Técnicas regionales guiadas por ultrasonido para manejo de analgesia para cesárea / Ultrasound regional analgesic technic for cesarian analgesia

One of the fundamental pillars for optimal patient recovery after a cesarean section is pain management after a surgical intervention. For years the gold standard for analgesic management the use of intrathecal morphine due to its long-lasting effect, however adverse effects related to the use of opioids are evidenced too, Currently, with the advent of multimodal analgesia, the use of opioids and the effects associated with them have been reduced, optimizing pain management, reducing hospital stay, lower risk of postpartum depression, reducing the presence of nausea and vomiting as well as pruritus and improving mother-child relationship. An essential component of the multimodal analgesia are regional blocks like the transversus abdominis plane block and the ilioinguinal / iliohypogastric block, Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless these have a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrate better outcomes compare with intrathecal morphine.

Uno de los pilares fundamentales para la recuperación de la paciente que fue intervenida de cesárea es el manejo del dolor posoperatorio. Por años el estándar de oro ha sido el uso de la morfina intratecal considerando su larga duración como también los efectos adversos, actualmente con el advenimiento de la analgesia multimodal, se ha reducido el uso de opiodes y de los efectos asociados a estos optimizando el manejo del dolor, disminuyendo la estancia hospitalaria, menor riesgo de depresión posparto, disminuye la presencia de náusea y vómitos como también prurito y mejorando la relación madre e hijo. Un componente esencial de la analgesia multimodal son los bloqueos: transverso del abdomen, ilioinguinal/ iliohipogástrico, cuadrado lumbar, erector de la espina; que han aportado eficazmente en el abordaje del dolor posoperatorio. El bloqueo de los planos y demuestra su utilidad con un mejor manejo del dolor en comparación con el bloqueo TAP, a pesar de que estos tienen un mayor nivel de complejidad debido al control del dolor visceral; pero no hay evidencia con suficiente calidad metodológica que demuestre mejores resultados en comparación con la morfina intratecal.

Evaluation of the effects of tramadol and diclofenac alone and in combination on post-cesarean pain.

Background: Post-cesarean pain is a common cause of acute pain in the obstetrics. Pain in the postoperative period is an important impediment to recovery from surgery and anesthesia. This study was conducted to evaluate the efficacy of postoperative analgesia and incidence of side-effects of centrally acting drug tramadol with peripherally acting drug diclofenac alone and in combination in patients undergoing elective cesarean delivery under spinal anesthesia. Methods: The study population of 90 patients was randomly divided into three groups of 30 each to receive the following treatments: tramadol (Group T), diclofenac (Group D), tramadol and diclofenac at reduced doses (Group TD). Results: Combination of tramadol and diclofenac produced significantly early analgesia in comparison to tramadol or diclofenac alone and decrease in the incidence of side-effects. Conclusion: We conclude that a multimodal approach to post-cesarean management with a combination of tramadol and diclofenac produced better analgesia than individual drugs and a reduction in the side-effects. Such a combination approach to relieve pain is more effective and advantageous.