Efeito da lidocaína endovenosa perioperatória sobre a analgesia e a concentração sérica de citocinas: estudo randomizado e duplo-cego

• Autor(a) principal: Ortiz, Michele Purper
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Manancial - Repositório Digital da UFSM
• dARK ID: ark:/26339/001300000wwjm
• Texto Completo: http://repositorio.ufsm.br/handle/1/5853
• topic: Lidocaína endovenosa; Dor pós-operatória; Citocinas; Endovenous lidocaine; Postoperative pain; Cytokines; CNPQ::CIENCIAS DA SAUDE

Postoperative pain still occurs in more than 50% of surgical procedures. It s known that inappropriate treatment of postoperative pain can worsen patient s outcome, either for increasing systemic surgical stress response, increasing cardiologic events, or even by the development of chronic pain. New multimodal analgesia strategies have been employed, based on the use of different drugs, by different administration methods and at different times, trying to reduce the amount of opioids and, consequently, their side effects. In this setting, continuous intravenous lidocaine used during perioperative period has shown to be promising. This trial aimed to compare postoperative analgesia in patients who underwent laparoscopic cholecystectomies, under general anesthesia, and received endovenous lidocaine in comparison to a control group. Opioid consumption, time of ileus, time to discharge and levels of interleukin 1, 6, 10, tumoral necrosis factor and interferon gamma were also compared. Forty-four patients undergoing laparoscopic cholecystectomies were randomly allocated in two groups. The first one received endovenous lidocaine bolus of 1.5 mg.kg-1 followed by continuous infusion of 3 mg.kg-1 during intraoperative period until one hour after the end of the procedure. The second one received saline, intravenously, at the same infusion rate (ml.h-1), during the same period. It was a double-blind intervention. In the postoperative period, both groups received dipyrone and morphine patient controlled analgesia (PCA). Pain was assessed by VNS (Visual Numeric Scale), both at rest and when coughing at the 1st, 2nd, 4th, 12th and 24th hour after the end of the surgery. Blood samples for cytokines measurement were taken at the end of procedure and 24 hours later. The total morphine PCA demand, the time for the first flatus and the length of hospital stay were also recorded and compared. Groups were similar relating to gender (p = 0,2), age (p = 0,5), weight (p = 0,08) and length of surgery (p = 0,6). No differences were observed regarding the intensity of postoperative pain between the groups, either at rest (p = 0,76) or when coughing (p = 0,31), in morphine consumption (p = 0,9) and in the duration of ileus (p = 0,5) or length of hospital stay (p = 0,9). The inflammatory markers, IL-1 (p = 0,02), IL-6 (p < 0,01), γ IFN (p < 0,01) and α TNF (p < 0,01), showed significant reduction in lidocaine group against placebo group, except IL-10 (p = 0,01), that, because of its antiinflammatory effects, increased its concentration. Thus, intravenous lidocaine in the perioperative period of laparoscopic cholecystectomies was not able to reduce postoperative pain, opioid consumption, and duration of ileus or length of hospital stay. However, its anti-inflammatory effect was evidenced by the significant changes in the studied cytokines.