Uso da cetamina na analgesia preemptiva como forma de alívio da dor no pós-operatório imediato / Use of ketamine in preemptive analgesia as a form of pain relief in the immediate postoperative period

Ellen Karine Saraiva de Sousa, Manuela Sobral Bentes de Melo, Ranyere Nobre da Silva, Eyder Figueiredo Pinheiro, Douglas Alves Lucena, Jéssica Fontenele Bezerra, Jamille Ferreira Leandro, Rafael Lucena Landim, Antonio Augusto Jordão Ramos, Francisco Alexandre Braga Tavares, Hermes Melo Teixeira Batista

Resumo


Os momento pós-operatório é tão relevante quanto o ato operatório em si, demandando manejo das dores advindas dessa atividade. Estudos têm demonstrado   que a analgesia no pós-operatório, em muitos casos, era realizada de forma inadequada. Este estudo objetiva analisar a o uso da cetamina na analgesia preemptiva como forma de alívio da dor no pós-operatório imediato, em estudos experimentais através de uma revisão na literatura. Os resultados dos estudos experimentais e clínicos aqui apresentados, apontaram que a S(+) cetamina é mais potente do que sua forma racêmica, indicando a superioridade daquela para fins de bloquear a sensibilização central, bem como que o uso da cetamina em pequenas doses na analgesia preemptiva, consiste no método mais eficaz no controle da dor do período pós-operatório. No entanto, ainda é muito restrito os artigos disponíveis sobre a temática, para fins de confirmar-se ou não, a efetividade dessa droga na analgesia preemptiva.

 


 


Palavras-chave


Cetamina. Analgesia preemptiva. Alívio da dor

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Referências


ABRAMS, R.; MORRISON, J. E.; VILLASENOR, A.; HENCMANN, D.; DA FONSECA, M.; MUELLER, W. Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures. Anesthesia Progress, 1993;40:63-66.

AIDA, S.; BABA, H.; YAMAKURA, T.; TAGA, K.; FUKUDA, S.; SHIMOJI, K. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesthesia and Analgesia, 1999;89:711-716.

AIDA, S.; YAMAKURA, T.; BABA, H.; TAGA, K.; FUKUDA, S.; SHIMOJI, K. Preemptive analgesia by intravenous low-dose ketamine and epidural morphine in gastrectomy: a randomized double-blind study. Anesthesiology, 2000;92:1624-1630.

BACH, S.; NORENG, M.F.; TJÉLLDEN, N.U. - Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain, 1988;33:297-301.

BOSSARD, A. E.; GUIRIMAND, F.; FLETCHER, D.; GAUDE-JOINDREAU, V.; CHAUVIN, M.; BOUHASSIRA, D. Interaction of a combination of morphine and ketamine on the nociceptive flexion reflex in human volunteers. Pain, 2002;98:47-57.

CARR, D. B. Preemptive analgesia implies prevention. Anesthesiology, 1996;85:1498

CLEMENTS, J. A.; NIMMO, W. S. Pharmacokinetics and analgesic effect of ketamine in man. British Journal of Anaesthesia, 1981;53:27-30.

Coderre TJ, Katz J, Vaccarino AL et al - Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain, 1993;52:259-285

COHEN, R. H.; PERL, E. R. Contributions of arachidonic acid derivates and substance P to the sensitization of cutaneos nociceptors. Journal of Neurophysiology, 1990;64:457-464.

CORSSEN, G.; REVES, J. G.; CARTER, J. R. Neuroleptanesthesia, dissociative anesthesia and hemorrhage. International Anesthesiology Clinics, 1974;12:145-161.

CRILE, G. W. The kinetic theory of shock and its prevention through anoci-association (shockless operation). Lancet, 1919;185: 7-16.

DE NEGRI, P.; IVANI G, VISCONTI, C.; DE VIVO, P. How to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S-ketamine versus clonidine. Paediatric Anaesthesia, 2001;11:679-683.

DICKENSON, A. H. Spinal cord pharmacology of pain. British Journal of Anaesthesia, 1995;75:193-200.

DICKENSON, A. H.; SULLIVAN, A. F. Evidence for a role of the NMDA receptor in the frequency dependent potentiation of deep rat dorsal horn nociceptive neurones following C fibre stimulation. Neuropharmacology, 1987;26:1235-1238.

DIX, P.; MARTINDALE, S.; STODDART, P. A. Double-blind randomized placebo-controlled trial of the effect of ketamine on postoperative morphine consumption in children following appendicectomy. Paediatric Anaesthesia, 2003;13:422-426.

DOENICKE, A.; KUGLER, J.; MAYER, M.; ANGSTER, R.; HOFFMANN, P. Ketamine racemate or S(+)-ketamine and midazolam. The effect on vigilance, efficacy and subjective findings. Der Anaesthesist, 1992;41:610-618

DRAY, A. Inflammatory mediators of pain. British Journal of Anaesthesia, 1995;75:125-131.

