QUALITY OF RECOVERY AFTER INTRAOPERATIVE MORPHINE OR METHADONE
Status:
Completed
Trial end date:
2017-04-20
Target enrollment:
Participant gender:
Summary
Introduction. Despite the advantages associated with the use of remifentanil during total
intravenous anesthesia (TIVA), it has been observed a frequent difficulty in the control of
postoperative pain due to the risk of developing hyperalgesia and acute tolerance associated
with the administration of this opioid. There is evidence that NMDA receptors are involved in
the development of these changes. Methadone is an opioid that exhibits analgesic potency
similar to that of morphine but has NMDA antagonist activity and longer duration of action as
additional features. The objective of the study was to evaluate the quality of recovery
(QoR40) of patients undergoing TIVA for laparoscopic cholecystectomy and who received
morphine or methadone to control postoperative pain. Methods. Patients aged 18 to 65 years,
physical status ASA I and II, submitted to total venous anesthesia (propofol and
remifentanil) for laparoscopic cholecystectomy and eligible to participate in this
prospective and randomized clinical study will be evaluated. After induction of anesthesia,
patients will receive a solution containing 0.1 mg.kg-1 morphine (MF group) or 0.1 mg.kg-1
methadone (MT group). Data on the presence of pain, nausea, vomiting, tremor, drowsiness,
presence of SpO2 <92%, even with O2 face mask (5 L.min-1) and length of stay will be recorded
at PACU. The pain will be evaluated every 15 minutes on a verbal numerical scale (ENV) from 0
to 10. E.v. morphine 0.1 mg.kg-1 (MF group) or methadone 0.1 mg.kg-1 (MT group) will be
administered every 15 minutes to obtain the score below 3. After discharge from the PACU, all
patients will receive intravenous ketoprofen every 12 hours and dipyrone every 6 hours. For
cases where the patient considers the analgesic regimen insufficient, tramadol (100 mg) will
be administered intravenously at 8-hour intervals. The consumption of analgesics, the
intensity of pain, the occurrence of nausea, vomiting and other complications in the ward
will be recorded. The application of the questionnaire (QoR40) will be performed in the ward
the morning after the surgery by a medical student.