Avaliação da analgesia intraoperatória e pós-operatória em pacientes submetidos à colecistectomia por videolaparoscopia sob anestesia geral com indução anestésica realizada utilizando sufentanil ou fentanil. Estudo comparativo e randomizado
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2024-02-23
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Universidade Estadual Paulista (Unesp)
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Introdução: a ocorrência de tolerância aguda e de hiperalgesia induzida por opioides tem sido descrita mesmo com a exposição a doses clínicas habituais de remifentanil durante o período perioperatório. Especula-se que sufentanil e fentanil têm potenciais diferentes para promover redução da dose intraoperatória do remifentanil.
Objetivo: avaliar o benefício, em relação à analgesia intraoperatória e pós-operatória, da utilização de sufentanil, quando comparado ao fentanil, durante a indução anestésica de anestesia geral para cirurgias de colecistectomia por videolaparoscopia.
Método: após análise preliminar com 40 pacientes, determinou-se que 76 pacientes divididos em dois grupos (1:1) seriam necessários para testar a hipótese de que o sufentanil, em comparação com o fentanil, em doses supostamente equipotentes, diminui a necessidade do uso de remifentanil, para complementação analgésica no intraoperatório, em pacientes submetidos à colecistectomia por videolaparoscopia. Os pacientes foram submetidos à anestesia geral venosa total. Após indução com propofol em infusão alvo controlada, os grupos diferiram apenas pelo opioide utilizado na indução da anestesia. Grupo fentanil: fentanil 4 µg/kg e Grupo sufentanil: sufentanil 0,4 µg/kg. De acordo com variações definidas de pressão arterial e frequência cardíaca, foi realizada a infusão contínua de remifentanil. Foram avaliados, também, a intensidade de dor e o consumo de morfina na sala de recuperação pós-anestésica, assim como a ocorrência de náuseas, vômitos, prurido, sonolência e depressão respiratória.
Resultados: as medianas (1o - 3o quartis) da dose de remifentanil (µg/kg/min) nos grupos fentanil e sufentanil foram, respectivamente, 0,072 (0,032 - 0,126) e 0,028 (0 - 0,061), p = 0,003. Não existiu diferença, entre os grupos, na intensidade da dor e no consumo de morfina na sala de recuperação pós-anestésica (p > 0,05), bem como na incidência dos efeitos adversos (náuseas, vômitos, prurido, sonolência e depressão respiratória) (p > 0,05).
Conclusão: em colecistectomias por videolaparoscopia, a indução anestésica com o sufentanil, em comparação com o fentanil, diminui a necessidade de utilização de remifentanil no intraoperatório, mas, no período da sala de recuperação pós-anestésica, não modificou as características da dor pós-operatória e a ocorrência de efeitos adversos.
Introduction: the occurrence of acute tolerance as well as opioid-induced hyperalgesia has been described even with exposure to usual clinical doses of remifentanil during the perioperative period. It is speculated that sufentanil and fentanyl have different potential to reduce the intraoperative dose of remifentanil. Objective: to evaluate the benefit in relation to intraoperative and postoperative analgesia of the use of sufentanil when compared to fentanyl during anesthetic induction of general anesthesia for laparoscopic cholecystectomy surgeries. Method: after preliminary analysis with 40 patients, it was determined that 76 patients divided into two groups (1:1) would be necessary to test the hypothesis that sufentanil, in comparison with fentanyl, in presumably equipotent doses, reduces the need for the use of remifentanil for intraoperative analgesic supplementation in patients undergoing laparoscopic cholecystectomy. Patients were undergoing total intravenous general anesthesia. After induction with propofol in a controlled target infusion, the groups differed only by the opioid used to induce anesthesia. Fentanyl group: fentanyl 4 µg/kg and Sufentanil group: sufentanil 0.4 µg/kg. According to defined variations in blood pressure and heart rate, continuous infusion of remifentanil was performed. Pain intensity and morphine consumption in the post-anesthesia recovery room were also evaluated, as well as the occurrence of nausea, vomiting, pruritus, somnolence, and respiratory depression. Results: the medians (1st - 3rd quartiles) of the remifentanil dose (µg/kg/min) in the fentanyl and sufentanil groups were, respectively, 0.072 (0.032 - 0.126) and 0.028 (0 - 0.061), p = 0.003. There was no difference between the groups in pain intensity and morphine consumption in the post-anesthesia recovery room (p > 0.05), as well as in the incidence of adverse effects (nausea, vomiting, pruritus, somnolence, and respiratory depression) (p > 0.05). Conclusion: in laparoscopic cholecystectomies, anesthetic induction with sufentanil, compared to fentanyl, reduces the need to use remifentanil intraoperatively, but, during the post-anesthesia recovery room period, it did not change the characteristics of postoperative pain and the occurrence of adverse effects.
Introduction: the occurrence of acute tolerance as well as opioid-induced hyperalgesia has been described even with exposure to usual clinical doses of remifentanil during the perioperative period. It is speculated that sufentanil and fentanyl have different potential to reduce the intraoperative dose of remifentanil. Objective: to evaluate the benefit in relation to intraoperative and postoperative analgesia of the use of sufentanil when compared to fentanyl during anesthetic induction of general anesthesia for laparoscopic cholecystectomy surgeries. Method: after preliminary analysis with 40 patients, it was determined that 76 patients divided into two groups (1:1) would be necessary to test the hypothesis that sufentanil, in comparison with fentanyl, in presumably equipotent doses, reduces the need for the use of remifentanil for intraoperative analgesic supplementation in patients undergoing laparoscopic cholecystectomy. Patients were undergoing total intravenous general anesthesia. After induction with propofol in a controlled target infusion, the groups differed only by the opioid used to induce anesthesia. Fentanyl group: fentanyl 4 µg/kg and Sufentanil group: sufentanil 0.4 µg/kg. According to defined variations in blood pressure and heart rate, continuous infusion of remifentanil was performed. Pain intensity and morphine consumption in the post-anesthesia recovery room were also evaluated, as well as the occurrence of nausea, vomiting, pruritus, somnolence, and respiratory depression. Results: the medians (1st - 3rd quartiles) of the remifentanil dose (µg/kg/min) in the fentanyl and sufentanil groups were, respectively, 0.072 (0.032 - 0.126) and 0.028 (0 - 0.061), p = 0.003. There was no difference between the groups in pain intensity and morphine consumption in the post-anesthesia recovery room (p > 0.05), as well as in the incidence of adverse effects (nausea, vomiting, pruritus, somnolence, and respiratory depression) (p > 0.05). Conclusion: in laparoscopic cholecystectomies, anesthetic induction with sufentanil, compared to fentanyl, reduces the need to use remifentanil intraoperatively, but, during the post-anesthesia recovery room period, it did not change the characteristics of postoperative pain and the occurrence of adverse effects.
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Analgesia, Anestesia, Fentanil, Remifentanil, Sufentanil