Fechamento de defeitos em padrão de figura geométrica associado ao emprego de anestesia por tumescência com lidocaína em coelhos (oryctolagus cuniculus)
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Data
2016-03-03
Autores
Serafim, Eduardo Luis [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Cirurgias reconstrutivas são empregadas no fechamento de feridas na qual existe dificuldades de oclusão. Podem apresentar um pós-operatório doloroso devido a grande manipulação tecidual. Assim, o uso de técnicas como a de anestesia por tumescência com lidocaína, são importantes, em virtude de proporcionar melhor analgesia trans e pós-operatória. No entanto, a lidocaína pode interferir na cicatrização. Assim, delineou-se um estudo a fim de avaliar a cicatrização de defeitos cutâneos induzidos, fechados em padrão de figura geométrica, associado ao emprego de anestesia por tumescência com lidocaína em coelhos (Oryctolagus cuniculus). Ademais, avaliar sua influência em parâmetros cardiorrespiratórios e na analgesia pós-operatória. Foi realizado no Hospital Veterinário da UNESP, Câmpus de Jaboticabal – SP, um estudo com 27 coelhos, separados em três grupos, compreendidos em GC (fechamento em padrão de figura geométrica sem o emprego de tumescência), GS (fechamento em padrão de figura geométrica associado ao emprego de tumescência com solução fisiológica 0,9%) e GL (fechamento em padrão de figura geométrica associado ao emprego de anestesia por tumescência com lidocaína). Realizaram-se avaliações macroscópicas das lesões, observando-se exsudato, edema, coloração e aspecto cosmético da ferida e microscópicas, observando-se proliferação vascular, células mononucleares e polimorfonucleares, proliferação fibroblástica, colagenização, reepitelização e hemorragia. A avaliação da analgesia pós-operatória foi realizada por Escala Visual Analógica e por filamentos de von Frey. Os dados obtidos foram submetidos à análise estatística (teste não paramétrico de Friedman, pós-teste de Dunns, análise de variância (ANOVA) e teste de Tukey, considerando-se diferença significativa quando p<0,05). Em nenhuma das variáveis macroscópicas e microscópicas ocorreu diferenças significativas entre os grupos (p>0,05). Houve diferença significativa na frequência cardíaca (p=0,0002), sendo menor no GL, e respiratória (p=0,002), sendo maior no GC. Houve diferença significativa na pressão arterial média (p=0,026), sendo maior no GL e na concentração expirada de isoflurano (p=0,02), sendo menor no GL. Não houve diferença significativa entre os grupos (p>0,05) no teste de filamentos de von Frey e na Escala Visual Analógica, bem como entre os momentos avaliados. Ainda em relação a Escala Visual Analógica, não ocorreu diferença significativa entre os avaliadores (p>0,05). Ademais, em nenhum animal foi necessário realizar reaplicação de analgésico além dos momentos propostos. Dessa forma, conclui-se que não há diferença entre a anestesia geral inalatória quando comparada a sua associação com anestesia por tumescência com lidocaína na analgesia pós-operatória de coelhos submetidos a fechamento de defeitos em padrão de figura geométrica. No entanto, a técnica tumescente oferece benefícios como a redução do consumo de anestésico inalatório, estabilidade das frequências cardíaca e respiratória e menor hipotensão. Ademais, não prejudica a cicatrização.
