Estudo prospectivo da eficácia da ablação de nervos geniculares com fenol guiada por ultrassonografia para o tratamento de dor por osteoartrite de joelho
Data
2021-06-07
Autores
Risso, Roberta Cristina [UNIFESP]
Orientadores
Sakata, Rioko Kimiko [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Justificativa e Objetivos:
A osteoartrite (OA) é uma das causas mais frequentes de dor crônica e
incapacidade funcional nos idosos e os joelhos são as articulações mais
acometidas. Os medicamentos sistêmicos são indicados antes de
procedimentos invasivos. O bloqueio dos nervos geniculares tem sido utilizado
para alívio da dor crônica em joelho, como terapia adjuvante. O uso do fenol para
ablação de nervos periféricos tem surgido como uma boa opção, de baixo custo.
O objetivo deste estudo foi avaliar a eficácia do fenol a 7% para a neurólise dos
geniculares, guiada por ultrassonografia, para o tratamento de dor crônica de
pacientes com osteoartrite no joelho.
Métodos
Foi realizado estudo prospectivo de 61 bloqueios neurolíticos de geniculares em
38 pacientes com dor crônica (mais de 6 meses) por osteoartrite graus III ou IV
de Kellgren-Lawrence, e intensidade da dor ≥4 (escala numérica de zero a 10).
Eles foram submetidos ao bloqueio teste de 3 nervos geniculares superior medial- SM, superior-lateral- SL e inferior-medial- IM, guiados por ultrassom, com
1,5mL de bupivacaína a 0,25% em cada nervo. Obtiveram redução da
intensidade da dor ≥ 50%, e a neurólise dos geniculares foi feita com 1,5mL de
fenol glicerinado a 7% em cada um dos 3 nervos geniculares. Os pacientes foram
avaliados antes do bloqueio e após 2semanas, 1mês, 2meses, 3meses e
6meses em relação à intensidade da dor e funcionalidade da articulação do
joelho pelo questionário WOMAC (Western Ontario and McMaster Universities).
Foram anotados os efeitos adversos e complicações.
Resultados
Foram avaliados para eligibilidade pacientes com 68 lesões de joelho por OA,
com exclusão de 5 (sem critérios para inclusão), sendo alocados pacientes com
63 lesões de joelho (38 pacientes), sendo que o bloqueio teste promoveu
redução da intensidade da dor 50% em 61, submetidos a neurólise. Houve
perda no seguimento de 18 bloqueios, com análise de 43 neurolises em 28
xiii
pacientes. Houve redução significante da intensidade da dor após bloqueio com
fenol em todos os tempos avaliados; a mediana dos escores de dor antes do
bloqueio foi de 7 e após, manteve em 4 durante os 180 dias. Houve melhora
significante da capacidade funcional do joelho pelo questionário de qualidade de
vida WOMAC. Antes do bloqueio foi de 45; após 2sem. foi de 22,5 e após 180
dias, de 17.
Os efeitos adversos observados foram: dor local, edema, hematoma, e fraqueza
motora.
Conclusões
A neurólise dos geniculares SM, SL e IM, guiada por ultrassonografia com uso
de fenol proporcionou bom efeito analgésico ao longo do período avaliado de
180 dias, sendo uma técnica com eficácia satisfatória e longa duração com
melhora da capacidade funcional do joelho.
