Eloisa Bonetti Espada

Residual analgesic effect of fentanyl in patients undergoing myocardial revascularization with cardiopulmonary bypass

JUSTIFICATIVA E OBJETIVOS: Apesar do uso frequente do fentanil em altas doses para operacoes de grande porte, a contribuicao da concentracao plasmatica residual desse farmaco sobre a analgesia pos-operatoria merece maiores investigacoes. O objetivo deste estudo e avaliar o efeito analgesico do fentanil residual no primeiro e segundo dias apos revascularizacao miocardica, bem como quantificar sua concentracao. METODO: Foram investigados 11 pacientes submetidos a revascularizacao do miocardio com circulacao extracorporea, sob anestesia geral empregando-se 50 µg.kg-1 de fentanil, por via venosa. Avaliou-se a analgesia pela escala numerica verbal nos tempos zero (extubacao), 70 minutos, 3, 5, 8 e 12 horas no primeiro dia e nos tempos zero (24 horas apos extubacao), 70 minutos, 3, 5, 8 e 12 horas no segundo dia. A dor foi avaliada mediante tosse vigorosa e fisioterapia respiratoria. A cada mensuracao da dor, questionou-se sobre a necessidade de o paciente receber complementacao analgesica. As amostras plasmaticas do fentanil foram coletadas nos tempos zero, 70 minutos, 3, 5, 8 e 12 horas do primeiro e segundo dia de pos-operatorio e mensuradas pelo metodo de radioimuno-ensaio. RESULTADOS: A intensidade da dor variou em media de 1,9 a 3,7 no primeiro dia e de 2,1 a 3,8 no segundo dia de pos-operatorio Os niveis plasmaticos de fentanil (> 1 ng/ml), evidenciaram sua contribuicao na analgesia no primeiro dia apos a operacao. CONCLUSOES: Apesar de nao ter sido observada correlacao entre a concentracao plasmatica residual de fentanil e a intensidade da dor, os pacientes apresentaram dor leve durante todo o periodo investigado.BACKGROUND AND OBJECTIVES In spite of the frequent use of high doses of fentanyl for major surgeries, the correlation of its residual plasma concentration to postoperative analgesia deserves further investigation. This study aimed at evaluating the residual analgesic effect of fentanyl in the first and second postoperative days of myocardial revascularization, as well as quantifying its concentration. METHODS Participated in this study 11 patients undergoing myocardial revascularization with cardiopulmonary bypass under general anesthesia with 50 microg.kg-1 intravenous fentanyl. Analgesia was evaluated by a numeric verbal scale at moments zero (extubation), 70 min, 3, 5, 8 and 12 hours in the first day; and moments zero (24 h after extubation), 70 min, 3, 5, 8 and 12 hours in second post-operative day. Pain intensity to vigorous cough and respiratory physical therapy was evaluated. At every measurement, patients were asked about the need for analgesic complementation. Plasma samples were collected in moments zero (extubation), 70 min, 3, 5, 8 and 12 hours during the first and second postoperative days for fentanyl radioimmunoassay. RESULTS Mean pain intensity varied from 1.9 to 3.7 in the first day and from 2.1 to 3.8 in the second postoperative day. Fentanyl plasma levels (> 1 ng/ml) evidenced its contribution to post-operative analgesia during the first postoperative day. CONCLUSIONS In spite of the lack of correlation between residual fentanyl plasma concentration and pain intensity, patients referred only mild pain during the whole investigation period.

Extraconal block for cataract extraction surgery with implantation of intraocular lens: contribution of fentanyl associated to local anesthetics for quality of block and postoperative analgesia

JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional para cirurgias oftalmologicas oferece vantagens, como: minimas alteracoes fisiologicas, anestesia completa, bloqueio dos reflexos oculares, pequena incidencia de nauseas e vomitos, menor tempo de recuperacao e analgesia pos-operatoria. A preocupacao constante com a qualidade do bloqueio, assim como da abordagem da analgesia pos-operatoria deve ficar sob a responsabilidade do anestesiologista. O objetivo deste estudo foi avaliar se o fentanil contribui na qualidade do bloqueio extraconal e na analgesia pos-operatoria de facectomias com implante de lente intra-ocular. METODO: Estudou-se a associacao do fentanil e bupivacaina a 0,75% na qualidade do bloqueio ocular e na analgesia pos-operatoria em 164 pacientes submetidos a facectomia com implante de lente intra-ocular (tecnica extracapsular), de ambos os sexos com homogeneidade de parâmetros antropometricos, olho operado, classificacao do estado fisico (ASA) e indice de risco cardiaco de Goldman. Os pacientes foram distribuidos em dois grupos (82 pacientes em cada grupo) por sorteio de forma aleatoria, com e sem fentanil. Avaliou-se a qualidade do bloqueio por: aparecimento da dor no per-operatorio, manutencao de movimentacao das palpebras ou do globo ocular, persistencia do reflexo de Bell, numero de bloqueios realizados para a obtencao de condicoes cirurgicas e avaliacao do bloqueio pelo cirurgiao. A analgesia pos-operatoria foi avaliada pela necessidade de complementacao analgesica pelo paciente. RESULTADOS: Fentanil associado a solucao anestesica no bloqueio extraconal aumentou significativamente o bloqueio do musculo reto medial (com fentanil - 17,1%, sem fentanil - 32,9%) e diminuiu o consumo de analgesicos no periodo pos-operatorio (uso de analgesicos com fentanil - 20,7%, nao uso de analgesicos com fentanil - 41,5%). CONCLUSOES: Nas condicoes deste estudo o fentanil melhorou a qualidade do bloqueio quanto a motilidade do musculo reto medial e diminuiu a necessidade de analgesicos no pos-operatorio.BACKGROUND AND OBJECTIVES Loco-regional anesthesia for cataract extraction surgery offers as advantages minimum physiological changes, complete anesthesia, eye reflexes blockade, lower incidence of nausea and vomiting and shorter recovery time, in addition to postoperative analgesia. Continuous concern with blockade quality as well as with postoperative analgesia is responsibility of the anesthesiologist. This study aimed at evaluating whether fentanyl has contributed to blockade quality and postoperative analgesia in cataract extraction surgery with implantation of intraocular lens. METHODS The association of fentanyl and 0.75% bupivacaine for eye blockade and postoperative analgesia was evaluated in 164 patients undergoing cataract extraction with implantation of intraocular lens (extracapsular technique). Patients were homogeneous in gender, demographics, operated eye, ASA physical status and Goldmans cardiac risk index. Patients were randomly allocated in two groups (82 patients each): with or without fentanyl. Blockade quality was evaluated according to the following parameters: intraoperative pain; eyelid and/or eyeball movement; Bells reflex persistence; number of blocks needed to produce akinesia and surgeons evaluation of blockade. Postoperative analgesia was evaluated by patients request for additional postoperative analgesia. RESULTS Results have shown that fentanyl has significantly improved medial rectus muscle blockade quality (with fentanyl - 17.1%; without fentanyl - 32.9%) and has decreased postoperative analgesics consumption (analgesics with fentanyl - 20.7%; no analgesics with fentanyl - 41.5%). CONCLUSIONS In the conditions of this study, fentanyl has improved block quality, has decreased medial rectus muscle motility and the need for postoperative analgesics.

Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência do fentanil associado ao anestésico local na qualidade do bloqueio e na analgesia pós-operatória

JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional para cirurgias oftalmologicas oferece vantagens, como: minimas alteracoes fisiologicas, anestesia completa, bloqueio dos reflexos oculares, pequena incidencia de nauseas e vomitos, menor tempo de recuperacao e analgesia pos-operatoria. A preocupacao constante com a qualidade do bloqueio, assim como da abordagem da analgesia pos-operatoria deve ficar sob a responsabilidade do anestesiologista. O objetivo deste estudo foi avaliar se o fentanil contribui na qualidade do bloqueio extraconal e na analgesia pos-operatoria de facectomias com implante de lente intra-ocular. METODO: Estudou-se a associacao do fentanil e bupivacaina a 0,75% na qualidade do bloqueio ocular e na analgesia pos-operatoria em 164 pacientes submetidos a facectomia com implante de lente intra-ocular (tecnica extracapsular), de ambos os sexos com homogeneidade de parâmetros antropometricos, olho operado, classificacao do estado fisico (ASA) e indice de risco cardiaco de Goldman. Os pacientes foram distribuidos em dois grupos (82 pacientes em cada grupo) por sorteio de forma aleatoria, com e sem fentanil. Avaliou-se a qualidade do bloqueio por: aparecimento da dor no per-operatorio, manutencao de movimentacao das palpebras ou do globo ocular, persistencia do reflexo de Bell, numero de bloqueios realizados para a obtencao de condicoes cirurgicas e avaliacao do bloqueio pelo cirurgiao. A analgesia pos-operatoria foi avaliada pela necessidade de complementacao analgesica pelo paciente. RESULTADOS: Fentanil associado a solucao anestesica no bloqueio extraconal aumentou significativamente o bloqueio do musculo reto medial (com fentanil - 17,1%, sem fentanil - 32,9%) e diminuiu o consumo de analgesicos no periodo pos-operatorio (uso de analgesicos com fentanil - 20,7%, nao uso de analgesicos com fentanil - 41,5%). CONCLUSOES: Nas condicoes deste estudo o fentanil melhorou a qualidade do bloqueio quanto a motilidade do musculo reto medial e diminuiu a necessidade de analgesicos no pos-operatorio.BACKGROUND AND OBJECTIVES Loco-regional anesthesia for cataract extraction surgery offers as advantages minimum physiological changes, complete anesthesia, eye reflexes blockade, lower incidence of nausea and vomiting and shorter recovery time, in addition to postoperative analgesia. Continuous concern with blockade quality as well as with postoperative analgesia is responsibility of the anesthesiologist. This study aimed at evaluating whether fentanyl has contributed to blockade quality and postoperative analgesia in cataract extraction surgery with implantation of intraocular lens. METHODS The association of fentanyl and 0.75% bupivacaine for eye blockade and postoperative analgesia was evaluated in 164 patients undergoing cataract extraction with implantation of intraocular lens (extracapsular technique). Patients were homogeneous in gender, demographics, operated eye, ASA physical status and Goldmans cardiac risk index. Patients were randomly allocated in two groups (82 patients each): with or without fentanyl. Blockade quality was evaluated according to the following parameters: intraoperative pain; eyelid and/or eyeball movement; Bells reflex persistence; number of blocks needed to produce akinesia and surgeons evaluation of blockade. Postoperative analgesia was evaluated by patients request for additional postoperative analgesia. RESULTS Results have shown that fentanyl has significantly improved medial rectus muscle blockade quality (with fentanyl - 17.1%; without fentanyl - 32.9%) and has decreased postoperative analgesics consumption (analgesics with fentanyl - 20.7%; no analgesics with fentanyl - 41.5%). CONCLUSIONS In the conditions of this study, fentanyl has improved block quality, has decreased medial rectus muscle motility and the need for postoperative analgesics.

Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia del fentanil asociado al anestésico local en la calidad del bloqueo y en la analgesia pos-operatoria

JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional para cirurgias oftalmologicas oferece vantagens, como: minimas alteracoes fisiologicas, anestesia completa, bloqueio dos reflexos oculares, pequena incidencia de nauseas e vomitos, menor tempo de recuperacao e analgesia pos-operatoria. A preocupacao constante com a qualidade do bloqueio, assim como da abordagem da analgesia pos-operatoria deve ficar sob a responsabilidade do anestesiologista. O objetivo deste estudo foi avaliar se o fentanil contribui na qualidade do bloqueio extraconal e na analgesia pos-operatoria de facectomias com implante de lente intra-ocular. METODO: Estudou-se a associacao do fentanil e bupivacaina a 0,75% na qualidade do bloqueio ocular e na analgesia pos-operatoria em 164 pacientes submetidos a facectomia com implante de lente intra-ocular (tecnica extracapsular), de ambos os sexos com homogeneidade de parâmetros antropometricos, olho operado, classificacao do estado fisico (ASA) e indice de risco cardiaco de Goldman. Os pacientes foram distribuidos em dois grupos (82 pacientes em cada grupo) por sorteio de forma aleatoria, com e sem fentanil. Avaliou-se a qualidade do bloqueio por: aparecimento da dor no per-operatorio, manutencao de movimentacao das palpebras ou do globo ocular, persistencia do reflexo de Bell, numero de bloqueios realizados para a obtencao de condicoes cirurgicas e avaliacao do bloqueio pelo cirurgiao. A analgesia pos-operatoria foi avaliada pela necessidade de complementacao analgesica pelo paciente. RESULTADOS: Fentanil associado a solucao anestesica no bloqueio extraconal aumentou significativamente o bloqueio do musculo reto medial (com fentanil - 17,1%, sem fentanil - 32,9%) e diminuiu o consumo de analgesicos no periodo pos-operatorio (uso de analgesicos com fentanil - 20,7%, nao uso de analgesicos com fentanil - 41,5%). CONCLUSOES: Nas condicoes deste estudo o fentanil melhorou a qualidade do bloqueio quanto a motilidade do musculo reto medial e diminuiu a necessidade de analgesicos no pos-operatorio.BACKGROUND AND OBJECTIVES Loco-regional anesthesia for cataract extraction surgery offers as advantages minimum physiological changes, complete anesthesia, eye reflexes blockade, lower incidence of nausea and vomiting and shorter recovery time, in addition to postoperative analgesia. Continuous concern with blockade quality as well as with postoperative analgesia is responsibility of the anesthesiologist. This study aimed at evaluating whether fentanyl has contributed to blockade quality and postoperative analgesia in cataract extraction surgery with implantation of intraocular lens. METHODS The association of fentanyl and 0.75% bupivacaine for eye blockade and postoperative analgesia was evaluated in 164 patients undergoing cataract extraction with implantation of intraocular lens (extracapsular technique). Patients were homogeneous in gender, demographics, operated eye, ASA physical status and Goldmans cardiac risk index. Patients were randomly allocated in two groups (82 patients each): with or without fentanyl. Blockade quality was evaluated according to the following parameters: intraoperative pain; eyelid and/or eyeball movement; Bells reflex persistence; number of blocks needed to produce akinesia and surgeons evaluation of blockade. Postoperative analgesia was evaluated by patients request for additional postoperative analgesia. RESULTS Results have shown that fentanyl has significantly improved medial rectus muscle blockade quality (with fentanyl - 17.1%; without fentanyl - 32.9%) and has decreased postoperative analgesics consumption (analgesics with fentanyl - 20.7%; no analgesics with fentanyl - 41.5%). CONCLUSIONS In the conditions of this study, fentanyl has improved block quality, has decreased medial rectus muscle motility and the need for postoperative analgesics.

Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia de la vía de acceso (superior o inferior) en la calidad de la anestesia

