Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20180026
Brazilian Journal of Pain
Original Article

Spinal anesthesia with bupivacaine and fentanyl associated with femoral nerve block in postoperative analgesia in the reconstruction of the anterior cruciate ligament

Raquianestesia com bupivacaína e fentanil associada ao bloqueio do nervo femoral na analgesia pós-operatória na reconstrução do ligamento cruzado anterior

Ursula Bueno do Prado Guirro; Elizabeth Milla Tambara; Ricardo Rasmussen Petterle

http://dx.doi.org/10.5935/2595-0118.20180026 BrJP, vol.1, n2, p.134-140, 2018
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Abstract

BACKGROUND AND OBJECTIVES: To evaluate postoperative analgesia and the need for tramadol in patients undergoing reconstruction of the anterior cruciate ligament with spinal anesthesia, fentanyl and femoral nerve block.

METHODS: 166 patients were divided into four groups (G). All patients received spinal anesthesia with 15mg of isobaric bupivacaine at 0.5%. In the G2 and G3 groups, 25µg of fentanyl was associated with bupivacaine and in groups G3 and G4 femoral nerve block was associated with 100mg of bupivacaine at 0.5%, without vasoconstrictor. Patients received timed dipyrone and ketoprofen and were instructed to request tramadol if the pain was ≥4 on the numerical scale. After 6, 12 and 24 hours of spinal anesthesia, the score was recorded on the numerical scale, the request of tramadol and adverse events.

RESULTS: Mean pain scores at 6 and 24 hours were not different. In the 12-hour evaluation, there was a difference only in G4 in relation to G1 (p=0.01). Tramadol was requested by 46.7% in G1, 52.9% in G2, 18.6% in G3 and 36.4% in G4 (p=0.009), with a difference between G1 and G3 and also between G2 and G3.

CONCLUSION: The association of spinal anesthesia and femoral nerve block in G4 provided lower pain scores in the evaluation at 12 hours after anesthesia. On the other hand, the highest indices were observed in G2, spinal anesthesia with fentanyl. Pain scores at 6 and 12 hours were similar. The highest consumption of analgesics occurred in those who reported more pain in G2.

Keywords

Anterior cruciate ligament reconstruction, Femoral nerve block, Fentanyl, Spinal anesthesia

Resumo

JUSTIFICATIVA E OBJETIVOS: Avaliar a analgesia pós-operatória e a necessidade de tramadol nos pacientes submetidos à operação de reconstrução do ligamento cruzado anterior com raquianestesia, fentanil e bloqueio do nervo femoral.

MÉTODOS: Cento e sessenta e seis pacientes foram divididos em quatro grupos (G). Todos os pacientes receberam raquianestesia com 15mg de bupivacaína isobárica a 0,5%. Nos grupos G2 e G3 foi associado 25µg de fentanil à bupivacaína e nos grupos G3 e G4 foi associado bloqueio do nervo femoral com 100mg de bupivacaína a 0,5% sem vasoconstritor. Os pacientes receberam dipirona e cetoprofeno de horário e eram orientados a solicitar tramadol caso a dor estivesse ≥4 na escala numérica. Após 6, 12 e 24 horas da raquianestesia foi registrado o escore na escala numérica, a solicitação de tramadol e eventos adversos.

RESULTADOS: Os escores médios de dor 6 e 24 horas não foram diferentes. Na avaliação 12 horas houve diferença apenas no G4 em relação ao G1 (p=0,01). O tramadol foi solicitado por 46,7% no G1, 52,9% no G2, 18,6% no G3 e 36,4% no G4 (p=0,009), com diferença entre G1 e G3 e também entre G2 e G3.

CONCLUSÃO: A associação de raquianestesia e bloqueio do nervo femoral no G4 proporcionou menores escores de dor na avaliação 12 horas após a anestesia, por outro lado os índices mais elevados foram observados na raquianestesia com fentanil do G2. As avaliações de dor em 6 e 12 horas foram semelhantes. O maior consumo de analgésicos ocorreu naqueles que relataram mais dor no G2.

Palavras-chave

Bloqueio do nervo femoral, Fentanil, Raquianestesia, Reconstrução do ligamento cruzado anterior

References

Roberts M, Brodribb W, Mitchell G. Reducing the pain: a systematic review of post discharge analgesia following elective orthopedic surgery. Pain Med. 2012;13(5):711-27.

Mall NA, Wright RW. Femoral nerve block use in anterior cruciate ligament reconstruction surgery. Arthroscopy. 2010;26(3):404-16.

