[Efficacy of intraoperative methadone and clonidine in pain control in the immediate postoperative period after the use of remifentanil].
OBJECTIVE
Due to its pharmacokinetic characteristics, remifentanil does not promote residual analgesia in the immediate postoperative period. The objective of this study was to compare the efficacy of methadone and clonidine in the control of postoperative pain of videolaparoscopic surgeries under total intravenous anesthesia with target-controlled remifentanil infusion.


METHODS
One hundred and twenty-six patients, ages 18 to 65 years, ASA I and II, of both genders, scheduled for laparoscopic surgeries, participated in this randomized, double- blind, placebo-controlled study. After venipuncture, intravenous ketoprofen and dypirone were administered. Target-controlled infusion of remifentanil and propofol was used for induction and maintenance of anesthesia. Before beginning the procedure, an intravenous solution containing 0.1 mg.kg-1 of methadone (methadone group), 2.0 (1/4)g.kg-1 of clonidine (clonidine group), or NS (placebo group) was administered. In the post-anesthetic care unit, postoperative pain was evaluated by the Verbal Numeric Scale (VNS). Absence of pain was defined as a score < 2, and pain as a score of > 3.


RESULTS
The incidence of pain in the methadone group was significantly lower than in the clonidine and placebo groups (11, 21, and 23, respectively; p < 0.02). Significant differences in the incidence of pain in the placebo and clonidine groups were not observed.


CONCLUSIONS
Methadone was more effective than clonidine in the control of postoperative pain in videolaparoscopic surgeries under total intravenous anesthesia with remifentanil; and using clonidine was not better than not using it.
Simoni
Ricardo Francisco
RF
Comitê de Anestesia Venosa, SBA. ricaboss@gmail.com
Cangiani
Luiz Marciano
LM
Pereira
Antônio Márcio Sanfim Arantes
AM
Abreu
Múcio Paranhos
MP
Cangiani
Luis Henrique
LH
Zemi
Guilherme
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010880:Piperidines / Q000627:therapeutic use*; D000077208:Remifentanil; D055815:Young Adult
D000700:Analgesics; D010880:Piperidines; D003000:Clonidine; D000077208:Remifentanil; D008691:Methadone