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Master's Dissertation
DOI
https://doi.org/10.11606/D.10.2019.tde-28082020-083441
Document
Author
Full name
Jéssica Sperandio Cavaco
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Fantoni, Denise Tabacchi (President)
Gomes, Cristina de Oliveira Massoco Salles
Klaumann, Paulo Roberto
Title in Portuguese
Avaliação da eficácia analgésica do bloqueio do plano transverso do abdome, guiado por ultrassom, em cadelas submetidas à ovariectomia eletiva
Keywords in Portuguese
Analgesia
Anestesia regional
Bupivacaína
Cortisol
Dor
Abstract in Portuguese
Na medicina, o bloqueio do plano transverso do abdome (TAP block) mostra-se eficaz em diversos procedimentos cirúrgicos. Desta forma, o presente estudo prospectivo, randomizado e cego teve como objetivo avaliar a eficácia analgésica do TAP block, guiado pela ultrassonografia em cadelas submetidas a ovariectomia. Para tanto, foram utilizados 32 animais distribuídos aleatoriamente em 2 grupos com 16 animais. O grupo TAP block controle (TBC) recebeu água para injeção 0,2 mL/kg/ponto. Já o grupo TAP block bupivacaína (TBB) recebeu bupivacaína 0,2 mL/kg/ponto à 0,25%, ambos os grupos na abordagem dos quatro pontos. Os animais foram pré-medicados com acepromazina (0,03 mg/kg) e meperidina (2 mg/kg) pela via intramuscular, a indução anestésica com propofol (3 a 5 mg/kg) pela via intravenosa e o isofluorano foi empregado para manutenção da anestesia. Ainda, todos os animais no período transoperatório receberam infusão contínua de remifentanil (0,2 ug/kg/min) e rocurônio (0,6 mg/kg), ambos pela via intravenosa. As variáveis mensuradas foram: frequências cardíaca e respiratória, pressão arterial, temperatura, saturação periférica da oxihemoglobina, concentração de dióxido de carbono no ar expirado, concentração de isofluorano no ar expirado, cortisol sérico, analgesia e sedação. As análises estatísticas foram efetuadas com o software GraphPad Prism versão 6.0 e o grau de significância estabelecido para os testes foi de 5% (P < 0,05). Foram analisados parâmetros vitais, grau de analgesia por meio da escala numérica verbal (ENV) e escala composta reduzida de Glasgow (GCMPS-SF), grau de sedação, bem como o cortisol sérico em diferentes tempos. Como principais resultados verificou-se que no período transoperatório não houve diferença significativa entre os grupos. Já no pós- operatório, no grupo TBC, 13 animais do total de 16 animais necessitaram de resgate analgésico ao passo que no grupo TBB apenas 1 animal. Com relação a mensuração do cortisol sérico, o grupo TBC apresentou diferença significativa quando comparado ao tempo basal (TB) na tração do primeiro ovário (P < 0,0001), e decorridas 2 horas (P = 0,0441) e 8 horas (P= 0,0384) da extubação. Já no grupo TBB, verificou-se que o cortisol apresentou aumento significativo apenas na tração do primeiro ovário e 2 horas após a extubação (P < 0,0001). Sendo assim, a partir dos resultados encontrados conclui-se que o TAP block promove analgesia adequada para o período pós-operatório de cadelas submetidas à ovariectomia, podendo ser uma nova alternativa para proporcionar o controle de dor nesse tipo de procedimento. Entretanto, este bloqueio não foi efetivo para modular a resposta neuroendócrina no transoperatório, tendo-se em vista o incremento dos valores do cortisol observados.
Title in English
Evaluation of analgesic efficacy of ultrasound-guided transversus abdominis plane block in female dogs submitted to elective ovariectomy
Keywords in English
Analgesia
Bupivacaine
Cortisol
Local anestesia
Pain
Abstract in English
In medicine, TAP block showed as an effective method in several surgical procedures. In this context, this prospective, randomized, blinded study aimed to evaluated the analgesic efficacy of TAP block, guided by ultrasound in bitches submitted to ovariectomy. Therefore, 32 animals randomly assigned in two groups with 16 animals were used. Groups consisted of TAP block control (TBC) which received water injection (0.2mL/kg/point) and TAP block bupivacaine (TBB) which received bupivacaine (0.2mL/kg/point at 0.25%), both groups were submitted to four-point approach. Animals were premedicated with acepromazine (0.03mg/kg) and meperidine (2mg/kg) intramuscularly, propofol were used as anesthetic induction (3 to 5mg/kg) intravenously and isofluorane was used to maintenance. In order to standardize groups, in the intraoperative period the animals received continuous infusion of remifentanil (0.2µg/kg/min) and rocuronium (0.6 mg/kg), both intravenously. Variables measured were heart and respiratory rates, blood pressure, temperature, oxyhemoglobin peripheral saturation, exhaled carbon dioxide concentration, exhaled isofluorane concentration, serum cortisol, analgesia and sedation. Statistical analyzes were performed using GraphPad Prism version 6.0 software and significance level established was 5% (P<0.05). Before the preanesthetic medication (TB) and 1,2,4,6 and 8 hours after extubation, pain and sedation were assessment using verbal numeric scale (ENV), Glasgow's reduced composite scale (GCMPS-SF) and sedation scale. Moreover, serum cortisol was measured in different moments. As main results it was observed that in intraoperative period there was no significant difference between groups. After surgery, in TBC group, 13 animals out of 16 animals required analgesic rescue, whereas in TBB group this occurred only in one animal. Regarding the measurement of serum cortisol, the TBC group showed significant difference when compared to the baseline time (TB) in the traction of the first ovary (P<0.0001), 2 hours (P=0.0441) and 8 hours (P&#;0.0384) after extubation. In TBB group, cortisol showed a significant increase only in the traction of the firsty ovary and 2 hours after extubation (P<0.0001). Thus, after this results, it is concluded that the TAP block promotes adequate analgesia in postoperative period of bitches submitted to ovariectomy, and may be a new alternative to provide pain control in this procedure. However, this block was not effective to modulate the neuroendocrine response in the intraoperative period, given the increase in cortisol values observed.
 
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Release Date
2022-10-08
Publishing Date
2020-10-09
 
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