Palavras-chave
Bloqueio do Plano Transverso do Abdome
Analgesia
Parto Cesariana
Como Citar
Resumo
Introdução: As taxas de parto cesárea (CD) vêm aumentando anualmente. Para as parturientes, a falta de analgesia afeta a recuperação pós-parto materna, assim como a amamentação e o desenvolvimento do bebê, além de aumentar o risco de depressão pós-parto.
Objetivo: Avaliar, por meio de uma revisão da literatura, os efeitos analgésicos da morfina intratecal (ITM) e do bloqueio do plano transverso do abdome (TAP) no CD.
Método: Trata-se de um estudo exploratório, baseado no método de revisão da literatura com síntese de evidências. A base de dados escolhida para seleção dos trabalhos foi a PUBMED, utilizando a seguinte estratégia de busca: "intrathecal morphine"[title] AND ("tap block"[title] OR "transversus abdominis plane block"[title]) AND cesarean.
Resultados: A busca foi realizada em novembro de 2022, e inicialmente foram identificados 11 trabalhos que atenderam a estratégia de busca. Após a leitura dos títulos e resumos, 2 textos foram excluídos por se tratarem de cartas ao editor.
Conclusão: Os efeitos analgésicos da ITM após CD parecem ser superiores ao bloqueio TAP, ainda que alguns trabalhos indiquem que ambos os métodos são comparáveis. Porém, o bloqueio TAP seria uma alternativa razoável quando a ITM é contraindicada, ou mesmo para as pacientes com alto risco de náuseas e vômitos pós-operatórios, além de apresentar menos reações adversas se comparado à ITM.
Referências
CANAKCI, E. et al. The Analgesic Efficacy of Transverse Abdominis Plane Block versus Epidural Block after Caesarean Delivery: Which One Is Effective? TAP Block? Epidural Block? Pain Research & Management, v. 2018, 2018.
COLE, J.; HUGHEY, S.; LONGWELL, J. Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review. Regional Anesthesia and Pain Medicine, p. rapm-2019-100483, 13 set. 2019.
COSTELLO, J. F. et al. The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery. Regional Anesthesia and Pain Medicine, v. 34, n. 6, p. 586–589, 2009.
DEER, T. R. et al. The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks. Neuromodulation: Journal of the International Neuromodulation Society, v. 20, n. 2, p. 155–176, fev. 2017.
DEREU, D. et al. The impact of a transversus abdominis plane block including clonidine vs. intrathecal morphine on nausea and vomiting after caesarean section: A randomised controlled trial. European Journal of Anaesthesiology, v. 36, n. 8, p. 575–582, ago. 2019.
EISENACH, J. C. et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain, v. 140, n. 1, p. 87–94, 15 nov. 2008.
EISENACH, J. C.; GRICE, S. C.; DEWAN, D. M. Patient-controlled analgesia following cesarean section: a comparison with epidural and intramuscular narcotics. Anesthesiology, v. 68, n. 3, p. 444–448, mar. 1988.
HABIB, A. S. et al. Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine. Journal of Clinical Anesthesia, v. 75, p. 110527, dez. 2021.
HUANG, J.-Y. et al. Impact of Transversus Abdominis Plane Block With Bupivacaine or Ropivacaine Versus Intrathecal Morphine on Opioid-related Side Effects After Cesarean Delivery: A Meta-analysis of Randomized Controlled Trials. The Clinical Journal of Pain, v. 38, n. 3, p. 231–239, 17 dez. 2021.
HUTCHINS, J. L. et al. The addition of intrathecal morphine to a transversus abdominis plane block with liposome bupivacaine provides more effective analgesia than transversus abdominis plane block with liposome bupivacaine alone: a retrospective study. Local and Regional Anesthesia, v. 12, p. 7–13, 2019.
KWIKIRIZA, A. et al. The analgesic effects of intrathecal morphine in comparison with ultrasound-guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital. Anaesthesia, v. 74, n. 2, p. 167–173, fev. 2019.
LEUNG, A. Y. Postoperative pain management in obstetric anesthesia--new challenges and solutions. Journal of Clinical Anesthesia, v. 16, n. 1, p. 57–65, fev. 2004.
LIM, Y. et al. Morphine for post-caesarean section analgesia: intrathecal, epidural or intravenous? Singapore Medical Journal, v. 46, n. 8, p. 392–396, ago. 2005.
LIU, S. S.; BLOCK, B. M.; WU, C. L. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis. Anesthesiology, v. 101, n. 1, p. 153–161, jul. 2004.
LOANE, H. et al. A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia. International Journal of Obstetric Anesthesia, v. 21, n. 2, p. 112–118, abr. 2012.
MCDONNELL, J. G. et al. The Analgesic Efficacy of Transversus Abdominis Plane Block After Cesarean Delivery: A Randomized Controlled Trial. Anesthesia & Analgesia, v. 106, n. 1, p. 186–191, jan. 2008.
ROOFTHOOFT, E. et al. PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations. Anaesthesia, v. 76, n. 5, p. 665, maio 2021.
SANDERSON, B. J.; DOANE, M. A. Transversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults. Regional Anesthesia and Pain Medicine, v. 43, n. 1, p. 5–13, jan. 2018.
SULTAN, P. et al. The Effect of Intrathecal Morphine Dose on Outcomes After Elective Cesarean Delivery: A Meta-Analysis. Anesthesia and Analgesia, v. 123, n. 1, p. 154–164, jul. 2016.
WANG, B. et al. Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China. BMC pregnancy and childbirth, v. 10, p. 78, 2 dez. 2010.
WITTELS, B.; SCOTT, D. T.; SINATRA, R. S. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology, v. 73, n. 5, p. 864–869, nov. 1990.
WU, C. L. et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology, v. 103, n. 5, p. 1079–1088; quiz 1109–1110, nov. 2005.
YANG, T.-R. et al. Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis. BMC anesthesiology, v. 21, n. 1, p. 174, 22 jun. 2021.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.