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Anestesia locorregional no doente com trauma torácico fechado
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Introdução: O trauma torácico, particularmente o resultante em fraturas de costelas, associa-se a elevada morbimortalidade. O controlo eficaz da dor aguda com uma abordagem multimodal, reflete-se na melhoria da função respiratória e diminuição de complicações associadas ao traumatismo, impactando a qualidade de vida após o evento. Apesar disso, a evidência relativamente à superioridade de determinada estratégia analgésica, convencional (AC) vs. locorregional (ALR), é ainda escassa. Objetivo: Perceber se as técnicas analgésicas locorregionais torácicas eram mais eficazes no controlo da dor do que a analgesia convencional. Métodos: Estudo de coorte, retrospetivo, observacional e analítico dos registos clínicos de doentes admitidos com trauma torácico fechado num hospital terciário português, entre abril e novembro de 2023. As principais variáveis em estudo foram a evolução da escala numérica da dor, a dose diária equivalente de morfina, a técnica locorregional utilizada, a SpO2, o TTSS, o tempo de internamento e a mortalidade a 30 dias. Resultados: No grupo ALR, verificou-se uma diminuição da dor às 24h (p=0,048) e às 72h (p=0,025). O subgrupo ALR periférica reportou menor dor às 48h que o subgrupo ALR epidural (p=0,016). A média de dias de internamento foi de 15,5 dias, sem diferenças significativas entre grupos. 16,7% dos doentes necessitaram de internamento em cuidados intensivos, tendo 8% necessitado de ventilação mecânica invasiva. Não se observaram diferenças significativas no desenvolvimento de complicações respiratórias, como síndrome de dificuldade respiratória aguda ou pneumonia. A mortalidade a 30 dias foi de 0%. Discussão: Doentes submetidos a ALR referem uma diminuição significativa da dor comparativamente aos submetidos a AC, particularmente quando utilizadas técnicas periféricas. O tipo de analgesia não influenciou o tempo de internamento nem o desenvolvimento de complicações de forma estatisticamente significativa.
Introduction: Chest wall trauma, particularly when resulting in rib fractures, is associated with high morbidity and mortality. Effective control of acute pain with a multimodal approach leads to the improvement of respiratory function and diminishes the complications associated with trauma, impacting the quality of life after the event. However, the evidence regarding the superiority of a given analgesic strategy, conventional (CA) vs. regional (RA), is still limited. Objective: Understand whether thoracic regional analgesic techniques were more effective in pain control than conventional analgesia. Methods: A cohort, retrospective, observational and analytical study of clinical records of patients admitted to a portuguese tertiary hospital with blunt chest trauma was carried out between April and November 2023. The main variables under study were the evolution of the numerical pain scale, the equivalent daily dose of morphine, the regional technique performed, SpO2, TTSS, length of stay and 30-day mortality. Results: There was a decrease in pain at 24h (p=0.048) and at 72h (p=0.025) in the RA group. The peripheral RA subgroup reported less pain at 48h than the epidural RA subgroup (p=0.016). The average hospitalization length was 15.5 days, with no significant differences between groups. 16.7% of patients required admission to the intensive care unit, with 8% requiring mechanical ventilation. No significant differences were observed in the development of respiratory complications, such as acute respiratory distress syndrome or pneumonia. The 30-day mortality was 0%. Discussion: Patients undergoing RA report a significant reduction in pain compared to CA, particularly when undergoing peripheral techniques. The type of analgesia did not influence the length of hospital stay or the development of complications in a statistically significant way.
Introduction: Chest wall trauma, particularly when resulting in rib fractures, is associated with high morbidity and mortality. Effective control of acute pain with a multimodal approach leads to the improvement of respiratory function and diminishes the complications associated with trauma, impacting the quality of life after the event. However, the evidence regarding the superiority of a given analgesic strategy, conventional (CA) vs. regional (RA), is still limited. Objective: Understand whether thoracic regional analgesic techniques were more effective in pain control than conventional analgesia. Methods: A cohort, retrospective, observational and analytical study of clinical records of patients admitted to a portuguese tertiary hospital with blunt chest trauma was carried out between April and November 2023. The main variables under study were the evolution of the numerical pain scale, the equivalent daily dose of morphine, the regional technique performed, SpO2, TTSS, length of stay and 30-day mortality. Results: There was a decrease in pain at 24h (p=0.048) and at 72h (p=0.025) in the RA group. The peripheral RA subgroup reported less pain at 48h than the epidural RA subgroup (p=0.016). The average hospitalization length was 15.5 days, with no significant differences between groups. 16.7% of patients required admission to the intensive care unit, with 8% requiring mechanical ventilation. No significant differences were observed in the development of respiratory complications, such as acute respiratory distress syndrome or pneumonia. The 30-day mortality was 0%. Discussion: Patients undergoing RA report a significant reduction in pain compared to CA, particularly when undergoing peripheral techniques. The type of analgesia did not influence the length of hospital stay or the development of complications in a statistically significant way.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Trauma torácico Fratura de costelas Analgesia locorregional Analgesia epidural Bloqueio do plano do serrátus anterior Anestesiologia