Analgesia Epidural em Cirurgia de Escoliose em Idade Pediátrica

  • Sónia Dória Nóbrega Centro Hospitalar Universitário Lisboa Central
  • Ana Ferreira
  • Sara Ramos
Palavras-chave: Analgesia Epidural; Criança; Dor Pós-Operatória/tratamento; Escoliose/cirurgia; Gestão da Dor

Resumo

Introdução: A cirurgia de escoliose pediátrica, que visa interromper a progressão da doença e melhorar a qualidade de vida, está associada a dor pós-operatória intensa. Em 2016, implementámos a analgesia
epidural no período pós-operatório, através de um ou dois cateteres epidurais, colocados pelo cirurgião no final da cirurgia. Os objetivos deste estudo foram avaliar a eficácia analgésica até 72 horas após a cirurgia, a incidência de eventos adversos e o tempo de permanência na Unidade de Cuidados Intensivos (UCI).

Material e Métodos: Foi realizada uma análise retrospectiva comparando dois grupos: Grupo Alfentanil (AG) - 25 doentes com analgesia sistémica por perfusão endovenosa de alfentanil - e Grupo Epidural (EG) - 21 doentes com perfusão de ropivacaína e morfina via epidural. Os dados foram analisados através do SPSS®, utilizando o teste não paramétrico de Mann-Whitney, o teste exato de Fisher e o coeficiente de correlação de Spearman (nível de significância considerado α = 0,05).

Resultados: Os scores de dor (escala numérica 0-10) foram inferiores no EG, no pós-operatório imediato (-3), 24 horas (-5) e 48 horas (-4) após a cirurgia (p<0,001). As necessidades de analgesia de resgate foram inferiores no EG (p<0,001). Houve menor incidência de eventos adversos no EG, não atingindo significância estatística. O tempo de internamento na UCI foi inferior no EG (p<0,001).

Conclusão: A analgesia epidural é uma alternativa eficaz na cirurgia de escoliose pediátrica. São necessários estudos prospectivos randomizados para confirmar estes resultados.

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Referências

McNicol ED, Tzortzopoulou A, Schumann R, Carr DB, Kalra A. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev. 2016;9:CD006883. doi: 10.1002/14651858.CD006883.pub3.

Negrini S, Minozzi S, Bettany-Saltikov J, Chockalingam N, Grivas TB, Kotwicki T, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. 2015;6:CD006850. doi: 10.1002/14651858.CD006850.pub3.

Mo F, Cunningham ME. Pediatric scoliosis. Curr Rev Musculoskelet Med. 2011;4:175–82.

Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Prim. 2015;1:15030.

Ailon T, Sure DR, Smith JS, Shaffrey CI. Surgical considerations for major deformity correction spine surgery. Best Pract Res Clin Anaesthesiol. 2016;30:3–11. doi: 10.1016/j.bpa.2015.11.005.

Hong R, Gibbons K, Li G, Holman A, Voepel-Lewis T. A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis. Paediatr Anaesth. 2017;27:91-7. doi: 10.1111/pan.13037.

Blumenthal S, Min K, Nadig M, Borgeat A. Double epidural catheter with ropivacaine versus intravenous morphine: A comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology. 2005;102:175-80.

Klatt J, Mickelson J, Hung M, Durcan S, Miller C, Smith J. A randomized prospective evaluation of 3 techniques of postoperative pain management after posterior spinal instrumentation and fusion. Spine. 2013;38:1626-31. doi:

1097/BRS.0b013e31829cab0b.

Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin in Anaesthesiol. 2008;21:313-6.

Tobias J, Gaines R, Lowry K, Kittle D, Bildner C. A dual epidural catheter technique to provide analgesia following posterior spinal fusion for scoliosis in children and adolescents. Paediatr Anaesth. 2001;ll:199-203.

Moriarty A. Postoperative extradural infusions in children: preliminary data from a comparison of bupivacaine/diamorphine with plain ropivacaine. Paediatr Anaesth. 1999;9:423–7.

Jorgensen H, Fomsgaard J, Dirks J, Wetterslev J, Andreasson B, Dahl J. Effect of epidural bupivacaine vs. combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery. Br J Anaesth. 2001;87:727–32.

Jorgensen H, Fomsgaard JS, Dirks J, Wetterslev J, Andreasson B, Dahl JB. Effect of peri and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. Br J Anaesth. 2001;87:577–83.

