Fiorentin Joana Zulian, Martins Alexandre Vieira, Cañola Juan Manuel Vélez, Gutierrez Linda Cecilia, Perches Fábio, Sakae Thiago Mamôru, Tenório Sérgio Bernardo
Hospital Universitário Cajuru, Serviço de Anestesiologia, Curitiba, PR, Brasil; Hospital Universitário Cajuru, Departamento de Residência Médica, Curitiba, PR, Brasil; Universidade Federal do Paraná (UFPR), Programa de Pós-Graduação em Clínica Cirúrgica, Curitiba, Paraná, Brasil.
Hospital Universitário Cajuru, Serviço de Anestesiologia, Curitiba, PR, Brasil; Hospital Universitário Cajuru, Departamento de Residência Médica, Curitiba, PR, Brasil.
Braz J Anesthesiol. 2020 Nov-Dec;70(6):613-619. doi: 10.1016/j.bjan.2019.08.006. Epub 2020 Oct 5.
There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia.
Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░μg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated.
Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (░<░0.05).
There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.
在膝关节韧带重建中，对于提供镇痛的理想技术尚无共识。本研究的目的是比较这些患者在不同镇痛方式下术后疼痛的强度。
2013年12月至2014年对前交叉韧带（ACL）采用屈肌腱重建的患者进行随机对照临床试验。所有患者均接受脊髓麻醉并用曲马多进行补救镇痛。将C组、M组、R0.375组和R0.25组分别与仅采用先前描述的技术、蛛网膜下腔注射吗啡（100μg）或分别用25mL 0.375%罗哌卡因和0.25%进行股神经阻滞（BNF）进行比较。评估6、12和24小时时的疼痛强度、年龄、性别、补救镇痛、不良反应和满意度。
在83例符合条件的患者中，观察到男性占优势（85.7%），年龄在28至31岁之间。C组比其他组需要更多的阿片类药物（27.3%），但比较时无显著差异。6、12和24小时时的疼痛强度无显著差异。M组尿潴留发生率（23.8%）高于R0.375组（0%），R0.375组股四头肌运动阻滞延长发生率（30%）高于M组和C组（0%），具有统计学意义（P<0.05）。
在所评估的镇痛方式下，采用屈肌腱进行ACL重建的患者术后疼痛强度无差异，尽管M组尿潴留占优势，R0.375组存在运动阻滞。
