Anestesia Multimodal versus Bloqueio Neuroaxial em Prostatectomias Radicais Abertas

Autor: Travassos, Thiago da Costa
Přispěvatelé: Pontifícia Universidade Católica de Campinas, Reis, Leonardo Oliveira, Tedrus, Gloria Maria de Almeida Souza, Ikari, Osamu
Jazyk: portugalština
Rok vydání: 2021
Předmět:
Zdroj: Biblioteca Digital de Teses e Dissertações da PUC_CAMPINAS
Pontifícia Universidade Católica de Campinas (PUC-CAMPINAS)
instacron:PUC_CAMP
Popis: Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2021-06-08T18:48:04Z No. of bitstreams: 1 THIAGO DA COSTA TRAVASSOS.pdf: 771342 bytes, checksum: dc6772a500a3e43ef694bee2d49519de (MD5) Made available in DSpace on 2021-06-08T18:48:04Z (GMT). No. of bitstreams: 1 THIAGO DA COSTA TRAVASSOS.pdf: 771342 bytes, checksum: dc6772a500a3e43ef694bee2d49519de (MD5) Previous issue date: 2021-02-26 Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES Introduction: More than 80% of patients undergoing surgical procedures experience acute pain in the postoperative period and approximately 75% report this pain as moderate, severe or extreme. Studies have shown that the combination of general and local anesthesia can improve postoperative results through synergistic effects in the pain path. In this sense, 3 phases-P.T.A.S. (Preemptive Target Anesthetic Solution), developed by Dr. Jo?o Carlos das Neves Pereira, as one of the 36 stages of the International Preemptive Eurasian Program (IPEP) protocol, witch for 23 years, has proving to be efficient in pain control and an important tool in the concept of E.R.A.S. (Enhanced Recovery After Surgery). Objective: To evaluate the decrease in hospital length of stay and costs in patients undergoing local multimodal anesthetic solution compared to neuraxial block, both in association with general anesthesia. It was also evaluated the relationship between hospitalization and costs with quantitative variables (age, biopsy result / ISUP, ASA score, anesthetic time, use of crystalloids and total drain volume) and qualitative variables (PSA value > 20, clinical stage, presence of comorbidities and lymphadenectomy). Methodology: This is a Retrospective Cohort Study where data from medical records were compared for 42 patients submitted to open radical prostatectomies, using general anesthesia associated with neuraxial block and 35 patients, using general anesthesia associated with 3 phases-P.T.A.S., multimodal. Exploratory data analysis was performed using summary measures and the level of significance adopted was 5%. Results: No statistically significant differences were found between the two groups for cost (p-value = 0.894) and length of stay (p-value = 0.062), however length of stay showed a tendency to be shorter in the group submitted to the solution. There were also no statistically significant differences between the two groups for age, biopsy / ISUP result, ASA score, anesthetic time, use of crystalloid, total drain volume, PSA value > 20, digital rectal examination > T2, presence of comorbidities , and lymphadenectomy. Cost was positively related to the result of biopsy / ISUP, anesthetic time, use of crystalloid and total drain volume. Length of hospital stay was positively related to the use of crystalloids and total drain volume, with a strong correlation with the latter. Conclusion: There was no statistically significant difference between the data of the studied groups, and it is not possible to state that the use of the solution effectively decreases the length of hospital stay; however, there was a tendency to reduce the length of stay in the group subjected to the infiltration of the multimodal anesthetic solution, that may be better evidenced in studies with greater sampling power. Introdu??o: Mais de 80% dos pacientes submetidos a procedimentos cir?rgicos experimentam dor aguda no p?s-operat?rio e aproximadamente 75% relatam essa dor como moderada, grave ou extrema. Estudos demonstraram que a associa??o da anestesia geral e local pode melhorar os resultados p?s-operat?rios por meio de efeitos sin?rgicos na via da dor. Nesse sentido, 3 phases-P.T.A.S. (Preemptive Target Anesthetic Solution), desenvolvido pelo Dr. Jo?o Carlos das Neves Pereira, como uma das 36 etapas do protocolo do International Preemptive Eurasian Program (IPEP), h? 23 anos, tem provado ser eficiente no controle da dor e uma ferramenta importante no conceito de E.R.A.S. (Enhanced Recovery After Surgery). Objetivo: Avaliar o impacto no tempo de interna??o e nos custos nos pacientes submetidos ? solu??o anest?sica local multimodal em compara??o com bloqueio neuroaxial, ambos em associa??o com anestesia geral. Avaliou-se tamb?m a rela??o do tempo de interna??o e dos custos com vari?veis quantitativas (idade, valor de PSA, resultado de bi?psia/ISUP, escore de ASA, tempo anest?sico, uso de cristaloides e volume total de dreno) e vari?veis qualitativas (PSA > 20, estadio cl?nico, presen?a de comorbidades e realiza??o de linfadenectomia). Metodologia: Trata-se de Estudo de Coorte Retrospectivo onde foram comparados dados de prontu?rios referentes a 42 pacientes submetidos ? prostatectomias radicais abertas, utilizando anestesia geral associada ao bloqueio neuroaxial e 35 pacientes, utilizando anestesia geral associada a 3 phases-P.T.A.S. multimodal. An?lise explorat?ria de dados foi realizada atrav?s de medidas de resumo e o n?vel de signific?ncia adotado foi de 5%. Resultados: N?o foram encontradas diferen?as estatisticamente significativas entre os dois grupos para custo (p-valor = 0,894) e tempo de interna??o (p-valor = 0,062), entretanto tempo de interna??o mostrou tend?ncia de ser menor no grupo submetido ? anestesia multimodal. Tamb?m n?o foram observadas diferen?as estatisticamente significativas entre os dois grupos para idade, resultado de bi?psia/ISUP, escore de ASA, tempo anest?sico, uso de cristaloide, volume total de dreno, valor de PSA > 20, toque retal > T2, presen?a de comorbidades, e realiza??o de linfadenectomia. Custo relacionou-se positivamente com resultado de bi?psia/ISUP, tempo anest?sico, uso de cristaloide e volume total dreno. Tempo de interna??o mostrou-se positivamente relacionado com utiliza??o de cristaloides e volume total do dreno, sendo a correla??o com este ?ltimo, forte. Conclus?o: N?o houve diferen?a, estatisticamente significativa entre os dados dos grupos estudados, n?o sendo poss?vel afirmar que a utiliza??o da solu??o diminui de forma efetiva o tempo de interna??o, entretanto observou-se tend?ncia de redu??o do tempo de interna??o no grupo submetido ? infiltra??o da solu??o anest?sica multimodal, identificando a necessidade de estudos com poder amostral maior.
Databáze: OpenAIRE
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