EDWARDS, N. D., FLETCHER, A., COLE, J. R.; PEACOCK, J. E. Combined infusions of morphine and ketamine for postoperative pain in elderly patients. Anaesthesia, 1993;48:124-127.

ELHAKIM, M.; KHALAFALLAH, Z.; EL-FATTAH, H. A.; FAROUK, S.; KHATTAB, A. Ketamine reduces swallowing-evoked pain after paediatric tonsillectomy. Acta Anaesthesiologica Scandinavica, 2003;47:604-609.

GARCIA, J. B. S.; ISSY, A. M.; SAKATA, R. K. Analgesia Preemptiva. Revista Brasileira de Anestesiologia, Vol. 51, Nº 5, setembro - Outubro, 2001.

GOZZANI, J. L. Analgesia Pós-Operatória, in MANICA, J. Anestesiologia - Princípios e Técnicas. Porto Alegre, Artes Médicas, 1997;763-769.

GRANT, I. S., NIMMO, W. S., CLEMENTS, J. A. Lack of effect of ketamine analgesia on gastric emptying in man. British Journal of Anaesthesia, 1981;53:1321-1323.

HATANO, S.; KEANE, D. M., BOGGS, R. E.; EL-NAGGAR, M. A.; SADOVE, M. S. Diazepam-ketamine anaesthesia for open heart surgery a “micro-mini” drip administration technique. Canadian Anaesthetists’ Society Journal, 1976;23:648-656.

HORVATH, G.; JOO, G.; KLIMSCHA, W.; DOBOS, I.; SZIKSZAY, M.; BENEDEK, G. The interaction of S(+)-ketamine with dexmedetomidine after intrathecal administration in rats. European Journal of Anaesthesiology, 2000;17:176-177.

HUSTVEIT, O.; MAURSET, A.; OYE, I. Interaction of the chiral forms of ketamine with opioid, phencyclidine, sigma and muscarinic receptors. Pharmacology & Toxicology, 1995;77:355-359.

ILKJAER, S.; PETERSEN, K. L.; BRENNUM, J.; WERNBERG, M.; DAHL, J. B. Effect of systemic N-methyl-D aspartate receptor antagonist (ketamine) on primary and secundary hyperalgesia in humans. British Journal of Anaesthesia, 1996;76:829-834.

JAVERY, K. B.; USSERY, T. W.; STEGER, H.; COLCLOUGH, G. W. Comparison of morphine and morphine with ketamine for postoperative analgesia. Canadian Anaesthetists’ Society Journal, 1996;43:212-215

JOO, G.; HORVATH, G.; KLIMSCHA, W.; KEKESI, G.; DOBOS, I.; SZIKSZAY, M.; BENEDEK, G. The effects of ketamine and its enantiomers on the morphine- or dexmedetomidine-induced antinociception after intrathecal administration in rats. Anesthesiology, 2000;93:231-241

KATZ, J.; MCCARTNEY, C. J. L. Current status of pre-emptive analgesia. Current Opinion in Anesthesiology, 2002;15:435-441.

KINGSTON, H. G.; BRETHERTON, K. W.; HOLLOWAY, A. M. A comparison between ketamine and diazepam as induction agents for pericardectomy. Anaesthesia and Intensive Care Journal, 1978;6:66-70.

KLIMSCHA, W.; HORVATH, G.; SZIKSZAY, M. Antinociceptive effect of the S(+)-enantiomer of ketamine on carrageenam hyperalgesia after intrathecal administration in rats. Anesthesia and Analgesia, 1998;86:561-565.

KOINIG, H.; MARHOFER, P.; KRENN, C. G.; ET AL. Analgesics effects of caudal and intramuscular S(+)-ketamine in children. Anesthesiology, 2000;93:976-980.

LEVINE, J. D.; FIELDS, H. L.; BASBAUM, A. I. Peptides and the primary afferent nociceptor. Journal of Neuroscience, 1993;13:2273-2286.

LI, J.; SIMONE, D. A.; LARSON, A. A. Wind-up leads to characteristics of central sensitization. Pain, 1999;79:75-82.

LUFT, A.; MENDES, F. F. S(+) Cetamina em Baixas Doses: Atualização. Revista Brasileira de Anestesiologia, 2005; 55: 4: 460 – 469.

MAURSET, A.; SKOGLUND, L. A.; HUSTVEIT, O.; OYE, I. Comparison of ketamine and pethidine in experimental and postoperative pain. Pain, 1989;36:37-41.

MCQUAY, H. J. Preemptive analgesia. British Journal of Anaesthesia, 1992;69:1-3.

MCQUAY, H. J., DICKENSON, A. H. Implications of nervous system plasticity for pain management. Anaesthesia, 1990;45: 101-102.

MIKKELSEN, S.; ILKJAER, S.; BRENNUM, J. The effect of naloxone on ketamine-induced effects on hyperalgesia and ketamine-induced side effects in humans. Anesthesiology, 1999;90:1539-1545.

MIKKELSEN, S.; JORGENSEN, H.; LARSEN, P. S.; BRENNUM, J.; DAHL, J. B. Effect of oral ketamine on secondary hyperalgesia, thermal and mechanical pain thresholds, and sedation in humans. Regional Anesthesia and Pain Medicine, 2000;25:452-458.

