ABSTRACT
Justificativa e objetivos: A dor pós-operatória é previsível, no entanto continua sendo inadequadamente tratada. O tratamento multimodal diminui os efeitos colaterais e propicia adequado alivio da dor. A lidocaína, anestésico local utilizado há mais de cinco décadas, vem sendo empregada por via intravenosa com o objetivo de tratar a dor em diversos tipos de operação com resultados promissores. O objetivo deste estudo foi rever o uso da lidocaína intravenosa no tratamento da dor pós-operatória e seu mecanismo de ação. Conteudo: Este artigo aborda o emprego da lidocaína intravenosa no manuseio da dor pós-operatória, seu mecanismo de ação e a aplicabilidade em diversos tipos de procedimentos cirúrgicos. Realizada busca ativa através das seguintes bases de dados: Medline via Pubmed (1974-2013), Cochrane Library (1990-2010), LILACS (1974-2013). A busca foi ajustada visando identificar os artigos que pesquisaram o mecanismo de ação e a analgesia pós-operatória da lidocaína intravenosa. Quanto à limitação do idioma, foram selecionados artigos nas línguas Portuguesa e Inglesa. Conclusão: A lidocaína intravenosa, pelo baixo custo, ação poupadora de opioides e mínimos efeitos colaterais, tem se mostrado adequada opção no tratamento da dor pós-operatória.
Background and objectives: Postoperative pain is foreseeable however it is still undermanaged. Multimodal management decreases side-effects and provides adequate pain control. Lidocaine, local anesthetic used for more than five decades, is being intravenously administered aiming at managing pain in different types of surgeries with promising results. This study aimed at reviewing the use of intravenous lidocaine to manage postoperative pain, and its action mechanism. Contents: This article addresses the use of intravenous lidocaine to manage postoperative pain, its action mechanism and its applicability for different types of surgeries. An active search was carried out in the following databases: Medline via Pubmed (1974-2013), Cochrane Library (1990-2010) and LILACS (1974-2013). Search was adjusted to identify articles addressing postoperative intravenous lidocaine action mechanism and postoperative analgesia. As to language, articles in Portuguese and English were selected. Conclusion: Intravenous lidocaine, due to its low cost, opioid-sparing action and minimum side-effects is an adequate option to manage postoperative pain.
Subject(s)
Analgesia , Combined Modality Therapy , Lidocaine , PainABSTRACT
Objetivo:Evaluar la influencia de la aplicación del ProtocoloERAS/ACERTO en pacientes sometidos a cirugía electiva del tractogastrointestinal (TGI) en comparación con el manejo clásico perio-peratorio sobre la respuesta postoperatoria. Métodos:Se realizóuna investigación de tipo descriptiva, se seleccionó una muestra noprobabilística conformada por 40 pacientes evaluados en dosperíodos. Un primer grupo control (n=20) evaluados de maneraretrospectiva desde el año 2002 hasta el 2013 manejados demanera tradicional y un grupo estudio (n=20) manejados con elprotocolo ERAS/ACERTO entre mayo y septiembre de 2013. Lasvariables evaluadas fueron tiempo de ayuno pre y post operatorio,residuo gástrico, valores de glicemia pre y post operatorio, estanciahospitalaria, respuesta inmune y complicaciones post operatorias.Resultados: Los pacientes del grupo estudio presentaron un resi-duo gástrico medido antes de la inducción anestésica de <10 ml,no hubo diferencias significativas en cuanto a las complicacionespost operatorias, un paciente del grupo control presentó dehiscen-cia de anastomosis y un paciente del grupo estudio presentó infec-ción del sitio operatorio, el ayuno preoperatorio en el grupo estu-dio fue de 4 horas para líquidos y el grupo control entre 17 y21 horas, el inicio de la vía oral en el post operatorio fue a las 4horas en el grupo estudio, y en el grupo control 2 a 3 días. Laestancia hospitalaria promedio para el grupo estudio fue de 3 díasvs 7 días para el grupo control. Conclusión:La aplicación de esteprotocolo es factible en un hospital general de escasos recursoslogrando obtener mejores resultados, disminuir la estancia hospita-laria y los costos(AU)
Objective: To evaluate the influence of the implementation ofERAS / ACERTO Protocol in patients undergoing elective surgery ofthe gastrointestinal tract (GIT) compared with classic perioperativemanagement on postoperative response. Methods:A descriptiveresearch was conducted, a non-probability sample comprised of 40patients evaluated in two periods. A first control group (n = 20)evaluated retrospectively from 2002 to 2013 managed traditionallyselected and a study group (n = 20) treated with ERAS / ACERTOprotocol between May and September 2013. The variables weretime pre and postoperative fasting, gastric residue, blood glucosevalues pre and postoperative hospital stay, response immune andpostoperative complications. Results:The patients in the studygroup had a measured gastric residue before anesthetic induction<10 ml, there were no significant differences in the postoperativecomplications, one patient in the control group had dehiscence ofanastomosis and one patient in the study group complications pre-sented surgical site infection, preoperative fasting in the study groupwas 4 hours for liquids and the control group between 17 and 21hours, the beginning of early oral nutrition in the postoperativeperiod was 4 hours in the study group, and control group 2 to 3days. The average hospital stay for the study group was 3 days vs 7days for the control group. Conclusion:The application of thisprotocol is feasible in a general hospital achieving best results, redu-ce hospital stay and costs(AU)