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Sono, Dor e Recuperação

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Por que o sono é interrompido após a cirurgia do membro superior, o que esperar por procedimento e as etapas práticas que ajudam você a descansar enquanto se recupera.

Uma ilustração desenhada à mão de uma pessoa sem rosto, dormindo tranquilamente na cama.
Sono, Dor e Recuperação Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O sono inadequado é uma das partes mais comuns e mais subestimadas da recuperação após cirurgia de membro superior. A dor, um braço que não consegue se acomodar e o uso de uma atadura trabalham contra um bom descanso noturno. A parte tranquilizadora é que isso é temporário, segue um padrão bastante previsível e há muito o que se pode fazer para ajudar.

O que esperar

O sono costuma piorar um pouco antes de melhorar, e o cronograma depende da sua cirurgia.

  • Após a reparação do manguito rotador, o sono frequentemente atinge seu pior nível por volta da segunda semana, quando o ombro está mais sensível. A maioria dos pacientes retoma o padrão de sono anterior à cirurgia por volta das seis semanas, e a perturbação se resolve em grande parte até os três meses.
  • Após a substituição do ombro, é útil saber que a maioria dos pacientes também dormia mal antes da cirurgia; o sono perturbado afeta a grande maioria das pessoas com um ombro artrítico. A melhora é real, mas gradual: espere pouca mudança nas primeiras seis semanas, seguida de ganhos constantes.
  • Após a liberação do túnel do carpo, o sono costuma ser uma das primeiras coisas a melhorar. O despertar noturno clássico com a mão dormente e dolorosa geralmente melhora nas primeiras uma ou duas semanas, e, para muitas pessoas, é o benefício mais perceptível da cirurgia.
  • Após cirurgias da mão e procedimentos menores, a pulsação nas primeiras noites é normal e geralmente se resolve rapidamente à medida que a ferida cicatriza.

Independentemente da sua cirurgia, o padrão geral é o mesmo: mais difícil na primeira ou segunda semana, com melhora clara até as seis semanas.

Por que o sono fica mais difícil após a cirurgia

Vários fatores se somam:

  • Deitar-se aumenta a pressão em um membro recém-operado, de modo que a dor latejante e a sensação de desconforto costumam ser piores à noite do que durante o dia.
  • Você não consegue assumir sua posição habitual. Dormir do lado operado é desconfortável ou não é permitido, e os que dormem de lado levam tempo para se adaptar.
  • A tipóia mantém o braço seguro, mas torna difícil rolar e encontrar uma posição confortável.
  • A dor acorda você, e a privação de sono faz com que a dor pareça pior no dia seguinte. É fácil entrar em um ciclo vicioso; quebrá-lo é o objetivo dos passos abaixo.

O que ajuda

Posição

  • Após a cirurgia de ombro, muitos pacientes dormem muito melhor apoiados: em uma poltrona reclinável ou com um travesseiro em cunha atrás das costas e da cabeça, nas primeiras duas semanas. Deitar-se completamente plano frequentemente piora a dor no ombro.
  • Apoie o braço operado em um travesseiro para que ele não fique pendurado ou arrastando.
  • Use o seu talabarte à noite exatamente conforme instruído (ver Usando um talabarte). Ele protege a reparação e impede que você role sobre o braço operado.

Controlar a dor antes de dormir

  • Tome seus analgésicos regulares em horários programados para que eles estejam fazendo efeito antes de deitar, e não depois que a dor o acordar (ver Controlando a dor após a cirurgia).
  • Um único comprimido de resgate antes de dormir geralmente é tudo o que é necessário na primeira ou segunda semana.
  • Gelo e elevação à noite reduzem o inchaço e a dor noturna (ver Calor versus gelo).

Hábitos de sono

  • Mantenha um horário regular para dormir e acordar, mesmo enquanto estiver em casa e menos ativo.
  • Reduza a cafeína após o almoço e o uso de telas na hora anterior ao sono.
  • Um quarto escuro, fresco e silencioso, juntamente com uma rotina breve de relaxamento antes de dormir, realmente ajudam.

Medicamentos e sono

A maioria dos distúrbios do sono é melhor tratada controlando a dor, em vez de usar comprimidos para dormir. Evitamos o uso regular de sedativos, pois perdem rapidamente o efeito e não interagem bem com analgésicos fortes.

Para alguns pacientes com problemas no ombro, podemos sugerir melatonina nas primeiras semanas; há evidências razoáveis de que ela melhora o sono inicial após cirurgia artroscópica do manguito rotador, e é um tratamento suave. Consulte-nos se achar que pode ajudar.

Se você estiver tendo dificuldades sérias com o sono apesar dessas medidas, informe-nos em vez de recorrer a medicamentos para dormir sem prescrição; preferimos revisar primeiro o controle da sua dor.

Se você tem apneia do sono

Se você utiliza uma máquina de CPAP ou foi diagnosticado com apneia obstrutiva do sono, informe-nos e ao anestesiologista antes da sua cirurgia e leve sua máquina ao hospital. Pacientes com apneia do sono apresentam uma taxa ligeiramente maior de complicações médicas de curto prazo após a artroplastia do ombro, embora o resultado a longo prazo da articulação em si não seja diferente. O bom manejo no período perioperatório é fundamental.

Quando nos ligar

  • Dor que está a piorar em vez de melhorar após os primeiros dias, ou que os seus medicamentos não estão a controlar
  • Dor intensa nova que surgiu de repente
  • Uma ferida que está cada vez mais vermelha, quente, inchada ou a libertar líquido
  • Febre ou sensação de mal-estar geral
  • Dor ou inchaço na panturrilha, dor no peito ou falta de ar: dirija-se à urgência

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