Background Objectives: Osteoarthritis (OA) is one of the more frequent causes of chronic pain and functional incapacity in the elderly, and the knees are the most affected joints. Systemic drugs are indicated prior to intervention procedures. Genicular nerve block has been used to relieve chronic knee pain as adjunctive therapy. The use of phenol for neurolysis of peripheral nerve has emerged as a good option and with low cost. The objective of this study is to assess the effectiveness of phenol on ultrasound guided neurolysis of genicular nerves for the treatment of patients with chronic pain in knee OA. Methods: A prospective study was carried out with 61 phenolization of the genicular nerves in 38 patients with chronic pain (more than 6 months) due to Kellgren-Lawrence grades III or IV osteoarthritis, and pain intensity ≥4 (numerical scale from zero to 10). They were submitted to ultrasound-guided 3 genicular (superomedial- SM, superolateral- SL and inferomedial- IM) nerve test block, performed with 1.5mL of 0.25% bupivacaine in each nerve. These patients obtained pain intensity reduction ≥50%, and underwent neurolysis of the same genicular with 1.5 mL of 7% phenol in each of the genicular nerves. Patients were evaluated before block and after 2weeks, 1, 2, 3, and 6months about pain intensity by numerical rating scale (NRS) and joint functionality by WOMAC questionnaire. Participants were assessed before the procedure, after 2 weeks, and after 1, 2, 3 and 6 months, on the intensity of the pain and functioning of knee joint based on WOMAC questionnaire. There were evaluated adverse effects and complications. Results: There were assessed for eligibility 68 lesions of the knee by OA (in 38 patients), with exclusion of 5, and allocation of 63 knee lesions (in 38 patients). The test block promoted reduction in pain intensity 50% in 61, submitted to neurolysis. There were lost to follow-up 18 procedures, with analyze of 43 neurolysis in 28 patients. There was significant reduction of pain intensity after phenol block in all xv evaluated times; the median pain scores before the block was 7 and after it was maintained in 4 during 180 days. There was a significant improvement in the functional capacity by quality of life WOMAC questionnaire. Before the block it was of 45; after 2 weeks, 22,5 and after 180 days, 17. The adverse effects were: local pain, swelling, bruise and motor weakness. Conclusion: Ultrasound-guided SM, SL and IM genicular neurolysis with the use of phenol offered good analgesic effect, and improved knee function during the period of 180 days followed. It is a technique that proved satisfactory and of long duration.
Background Objectives: Osteoarthritis (OA) is one of the more frequent causes of chronic pain and functional incapacity in the elderly, and the knees are the most affected joints. Systemic drugs are indicated prior to intervention procedures. Genicular nerve block has been used to relieve chronic knee pain as adjunctive therapy. The use of phenol for neurolysis of peripheral nerve has emerged as a good option and with low cost. The objective of this study is to assess the effectiveness of phenol on ultrasound guided neurolysis of genicular nerves for the treatment of patients with chronic pain in knee OA. Methods: A prospective study was carried out with 61 phenolization of the genicular nerves in 38 patients with chronic pain (more than 6 months) due to Kellgren-Lawrence grades III or IV osteoarthritis, and pain intensity ≥4 (numerical scale from zero to 10). They were submitted to ultrasound-guided 3 genicular (superomedial- SM, superolateral- SL and inferomedial- IM) nerve test block, performed with 1.5mL of 0.25% bupivacaine in each nerve. These patients obtained pain intensity reduction ≥50%, and underwent neurolysis of the same genicular with 1.5 mL of 7% phenol in each of the genicular nerves. Patients were evaluated before block and after 2weeks, 1, 2, 3, and 6months about pain intensity by numerical rating scale (NRS) and joint functionality by WOMAC questionnaire. Participants were assessed before the procedure, after 2 weeks, and after 1, 2, 3 and 6 months, on the intensity of the pain and functioning of knee joint based on WOMAC questionnaire. There were evaluated adverse effects and complications. Results: There were assessed for eligibility 68 lesions of the knee by OA (in 38 patients), with exclusion of 5, and allocation of 63 knee lesions (in 38 patients). The test block promoted reduction in pain intensity 50% in 61, submitted to neurolysis. There were lost to follow-up 18 procedures, with analyze of 43 neurolysis in 28 patients. There was significant reduction of pain intensity after phenol block in all xv evaluated times; the median pain scores before the block was 7 and after it was maintained in 4 during 180 days. There was a significant improvement in the functional capacity by quality of life WOMAC questionnaire. Before the block it was of 45; after 2 weeks, 22,5 and after 180 days, 17. The adverse effects were: local pain, swelling, bruise and motor weakness. Conclusion: Ultrasound-guided SM, SL and IM genicular neurolysis with the use of phenol offered good analgesic effect, and improved knee function during the period of 180 days followed. It is a technique that proved satisfactory and of long duration.