ABSTRACT
Objetivo. Comparar el bloqueo con la radiofrecuencia térmica bipolar para el dolor de la articulación sacroilíaca. Método. Estudio prospectivo, aleatorizado y experimental en 60 pacientes, seleccionados en 9 meses en 2 centros, con dolor intenso (escala visual analógica [EVA] > 6) de > 3 meses de duración. Fueron divididos en 3 grupos (n = 20). Grupo A: pacientes a los que se les realizaron 2 bloqueos intraarticulares, con control ecográfico en 7 días. Grupo B: radiofrecuencia bipolar «palisade» utilizando 6 agujas perpendiculares a la zona dorsal del sacro, a una distancia de 1 cm, para producir lesiones contiguas entre los forámenes S1-S2-S3 y la línea articular. Grupo C: radiofrecuencia bipolar «palisade» modificada (distancia entre agujas > 1 cm). Los pacientes fueron evaluados al mes, a los 3 y a los 12 meses del tratamiento. Se valoraron los datos demográficos (en la visita basal), la eficacia analgésica y los efectos secundarios (en el resto). Resultados. Al mes, la reducción del dolor en los 3 grupos fue > 50% (p ≤ 0,001). A los 3 y 12 meses el grupo A no refirió disminución significativa del dolor. El grupo B, a los 3 meses, alivio cercano al 50% (p = 0,03), y < 25% (23,8) a los 12 meses (p = 0,01). En el grupo C, alivio próximo al 50% a los 3 y 12 meses (p < 0,001) respecto al basal. Todos los pacientes finalizaron el estudio. Conclusiones. La radiofrecuencia bipolar «palisade», especialmente aumentando la distancia entre las agujas, ha sido eficaz, a más largo plazo, que el bloqueo con anestésicos y corticoides en el alivio del dolor de la articulación sacroilíaca (AU)
Objective. To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. Method. Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS] > 6) that lasted more than 3 months. Patients were randomised into three groups (n = 20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency «palisade». Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1 cm. Group C: modified bipolar radiofrequency «palisade» (needle distance > 1 cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. Results. One month after the treatment, pain reduction was > 50% in the three groups P < .001. Three and 12 months after the technique, the patients of the group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the group B referred to improvement of the pain (P = .03), and < 25% at 12 months, and those results were statistically significant (P = .01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12 months (P < .001). All patients completed the study. Conclusions. Bipolar radiofrequency «palisade», especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint (AU)
Subject(s)
Humans , Male , Female , Sacroiliac Joint/radiation effects , Radio Waves/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Pain Management/instrumentation , Pain Management , Prospective Studies , Anesthesia, Local/instrumentation , Anesthesia, Local/methods , Spondylarthropathies/therapy , Analysis of VarianceABSTRACT
OBJECTIVE: To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. METHOD: Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS]>6) that lasted more than 3 months. Patients were randomised into three groups (n=20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency "palisade". Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1cm. Group C: modified bipolar radiofrequency "palisade" (needle distance >1cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. RESULTS: One month after the treatment, pain reduction was >50% in the three groups P<.001. Three and 12 months after the technique, the patients of the group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the group B referred to improvement of the pain (P=.03), and <25% at 12 months, and those results were statistically significant (P=.01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12 months (P<.001). All patients completed the study. CONCLUSIONS: Bipolar radiofrequency "palisade", especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint.