Matava MJ, Prickett WD, Khodamoradi S, Abe S, Garbutti J. Femoral nerve blockade as a preemptive anesthetic in patients undergoing anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2009;37(1):78-86.

Souza RL, Correa CH, Henriques MD, Oliveira CB, Nunes TA, Gomez RS. Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament repair. J Clin Anesth. 2008;20(7):521-7.

Gandhi K, Heitz JW, Viscusi ER. Challenges in acute pain management. Anesthesiol Clin. 2011;29(2):291-309.

Astur DC, Aleluia V, Veronese C, Astur N, Oliveira SG, Arliani GG. A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block. Knee. 2014;21(5):911-5.

Edkin BS, Spindler KP, Flanagan JF. Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. Arthroscopy. 1995;11(4):404-9.

Jansen TK, Miller BE, Arretche N, Pellegrini JE. Will the addition of a sciatic nerve block to a femoral nerve block provide better pain control following anterior cruciate ligament repair surgery?. AANA J. 2008;77(3):213-8.

Sakura S, Hara K, Ota J, Tadenuma S. Ultrasound-guided peripheral nerve blocks for anterior cruciate ligament reconstruction: effect of obturator nerve block during and after surgery. J Anesth. 2010;24(3):411-7.

Wulf H, Löwe J, Gnutzmann KH, Steinfeldt T. Femoral nerve block with ropivacaine in day case anterior crucial ligament reconstruction. Acta Anaesthesiol Scand. 2010;54(4):414-20.

Faunø P, Lund B, Christiansen SE, Gjøderum O, Lind M. Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: a prospective randomized trial. Arthroscopy. 2015;31(1):63-8.

Mulroy MF, Larkin KL, Batra MS, Hodgson PS, Owens BD. Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Reg Anesth Pain Med. 2001;26(1):24-9.

Fonseca NM, Ruzi RA, Ferreira FX, Arruda FM. [Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1) and spinal anestesia with morphine]. Rev Bras Anestesiol. 2003;53(2):188-97.

Aydin F, Akan B, Susleyen C, Albayrak D, Erdem D, Gogus N. Comparison of bupivacaine alone and in combination with sufentanil in patients undergoing arthroscopic knee surgery. Knee Surg Sports Traumatol Arthrosc. 2011;19(11):1915-9.

Guirro UB, Tambara EM, Munhoz FR. Femoral nerve block: assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction. Braz J Anesthesiol. 2013;63(6):483-91.

Arango HC. Bioestatística Teórica e Computacional. 2005.

Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149-60.

Alley EA, Mulory MF. Neuraxial anesthesia for outpatients. Anesthesiol Clin. 2014;32(2):357-69.

Szucs S, Morau D, Iohom G. Femoral nerve blockade. Med Ultrason. 2010;12(2):139-44.

Buller LT, Best MJ, Baraga MG, Kaplan LD. Trends in anterior cruciate ligament reconstruction in the United States. Orthop J Sports Med. 2014;3:1-8.

Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and demographics in anterior cruciate ligament reconstruction in the United States. J Knee Surg. 2015;28(5):390-4.

Forster MC, Forster IW. Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee. 2005;12(3):225-30.

Baverel L, Demey G, Odri GA, Leroy P, Saffarini M, Dejour D. Do outcomes of outpatient ACL reconstruction vary with graft type?. Orthop Traumatol Surg Res. 2015;101(7):803-6.

Sahin AS, Türker G, Bekar A, Bilgin H, Korfali G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. Eur Spine J. 2014;23(3):695-700.

Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112(6):991-1004.

Méleine M, Rivat C, Laboureyras E, Cahana A, Richebé P. Sciatic nerve block fails in preventing the development of late stress-induced hyperalgesia when high-dose fentanyl is administered perioperatively in rats. Reg Anesth Pain Med. 2012;37(4):448-54.

Lyons PJ, Rivosecchi RM, Nery JP, Kane-Gill SL. Fentanyl-induced hyperalgesia in acute pain management. J Pain Palliat Care Pharmacother. 2015;29(2):153-60.

Mauermann E, Filitz J, Dolder P, Rentsch KM, Bandschapp O, Ruppen W. Does fentanyl lead to opioid-induced hyperalgesia in healthy volunteers? A double-blind, randomized, crossover trial. Anesthesiology. 2016;124(2):453-63.

Daniulaityte R, Falck R, Carlson RG. "I'm not afraid of those ones just 'cause they've been prescribed': perceptions of risk among illicit users of pharmaceutical opioids. Int J Drug Policy. 2012;23(5):374-84.

Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet. 2016;387(10028):1644-56.

Submitted date:
10/02/2017

Accepted date:
04/04/2018

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