Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-18T02:10:00Z No. of bitstreams: 4 Projeto Final_Christiane.doc: 14882816 bytes, checksum: 6f2443d86ff0e57a5ff5fc5c601ed125 (MD5) Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2018-10-18T03:16:11Z (GMT) No. of bitstreams: 4 Projeto Final_Christiane.doc: 14882816 bytes, checksum: 6f2443d86ff0e57a5ff5fc5c601ed125 (MD5) Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Rejected by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br), reason: O Documento deve estar no formato PDF. Retorne ao sistema e fa??a o upload de uma vers??o neste formato. D??vidas: ddbc@ufam.edu.br on 2018-10-18T12:29:56Z (GMT) Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-19T03:06:49Z No. of bitstreams: 4 Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Rejected by PPGRACI Cirurgia (ppgraci@ufam.edu.br), reason: J?? foi aceita a submiss??o da disserta????o, na l??ngua portuguesa, com abstract em ingl??s. Ressubmiss??o com o t??tulo do documento em ingl??s cria a expectativa que toda a disserta????o foi traduzida, o que n??o ocorre com esta nova submiss??o. on 2018-10-19T16:11:42Z (GMT) Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-19T17:01:37Z No. of bitstreams: 4 Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2018-10-19T17:54:31Z (GMT) No. of bitstreams: 4 Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-10-19T18:22:40Z (GMT) No. of bitstreams: 4 Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Made available in DSpace on 2018-10-19T18:22:40Z (GMT). No. of bitstreams: 4 Carta de encaminhamento para Autodep??sito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa P??blica.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-09-21 BACKGROUND. Untreated pain leads to postoperative complications that prolong hospital stay. The association of analgesic drugs with different mechanisms of action, such as clonidine, allows the use of smaller doses of medication for better control of pain. OBJECTIVES. This dissertation aims to evaluate the use of multimodal analgesia in the control of postoperative pain in patients submitted to videolaparoscopic cholecystectomy (VLC); to compare the analgesic activities of intrathecal and intravenous clonidine for postoperative analgesia; to analyze the need for analgesic drugs in the immediate postoperative (tramadol / morphine) and to identify possible complications. METHOD. A prospective, randomized clinical trial was conducted with patients divided into three blocks, with 20 patients each one: Group I (n = 20) control, submitted to standard anesthesia; Group II (n = 20) intrathecal clonidine, submitted to standard anesthesia associated with the use of intrathecal clonidine; Group III (n = 20) intravenous clonidine, submitted to standard anesthesia associated with the use of intravenous clonidine. RESULTS. The pain scores between the groups did not present significant differences, but a greater analgesic need was observed in the control group (p = 0.005), as well as a higher incidence of nausea and vomiting (p = 0.240), probably due to side effects of morphine as rescue medication. Groups II and III presented a significant reduction of heart rate (p ?? 0.001), but without clinical repercussion. CONCLUSIONS. In patients undergoing VLC there is evidence that the perioperative administration of alpha 2-agonists preserves hemodynamic stability, decreases opioid consumption and the incidence of nausea and vomiting in the postoperative. JUSTIFICATIVA. A dor n??o tratada leva a complica????es p??s-operat??rias que prolongam o tempo de interna????o hospitalar. A associa????o de f??rmacos analg??sicos com diferentes mecanismos de a????o, como a clonidina, permite usar doses menores de medicamentos para melhor controle da dor. OBJETIVOS. Esta disserta????o tem por objetivo avaliar o emprego de analgesia multimodal no controle da dor p??s-operat??ria de pacientes submetidos ?? colecistectomia por videolaparoscopia (CVLP); comparar as atividades analg??sicas da clonidina intratecal e endovenosa para analgesia p??s-operat??ria; analisar a necessidade de drogas analg??sicas no p??s-operat??rio imediato (tramadol/morfina) e identificar poss??veis complica????es. M??TODO. Foi realizado um estudo de ensaio cl??nico prospectivo, experimental e rand??mico, com os pacientes divididos em 03 blocos, com 20 pacientes cada: Grupo I (n=20) controle, submetido ?? anestesia padr??o; Grupo II (n=20) clonidina intratecal, submetido ?? anestesia padr??o associada ao uso de clonidina intratecal; Grupo III (n=20) clonidina endovenosa, submetido ?? anestesia padr??o associada ao uso de clonidina endovenosa. RESULTADOS. Os escores de dor entre os grupos n??o apresentaram valores com diferen??as significativas, por??m foi observada maior necessidade analg??sica do uso da morfina no grupo controle (p = 0,005), assim como maior incid??ncia de n??useas e v??mitos (p=0,240), provavelmente devido aos efeitos colaterais da morfina como medica????o de resgate. Os grupos II e III apresentaram uma redu????o significativa da frequ??ncia card??aca (p ??0,001), por??m sem repercuss??o cl??nica. CONCLUS??ES. Nos pacientes submetidos ?? CVLP h?? evid??ncias de que a administra????o perioperat??ria de alfa 2-agonistas preserva a estabilidade hemodin??mica, diminui o consumo de opi??ides e a incid??ncia de n??useas e v??mitos no p??s-operat??rio.