Subject(s)
Sacroiliac Joint , Back Pain , Humans , Pain Measurement , Prospective StudiesABSTRACT
No disponible
Subject(s)
Female , Humans , Male , Endoscopy/instrumentation , Endoscopy , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Anesthesia, Epidural , Low Back Pain/drug therapy , Chronic Pain/therapy , Epidural Space , Injections, Epidural , Pain Management/methods , Pain Management , Analgesia, Epidural/instrumentation , Analgesia, Epidural/methods , Analgesia, EpiduralABSTRACT
La Sociedad Española de Oncología Médica (SEOM), la Sociedad Española de Cuidados Paliativos (SECPAL) y la Sociedad Española de Dolor (SED), establecieron un documento de consenso en el que asumieron el término "dolor irruptivo", para definir una exacerbación del dolor de forma súbita y transitoria, de gran intensidad (EVA > 7) y de corta duración (usualmente inferior a 20-30 minutos), que aparece sobre la base de un dolor persistente estable, cuando este se encuentra reducido a un nivel tolerable (EVA < 5) mediante el uso fundamental de opioides mayores. La clasificación del dolor irruptivo más utilizada es la que distingue entre dolor irruptivo incidental (predecible o impredecible), idiopático y relacionado con el final de dosis. El manejo adecuado del dolor irruptivo se basa en tres aspectos: prevención, anticipación y uso de la medicación adecuada. Existen formulaciones de opioides de inicio de acción rápida y duración de acción corta (ROOs) que se ajustan mucho mejor al perfil y al tratamiento de este tipo de dolor. Todas ellas contienen citrato de fentanilo y se administran a través de la mucosa oral (transmucosa oral, bucal o sublingual) o nasal. Todos tienen un inicio precoz del efecto, entre 5-15 minutos tras la administración y un tiempo de duración entre 2-4 h y una biodisponibilidad que puede variar según la presentación. Fentanilo sublingual, bucal e intranasal tienen un inicio de acción más rápido y una mayor biodisponibilidad que fentanilo transmucosa oral. Aunque la mayoría de los estudios controlados publicados al respecto, sobre la utilización de ROOs en el dolor irruptivo, recomiendan la necesidad de titulación de dosis (sobre todo los que incluyen CFOT y fentanilo bucal), la elección de una dosis eficaz sigue siendo dificultosa (AU)
Breakthrough pain is defined as an exacerbation of the pain of sudden and transient, high intensity (VAS > 7) and short duration (usually less than 20-30 minutes), which appears on the basis of a stable persistent pain, when this is reduced to a tolerable level (VAS < 5) by using strong opioids. The classification most used is the classification based on the following: Incident (predictable, unpredictable), idiopathic and end-of-dose. Proper management of breakthrough pain is based on three aspects: prevention, early and appropriate medication use. There are formulations of opioids rapid onset and short duration of action (ROOS) that better fit the profile and treatment of this type of pain. Everyone has an early onset of effect, between 5-15 minutes after dosing and a duration of 2-4 h and a bioavailability which may vary according to the filing. Fentanyl buccal tablets, sublingual fentanyl and intranasal nasal fentanyl have a faster onset of action and greater bioavailability of fentanyl transmucosal oral. Although most published controlled studies on this question, the use of de ROOs in the breakthrough pain, indicate the need for dose titration (especially fentanyl OTFC and oral), the choice of an effective dose is still difficult (AU)
Subject(s)
Humans , Male , Female , Pain Management/instrumentation , Pain Management/methods , Pain Management , Fentanyl/therapeutic use , Analgesics, Opioid/pharmacology , Analgesics, Opioid/pharmacokinetics , Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Pain Management/standards , Pain Management/trends , Prognosis , Biological AvailabilityABSTRACT
OBJECTIVES: Pain control is essential to patient comfort and reduced stress response, morbidity, and mortality after pediatric anesthesia. We assessed analgesic quality and the incidence of complications of regional blocks in combination with general anesthesia. MATERIAL AND METHODS: Prospective study of 116 patients under 3 years of age who underwent surgery in our hospital over a period of 2 years. The studied patients were classified in 3 groups according to whether they received general anesthesia only, a regional block by single injection, or a caudal nerve block via catheter. We recorded demographic and intraoperative variables, postoperative analgesic requirements, and the time the first postoperative analgesic dose was needed. RESULTS: Analgesia was significantly more effective in the patients who received either type of regional block. The patients who received general anesthesia alone needed supplemental analgesia earlier than the others (P < .001); patients with nerve blocks required fewer doses of rescue analgesics (P < .001). The incidence of complications was low and all were minor. No case of caudal catheter contamination occurred. CONCLUSIONS: Regional nerve blocks combined with general anesthesia in children are effective and safe. Advantages of providing nerve blocks include hemodynamic stability, prolonged postoperative analgesia, lower consumption of analgesics, and few complications.
