Analgesia em pacientes neurocirúrgicos: incidência e fatores preditivos do uso de opioides, do resgate álgico, da ocorrência de eventos adversos e da evolução clínica

Abstract

Background: Neuroanesthesia and neurosurgery are crucial approaches for managing pathologies of the human nervous system, responsible for minimizing the severity of pain, physical limitations and cognitive-functional impairment. In view of this question, this study aims to describe the clinical-epidemiological profile, anesthetic-surgical procedure, postoperative pain management and clinical evolution. Methods: Descriptive cross-sectional study conducted at a tertiary hospital, involving patients undergoing elective neurosurgery from January 2020 to December 2022, with data collected from electronic medical records. Results: In the sample (n=171), males were predominant (53.8%), aged between 60 and 69 years (21.0%; mean 56.1 ± 2.5 years), white skin color (94.2%), current or previous smoking (33.9%), alcohol consumption (55.6%), inadequate weight (60.4%), comorbidities (94.2%) and previous surgeries (86.0%). In the anesthetic-surgical procedure, preoperative hospitalization duration was 1 day (46.8%), surgical time ranged between 61 and 120 minutes (26.9%), cranial surgical site (56.7%), with cranioplasty (31.0%), general anesthesia (90.6%), orotracheal intubation (90.6%) and dorsal decubitus (77.1%). Hemocomponent reserve and transfusion occurred in, respectively, 40.4% and 26.3% of procedures. The most commonly used intraoperative medications were propofol (89.5%), remifentanil (90.6%), sevoflurane (9.9%), intravenous lidocaine (90.1%), cisatracurium (73.7%), neostigmine (16.4%) and levobupivacaine (43.9%). In immediate and late postoperative pain management, tramadol, dipyrone, and ketoprofen showed the highest prevalences. Regarding clinical evolution, the total duration of hospitalization (33.9%; mean 8.7 ± 1.8 days) and preoperative (41.5%; mean 6.4 ± 1.1 days) was between 4 and 5 days, intensive care unit admission (17.0%), hospital discharge (90.1%), and death (2.3%) were highlighted. Conclusion: Elective neurosurgical patients are predominantly men aged 60 to 69 years with inadequate weight, comorbidities, and previous surgeries, undergoing cranial procedures with general anesthesia, orotracheal intubation, multimodal postoperative analgesia, and hospital discharge.