BACKGROUND AND OBJECTIVES There is no completely safe anesthetic technique for ophthalmic surgery. The introduction of extraconal anesthesia has increased the number of ophthalmic surgeries with blockade since the incidence of severe complications is lower, as reported by Hay in 1991. Extraconal blockades may be induced by several access ways, among them upper and lower ways. This study aimed at evaluating the influence access ways (upper or lower) in anesthetic outcome. METHODS Participated in this study 164 patients of both genders, aged 23 to 92 years, physical status ASA I to IV, 1 and 2 Goldmans cardiac risk index, undergoing elective cataract extraction surgery with intraocular lens implantation. Patients were randomly distributed in two groups of 82 according to primary extraconal block access way: group UE (upper extraconal), group LE (lower extraconal). Blockade quality was evaluated by the following parameters: intraoperative pain, eyelid and/or eyeball movement, persistence of Bell s reflex, number of blocks needed for eye akinesia, and surgeons evaluation. RESULTS Upper extraconal approach was associated to more effective eyelid (upper access - 56.1%; lower access 36.6%) and superior rectus muscle akinesia (upper access - 93.9%; lower access 65.9%) and also a lower incidence of supplementary blocks (upper access - 29.3%; lower access 42.7%). The lower extraconal approach was associated to more effective inferior rectus muscle akinesia (upper access - 72%; lower access - 84.1%), however without statistical differences. CONCLUSIONS In the conditions of this study the upper extraconal approach was better as compared to the lower approach as the primary access way for anesthetic block for cataract extraction with intraocular lens implantation.JUSTIFICATIVA Y OBJETIVOS: En las intervenciones quirurgicas para oftalmologia no se encontro tecnica de anestesia totalmente segura, la introduccion de la anestesia extraconal hizo que aumentasen las indicaciones de cirugias oculares con bloqueo, ya que la incidencia de complicaciones graves es menor, un hecho ya descrito por Hay, en 1991. Los bloqueos extraconales pueden ser realizados por varias vias de acceso, entre ellas, la superior y la inferior. El objetivo de este estudio fue evaluar cual via de acceso (superior o inferior) promueve bloqueo anestesico de mejor calidad. METODO: Fueron incluidos en este estudio 164 pacientes, de ambos sexos, con edades entre 23 y 92 anos, estado fisico ASA I a IV, indice cardiaco 1 y 2 de Goldman, con indicacion de facectomia con implantacion de lente intra-ocular. Los pacientes fueron distribuidos aleatoriamente en dos grupos de 82 de acuerdo con la via de acceso primaria del bloqueo extraconal: grupo ES (extraconal superior) y EI (extraconal inferior). La calidad del bloqueo fue evaluada por el aparecimiento de dolor en el per-operatorio, manutencion de movimentacion de las palpebras o del globo ocular, persistencia del reflejo de Bell, numero de bloqueos realizados para la obtencion de condiciones quirurgicas y evaluacion del bloqueo por el cirujano. RESULTADOS: La via de acceso superior presento mayor incidencia de acinesis de palpebras (Via superior - 56,1%; via inferior - 36,6%) del musculo recto superior (via superior 93,9%; via inferior 65,9%), asi como menor necesidad de bloqueos complementares (via superior 29,3%; via inferior 42,7%). La via de acceso inferior presento mayor acinesis del musculo recto inferior (via superior 72%; via inferior - 84,1%) sin diferencia estadistica. CONCLUSIONES: En las condiciones de este estudio, la via extraconal superior demostro que es superior en relacion a la via extraconal inferior, como via de acceso primaria para bloqueo locorregional para cirugia de facectomia con implantacion de lente intra-ocular.

Extraconal block for cataract extraction surgery with implantation of intraocular lens: influence of access way (upper or lower) in anesthetic outcome