Subject(s)
Analgesia/methods , Nerve Block , Pain, Postoperative/prevention & control , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Intraoperative Period , Male , Postoperative Period , Prospective StudiesABSTRACT
OBJETIVOS: El tratamiento del dolor es imperativopara mejorar el confort del paciente y disminuir la respuestaal estrés y la morbi-mortalidad durante el periodopostoperatorio en anestesia pediátrica. En este estudioevaluamos la calidad analgésica y la incidencia decomplicaciones de los bloqueos regionales, asociados aanestesia general.MATERIAL Y MÉTODOS: Estudio prospectivo de 116pacientes menores de 3 años, intervenidos en nuestrohospital en un periodo de 2 años. Los pacientes se dividieronen 3 grupos: (A) sólo anestesia general, (B) bloqueoregional de punción única y (C) catéter caudal. Serecogieron las variables demográficas e intraoperatorias,la necesidad de analgésicos en el postoperatorio y elmomento en que se precisó la primera dosis analgésica.RESULTADOS: La eficacia analgésica fue significativamentemayor en los grupos B y C. Los pacientes del grupoA precisaron analgesia suplementaria más precozmenteque los de los grupos B y C (p < 0,001) y elnúmero de dosis de analgésicos de rescate fue significativamentemenor (p < 0,001). Se produjo una baja incidenciade complicaciones, todas ellas leves y ningunacontaminación de catéter caudal.CONCLUSIONES: Los bloqueos regionales asociados a laanestesia general en niños son efectivos y seguros puesproporcionan numerosas ventajas: estabilidad hemodinámica,analgesia postoperatoria prolongada, menorconsumo de analgésicos y escasas complicaciones(AU)
OBJETIVES: Pain control is essential to patient comfort and reduced stress response, morbidity, and mortality after pediatric anesthesia. We assessed analgesic quality and the incidence of complications of regional blocks in combination with general anesthesia. MATERIAL AND METHODS: Prospective study of 116 patients under 3 years of age who underwent surgery in our hospital over a period of 2 years. The studied patients were classified in 3 groups according to whether they received general anesthesia only, a regional block by single injection, or a caudal nerve block via catheter. We recorded demographic and intraoperative variables, postoperative analgesic requirements, and the time the first postoperative analgesic dose was needed. RESULTS: Analgesia was significantly more effective in the patients who received either type of regional block. The patients who received general anesthesia alone needed supplemental analgesia earlier than the others (P<.001); patients with nerve blocks required fewer doses of rescue analgesics (P<.001). The incidence of complications was low and all were minor. No case of caudal catheter contamination occurred. CONCLUSIONS: Regional nerve blocks combined with general anesthesia in children are effective and safe. Advantages of providing nerve blocks include hemodynamic stability, prolonged postoperative analgesia, lower consumption of analgesics, and few complications(AU)
Subject(s)
Humans , Male , Female , Child , Anesthesia/methods , Analgesia/instrumentation , Analgesia/methods , Anesthesia, General/instrumentation , Anesthesia, General/methods , Pain, Postoperative/prevention & control , Atropine/therapeutic use , Fentanyl/therapeutic use , Propofol/therapeutic use , Intubation, Intratracheal/methods , Indicators of Morbidity and Mortality , Pain, Postoperative/drug therapy , Postoperative Period , Prospective Studies , Cohort Studies , Treatment OutcomeABSTRACT
Objetivo: Duloxetina y pregabalina han demostrado su eficacia por separado, y cuentan con la aprobación de la Food and Drug Administration para el tratamiento de determinados tipos de dolor neuropático. Nuestro objetivo fue valorar si la asociación de ambos puede mejorar su eficacia analgésica y el impacto de esta asociación en la calidad de vida del paciente. Material y métodos: Se estudiaron 60 pacientes con dolor neuropático severo (escala visual analógica [EVA] > 6) durante un período de 3 meses. Se distribuyeron aleatoriamente en 3 grupos (n = 20): grupo A (duloxetina 30 mg/24 h los primeros 3 días y luego 60 mg/24 h en medio del desayuno, con incrementos progresivos