Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Manancial - Repositório Digital da UFSM |
Texto Completo: | http://repositorio.ufsm.br/handle/1/14814 |
Resumo: | Despite the development of anesthesia and analgesia techniques, pain has been a frequent complaint. Acute postoperative pain may cause reflex muscle contraction, immobility, restrictive ventilatory mechanics, accumulation of respiratory secretions, atelectasis, and pneumonia. In addition, pain delays the response to surgical stress, which includes inflammatory, endocrine, and metabolic activation, resulting in catabolic changes, hypercoagulable states, and postoperative organic dysfunction. The influence of analgesia techniques on these events has been extensively investigated. Epidural analgesia has the greatest potential for reduction of postoperative complications and has, indeed, been the most widely investigated technique. Both at the Santa Maria Universitary Hospital and in the literature, thoracic epidural analgesia (TEA) is the gold standard for the treatment of pain following esophagectomy. However, the incidence of postoperative clinical complications and of early mortality is unknown. An observational, analytical, and retrospective study was then conducted to compare TEA with intravenous (IV) analgesia, in which the influence of TEA on the reduction of outcomes such as pneumonia, surgical wound dehiscence, and mortality was hypothesized. A total of 211 medical records were reviewed, of which 203 provided sufficient data for analysis. Patients could be compared in terms of all clinical and demographic characteristics. One hundred eighty-three patients received TEA (Group 1), among whom the incidence of pneumonia (n=41; 22.4%) and of wound dehiscence (n=27; 14.8%) was significantly lower (p<0.001) than among those patients who received IV analgesia (Group 2, n=20). No significant difference was found between the groups regarding the other clinical outcomes. Notwithstanding the small number of patients in this study, it was possible to observe that the incidence of pneumonia and of wound dehiscence was lower in Group 1. |
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Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatóriaMorbidity and mortality in esophagectomies: a comparative restrospective study of two postoperative analgesia techniquesAnalgesia peridural torácicaEsofagectomiaMorbimortalidadeThoracic epidural analgesiaEsophagectomyMorbidity and mortalityCNPQ::CIENCIAS DA SAUDE::MEDICINADespite the development of anesthesia and analgesia techniques, pain has been a frequent complaint. Acute postoperative pain may cause reflex muscle contraction, immobility, restrictive ventilatory mechanics, accumulation of respiratory secretions, atelectasis, and pneumonia. In addition, pain delays the response to surgical stress, which includes inflammatory, endocrine, and metabolic activation, resulting in catabolic changes, hypercoagulable states, and postoperative organic dysfunction. The influence of analgesia techniques on these events has been extensively investigated. Epidural analgesia has the greatest potential for reduction of postoperative complications and has, indeed, been the most widely investigated technique. Both at the Santa Maria Universitary Hospital and in the literature, thoracic epidural analgesia (TEA) is the gold standard for the treatment of pain following esophagectomy. However, the incidence of postoperative clinical complications and of early mortality is unknown. An observational, analytical, and retrospective study was then conducted to compare TEA with intravenous (IV) analgesia, in which the influence of TEA on the reduction of outcomes such as pneumonia, surgical wound dehiscence, and mortality was hypothesized. A total of 211 medical records were reviewed, of which 203 provided sufficient data for analysis. Patients could be compared in terms of all clinical and demographic characteristics. One hundred eighty-three patients received TEA (Group 1), among whom the incidence of pneumonia (n=41; 22.4%) and of wound dehiscence (n=27; 14.8%) was significantly lower (p<0.001) than among those patients who received IV analgesia (Group 2, n=20). No significant difference was found between the groups regarding the other clinical outcomes. Notwithstanding the small number of patients in this study, it was possible to observe that the incidence of pneumonia and of wound dehiscence was lower in Group 1.Apesar do desenvolvimento das técnicas de anestesia e analgesia, a dor ainda é um problema frequente. A dor aguda, no contexto pós-operatório, pode causar contratura muscular reflexa, imobilidade, restrição da mecânica ventilatória, acúmulo de secreções respiratórias, atelectasia e pneumonia. Além disso, a presença de dor prolonga a resposta ao estresse cirúrgico, o que inclui ativação inflamatória e endócrino-metabólica, promovendo catabolismo, hipercoagulabilidade e disfunção orgânica pós-operatória. A influência da técnica de analgesia sobre esses eventos tem sido extensamente estudada. A analgesia peridural é a técnica com maior potencial para redução de complicações pós-operatórias em cirurgias de andar superior de abdome e tórax e tem sido, de fato, a mais investigada. No Hospital Universitário de Santa Maria, assim como na literatura, analgesia peridural torácica (APDT) é a técnica padrão na abordagem da dor pós-operatória em esofagectomia. Entretanto, a incidência de complicações clínicas pós-operatórias e a mortalidade precoce são desconhecidas. Foi realizado, então, um estudo observacional, analítico e retrospectivo, que comparou analgesia peridural torácica com analgesia intravenosa, tendo como hipótese a influência da APDT na redução de desfechos como pneumonia, deiscência de sutura e mortalidade. Foram revisados 211 prontuários, dos quais 203 forneceram dados suficientes para análise. Os pacientes foram comparáveis em relação a todas as características clínicas e demográficas consideradas. Cento e oitenta e três pacientes receberam APDT (grupo 