ABSTRACT
Introducción: El dolor postoperatorio es un tipo especial de dolor agudo, de gran repercusión en el sector de la salud. Un control óptimo del mismo en procederes proctológicos y del periné es un verdadero reto. Su tratamiento correcto puede aliviar el sufrimiento y permitir la movilización temprana y acortar la estadía hospitalaria. Objetivos: Identificar la utilidad de opioides en analgesia postoperatoria en cirugía proctológica. Método: Se realizó un estudio experimental, a simple ciegas, comparativo y prospectivo, para seleccionar la dosis de morfina intratecal a utilizar para la analgesia postoperatoria en pacientes a quienes se les realizó cirugía proctológica en el Servicio de Anestesia y Reanimación del Hospital Docente Clínico Quirúrgico Dr. Salvador Allende durante el 2009. La muestra estuvo constituida por 210 pacientes, seleccionados de forma aleatoria. Se agruparon en tres grupos según la dosis de morfina administrada: Grupo I (74 pacientes) se administró 3 µg/Kg; Grupo II (68 pacientes) 4 µg/Kg y en el Grupo III (68 pacientes) 5 µg/Kg. Resultados: El valor medio de la duración de la analgesia en horas en el Grupo I fue de 11,97 ± 1,67 DS, en el grupo II fue de 21,54 ± 2,29 y en el III de 21,4 ± 2,03. El prurito fue el efecto adverso con mayor incidencia, seguido por la retención urinaria, las nauseas y los vómitos. Conclusiones: La dosis de 4 µg/Kg parece ser la más recomendable para la analgesia postoperatoria con morfina intratecal en cirugía proctológica si se toma en cuenta la duración de la analgesia y los efectos adversos encontrados en nuestro estudio.
Postoperative pain is a special type of acute pain of a great repercussion in the health sector. Its optimal control in proctologic procedures and of perineum is a real challenge. Its appropriate treatment may to relief suffering allowing an early mobilization and to shorten the hospital stay. Objectives: to identify the usefulness of opioids in postoperative surgery in proctologic anesthesia. Method: A prospective, comparative, double blind and experimental study was conducted to choice the dose of intrathecal morphine to be used for postoperative analgesia in patients underwent proctologic surgery in the Service of Anesthesia and Resuscitation of the "Dr. Salvador Allende" Clinical Surgical Teaching Hospital during 2009. Sample included 210 randomized patients divided into three groups according the dose of morphine administered: I Group (74 patients) received 3 µg/Kg; II Group (68 patients) received 4 µg/Kg and III group (68 patients) received 5 µg/Kg. Results: The mean value in hours of analgesia length in I group was of 11,97 ± 1,67 DS, in the II group it was of 21,54 ± 2,29, and in the III group, it was of 21,4 ± 2,03. Pruritus had the higher incidence as adverse effect, followed by urinary retention, nauseas and vomiting. Conclusions: Dose of 4 µg/Kg seems to be the more recommendable for the postoperative analgesia using intrathecal morphine in proctologic surgery if we take into account the analgesia length and the adverse effects found in our study.
ABSTRACT
BACKGROUND: Clonidine, an 2-adrenergic agonist, shows the analgesic effect and potentiates the analgesic effect of opioid. However, when it is injected with bolus technique, it reveals the short duration of inadequate analgesia and induces hypotension, bradycardia or sedation. We examined the analgesic and side effects of clonidine administered by continuous epidural infusion over 24 hrs, following epidural morphine injection. METHODS: Sixty parturients, scheduled for elective cesarean section under epidural anesthesia were randomly allocated into three groups. They received an infusion of saline alone (group 1, n= 20), clonidine 20 g/hr (group 2, n= 20), or 40 g/hr (group 3, n= 20) respectively, following epidural morphine 3 mg injection at the end of operation. The total doses and number of request for supplemental analgesic, blood pressure, heart rate, and degree of sedation were measured during 24 hrs. RESULTS: There were significant differences in pain relief between clonidine groups and group 1. The total doses and number of patient's request for supplemental analgesic in clonidine groups, compared to group 1 were significantly decreased (p<0.05), but no significant differences between the two clonidine groups. The diastolic pressure of group 3 was significantly lower than that of group 1 over 24 hrs, and that of group 2 at 18 hr, 24 hr (p<0.05). However, there was no severe hypotension, bradycardia or sedation in the three groups. CONCLUSION: Clonidine administered by continuous epidural infusion over 24 hrs enhances the analgesic effect of epidural morphine, and the infusion of clonidine with 20 g/hr rather than 40 g/hr shows minimal changes of blood pressure. Therefore, administration of epidural clonidine (20 g/hr) following epidural morphine may be considered as a regimen for pain management after cesarean section.