de 30 mg/3 días hasta alivio del dolor); grupo B (pregabalina 75 mg/noche los primeros 3 días, con incrementos de 75 mg/3 días hasta alivio del dolor; pautado/12 h), y grupo C (A + B). Las variables estudiadas fueron: edad; sexo; diagnóstico; EVA; componente lancinante, sordo y alodinia (EVA); dosis necesaria para alivio del dolor > 50%; impresión clínica de mejoría del paciente y del sueño (0-3; 0: nula, 1: leve, 2: moderada y 3: importante), y efectos indeseables. Los pacientes fueron evaluados semanalmente el primer mes, cada 15 días el segundo mes y luego mensualmente. Resultados: No se encontraron diferencias significativas en edad y diagnóstico según el grupo, siendo los diagnósticos más frecuentes: radiculopatía cervical y lumbar (68%), fibrosisposcirugía (17%), estenosis de canal (12%) y neuralgia postherpética (8%). Hubo un predominio del sexo femenino, excepto en el grupo A, con una distribución similar (50% F/M). La reducción del dolor > 50% se produjo con: 96,2 ± 24,1 mg de duloxetina en el 60% de los pacientes del grupo A; 532 ± 63 mg de pregabalina en el 68% de los pacientes del B, y 298,5± 56 mg de pregabalina + 65,2 ± 31,1 mg de duloxetina en el 73% de los pacientes del C (p< 0,05)...(AU)
Objective: The efficacy of duloxetine and pregabalin has been demonstrated separately and both drugs are approved by the Food and Drug Administration for the treatment of specific types of neuropathic pain. Our objective was to determine whether the association of both drugs improves their analgesic effectiveness and the effect of this association on patients quality of life. Material and methods: We studied 60 patients with severe neuropathic pain (visual analog scale [VAS] > 6) over a 3-month period. The patients were randomized to three groups (n = 20): group A (duloxetine 30 mg/24 h the first 3 days followed by 60 mg/24 hat breakfast, with progressive increases of 30 mg every 3 days until pain relief was achieved). Group B (pregabalin 75 mg/night for the first 3 days, with increases of 75 mg every 3 days until pain relief was achieved. Group C (A+B). The variables studied were age, sex, diagnosis, VAS; stabbing pain, dull pain and allodynia (VAS); the dose required for pain relief > 50%, and subjective feeling of overall symptom improvement in patients and their sleep quality (0-3: 0 = none; 1 = mild; 2 = moderate; 3 = excellent). Patients were evaluated weekly in the first month, every 15 days in the second month and then once a month. Results: No significant differences were found in age or diagnosis among the three groups. The most common diagnoses were cervical and lumbar radiculopathy (68%), fibrosis after lumbar disc surgery (17%), lumbar canal stenosis (12%) and postherpetic neuralgia (8%).There were more women, except in group A, with equal distribution of men and women (50% F/M). Pain relief > 50% was achieved with 96.2 ± 24.1 mg of duloxetine in 60% of patients in group A, 532 ± 63mg of pregabalin in 68% of patients in group B, and 298.5 ±56 mg of pregabalin plus 65.2 ± 31.1 mg of duloxetine in 73% of patients in group C (p >0.05)...(AU)
Subject(s)
Humans , Pain/drug therapy , Neuralgia/drug therapy , Antidepressive Agents/pharmacokinetics , Anticonvulsants/therapeutic use , Age and Sex Distribution , Drug Combinations , Analgesics/pharmacokinetics , Prospective StudiesABSTRACT
La metadona es un opioide sintético agonista total en receptores micro, y antagonista de los receptores NMDA. Es altamente liposoluble, con una vida media de unas 23 horas, pudiendo variar entre 13 y 54 horas. Es un isómero óptico, cuya forma L es la responsable de la mayor actividad analgésica. Este fármaco ha sido utilizado satisfactoriamente desde hace años para el tratamiento sustitutivo de pacientes drogodependientes, sin embargo, su utilización como analgésico es menos generalizada, a pesar de su perfil farmacológico que podría ser beneficioso en este aspecto. Teniendo esto en cuenta, hemos revisado las principales aplicaciones terapéuticas de la metadona, y su implicación tanto en el dolor agudo como en el dolor crónico. La metadona es una alternativa atractiva para el tratamiento del dolor oncológico y neuropático, dada su buena disponibilidad oral, su larga vida media con escasas dosis diarias y su bajo coste. Las vías intravenosa, intradural, y epidural, se han mostrado eficaces y seguras para el tratamiento del dolor posoperatorio