BACKGROUND AND OBJECTIVES There is no completely safe anesthetic technique for ophthalmic surgery. The introduction of extraconal anesthesia has increased the number of ophthalmic surgeries with blockade since the incidence of severe complications is lower, as reported by Hay in 1991. Extraconal blockades may be induced by several access ways, among them upper and lower ways. This study aimed at evaluating the influence access ways (upper or lower) in anesthetic outcome. METHODS Participated in this study 164 patients of both genders, aged 23 to 92 years, physical status ASA I to IV, 1 and 2 Goldmans cardiac risk index, undergoing elective cataract extraction surgery with intraocular lens implantation. Patients were randomly distributed in two groups of 82 according to primary extraconal block access way: group UE (upper extraconal), group LE (lower extraconal). Blockade quality was evaluated by the following parameters: intraoperative pain, eyelid and/or eyeball movement, persistence of Bell s reflex, number of blocks needed for eye akinesia, and surgeons evaluation. RESULTS Upper extraconal approach was associated to more effective eyelid (upper access - 56.1%; lower access 36.6%) and superior rectus muscle akinesia (upper access - 93.9%; lower access 65.9%) and also a lower incidence of supplementary blocks (upper access - 29.3%; lower access 42.7%). The lower extraconal approach was associated to more effective inferior rectus muscle akinesia (upper access - 72%; lower access - 84.1%), however without statistical differences. CONCLUSIONS In the conditions of this study the upper extraconal approach was better as compared to the lower approach as the primary access way for anesthetic block for cataract extraction with intraocular lens implantation.JUSTIFICATIVA Y OBJETIVOS: En las intervenciones quirurgicas para oftalmologia no se encontro tecnica de anestesia totalmente segura, la introduccion de la anestesia extraconal hizo que aumentasen las indicaciones de cirugias oculares con bloqueo, ya que la incidencia de complicaciones graves es menor, un hecho ya descrito por Hay, en 1991. Los bloqueos extraconales pueden ser realizados por varias vias de acceso, entre ellas, la superior y la inferior. El objetivo de este estudio fue evaluar cual via de acceso (superior o inferior) promueve bloqueo anestesico de mejor calidad. METODO: Fueron incluidos en este estudio 164 pacientes, de ambos sexos, con edades entre 23 y 92 anos, estado fisico ASA I a IV, indice cardiaco 1 y 2 de Goldman, con indicacion de facectomia con implantacion de lente intra-ocular. Los pacientes fueron distribuidos aleatoriamente en dos grupos de 82 de acuerdo con la via de acceso primaria del bloqueo extraconal: grupo ES (extraconal superior) y EI (extraconal inferior). La calidad del bloqueo fue evaluada por el aparecimiento de dolor en el per-operatorio, manutencion de movimentacion de las palpebras o del globo ocular, persistencia del reflejo de Bell, numero de bloqueos realizados para la obtencion de condiciones quirurgicas y evaluacion del bloqueo por el cirujano. RESULTADOS: La via de acceso superior presento mayor incidencia de acinesis de palpebras (Via superior - 56,1%; via inferior - 36,6%) del musculo recto superior (via superior 93,9%; via inferior 65,9%), asi como menor necesidad de bloqueos complementares (via superior 29,3%; via inferior 42,7%). La via de acceso inferior presento mayor acinesis del musculo recto inferior (via superior 72%; via inferior - 84,1%) sin diferencia estadistica. CONCLUSIONES: En las condiciones de este estudio, la via extraconal superior demostro que es superior en relacion a la via extraconal inferior, como via de acceso primaria para bloqueo locorregional para cirugia de facectomia con implantacion de lente intra-ocular.

Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência da via de acesso (superior ou inferior) na qualidade da anestesia

BACKGROUND AND OBJECTIVES There is no completely safe anesthetic technique for ophthalmic surgery. The introduction of extraconal anesthesia has increased the number of ophthalmic surgeries with blockade since the incidence of severe complications is lower, as reported by Hay in 1991. Extraconal blockades may be induced by several access ways, among them upper and lower ways. This study aimed at evaluating the influence access ways (upper or lower) in anesthetic outcome. METHODS Participated in this study 164 patients of both genders, aged 23 to 92 years, physical status ASA I to IV, 1 and 2 Goldmans cardiac risk index, undergoing elective cataract extraction surgery with intraocular lens implantation. Patients were randomly distributed in two groups of 82 according to primary extraconal block access way: group UE (upper extraconal), group LE (lower extraconal). Blockade quality was evaluated by the following parameters: intraoperative pain, eyelid and/or eyeball movement, persistence of Bell s reflex, number of blocks needed for eye akinesia, and surgeons evaluation. RESULTS Upper extraconal approach was associated to more effective eyelid (upper access - 56.1%; lower access 36.6%) and superior rectus muscle akinesia (upper access - 93.9%; lower access 65.9%) and also a lower incidence of supplementary blocks (upper access - 29.3%; lower access 42.7%). The lower extraconal approach was associated to more effective inferior rectus muscle akinesia (upper access - 72%; lower access - 84.1%), however without statistical differences. CONCLUSIONS In the conditions of this study the upper extraconal approach was better as compared to the lower approach as the primary access way for anesthetic block for cataract extraction with intraocular lens implantation.JUSTIFICATIVA Y OBJETIVOS: En las intervenciones quirurgicas para oftalmologia no se encontro tecnica de anestesia totalmente segura, la introduccion de la anestesia extraconal hizo que aumentasen las indicaciones de cirugias oculares con bloqueo, ya que la incidencia de complicaciones graves es menor, un hecho ya descrito por Hay, en 1991. Los bloqueos extraconales pueden ser realizados por varias vias de acceso, entre ellas, la superior y la inferior. El objetivo de este estudio fue evaluar cual via de acceso (superior o inferior) promueve bloqueo anestesico de mejor calidad. METODO: Fueron incluidos en este estudio 164 pacientes, de ambos sexos, con edades entre 23 y 92 anos, estado fisico ASA I a IV, indice cardiaco 1 y 2 de Goldman, con indicacion de facectomia con implantacion de lente intra-ocular. Los pacientes fueron distribuidos aleatoriamente en dos grupos de 82 de acuerdo con la via de acceso primaria del bloqueo extraconal: grupo ES (extraconal superior) y EI (extraconal inferior). La calidad del bloqueo fue evaluada por el aparecimiento de dolor en el per-operatorio, manutencion de movimentacion de las palpebras o del globo ocular, persistencia del reflejo de Bell, numero de bloqueos realizados para la obtencion de condiciones quirurgicas y evaluacion del bloqueo por el cirujano. RESULTADOS: La via de acceso superior presento mayor incidencia de acinesis de palpebras (Via superior - 56,1%; via inferior - 36,6%) del musculo recto superior (via superior 93,9%; via inferior 65,9%), asi como menor necesidad de bloqueos complementares (via superior 29,3%; via inferior 42,7%). La via de acceso inferior presento mayor acinesis del musculo recto inferior (via superior 72%; via inferior - 84,1%) sin diferencia estadistica. CONCLUSIONES: En las condiciones de este estudio, la via extraconal superior demostro que es superior en relacion a la via extraconal inferior, como via de acceso primaria para bloqueo locorregional para cirugia de facectomia con implantacion de lente intra-ocular.

