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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(02): 257-266
DOI: 10.1055/s-0040-1718514
Artigo Original
Pé e Tornozelo

Avaliação da adição da epinefrina à bupivacaína intra-articular no controle da dor aguda em pacientes submetidos a reconstrução do ligamento cruzado anterior[*]

Article in several languages: português | English
Marcos George de Souza Leão 
1   Departamento de Ortopedia e Traumatologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
,
Juscimar Carneiro Nunes 
2   Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brasil
,
Ivan Tramujas da Costa e Silva 
2   Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brasil
,
Alan Braga Perfeito 
1   Departamento de Ortopedia e Traumatologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
,
Wagner de Paula Rogério 
3   Serviço de Anestesiologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
,
Rafaela Brasil e Silva Nunes 
3   Serviço de Anestesiologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
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Resumo

Objetivo Avaliar primariamente a dor pós-operatória, por meio da escala visual analógica (EVA), nos pacientes submetidos a reconstrução do ligamento cruzado anterior (RLCA) que receberam soluções anestésicas intra-articulares (IAs).

Métodos Ensaio clínico randomizado com uma amostra de 48 pacientes, divididos em 4 grupos: Grupo I (n = 12) – 20 ml de solução fisiológica (controle); Grupo II (n = 12) – 20 ml de bupivacaína a 0,5%; Grupo III (n = 12) – 20 ml de bupivacaína a 0,5% + 0,1 mg de epinefrina; e Grupo IV (n = 12) – 20 ml de solução fisiológica + 0,1 mg de epinefrina, injetados no joelho ao término da cirurgia. A dor foi avaliada pela EVA imediatamente e 6, 12, 24 e 48 horas após o procedimento.

Resultados Observou-se grande variabilidade nos resultados da EVA entre os pacientes avaliados em cada grupo. Verificou-se, pela análise de variância (analysis of variance, ANOVA) de Kruskal-Wallis, considerando um nível de 5% de significância, que as soluções anestésicas IAs de cada grupo influenciaram na avaliação da dor desses pacientes (p = 0,003), sendo os do Grupo III os que apresentaram menor dor pós-operatória. Não se evidenciou um maior ou menor consumo de drogas analgésicas suplementares, ou efeitos adversos das decorrentes das soluções empregadas.

Conclusão A solução combinada de bupivacaína e epinefrina foi a mais eficaz no controle da dor nos pacientes submetidos a RLCA, mas sem diferenças estatisticamente significativas com relação ao grupo II (p = 0,547). Não se observou diminuição ou aumento no consumo de analgésicos suplementares, ou o aparecimento de efeitos sistêmicos adversos (p > 0,05).

Palavras-chave

ligamento cruzado anterior - medição da dor - analgesia - tratamento farmacológico - artroscopia

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* Trabalho desenvolvido no Departamento de Ortopedia e Traumatologia, Fundação Hospital Adriano Jorge, Cachoeirinha, Manaus, AM, Brasil.




Publication History

Received: 29 August 2019

Accepted: 06 July 2020

Article published online:
19 April 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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