Bloqueio interpleural em reconstrução mamária imediata pós-mastectomia, com retalho musculocutâneo transverso do reto abdominal. relato de três casos / Interplelural block for immediate breast reconstruction post-mastectomy, with transverse rectus abdominis myocutaneous flap. report of three cases

RESUMO

JUSTIFICATIVA E OBJETIVOS: O retalho musculocutâneo transverso do reto abdominal (TRAM) permite uma reconstrução completamente autóloga. É um procedimento complexo, de grande porte, exigindo analgesia eficiente. O objetivo deste estudo foi relatar o uso do bloqueio interpleural, associado à anestesia geral, para mastectomia e reconstrução imediata com retalho TRAM.RELATOS DOS CASOS Foram avaliadas três pacientes com 37, 43 e 49 anos, apresentando neoplasia mamária. A indução anestésica foi realizada com etomidato (0,2 mg.kg-1), alfentanil (30 µg.kg-1) e rocurônio (0,6 mg.kg-1), sendo a manutenção obtida pela administração de isoflurano (0,5vol% a 3,0vol%). No bloqueio interpleural foram administradas ropivacaína a 0,75% (150 mg), morfina (3 mg) e clonidina (3 µg.kg-1), ao nível do EIC5, na linha axilar média, com agulha de Tuohy 17G; as pacientes foram colocadas na posição céfalodeclive (20º) imediatamente antes da realização do bloqueio, permanecendo por aproximadamente 10 minutos. A intensidade da dor pós-operatória foi analisada pela escala analógica verbal, nas primeiras 24 horas. Durante o intraoperatório foi administrado isoflurano em doses superiores a 0,5% e inferiores a 3%. Com a associação das técnicas anestésicas utilizadas, as pacientes se queixaram de dor leve nas primeiras 24 horas após o término do procedimento anestésico-cirúrgico, necessitando somente de anti-inflamatório não hormonal (dipirona).CONCLUSÃO: A técnica do bloqueio interpleural é segura e de fácil realização em cirurgias de mastectomia e reconstrução mamária imediata com retalho TRAM. Reduz o consumo de fármacos utilizados no intraoperatório e a solicitação de analgésicos no pós-operatório imediato.

ABSTRACT

BACKGROUND AND OBJECTIVES: Transverse rectus abdominis myocutaneous flap allows for a totally autologous reconstruction (TRAM). It is a complex and major procedure requiring efficient analgesia. This study aimed at reporting the use of interpleural block associated to general anesthesia for mastectomy and immediate reconstruction with TRAM flap. CASES REPORTS Three patients aged 37, 43 and 49 years with breast neoplasia were evaluated. Anesthesia was induced with used for interpleural block at the level of EIC5 on the medium axillary line with 17G Tuohy needle; patients were placed in the head-down position (20º) immediately before the block, remaining for approximately 10 minutes. Postoperative pain intensity was evaluated by the verbal analog scale in the first 24 hours. Isoflurane was administered in the perioperative period in doses above 0.5% and below 3%. With the association of the anesthetic techniques, patients reported mild pain during the first 24 hours after anesthetic-surgical procedure completion, needing only non-steroid anti-inflammatory drugs (dipirone).CONCLUSION: Interpleural block is a safe and easy technique for mastectomy and immediate breast reconstruction with TRAM flap. It decreases perioperative drugs consumption and the request for analgesia in the immediate postoperative period.etomidate (0.2 mg.kg-1), alfentanil (30 µg.kg-1) and rocuronium (0.6 mg.kg-1) and was maintained with isoflurane (0.5vol% to 3.0vol%). 0.75% ropivacaine (150 mg), morphine (3 mg) and clonidine (3 µg.kg-1) were used for interpleural block at the level of EIC5 on the medium axillary line with 17G Tuohy needle; patients were placed in the head-down position (20º) immediately before the block, remaining for approximately 10 minutes. Postoperative pain intensity was evaluated by the verbal analog scale in the first 24 hours. Isoflurane was administered in the perioperative period in doses above 0.5% and below 3%. With the association of the anesthetic techniques, patients reported mild pain during the first 24 hours after anesthetic-surgical procedure completion, needing only non-steroid anti-inflammatory drugs (dipirone).CONCLUSION: Interpleural block is a safe and easy technique for mastectomy and immediate breast reconstruction with TRAM flap. It decreases perioperative drugs consumption and the request for analgesia in the immediate postoperative period.