Efeito analgésico residual do fentanil em pacientes submetidos a revascularização do miocárdio com circulação extracorpórea

JUSTIFICATIVA E OBJETIVOS: Apesar do uso frequente do fentanil em altas doses para operacoes de grande porte, a contribuicao da concentracao plasmatica residual desse farmaco sobre a analgesia pos-operatoria merece maiores investigacoes. O objetivo deste estudo e avaliar o efeito analgesico do fentanil residual no primeiro e segundo dias apos revascularizacao miocardica, bem como quantificar sua concentracao. METODO: Foram investigados 11 pacientes submetidos a revascularizacao do miocardio com circulacao extracorporea, sob anestesia geral empregando-se 50 µg.kg-1 de fentanil, por via venosa. Avaliou-se a analgesia pela escala numerica verbal nos tempos zero (extubacao), 70 minutos, 3, 5, 8 e 12 horas no primeiro dia e nos tempos zero (24 horas apos extubacao), 70 minutos, 3, 5, 8 e 12 horas no segundo dia. A dor foi avaliada mediante tosse vigorosa e fisioterapia respiratoria. A cada mensuracao da dor, questionou-se sobre a necessidade de o paciente receber complementacao analgesica. As amostras plasmaticas do fentanil foram coletadas nos tempos zero, 70 minutos, 3, 5, 8 e 12 horas do primeiro e segundo dia de pos-operatorio e mensuradas pelo metodo de radioimuno-ensaio. RESULTADOS: A intensidade da dor variou em media de 1,9 a 3,7 no primeiro dia e de 2,1 a 3,8 no segundo dia de pos-operatorio Os niveis plasmaticos de fentanil (> 1 ng/ml), evidenciaram sua contribuicao na analgesia no primeiro dia apos a operacao. CONCLUSOES: Apesar de nao ter sido observada correlacao entre a concentracao plasmatica residual de fentanil e a intensidade da dor, os pacientes apresentaram dor leve durante todo o periodo investigado.BACKGROUND AND OBJECTIVES In spite of the frequent use of high doses of fentanyl for major surgeries, the correlation of its residual plasma concentration to postoperative analgesia deserves further investigation. This study aimed at evaluating the residual analgesic effect of fentanyl in the first and second postoperative days of myocardial revascularization, as well as quantifying its concentration. METHODS Participated in this study 11 patients undergoing myocardial revascularization with cardiopulmonary bypass under general anesthesia with 50 microg.kg-1 intravenous fentanyl. Analgesia was evaluated by a numeric verbal scale at moments zero (extubation), 70 min, 3, 5, 8 and 12 hours in the first day; and moments zero (24 h after extubation), 70 min, 3, 5, 8 and 12 hours in second post-operative day. Pain intensity to vigorous cough and respiratory physical therapy was evaluated. At every measurement, patients were asked about the need for analgesic complementation. Plasma samples were collected in moments zero (extubation), 70 min, 3, 5, 8 and 12 hours during the first and second postoperative days for fentanyl radioimmunoassay. RESULTS Mean pain intensity varied from 1.9 to 3.7 in the first day and from 2.1 to 3.8 in the second postoperative day. Fentanyl plasma levels (> 1 ng/ml) evidenced its contribution to post-operative analgesia during the first postoperative day. CONCLUSIONS In spite of the lack of correlation between residual fentanyl plasma concentration and pain intensity, patients referred only mild pain during the whole investigation period.

