analgesia perioperatória com infusão peridural contínua da combinação de morfina e clonidina em crianças submetidas a procedimentos cirúrgicos abdominais analgesia perioperatoria con infusión peridural continua de la combinación de morfina y clonidina en niños sometidos a procedimientos quirúrgicos abdominales perioperative analgesia with continuous epidural infusion of morphine combined with clonidine in children undergoing abdominal surgeries
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ID: 187868
2007
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Abstract
JUSTIFICATIVA E OBJETIVOS: O presente estudo foi desenvolvido para avaliar o efeito analgésico da combinação de morfina e clonidina administrada por via peridural, cuja eficácia foi demonstrada em pacientes adultos, sobre o consumo de isoflurano e o consumo de medicação analgésica no período pós-operatório em crianças. MÉTODO: Vinte e seis crianças escaladas para operações intra-abdominais foram alocadas de forma aleatória em dois grupos. Os dois grupos receberam, por via peridural, bolus de morfina (8 µg.kg-1) e de clonidina (0,8 µg.kg-1) antes do início da intervenção cirúrgica, seguidos de infusão contínua de clonidina (0,12 µg.kg-1.h-1) mais morfina (1,2 µg.kg-1.h-1) no Grupo I e o dobro dessas doses no Grupo II, durante 24 horas. Foram medidas as concentrações inspiratórias de isoflurano durante a operação e o número de doses (1 mg.kg-1) de tramadol durante 24 horas no pós-operatório. RESULTADOS: As concentrações de isoflurano foram significativamente menores em relação aos valores observados antes da incisão cirúrgica após 60 e 90 minutos nos Grupos II e I, respectivamente, porém não houve diferença entre os dois grupos. O consumo de tramadol foi muito menor no Grupo II, e sete (53,8%) não necessitaram analgesia de resgate, porém foram observadas maior sedação e hipotensão arterial. Não foi observada depressão respiratória nos dois grupos. CONCLUSÕES: A infusão peridural da combinação de baixas doses de clonidina e morfina promoveu redução da necessidade de isoflurano no período intra-operatório e analgesia pós-operatória de boa qualidade.
JUSTIFICATIVA Y OBJETIVOS: El presente estudio fue desarrollado para evaluar el efecto analgésico de la combinación de morfina y clonidina administrada por vía peridural, cuya eficacia fue demostrada en pacientes adultos, sobre el consumo de isoflurano y el consumo de medicación analgésica en el período postoperatorio en niños. MÉTODO: Veinte y seis niños destinados a operaciones intra-abdominales fueron ubicados aleatoriamente en de los grupos. Los de los grupos recibieron, por vía peridural, bolus de morfina (8 µg.kg-1) y de clonidina (0,8 µg.kg-1) antes del inicio de la intervención quirúrgica, seguidos de infusión continua de clonidina (0,12 µg.kg-1.h-1) más morfina (1,2 µg.kg-1.h-1) en el Grupo I y el doble de esa dosis en el Grupo II, durante 24 horas. Fueron medidas las concentraciones inspiratorias de isoflurano durante la operación y el número de dosis (1 mg.kg-1) de tramadol durante 24 horas en el postoperatorio. RESULTADOS: Las concentraciones de isoflurano fueron significativamente menores con relación a los valores observados antes de la incisión quirúrgica después 60 y 90 minutos en los grupos II y I, respectivamente, sin embargo no hubo diferencia entre los de los grupos. El consumo de tramadol fue significativamente menor en el grupo 2, siendo que 7 (53,8%) no necesitaron analgesia de rescate, sin embargo fueron observadas mayor sedación e hipotensión arterial. No fue observada depresión respiratoria en los de los grupos. CONCLUSIÓN: La infusión peridural de la combinación de bajas dosis de clonidina y morfina promovieron reducción de la necesidad de isoflurano en el período intraoperatorio y analgesia postoperatoria de buena calidad.