MOINICHE, S.; KEHLET, H.; DAHL, J. B. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology, 2002;96:725-741.

NAGUIB, M.; ADU-GYAMFI, Y.; ABSOOD, G. H.; FARAG, H.; GYASI, H. K. Epidural ketamine for postoperative analgesia. Canadian Anaesthetists’ Society Journal, 1986;33:16-21.

OWEN, H.; REEKIE, R. M.; CLEMENTS, J. A ET AL. Analgesia from morphine and ketamine. A comparison of infusions of morphine and ketamine for postoperative analgesia. Anaesthesia, 1987;42:1051-1056

PEDERSEN, J. L.; GALLE, T. S.; KEHLET, H. Peripheral analgesic effects of ketamine in acute inflammatory pain. Anesthesiology, 1998;89:58-66

RABBEN, T. Effects of the NMDA receptor antagonist ketamine in electrically induced A-fiber pain. Methods and findings in experimental and clinical pharmacology, 2000;22:185-189

REN, K. Wind-up and the NMDA receptor: from animal studies to humans. Pain, 1994;59:157-158.

SADOVE, M. S.; SHULMAN, M.; HATANO, S.; ET AL. Analgesic effects of ketamine administered in subdissociative doses. Anesthesia and Analgesia, 1971;50:452-457

SCHELLER, M.; BUFLER, J.; HERTLE, I.; ET AL - Ketamine blocks currents through mammalian nicotinic acetylcholine receptor channels by interaction with both the open and the closed state. Anesthesia and Analgesia, 1996;83:830-836.

SCHMID, R. L.; SANDLER, A. N.; KATZ, J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain, 1999;82: 111-125.

SCHUMAN, E. M.; MADISON, D. V. Nitric oxide and synaptic function. Annual Review of Neuroscience, 1994;17:153-183.

SMITH, D. J.; PEKOE, G. M.; MARTIN, L. L.; ET AL. The interaction of ketamine with the opiate receptor. Life Sciences Journal, 1980;26:789-795.

STEIN, C. Peripheral mechanisms of opioid analgesia. Anesthesia and Analgesia, 1993;76:182-191.

STUBHAUG, A.; BREIVIK, H.; EIDE, P. K.; ET AL - Mapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery. Acta Anaesthesiologica Scandinavica, 1997;41:1124-1132

SUZUKI, M.; TSUEDA, K.; LANSING, P. S.; ET AL. Small-dose ketamine enhances Morphine-induced analgesia after outpatient surgery. Anesthesia and Analgesia, 1999;89:98-103

URBAN, L.; THOMPSON, S. W. N.; DRAY, A. Modulation of spinal excitability: co-operation between neurokinin and excitatory amino acid neurotransmitters. Trends in Neurosciences, 1994;17:432-438

VAN DER LINDEN, P.; GILBART, E.; ENGELMAN, E. Comparison of halothane, isoflurane, alfentanil, and ketamine in experimental septic shock. Anesthesia and Analgesia, 1990;70:608-617.

WALL, P. D. The prevention of postoperative pain. Pain, 1988;33: 289-290.

WARNCKE, T.; STUBHAUG, A.; JORUM, E. Preinjury treatment with morphine or ketamine inhibits the development of experimentally induced secondary hyperalgesia in man. Pain, 2000;86:293-303.

WEBER, F.; WULF, H. Caudal bupivacaine and S(+)-ketamine for postoperative analgesia in children. Paediatric Anaesthesia, 2003;13:244-248.

White PF, Way WL, Trevor AJ - Ketamine - its pharmacology and therapeutic uses. Anesthesiology, 1982;56:119-136.

WONG, C. S.; LIAW, W. J.; TUNG, C. S.; SU, Y. F.; HO, S. T. Ketamine potentiates analgesic effect of morphine in postoperative epidural pain control. Regional Anesthesia, 1996;21:534-541.

WOOLF, C. J. Recent advances in the pathophysiology of acute pain. British Journal of Anaesthesia, 1989;63:139-146.

WOOLF, C. J. Somatic pain - pathogenesis and prevention. British Journal of Anaesthesia, 1995;75:169-176.

WOOLF, C. J. Evidence for a central component of post-injury pain hypersensitivity. Nature, 1983;306:686-688.

WOOLF, C. J, THOMPSON, S. W. N. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain, 1991;44:293-299.

WOOLF, C. J; WALL, P. D. Morphine sensitive and morphine insensitive actions of C-fibre input on the rat spinal cord. Neuroscience Letters, 1986;64:221-225.

YASHPAL, K., MASON, P., MCKENNA, J. E., SHARMA, S. K., HENRY, J. L., CODERRE, T. J. Comparison of the effects of treatment with intrathecal lidocaine given before and after formalin on both nociception and Fos expression in the spinal cord dorsal horn. Anesthesiology, 1998;88:157-164




DOI: https://doi.org/10.14295/idonline.v13i45.1855

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