Efecto analgésico residual del fentanil en pacientes sometidos a revascularización del miocárdio con circulación extracorpórea

JUSTIFICATIVA E OBJETIVOS: Apesar do uso frequente do fentanil em altas doses para operacoes de grande porte, a contribuicao da concentracao plasmatica residual desse farmaco sobre a analgesia pos-operatoria merece maiores investigacoes. O objetivo deste estudo e avaliar o efeito analgesico do fentanil residual no primeiro e segundo dias apos revascularizacao miocardica, bem como quantificar sua concentracao. METODO: Foram investigados 11 pacientes submetidos a revascularizacao do miocardio com circulacao extracorporea, sob anestesia geral empregando-se 50 µg.kg-1 de fentanil, por via venosa. Avaliou-se a analgesia pela escala numerica verbal nos tempos zero (extubacao), 70 minutos, 3, 5, 8 e 12 horas no primeiro dia e nos tempos zero (24 horas apos extubacao), 70 minutos, 3, 5, 8 e 12 horas no segundo dia. A dor foi avaliada mediante tosse vigorosa e fisioterapia respiratoria. A cada mensuracao da dor, questionou-se sobre a necessidade de o paciente receber complementacao analgesica. As amostras plasmaticas do fentanil foram coletadas nos tempos zero, 70 minutos, 3, 5, 8 e 12 horas do primeiro e segundo dia de pos-operatorio e mensuradas pelo metodo de radioimuno-ensaio. RESULTADOS: A intensidade da dor variou em media de 1,9 a 3,7 no primeiro dia e de 2,1 a 3,8 no segundo dia de pos-operatorio Os niveis plasmaticos de fentanil (> 1 ng/ml), evidenciaram sua contribuicao na analgesia no primeiro dia apos a operacao. CONCLUSOES: Apesar de nao ter sido observada correlacao entre a concentracao plasmatica residual de fentanil e a intensidade da dor, os pacientes apresentaram dor leve durante todo o periodo investigado.BACKGROUND AND OBJECTIVES In spite of the frequent use of high doses of fentanyl for major surgeries, the correlation of its residual plasma concentration to postoperative analgesia deserves further investigation. This study aimed at evaluating the residual analgesic effect of fentanyl in the first and second postoperative days of myocardial revascularization, as well as quantifying its concentration. METHODS Participated in this study 11 patients undergoing myocardial revascularization with cardiopulmonary bypass under general anesthesia with 50 microg.kg-1 intravenous fentanyl. Analgesia was evaluated by a numeric verbal scale at moments zero (extubation), 70 min, 3, 5, 8 and 12 hours in the first day; and moments zero (24 h after extubation), 70 min, 3, 5, 8 and 12 hours in second post-operative day. Pain intensity to vigorous cough and respiratory physical therapy was evaluated. At every measurement, patients were asked about the need for analgesic complementation. Plasma samples were collected in moments zero (extubation), 70 min, 3, 5, 8 and 12 hours during the first and second postoperative days for fentanyl radioimmunoassay. RESULTS Mean pain intensity varied from 1.9 to 3.7 in the first day and from 2.1 to 3.8 in the second postoperative day. Fentanyl plasma levels (> 1 ng/ml) evidenced its contribution to post-operative analgesia during the first postoperative day. CONCLUSIONS In spite of the lack of correlation between residual fentanyl plasma concentration and pain intensity, patients referred only mild pain during the whole investigation period.