-351.

Schulz-Stübner S. The critically ill patient and regional anesthesia. Curr Opin Anaesthesiol. 2006;19(5):538-44.

Epstein J, Breslow MJ. The stress response of critical illness. Crit Care Clin. 1999;15(1):17-33.

Lewis KS, Whipple JK, Michael KA, Quebbeman EJ. Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm. 1994;51(12):1539-1554.

Clark F, Gilbert HC. Regional analgesia in the intensive care unit: Principles and practice. Crit Care Clin. 2001;17(4):943-966.

Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.

Richman JM, Liu SS, Courpas G. Does continuous peripheral nerve block provide superior pain control to opioids?: A meta-analysis. Anesth Analg. 2006;102:248-257.

Finlayson BJ, Underhill TJ. Femoral nerve block for analgesia in fractures of the femoral neck. Arch Emerg Med. 1988;5:173-176.

Tan TT, Coleman MM. Femoral blockade for fractured neck of femur in the emergency department. Ann Emerg Med. 2003;42:596-597.

Davis ET, Harris A, Keene D. The use of regional anaesthesia in patients at risk of acute compartment syndrome. Injury. 2006;37:128-133.

Kostler W, Strohm PC, Sudkamp NP. Acute compartment syndrome of the limb. Injury. 2004;35:1221-1227.

Furuno JP, Perencevich EN, Johnson JA. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci cocolonization. Emerg Infect Dis. 2005;11:1539-1544.

Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29:564-575.

Jorgensen H, Wetterslev J, Moiniche S, Dahl JB. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev. 2000;4.

Peyton PJ, Myles PS, Silbert BS. Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg. 2003;96:548-554.

Ballantyne JC. Does epidural analgesia improve surgical outcome?. Br J Anaesth. 2004;92:4-6.

Ballantyne JC, Carr DB, de Ferranti S. The comparative effects of postoperative analgesic therapies on pulmonary outcome. Anest Analg. 1998;86:598-612.

Visser WA, Gielen MJ, Giele JL. Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine. Anesth Analg. 2006;102:268-271.

Darchy B, Forceville X, Bavoux E, Soriot F, Domart Y. Clinical and bacteriologic survey of epidural analgesia in patients in the intensive care unit. Anesthesiology. 1996;85(5):988-998.

Morin AM, Kerwat KM, Klotz M. Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol. 2005;5.

Herwaldt LA, Coffin SA, Schulz-Stübner S. Nosocomial infections associated with anesthesia. Hospital Epidemiology and Infection Control. 2004:1073-1117.

Tsui BC, Guenther C, Emery D, Finucane B. Determining epidural catheter location using nerve stimulation with radiological confirmation. Reg Anesth Pain Med. 2000;25:306-309.

Borges S, Azevedo A, Bezerra M, Canas M. Efeitos adversos dos anestésicos locais. CAR. 2001:28-32.

Fonseca C, Lages N, Correia C. II Reunião de Consenso de Doentes medicados com fármacos inibidores da hemostase propostos para anestesia locorregional. Rev SPA. 2010;19(2):12-29.

Burton AW, Eappen S. Regional anesthesia techniques for pain control in the intensive care unit. Crit Care Clin. 1999;15:77-1588.

Analgesia regional em cuidados intensivos

Regional analgesia in intensive care

Luísa Guedes; Helena Rebelo; Raquel Oliveira; Aida Neves

Resumo

Palavras-chave

Abstract

Keywords

Referencias

Links

compartir

Braz J Anesthesiol