Estudo comparativo randomizado duplo cego do efeito analgésico do tramadol por infiltração ou via venosa em crianças submentidas a hernioplastia inguinal
Data
2013
Autores
Giraldes, Ana Laura Albertoni 
Orientadores
Sakata, Rioko Kimiko
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: O objetivo do estudo foi avaliar o efeito analgesico do tramadol injetado na incisao cirurgica comparando com administracao venosa em criancas submetidas a hernioplastia inguinal. Metodos: O estudo foi randomizado, prospectivo, comparativo e duplo cego. Foram avaliadas 40 criancas, entre 3 e 12 anos, submetidas a hernioplastia inguinal e distribuidas em 2 grupos. Os pacientes do grupo subcutaneo receberam infiltracao local com 2 mg/kg de tramadol diluidos em 5ml de solucao salina a 0,9% e 20ml de SF a 0,9% por via venosa ao final do procedimento cirurgico. Os pacientes do grupo venoso receberam 2 mg.kg-1 de tramadol por via venosa diluidos em 20 ml de SF a 0,9% e infiltracao local com 5ml de solucao salina a 0,9% ao final do procedimento cirurgico. Foi realizado bloqueio de nervo periferico com lidocaina a 1% antes do inicio da incisao cirurgica. Foi mantida anestesia com sevoflurano. Havendo necessidade foi administrado fentanila (0,5 mcg/kg) em bolo. As criancas receberam 30 mg.kg-1 de dipirona por via venosa quando tiveram dor. Apos 5 minutos da injecao da dipirona, aquelas que permaneceram com queixa de dor moderada ou intensa receberam 0,1 mg.kg-1 de morfina por via venosa, a qual poderia ser repetida ate que o paciente atingisse intensidade da dor leve ou ausente. Foram avaliados: intensidade de dor medida pelas escalas de faces e descritiva verbal, duracao da analgesia, dose total de dipirona e de morfina necessaria durante 2h, consumo de fentanil durante a operacao. Resultados: Os grupos foram semelhantes quanto a duracao de operacao (subcutaneo: 34,2 ± 14,9min; venoso: 34,2 ± 14,1min), e tempo entre bloqueio e final da cirurgia (subcutaneo: 41,1 ± 15min; venoso: 39,7 ± 14,1min). Nao houve diferenca estatistica significante entre os grupos na intensidade da dor (escala descritiva verbal e escala de faces), no tempo decorrido entre a injecao da solucao e a necessidade de complementacao de analgesico (subcutaneo: 32,7 ± 21,9min; venoso: 33,5 ± 26), consumo de fentanila intra operatorio (subcutaneo: 2; venoso: 4), consumo de dipirona (subcutaneo: 472,2 ± 386,2mg; venoso: 465,8 ± 411mg) e de morfina (subcutaneo: 1,14 ± 1,49mg; venoso: 0,74 ± 0,86mg), e na incidencia de efeitos adversos. Conclusoes: Nao houve diferenca em relacao ao efeito analgesico do tramadol na dose de 2mg/kg apos a infiltracao da ferida operatoria, antes do fechamento da incisao, em relacao a administracao por via venosa. Tambem nao houve diferenca em relacao aos efeitos adversos em ambos os grupos de criancas submetidas a hernioplastia inguinal
ABSTRACT Objective: The objective of the study was to evaluate the analgesic effect of tramadol injected into the surgical incision compared with intravenous administration in children undergoing inguinal hernia repair. Methods: The study was randomized, prospective, comparative, and doubleblinded.There were evaluated 40 children between 3 and 12 years old scheduled for inguinal hernia repair and distributed in 2 groups. Patients in subcutaneous group received local infiltration with 2 mg/kg tramadol diluted in 5 ml of 0.9% saline solution and 20ml of saline intravenously at the end of the surgery. Patients in intravenous group received 2 mg/kg tramadol intravenously diluted in 20 ml of saline and local infiltration with 5 mL of saline solution 0.9% at the end of the surgery. Peripheral nerve block was performed with 1% lidocaine before the incision. Anesthesia was maintained with sevoflurane. When needed there was administered fentanyl bolus of 0.5 mcg/kg. Analgesic supplementation was with 30 mg/kg dypirone intravenously, and when necessary there was administered 0.1 mg/kg of intravenous morphine, repeated until mild or absent pain. There