Ensaio clínico randomizado e controlado do efeito analgésico com infiltração local ou bloqueio espinal para hemorroidectomia fechada

• Ano de defesa: 2016
• Autor(a) principal: Borges, Luis Antonio [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Local anesthesia; Hemorrhoidectomy; Anestesia local; Hemorroidectomia
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3780785; http://repositorio.unifesp.br/handle/11600/47202

Objectives: Hemorrhoidectomy is often an outpatient surgery. Effective postoperative analgesia and early recovery are important to the hospital discharge. The aim of this study was to evaluate the postoperative analgesic effect, time for discharge, and adverse effects of perianal infiltration compared with spinal anesthesia for hemorrhoidectomy. Methods: In a prospective, randomized and comparative study, there were included 40 patients between 18 and 60 years. Local group (LG) patients were operated with local infiltration and general anesthesia and spinal group (SG) with spinal block. In LG, infiltration was with 20 ml of 0.75% ropivacaine, and general anesthesia with propofol, atracurium, and propofol infusion. SG patients received 2 ml of 0.5% hyperbaric bupivacaine. Complementation in LG could be made with fentanyl (50 ?g) and SG with 5 ml of 1% lidocaine. Postoperative could be made with acetaminophen (500mg) and if necessary with tramadol (50 mg). There were evaluated: the intensity of postoperative pain, sphincter relaxation, lower limbs strength, time to discharge, analgesic dose in one week, and adverse effects. Results: There was need for complementation of anesthesia with fentanyl in 11 LG (median = 50 ?g) and there was no need for supplementation with lidocaine in SG. Pain intensity was higher in the LG at 0, 30, 60, 90 and 120 minutes after the end of surgery, with no significant difference after 150 and 180 minutes. There were no differences in acetaminophen (LG = 4.929 mg; SG = 6.426 mg; p = 0.1396, Student?s t test) and tramadol consumption (LG = 450 mg; SG = 450 mg; p = 0.8169; Mann-Whitney test) at one week after the surgery. The time for first complementation of postoperative analgesia was higher after spinal (LG = 84 min; SG = 292 min; p < 0.0001; Mann-Whitney test). The time to discharge was higher after spinal (LG = 241.9 min; SG = 347.5 min; p = 0.0005, Student?s t test). Adverse effects were nausea (LG = 3; SG = 0; p = 0.1395), dizziness (LG = 1; SG = 0; p = 0.3395) and urinary retention (LG = 0; SG = 4; p = 0.0913); chi-square test. Conclusions: After hemorrhoidectomy, the intensity of pain was higher in the local infiltration than in spinal anesthesia during the first two hours, with no difference after 150 and 180 min. The time for first complementation was lower; with no difference in the paracetamol and tramadol dose in one week, and adverse effects.