Guay J, Suresh S, Kopp S, Johnson RL. Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children. Cochrane Database Syst Rev. 2019;1:CD012819. doi: 10.1002/14651858.CD012819.pub2

Li Y, Hong R, Robbins C, Gibbons K, Holman A, Caird M, et al. Intrathecal morphine and oral analgesics provide safe and effective pain control after posterior spinal fusion for adolescent idiopathic scoliosis. Spine. 2018;43:E98-104. doi: 10.1097/BRS.0000000000002245.

Ibach B, Loeber C, Shukry M, Hagemann T, Harrison D, Johnson P. Duration of intrathecal morphine effect in children with idiopathic scoliosis undergoing posterior spinal fusion. J Opioid Manag. 2015;11:295-303. doi: 10.5055/jom.2015.0278.

Trzcinski S, Rosenberg R, Vasquez Montes D, Sure A, Zhou P,Tishelman J, et al. Use of gabapentin in posterior spinal fusion is associated with decreased postoperative pain and opioid use in children and adolescents. Clin Spine Surg. 2019;32:210-4. doi: 10.1097/BSD.0000000000000783.

Rusy L, Hainsworth K, Nelson T, Czamecki M, Tassone J, Thometz J, et al. Gabapentin use in pediatric spinal fusion patients: a randomized, doubleblind, controlled trial. Anesth Analg. 2010;110:1393-8.

Pestieau S, Finkel J, Junqueira M, Cheng Y, Lovejoy J, Wang J, et al. Prolonged perioperative infusion of low-dose ketamine does not alter opioid use after pediatric scoliosis surgery. Paediatr Anaesth. 2014;24:582-90. doi: 10.1111/pan.12417.

Wade Shrader M, Nabar S, Jones J, Falk M, Cotugno R, White G, et al. Adjunctive pain control methods lower narcotic use and pain scores for patients with adolescent idiopathic scoliosisundergoing posterior spinal fusion. Spine Deform. 2015;3:82-7. doi: 10.1016/j.jspd.2014.06.002. Consulted references but not mentioned in the article:

Ekatodramis G, Min K, Cathrein P, Borgeat A. Use of a double epidural catheter provides effective postoperative analgesia after spine deformity surgery. Can J Anaesth. 2002;49:173-7.

Turner A, Lee J, Mitchell R, Berman J, Edge G, Fennelly M. The efficacy of surgically placed epidural catheters for analgesia after posterior spinal surgery. Anaesthesia. 2000;55:370-3.

Cassady J, Lederhaas G, Cancel DD, Cummings R, Loveless E. A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient controlled analgesia after posterior spinal fusion in adolescents. Reg Anesth Pain Med. 2000;25:246–53.

O'Hara J, Cywinski J, Tetzlaff J, Xu M, Gurd A, Andrish J. The effect of epidural vs. intravenous analgesia for posterior spinal fusion surgery. Paediatr Anaesth. 2004;14:1009-15.

Gauger V, Voepel-Lewis T, Burke C, Kostrzewa A, Caird M, Wagner D, et al. Epidural analgesia compared with intravenous analgesia after pediatric posterior spinal fusion. Pediatr Orthop. 2009;29:588-93. doi: 10.1097/

BPO.0b013e3181b2ba08.

Tobias J. A review of intrathecal and epidural analgesia after spinal surgery in children. Anesth Analg. 2004;98:956-65.

Poe-Kochert C, Tripi PA, Potzman J, Son-Hing H, Thompson G. Continuous intravenous morphine infusion for postoperative analgesia following posterior spinal fusion for idiopathic scoliosis. Spine. 2010;35:754-7.

Saudan S, Habre W, Ceroni D, Meyer P, Greenberg R, Kaellin A, et al. Safety and efficacy of patient controlled epidural analgesia following pediatric spinal surgery. Paediatr Anaesth. 2008;18:132-9.

Taenzer A, Clark C. Eficacy of postoperative epidural analgesia in adolescent scoliosis surgery: a meta-analysis. Paediatri Anaesth. 2010;20:135-43

Publicado
2020-04-02
Como Citar
Nóbrega, S. D., Ferreira, A., & Ramos, S. (2020). Analgesia Epidural em Cirurgia de Escoliose em Idade Pediátrica. Revista Da Sociedade Portuguesa De Anestesiologia, 29(1), 12 - 17. https://doi.org/10.25751/rspa.19016