Reconstructive surgeries are used to close wounds in which there is difficulties of occlusion. Because of its large tissue manipulation it may have a painful post-operative. Thus, the use of techniques such as tumescent anesthesia with lidocaine are important because it provides better analgesia during and after the surgery. However, lidocaine can interfering in the healing process. Therefore, a study was devised to evaluate the healing process of induced cutaneous defects, closed in geometric figure associated with the use of tumescent anesthesia with lidocaine in rabbits (Oryctolagus cuniculus). Besides, to assess its influence in cardiorespiratory parameters and in postoperative analgesia. It was held at the Veterinary Teaching Hospital of UNESP, campus of Jaboticabal - SP, a study involving 27 rabbits, divided into three groups being GC (defects closed in geometric figure without the use of tumescence), GS (defects closed in geometric figure associated with the use of tumescence with saline solution 0,9 %) and GL (defects closed in geometric figure associated with the use of tumescent anesthesia with lidocaine). Macroscopic assessments were made observing exudate, edema, color and cosmetic aspect of the wound and microscopic evaluations, observing vascular proliferation, mononuclear cells and polymorphonuclear cells, fibroblast proliferation, collagen deposition, reepithelialization and bleeding. The evaluation of postoperative analgesia was made by Visual Analogue Scale and von Frey filaments. Data were subjected to statistical analysis (nonparametric Friedman test, Dunns post-test, analysis of variance (ANOVA) and Tukey test, considering significant difference when p<0,05). There was no significant difference between groups (p>0,05) on macroscopic variables and microscopic variables. There was significant difference in heart rate (p=0,0002), being lower in GL, and respiratory rate (p=0,002), being higher in GC. There was significant difference in mean blood pressure (p=0,026), being higher in GL, and In the isoflurane expired concentration (p=0,02), being lower in GL. There was no significant difference between groups (p>0,05) on von Frey filaments test and Visual Analogue Scale and between the moments assessed. Furthermore, in the Visual Analogue Scale, there was no significant difference between the evaluators (p>0,05). Moreover, in no animal was necessary to reapply analgesic besides the proposed times. Thus, it's concluded that there is no difference between inhalation anesthesia when compared to its association with tumescent anesthesia with lidocaine in postoperative analgesia of rabbits subjected to the closing of defects in geometric figure. However, tumescent technique offers benefits such as reducing the consumption of inhalational anesthetic, stability of heart rate and respiratory rate and less hypotension. Besides, it do not affect the healing process.
Reconstructive surgeries are used to close wounds in which there is difficulties of occlusion. Because of its large tissue manipulation it may have a painful post-operative. Thus, the use of techniques such as tumescent anesthesia with lidocaine are important because it provides better analgesia during and after the surgery. However, lidocaine can interfering in the healing process. Therefore, a study was devised to evaluate the healing process of induced cutaneous defects, closed in geometric figure associated with the use of tumescent anesthesia with lidocaine in rabbits (Oryctolagus cuniculus). Besides, to assess its influence in cardiorespiratory parameters and in postoperative analgesia. It was held at the Veterinary Teaching Hospital of UNESP, campus of Jaboticabal - SP, a study involving 27 rabbits, divided into three groups being GC (defects closed in geometric figure without the use of tumescence), GS (defects closed in geometric figure associated with the use of tumescence with saline solution 0,9 %) and GL (defects closed in geometric figure associated with the use of tumescent anesthesia with lidocaine). Macroscopic assessments were made observing exudate, edema, color and cosmetic aspect of the wound and microscopic evaluations, observing vascular proliferation, mononuclear cells and polymorphonuclear cells, fibroblast proliferation, collagen deposition, reepithelialization and bleeding. The evaluation of postoperative analgesia was made by Visual Analogue Scale and von Frey filaments. Data were subjected to statistical analysis (nonparametric Friedman test, Dunns post-test, analysis of variance (ANOVA) and Tukey test, considering significant difference when p<0,05). There was no significant difference between groups (p>0,05) on macroscopic variables and microscopic variables. There was significant difference in heart rate (p=0,0002), being lower in GL, and respiratory rate (p=0,002), being higher in GC. There was significant difference in mean blood pressure (p=0,026), being higher in GL, and In the isoflurane expired concentration (p=0,02), being lower in GL. There was no significant difference between groups (p>0,05) on von Frey filaments test and Visual Analogue Scale and between the moments assessed. Furthermore, in the Visual Analogue Scale, there was no significant difference between the evaluators (p>0,05). Moreover, in no animal was necessary to reapply analgesic besides the proposed times. Thus, it's concluded that there is no difference between inhalation anesthesia when compared to its association with tumescent anesthesia with lidocaine in postoperative analgesia of rabbits subjected to the closing of defects in geometric figure. However, tumescent technique offers benefits such as reducing the consumption of inhalational anesthetic, stability of heart rate and respiratory rate and less hypotension. Besides, it do not affect the healing process.
Descrição
Palavras-chave
Anestésico local, Cirurgia reconstrutiva, Dor, Reparação tecidual, Local anesthetic, Pain, Reconstructive surgery, Tissue repair