Comparação da eficácia analgésica entre o bloqueio do plano dos eretores da espinha (BPEE) e a morfina subaracnoidea após a cesariana. Estudo clínico randomizado
Data
2023-10-02
Autores
Souza, Alan Anderson Medeiros Ferreira de 
Orientadores
Sakata, Rioko Kimiko
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Justificativa: A analgesia pós-operatória da cesariana é essencial, pois proporciona, dentre outros benefícios, o conforto necessário para deambulação precoce e aleitamento materno. A estratégia mais usada para isso é a associação opioides como a morfina ao anestésico local para prolongar o efeito analgésico. No entanto, existem efeitos adversos relevantes que nos direcionam a busca de métodos alternativos para promover boa analgesia. O bloqueio do plano dos eretores da espinha (BPEE) tem sido usado para procedimentos cirúrgicos torácicos e abdominais. Objetivos: O objetivo primário deste estudo é comparar a intensidade da dor do BPEE com a da morfina subaracnoidea para analgesia após cesariana. Os objetivos secundários são avaliar a necessidade de complementação e os efeitos adversos. Métodos: Foram estudadas 56 participantes, alocadas em dois grupos. As do grupo 1 foram submetidas a anestesia subaracnoidea com 12mg de levobupivacaína hiperbárica a 0,5%, antes da cirurgia. Após o término da cirurgia, foram submetidas ao BPEE com 20 ml de levobupivacaína a 0,25% em cada lado, 40ml no total. As do grupo 2 foram submetidas a anestesia subaracnoidea com 12mg de levobupivacaína hiperbárica a 0,5%, associados a 0,1 mg de morfina antes da cirurgia. A intensidade da dor foi avaliada pela escala numérica verbal, 2, 6, 12 e 24h após o BPEE por outro anestesista. Foi anotada a dose de analgésico complementar em 24h assim como os efeitos adversos. Resultados: Não houve diferença significante na intensidade da dor entre os grupos BPEE e morfina subaracnoidea, assim como a satisfação com os procedimentos. O uso de analgésico complementar foi maior no grupo BPEE. A incidência de náusea, vômito, e prurido assim como o tempo para primeira evacuação ou flato foi menor no grupo BPEE. Houve um caso de cefaleia pós-punção dural no grupo MS. Conclusões: O grupo BPEE promoveu escores de dor semelhantes aos do grupo MS nas primeiras 24h com maior consumo de tramadol, menos náusea, vômito, prurido e recuperação mais rápida da motilidade intestinal. Pode ser uma alternativa para analgesia após cesariana.
Background: Postoperative analgesia after cesarean section provides early ambulation, selfcare, and breastfeeding. The golden standard method used is the association of morphine with the local anesthetic to prolong the analgesic effect of spinal anesthesia. This technique can cause relevant adverse effects, and there is a need to evaluate another methods for analgesia. Erector spinae plane block has been used fot thoracic and abdominal surgical procedures. Objectives: The primary objective of this study is to compare the pain intensity between group spine erector plane block (SEPB) and spinal morphine after cesarean section. Secondary objectives are to evaluate adverse effects such as nausea, vomiting, pruritus, the need of complementation, and patient satisfaction. Methods: There were included 56 participantss randomly allocated into two groups of 27. SEPB group underwent spinal anesthesia with 12mg with 0.5% hyperbaric bupivacaine. After surgery, bilateral SPPB was performed with 20 ml of 0.25% levobupivacaine each side. Spinal morphine (SM) group underwent spinal anesthesia with 12mg of 0.5% hyperbaric bupivacaine, associated with 0.1mg of morphine. There were assessed: pain intensity by numerical rating scale (NRS), and supplementay analgesics at 2, 6, 12, and 24 hours after surgery by another anesthetist, so as the side effects. Results: There was no difference in pain intensity between the SEPB group and SM group so as in satisfaction. The use of supplementary analgesics was higher on SEPB group. Nausea, vomiting, and pruritus incidence so as the time to first flatus or defecation was lower in SEPB group. There was one case of postdural punction headache on SM group. Conclusion: The SEPB provided similar pain scores as the SM group in the first 24 postoperative hours, with a greater tramadol consumption, less nausea, vomit, pruritus, and a faster recovery of intestinal motility. It may be an alternative to cesarean delivery postoperative analgesia.
Background: Postoperative analgesia after cesarean section provides early ambulation, selfcare, and breastfeeding. The golden standard method used is the association of morphine with the local anesthetic to prolong the analgesic effect of spinal anesthesia. This technique can cause relevant adverse effects, and there is a need to evaluate another methods for analgesia. Erector spinae plane block has been used fot thoracic and abdominal surgical procedures. Objectives: The primary objective of this study is to compare the pain intensity between group spine erector plane block (SEPB) and spinal morphine after cesarean section. Secondary objectives are to evaluate adverse effects such as nausea, vomiting, pruritus, the need of complementation, and patient satisfaction. Methods: There were included 56 participantss randomly allocated into two groups of 27. SEPB group underwent spinal anesthesia with 12mg with 0.5% hyperbaric bupivacaine. After surgery, bilateral SPPB was performed with 20 ml of 0.25% levobupivacaine each side. Spinal morphine (SM) group underwent spinal anesthesia with 12mg of 0.5% hyperbaric bupivacaine, associated with 0.1mg of morphine. There were assessed: pain intensity by numerical rating scale (NRS), and supplementay analgesics at 2, 6, 12, and 24 hours after surgery by another anesthetist, so as the side effects. Results: There was no difference in pain intensity between the SEPB group and SM group so as in satisfaction. The use of supplementary analgesics was higher on SEPB group. Nausea, vomiting, and pruritus incidence so as the time to first flatus or defecation was lower in SEPB group. There was one case of postdural punction headache on SM group. Conclusion: The SEPB provided similar pain scores as the SM group in the first 24 postoperative hours, with a greater tramadol consumption, less nausea, vomit, pruritus, and a faster recovery of intestinal motility. It may be an alternative to cesarean delivery postoperative analgesia.