were evaluated: pain intensity measured by faces and verbal descriptive scales, duration of analgesia, total dose of dipyrone and morphine required for 2h, and fentanyl consumption during surgery. Results: The groups were similar in terms of duration of operation (subcutaneous: 34.2 ± 14.9 min; intravenous: 34.2 ± 14.1min), and time between blocking and end of surgery (subcutaneous: 41.1 ± 15min; intravenous: 39.7 ± 14.1min). There was no statistically significant difference between groups in pain intensity (verbal descriptive scale and faces scale), the time between the injection of the solution and the need for supplementary analgesic (subcutaneous: 32.7 ± 21.9min; intravenous: 33 5 ± 26), intraoperative use of fentanyl (subcutaneous: 2; intravenous: 4), use of dipyrone (subcutaneous: 472.2 ± 386.2 mg, intravenous: 465.8 ± 411mg) and morphine (subcutaneous: 1.14 ± 1.49 mg intravenous: 0.74 ± 0.86 mg) and in the incidence of adverse effects. Conclusions: There was no difference in the analgesic effect of tramadol 2mg/kg after the infiltration of the surgical wound before closing the incision, compared to intravenous administration. There was also no difference in adverse effects in both groups of children undergoing inguinal hernia repair.
ABSTRACT Objective: The objective of the study was to evaluate the analgesic effect of tramadol injected into the surgical incision compared with intravenous administration in children undergoing inguinal hernia repair. Methods: The study was randomized, prospective, comparative, and doubleblinded.There were evaluated 40 children between 3 and 12 years old scheduled for inguinal hernia repair and distributed in 2 groups. Patients in subcutaneous group received local infiltration with 2 mg/kg tramadol diluted in 5 ml of 0.9% saline solution and 20ml of saline intravenously at the end of the surgery. Patients in intravenous group received 2 mg/kg tramadol intravenously diluted in 20 ml of saline and local infiltration with 5 mL of saline solution 0.9% at the end of the surgery. Peripheral nerve block was performed with 1% lidocaine before the incision. Anesthesia was maintained with sevoflurane. When needed there was administered fentanyl bolus of 0.5 mcg/kg. Analgesic supplementation was with 30 mg/kg dypirone intravenously, and when necessary there was administered 0.1 mg/kg of intravenous morphine, repeated until mild or absent pain. There were evaluated: pain intensity measured by faces and verbal descriptive scales, duration of analgesia, total dose of dipyrone and morphine required for 2h, and fentanyl consumption during surgery. Results: The groups were similar in terms of duration of operation (subcutaneous: 34.2 ± 14.9 min; intravenous: 34.2 ± 14.1min), and time between blocking and end of surgery (subcutaneous: 41.1 ± 15min; intravenous: 39.7 ± 14.1min). There was no statistically significant difference between groups in pain intensity (verbal descriptive scale and faces scale), the time between the injection of the solution and the need for supplementary analgesic (subcutaneous: 32.7 ± 21.9min; intravenous: 33 5 ± 26), intraoperative use of fentanyl (subcutaneous: 2; intravenous: 4), use of dipyrone (subcutaneous: 472.2 ± 386.2 mg, intravenous: 465.8 ± 411mg) and morphine (subcutaneous: 1.14 ± 1.49 mg intravenous: 0.74 ± 0.86 mg) and in the incidence of adverse effects. Conclusions: There was no difference in the analgesic effect of tramadol 2mg/kg after the infiltration of the surgical wound before closing the incision, compared to intravenous administration. There was also no difference in adverse effects in both groups of children undergoing inguinal hernia repair.
Descrição
Citação
GIRALDES, Ana Laura Albertoni. Estudo comparativo randomizado duplo cego do efeito analgésico do tramadol por infiltração ou via venosa em crianças submentidas a hernioplastia inguinal. 2013. 54 f. Dissertação (Mestrado em Clínica Cirúrgica Interdisciplinar) - Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2013.