Estudo randomizado, controlado com placebo, duplo encoberto do efeito analgésico do esmolol intraoperatório para gastroplastia laparoscópica

• Autor(a) principal: Morais, Vinicius Barros Duarte De [UNIFESP]
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9292319; https://hdl.handle.net/11600/64775
• topic: Esmolol; Analgesic Effect; Gastroplasty; Esmolol; Efeito Analgésico; Gastroplastia

Background and Objectives: Opioids are effective for postoperative pain but, especially in large doses, may cause adverse effects in morbidly obese patients, and multimodal analgesia is recommended. Some studies have indicated that beta blockers decrease the need for anesthetics and postoperative analgesic consumption. The aim of this study was to evaluate the analgesic effect of esmolol in patients undergoing laparoscopic gastroplasty. Methods: The study was prospective, randomized and double blinded. Forty patients, aged 18 to 60 years, of both genders, physical status ASA I or II, submitted to laparoscopic by-pass gastroplasty, were evaluated, divided into two groups. Group 1 (Esmolol) participants received 0.5mg / kg bolus of esmolol in 30mL of isotonic saline prior to anesthetic induction, followed by intravenous infusion of 15ug / kg / min until surgery completion; Group 2 (Saline) patients received 30mL of isotonic saline in bolus and isotonic saline infusion at the same volume as the esmolol group until surgery was completed. General anesthesia was with fentanyl (3ug / kg), propofol (2-4mg / kg), rocuronium (0.6mg / kg), 50% oxygen without nitrous oxide, and sevoflurane 2%. If necessary, they received remifentanil infusion. There were evaluated: intraoperative remifentanil consumption, time to need of postoperative analgesic complementation, intensity of postoperative pain during 24h, number of patients requiring supplementation and total morphine dose in 24h. Adverse effects were noted. Results: There were evaluated for elegibility, 41 participants, with esclusion of 1 patient, and randomized 40, 20 per group. The number of patients who needed intraoperative remifentanil supplementation was lower in esmolol group, as the dose of remifentanil. Time to recovery was shorter in esmolol group. Postoperative morphine supplementation dose were lower in the esmolol group; Pain intensity was lower in the esmolol group during 24h, except at T0 and after 12h. There were no differences in adverse effects, nausea, vomiting, hipotension and bradicardia. Conclusions: Intraoperative esmolol promotes analgesic effect without causing adverse effects, being an effective drug for multimodal analgesia in obese submitted to gastroplasty.