Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial / Comparação entre morfina subaracnoidea e bloqueio do nervo femoral para analgesia após reconstrução ligamentar de joelho: estudo clínico randomizado

Abstract Background and objectives There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. Method Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░µg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. Results Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (p░<░0.05). Conclusion There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.

Resumo Justificativa e objetivos Não há consenso sobre qual é a técnica ideal para prover analgesia em reconstruções ligamentares de joelho. Objetivou‐se comparar a intensidade da dor pós‐operatória desses pacientes sob diferentes modalidades de analgesia. Método Ensaio clínico randomizado e controlado de pacientes submetidos à reconstrução do ligamento cruzado anterior com tendões flexores entre dezembro de 2013 e 2014. Todos os pacientes foram submetidos a raquianestesia e analgesia de resgate com tramadol. Compararam‐se os grupos C, M, R0,375 e R0,25; aos quais se ofertou apenas a técnica anteriormente descrita, morfina subaracnóidea (100 µg) ou bloqueio de nervo femoral com 25 mL de ropivacaína 0,375% e 0,25%, respectivamente. Avaliou‐se intensidade da dor em 6, 12 e 24 horas, idade, sexo, analgesia de resgate, reações adversas e satisfação. Resultados Entre os 83 pacientes elegíveis, observou‐se predomínio do sexo masculino (85,7%) entre 28 e 31 anos. O Grupo C solicitou mais opioide (27,3%) do que os demais grupos, sem significância quando comparados. Não houve diferenças significativas na intensidade da dor em 6, 12 e 24 horas. Houve maior incidência de retenção urinária no Grupo M (23,8%) do que no R0,375 (0%) e de bloqueio motor prolongado do quadríceps no Grupo R0,375 (30%) do que nos Grupos M e C (0%), com significância estatística (p< 0,05). Conclusão Não houve diferença na intensidade da dor pós‐operatória nos pacientes submetidos à reconstrução de ligamento cruzado anterior com tendões flexores sob as modalidades analgésicas avaliadas, apesar do predomínio de retenção urinária no Grupo M e bloqueio motor no Grupo R0,375.

[Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial]. / Comparação entre morfina subaracnoidea e bloqueio do nervo femoral para analgesia após reconstrução ligamentar de joelho: estudo clínico randomizado.

BACKGROUND AND OBJECTIVES: There is no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. METHOD: Randomized and controlled clinical trial of patients undergoing reconstruction of the anterior cruciate ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The Groups C, M, R0,375 and R0,25 were compared with only the previously described technique, subarachnoid morphine (100 µg) or femoral nerve block with 25 mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. RESULTS: Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The Group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24hours. There was a higher incidence of urinary retention in the Group M (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 Group (30%) than in the M and C Groups (0%), with statistical significance (p < 0.05). CONCLUSION: There was no difference in the intensity of postoperative pain in patients submitted to anterior cruciate ligament reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M Group and motor block in the R0,375 Group.

Cesárea eletiva: complicações maternas e fetais / Elective cesarean: maternal and fetal complications

Objetivos: Conhecer o índice de complicações maternas e fetais imediatas nas cesáreas eletivas realizadas nos Hospital São João Batista de Criciúma no período de janeiro a junho de 2008. Métodos: Estudo do tipo coorte prospectivo, observacional,exploratório e documental com 107 pacientes que foram submetidas à cesárea eletiva, sendo excluídasaquelas que entraram em trabalho de parto antes da cirurgia. Resultados: Das 107 pacientes estudadas, duas nãopreencheram os critérios de inclusão, resultando em 105 pacientes na amostra. A idade média das pacientes foide 27,3 anos, com idade mínima de 18 anos e idade máxima de 41 anos. Com relação à idade gestacional, a média foi 38,5 semanas, variando de 36 a 41 semanas. Neste estudo, foram observadas duas complicações imediatas; sendo uma materna e uma fetal. Das 105 pacientes submetidas à cesárea, uma (0,95%) apresentouinfecção puerperal; enquanto nos recém nascidos, um (0,95%) apresentou taquipnéia transitória. Conclusão: Concluiu-se nesse trabalho, que apesardo índice de complicações imediatas maternas e fetais evidenciados nas cesáreas eletivas ter sido de 0,95%, acesárea eletiva não é um procedimento isento de risco.

Objectives: To know the rate of immediate maternal and fetal complications in the elective cesareans achieved in São João Hospital in Criciúma, from January to June of 2008.Methods: Cohort prospective study, observational, exploratory and documental with 107 patients who weresubmitted to elective cesarean, excluding those one who started the delivery labor until the surgery.Results: From the 107 patients studied, two didn’t fill includes criterion, resulting in 105 patients in the sample.The median age of the patients was 27,3 years, with the minimal of 18 years and the maximum of 41 years. About the gestational age, the median was 38,5 weeks, changing between 36 and 41 weeks. In this study, was observed two immediate complications; one maternal and one fetal. From the 105 patients submitted to cesarean, one (0,95%) presents puerperal infection; while in theinfant, one (0,95%) presents transient tachypnea. Conclusion: Concluded in this study, that although the rate of immediate maternal and fetal complications evidenced in the elective cesarean was about 0,95%, the elective cesarean is not a procedure without risks.