ABSTRACT
Se define dolor neuropático, como aquel causado por una lesión primaria o disfunción en el sistema nervioso. Métodos: Estudio prospectivo, ensayo terapéutico, no aliatorizado, con grupos paralelos y comparativos. Se seleccionaron 40 pacientes (n=40), adultos, con diagnóstico clínico de dolor neuropático, agrupados en: Grupo A: Veinte pacientes (n=20), se les administró 70 mg de lidocaína al 1% más 5 mg de Levobupivacaína. Grupo B: Veinte pacientes (n=20), se les administró 70 mg de lidocaína al 1% más 5 mg de Levobupivacaína más Dexmedetomidine a la dosis de 0.3 microgramos/kg/dosis. A ambos grupos de pacientes se les realizó bloqueos simpáticos y periféricos de acuerdo a la patología y localización del dolor neuropático. Al minuto y cinco minutos de realizado el bloqueo se registro la presencia o no de efectos adversos, reportados espontáneamente y a través de preguntas abiertas. Resultados: El 42.5% de los pacientes negó efectos adversos; es mayor el porcentaje de pacientes que no tuvo ningún efecto adverso en el grupo B, que recibió Dexmedetomidina (50%) que en el grupo A (35%). Conclusión: Por lo que se concluye, que además de su acción sedante la dexmedetomidina, no produce depresión respiratoria y son más fáciles de manejar los pacientes. Además las variaciones de la frecuencia cardiaca y la tensión arterial fueron predecibles y estables, presentan menos ansiedad y resulta ser bien tolerado.
Neuropathic pain is defined as that which is caused by either a primary injury or dysfunction in the nervous system. Methods: We conducted a prospective, non-randomized, parallel group, comparative clinical trial, where adult patients (n=40) with a clinical diagnosis of neuropathic pain were screened and selected for admission in the trial. Patients were divided into two groups: Group A patients, n=20, were administered lidocaine 1%, 70 mg and levobupivacaine 5 mg, both locally; Group B patients, n= 20, were locally administered lidocaine 1%, 70 mg, levobupivacaine 5 mg, and dexmedetomidine at 3 mg/kg/dose. Sympathetic and peripheral blocks were made to each patient, according to the specific clinical picture and neuropathic pain localization. Pre-block-assessed parameters were again determined 1 and 5 minutes after finalizing the anesthetic procedure. Adverse events, either spontaneously reported or obtained through open questions, were also determined. Results: Tolerability assessment resulted in 42.5% of overall patients not reporting treatment-related adverse events, and again when comparing both groups, those receiving dexmedetomidine reported adverse events less frequently (50%) than Group A patients (35%). Conclusions: We conclude that, besides its sedative properties, dexmedetomidine together with local anesthetics showed excellent analgesia-enhancing effects, with the additional benefit of a favorable side-effect profile, lacking respiratory-depressant actions and improving overall patient management. In addition, patients receiving dexmedetomidine showed changes in heart rate and blood pressure that were both predictable and stable during and after the anesthetic procedures, while the patient achieved anxiolysis, improving his tolerance to the procedure itself.