r e v b r a s o r t o p . 2 0 1 5;5 0(1):72-76 w w w . r b o . o r g . b r Artigo Original Nível de dor no pós-operatório imediato de artrodese lombar após infiltração epidural com sulfato de morfina ଝ informações sobre o artigo Histórico do artigo: Recebido em 15 de dezembro de 2013 Aceito em 24 de fevereiro de 2014 On-line em 23 de janeiro de 2015 Palavras-chave: Morfina Analgesia epidural Dor pós-operatória Artrodese Fusão vertebral r e s u m o Objetivo: Avaliar o nível de dor em pacientes tratados com infusão epidural de sulfato de morfina em Dose única, após procedimento cirúrgico de artrodese lombar. Métodos: Foram submetidos à artrodese lombar posterolateral ou artrodese lombar intersomática por via posterior, em um, dois ou três níveis, 40 pacientes, divididos, prospectivos e randomizados em dois grupos de 20. No primeiro grupo (de estudo) foram infiltrados no espaço epidural, através da área da laminectomia, 2 mg de sulfato de morfina diluídos em 10 mL de soro fisiológico. O segundo grupo (controle) não recebeu analgesia. Os pacientes foram interrogados quanto ao nível de dor, no pré e pós-operatório, com o uso da escala visual analógica (EVA). Resultados: Verificou-se que os pacientes apresentaram uma queda significativa da dor pela EVA. A dor entre o pré e o pós-operatório diminuiu em média 4,7 pontos (p = 0,0001), o que corresponde a 53,2% (p = 0,0001). Conclusão: Aplicação de 2 mg de sulfato de morfina, em dose única epidural, demonstrou ser uma boa técnica na terapia da dor após cirurgia na coluna lombar. © 2014 Sociedade Brasileira de Ortopedia e Traumatologia. Publicado por Elsevier Editora Ltda. Todos os direitos reservados. Immediate postoperative pain level from lumbar arthrodesis following epidural infiltration of morphine sulfate Keywords: Morphine Epidural analgesia Postoperative pain a b s t r a c t Objective: To evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.Methods: Forty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively

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ObjectiveTo evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.MethodsForty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively randomized into two groups of 20. In the first group (study group), 2 mg of morphine sulfate diluted in 10 mL of physiological serum was infiltrated into the epidural space, through the laminectomy area. The second group (controls) did not receive analgesia. The patients were asked about their pain levels before and after the operation, using a visual analog scale (VAS).ResultsIt was found that the patients presented a significant diminution of pain as shown by the VAS. From before to after the operation, it decreased by an average of 4.7 points (p = 0.0001), which corresponded to 53.2% (p = 0.0001).ConclusionApplication of 2 mg of morphine sulfate in a single epidural dose was shown to be a good technique for pain therapy following lumbar spinal surgery.

Objective:To evaluate the bone area of the odontoid process through computed tomography and its relation with the area of one and two screws in the male and female subjects.Methods:188 CT scans of adults were analyzed. The isthmus area was selected and the transverse diameter was measured at 1.2 mm from the base of odontoid.Results:After placement of a screw, the odontoid area remains with 82% of free bone for both men and women. With two screws, 45.6% of women, had a free bone area of the odontoid process between 50% and 75% and 54.4% were above 75%. 26.6% men had percentage from 50% to 75% of free bone area and 73.4% above 75% (p=0.07). After the placement of two screws, the bone area was, in average, 77.3% in men and 75.4% in women. Using the Student t-test, the differences between the average of percentage of free bone area in men and women are significantly lower in women (p=0.0012).Conclusion:The pre-operative planning through CT can help to choose the number of screws in the odontoid process. The choice should be particularly careful when using two screws in women.