1), nos quais a incidência de pneumonia (n=41; 22,4%) e deiscência de suturas (n=27; 14,8%) foi significativamente inferior (p<0,001) em relação ao grupo que recebeu analgesia intravenosa (grupo 2, n=20). Não houve diferença significativa, entre os grupos, quanto aos demais desfechos clínicos estudados. Apesar do número reduzido de pacientes no estudo, pode-se constatar que houve menor incidência de pneumonia e deiscência de suturas relacionada ao uso de APDT.Universidade Federal de Santa MariaBrasilMedicinaUFSMPrograma de Pós-Graduação em Ciências da SaúdeCentro de Ciências da SaúdeMenezes, Miriam Seligman dehttp://lattes.cnpq.br/8746728488629971Weinmann, Angela Regina Macielhttp://lattes.cnpq.br/9151119377173425Cóser, Virgínia Mariahttp://lattes.cnpq.br/4601008307298787Cunha, Diego da2018-11-12T21:13:57Z2018-11-12T21:13:57Z2018-04-23info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://repositorio.ufsm.br/handle/1/14814porAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Manancial - Repositório Digital da UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSM2018-11-13T05:00:40Zoai:repositorio.ufsm.br:1/14814Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufsm.br/ONGhttps://repositorio.ufsm.br/oai/requestatendimento.sib@ufsm.br||tedebc@gmail.comopendoar:2018-11-13T05:00:40Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM)false |
dc.title.none.fl_str_mv |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória Morbidity and mortality in esophagectomies: a comparative restrospective study of two postoperative analgesia techniques |
title |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória |
spellingShingle |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória Cunha, Diego da Analgesia peridural torácica Esofagectomia Morbimortalidade Thoracic epidural analgesia Esophagectomy Morbidity and mortality CNPQ::CIENCIAS DA SAUDE::MEDICINA |
title_short |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória |
title_full |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória |
title_fullStr |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória |
title_full_unstemmed |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória |
title_sort |
Morbimortalidade em esofagectomias: estudo retrospectivo comparativo entre duas técnicas de analgesia pós-operatória |
author |
Cunha, Diego da |
author_facet |
Cunha, Diego da |
author_role |
author |
dc.contributor.none.fl_str_mv |
Menezes, Miriam Seligman de http://lattes.cnpq.br/8746728488629971 Weinmann, Angela Regina Maciel http://lattes.cnpq.br/9151119377173425 Cóser, Virgínia Maria http://lattes.cnpq.br/4601008307298787 |
dc.contributor.author.fl_str_mv |
Cunha, Diego da |
dc.subject.por.fl_str_mv |
Analgesia peridural torácica Esofagectomia Morbimortalidade Thoracic epidural analgesia Esophagectomy Morbidity and mortality CNPQ::CIENCIAS DA SAUDE::MEDICINA |
topic |
Analgesia peridural torácica Esofagectomia Morbimortalidade Thoracic epidural analgesia Esophagectomy Morbidity and mortality CNPQ::CIENCIAS DA SAUDE::MEDICINA |
description |
Despite the development of anesthesia and analgesia techniques, pain has been a frequent complaint. Acute postoperative pain may cause reflex muscle contraction, immobility, restrictive ventilatory mechanics, accumulation of respiratory secretions, atelectasis, and pneumonia. In addition, pain delays the response to surgical stress, which includes inflammatory, endocrine, and metabolic activation, resulting in catabolic changes, hypercoagulable states, and postoperative organic dysfunction. The influence of analgesia techniques on these events has been extensively investigated. Epidural analgesia has the greatest potential for reduction of postoperative complications and has, indeed, been the most widely investigated technique. Both at the Santa Maria Universitary Hospital and in the literature, thoracic epidural analgesia (TEA) is the gold standard for the treatment of pain following esophagectomy. However, the incidence of postoperative clinical complications and of early mortality is unknown. An observational, analytical, and retrospective study was then conducted to compare TEA with intravenous (IV) analgesia, in which the influence of TEA on the reduction of outcomes such as pneumonia, surgical wound dehiscence, and mortality was hypothesized. A total of 211 medical records were reviewed, of which 203 provided sufficient data for analysis. Patients could be compared in terms of all clinical and demographic characteristics. One hundred eighty-three patients received TEA (Group 1), among whom the incidence of pneumonia (n=41; 22.4%) and of wound dehiscence (n=27; 14.8%) was significantly lower (p<0.001) than among those patients who received IV analgesia (Group 2, n=20). No significant difference was found between the groups regarding the other clinical outcomes. Notwithstanding the small number of patients in this study, it was possible to observe that the incidence of pneumonia and of wound dehiscence was lower in Group 1. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-11-12T21:13:57Z 2018-11-12T21:13:57Z 2018-04-23 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/14814 |
url |
http://repositorio.ufsm.br/handle/1/14814 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Medicina UFSM Programa de Pós-Graduação em Ciências da Saúde Centro de Ciências da Saúde |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Medicina UFSM Programa de Pós-Graduação em Ciências da Saúde Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Manancial - Repositório Digital da UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
instname_str |
Universidade Federal de Santa Maria (UFSM) |
instacron_str |
UFSM |
institution |
UFSM |
reponame_str |
Manancial - Repositório Digital da UFSM |
collection |
Manancial - Repositório Digital da UFSM |
repository.name.fl_str_mv |
Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
atendimento.sib@ufsm.br||tedebc@gmail.com |
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1805922079278628864 |