RESUMO
BACKGROUND: The postoperative opioid-sparing effects of systemic L-type calcium channel blockers are controversial. We investigated whether the postoperative analgesic effect of epidural fentanyl was enhanced by i.v. infusion of diltiazem at a rate that would minimize any cardiovascular depressant effect. METHODS: After elective lower abdominal gynaecological surgery, 30 patients were randomized to receive continuous i.v. diltiazem 1 micro g kg(-1) min(-1) (diltiazem group) or the same volume of saline (control group) for 24 h. Cumulative postoperative epidural fentanyl consumption, visual analogue scale (VAS) scores and verbal rating scores (VRS) at rest and during mobilization, sedation scores, incidence of side-effects and overall patient satisfaction were assessed. RESULTS: There was no significant difference in cumulative epidural fentanyl consumption between the groups at any period. Although there were no statistically significant differences in VAS scores, VRS, sedation scores, incidence of side-effects and overall patient satisfaction, there was a trend to an increased incidence of nausea in the diltiazem group. CONCLUSIONS: Continuous i.v. infusion of diltiazem did not reduce epidural fentanyl consumption when administered at dosages having minimal haemodynamic depressant effects.
Assuntos
Analgesia Epidural/métodos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diltiazem/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia , Dor Pós-Operatória/tratamento farmacológico , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Bloqueadores dos Canais de Cálcio/administração & dosagem , Diltiazem/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada , Feminino , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Infusões Intravenosas , Medição da DorRESUMO
We report two patients who developed extrapyramidal reactions after epidural droperidol given to prevent postoperative nausea and vomiting. The reactions may have been related to interactions of drugs given perioperatively. One patient had been taking amlodipine and amitriptyline preoperatively, capable of causing extrapyramidal reactions, and developed akathisia after 2.5 mg of droperidol given epidurally. The other patient had received 1.5 mg of prophylactic epidural droperidol and 10 mg of metoclopramide for postoperative nausea and vomiting, and developed acute dystonia shortly after 0.5 mg of intravenous droperidol.
