Morfina endovenosa para analgesia de crianças submetidas a tonsilectomias: ensaio clínico
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2017-08-16
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Universidade Federal de Goiás
Resumo
This dissertation was carried out in the form of two articles. The first
one had the objective conduct a systematic reviewof about intravenous and
intraoperative administration of morphine for the analgesia of children
submitted to palatine tonsillectomy. These surgeries may have significant
perioperative morbidity, with the possibility of nausea, vomiting and
respiratory events such as hypoxia, especially in pediatric patients, in
addition to postoperative pain, which is considered intense and can be
difficult to evaluate and treat. Morphine is an opioid drug that can be used as
an analgesic in these patients, but it also has the potential to lead to some of
these adverse events, which makes its use infrequent in these procedures.
Thus, a bibliographic review was performed in the electronic databases
Pubmed, Cochrane, Lilacs, Scielo and ClinicalKey, searching for studies
written in English, Portuguese or Spanish, published until June 2017. The
selected uniterms were "morphine", "opioid", "analgesia", "tonsillectomy" and
"tonsillectomies" and the keyword "tonsillectomy", separated by the AND and
OR interlocutors. Randomized, prospective clinical trials with patients up to
the age of 18 years who underwent tonsillectomy and who used intravenous
morphine administered intravenously with postoperative pain evaluation were
included. The research was complemented by a review of the bibliographic
references of each relevant article found. In the results found, the total
number of children evaluated was 1076, with physical status ASA I to III, and
the postoperative pain intensity evaluation was variable, being performed
through numerical pain scales (NRS), behavioral (FLACC, Hannallah,
CHEOPS and modified CHEOPS), by nursing assessment in the recovery
room or by simple patient complaint. Only one of the studies was placebocontrolled
and eight were double-blind. Pre-anesthetic medication was
administered in 6 studies and the main one was paracetamol
(acetaminophen). Morphine was used as the main analgesic, with pain
reduction, as well as analgesia recovery, and there were adverse effects in
the postoperative period, with variable incidence of nausea, vomiting,
Abstract xxi
pruritus, sedation and oxygen desaturation, but without reports of gravity.
The conclusion was that intravenous morphine can be successfully used to
treat pain in children after tonsillectomy, despite the need for rigorous
postoperative monitoring, mainly breathing, and addition of prevention of
nausea and vomiting.
The second article was a prospective randomized clinical trial aimed at
evaluating the use of intravenous morphine for postoperative analgesia in
children submitted to tonsillectomy. It includes fifty-seven children 5 to 12
years old, ASA I, submitted to elective tonsillectomy, with or without
adenoidectomy, under standardized general anesthesia and distributed in
two groups to receive intraoperative analgesia. One group received 0.1mg /
kg morphine intravenously shortly after intubation and another group did not.
Postoperative pain was assessed independently by parents / guardians and
children through the Face Pain Scale at 30, 60, 120, 180 and 240 minutes. In
addition, the time of awakening of the anesthesia, the need for rescue
analgesics and the possible adverse effects were observed. The results
showed that the group that used morphine had a lower level of pain both in
the evaluation by the children, at the moment of 30 min after awakening, and
by the parents / guardians, in the moments of 30, 60 and 180 minutes in
relation to the other group, without increase the awakening time of
anesthesia and without significant adverse effects. There was a greater need
for rescue analgesics in the group that did not use morphine. The conclusion
was that administration of intravenous morphine during surgery reduced the
intensity of pain in the immediate postoperative period, both in the reports of
the children and the parents / guardians, without increasing the time of
awakening from general anesthesia or adverse effects.
Descrição
Palavras-chave
Tonsilectomia , Analgesia , Criança , Dor , Morfina , Tonsillectomy , Analgesia , Child , Pain , Morphine
Citação
ARAÚJO, M. C. O. Morfina endovenosa para analgesia de crianças submetidas a tonsilectomias: ensaio clínico. 2017. 83 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2017.