BACKGROUND AND OBJECTIVES: The present study was developed to evaluate the analgesic effects of the epidural administration of a combination of morphine and clonidine, whose efficacy has been demonstrated in adults, on the consumption of isoflurane and postoperative consumption of analgesics in children. METHODS: Twenty-six children scheduled for intra-abdominal surgeries were randomly divided in two groups. Both groups received an epidural bolus of morphine (8 µg.kg-1) and clonidine (0.8 µg.kg-1) before the surgery, followed by the continuous infusion of clonidine (0.12 µg.kg-1.h-1) plus morphine (1.2 µg.kg-1.h-1) in Group I, and twice those dosages in Group II, during 24 hours. Inspiratory concentrations of isoflurane were measured during the surgery, as well as the number of doses (1 mg.kg-1) of tramadol during 24 hours in the postoperative period. RESULTS: The concentrations of isoflurane were significantly smaller after 60 and 90 minutes than the concentrations before the incision in Groups II and I, respectively, but those differences were not statistically significant. The consumption of tramadol was significantly lower in Group II, and 7 (53.8%) patients in this group did not need rescue analgesia, but we observed an increase in the incidence of sedation and hypotension. Respiratory depression was not observed in either group. CONCLUSIONS: Epidural infusion of low doses of clonidine combined with morphine reduced the intraoperative need of isoflurane and postoperative analgesia.
JUSTIFICATIVA Y OBJETIVOS: El presente estudio fue desarrollado para evaluar el efecto analgésico de la combinación de morfina y clonidina administrada por vía peridural, cuya eficacia fue demostrada en pacientes adultos, sobre el consumo de isoflurano y el consumo de medicación analgésica en el período postoperatorio en niños. MÉTODO: Veinte y seis niños destinados a operaciones intra-abdominales fueron ubicados aleatoriamente en de los grupos. Los de los grupos recibieron, por vía peridural, bolus de morfina (8 µg.kg-1) y de clonidina (0,8 µg.kg-1) antes del inicio de la intervención quirúrgica, seguidos de infusión continua de clonidina (0,12 µg.kg-1.h-1) más morfina (1,2 µg.kg-1.h-1) en el Grupo I y el doble de esa dosis en el Grupo II, durante 24 horas. Fueron medidas las concentraciones inspiratorias de isoflurano durante la operación y el número de dosis (1 mg.kg-1) de tramadol durante 24 horas en el postoperatorio. RESULTADOS: Las concentraciones de isoflurano fueron significativamente menores con relación a los valores observados antes de la incisión quirúrgica después 60 y 90 minutos en los grupos II y I, respectivamente, sin embargo no hubo diferencia entre los de los grupos. El consumo de tramadol fue significativamente menor en el grupo 2, siendo que 7 (53,8%) no necesitaron analgesia de rescate, sin embargo fueron observadas mayor sedación e hipotensión arterial. No fue observada depresión respiratoria en los de los grupos. CONCLUSIÓN: La infusión peridural de la combinación de bajas dosis de clonidina y morfina promovieron reducción de la necesidad de isoflurano en el período intraoperatorio y analgesia postoperatoria de buena calidad.
BACKGROUND AND OBJECTIVES: The present study was developed to evaluate the analgesic effects of the epidural administration of a combination of morphine and clonidine, whose efficacy has been demonstrated in adults, on the consumption of isoflurane and postoperative consumption of analgesics in children. METHODS: Twenty-six children scheduled for intra-abdominal surgeries were randomly divided in two groups. Both groups received an epidural bolus of morphine (8 µg.kg-1) and clonidine (0.8 µg.kg-1) before the surgery, followed by the continuous infusion of clonidine (0.12 µg.kg-1.h-1) plus morphine (1.2 µg.kg-1.h-1) in Group I, and twice those dosages in Group II, during 24 hours. Inspiratory concentrations of isoflurane were measured during the surgery, as well as the number of doses (1 mg.kg-1) of tramadol during 24 hours in the postoperative period. RESULTS: The concentrations of isoflurane were significantly smaller after 60 and 90 minutes than the concentrations before the incision in Groups II and I, respectively, but those differences were not statistically significant. The consumption of tramadol was significantly lower in Group II, and 7 (53.8%) patients in this group did not need rescue analgesia, but we observed an increase in the incidence of sedation and hypotension. Respiratory depression was not observed in either group. CONCLUSIONS: Epidural infusion of low doses of clonidine combined with morphine reduced the intraoperative need of isoflurane and postoperative analgesia.
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klamt2007revistaanalgesia
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|---|---|
| Authors | ;Jyrson Guilherme Klamt;Magaly Santoni;Luis Vicente Garcia;Renato Mestriner Stocche |
| Journal | methods in molecular biology (clifton, nj) |
| Year | 2007 |
| DOI |
10.1590/S0034-70942007000600003
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