Methadone is a synthetic opioid that is primarily a micro-opioid agonist, but also a NMDA-antagonist. It is highly liposoluble and has an average lifee in blood of approximately 23 hours, although it can vary from 13 to 54 hours. It is an optical isomer, where l-methadone is the primarily responsible factor for the analgesic effect. Methadone has successfully been used for many years for the treatment of dependence on opioid drugs. However, it has been less used as an analgesic, in spite of its useful pharmacolog ic profile. Bearing this in mind, we have reviewed the main therapeutic uses of methadone, and its effectiveness in treating both acute and chronic pain. Methadone is an attractive alternative for the treating cancer and neuropathic pain, because of its good oral bioavailability, its long average lHe at low daily doses and its oral bioavailability, its long average life at low daily doses and its low cost. Intravenous, intrathecal and epidural viae have shown to be effective and safe for the treatment of postoperative pain
Subject(s)
Adult , Humans , Methadone/analogs & derivatives , Methadone/administration & dosage , Methadone , Analgesia, Epidural/methods , Analgesia, Epidural , Anesthesia, Epidural/methods , Anesthesia, Epidural , Methadone/agonists , Methadone/chemical synthesis , Analgesia, Epidural , Anesthesia, Epidural , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Analgesics, Opioid/agonists , Analgesics, Opioid/pharmacologyABSTRACT
OBJECTIVE: To compare the analgesic efficacy, pharmacokinetics and histamine release of ropivacaine and bupivacaine with fentanyl in continuous epidural perfusion during labor and childbirth. MATERIAL AND METHODS: Prospective study of 40 women at full-term pregnancy who requested epidural analgesia. The patients were randomly assigned to 2 groups of 20: group R received an initial bolus dose of 10 mL of 0.25% ropivacaine and group B received 0.25% bupivacaine, followed in both groups by epidural infusion of the assigned drugs at a concentration of 0.125% plus 0.30 mg of fentanyl at a rate of 5 mL/h through a patient-controlled analgesia device that allowed additional bolus doses. The studied variables were age, weight, height, sensory and motor block, mean blood pressure and maternal-fetal heart rates, number of bolus doses, total local anesthetic administered, duration and type of delivery, oxytocin increase, Apgar at 1 and 5 minutes, plasma levels of local anesthetic (30 minutes after the initial dose, at the end of dilation, in the umbilical vein, and 30 minutes after switching off the perfusion pump), time to clearance, elimination half-life, and a test of histamine release by radioimmunoassay. RESULTS: No significant differences were observed in the course of labor or in Apgar scores. The plasma concentrations of ropivacaine were higher than those of bupivacaine (p<0.03). Clearance of both drugs was similar. The elimination half-life of ropivacaine was significantly less than that of bupivacaine (5.2 +/- 0.7 h vs. 10.8 +/- 1.06 h). CONCLUSIONS: Analgesia was equally effective in both groups, without adverse maternal-fetal effects, with spontaneous micturition and absence of motor blockade in both groups. The plasma concentrations were higher with ropivacaine but were not toxic.
Subject(s)
Amides , Analgesia, Epidural , Analgesia, Obstetrical , Analgesia, Patient-Controlled , Analgesics, Non-Narcotic , Bupivacaine , Adult , Amides/administration & dosage , Amides/adverse effects , Amides/blood , Amides/pharmacology , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/adverse effects , Analgesics, Non-Narcotic/blood , Analgesics, Non-Narcotic/pharmacology , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Analgesics, Opioid/blood , Analgesics, Opioid/pharmacology , Apgar Score , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Bupivacaine/blood , Bupivacaine/pharmacology , Female , Fentanyl/administration & dosage , Fentanyl/adverse effects , Fentanyl/pharmacokinetics , Fentanyl/pharmacology , Fetal Heart/drug effects , Half-Life , Hemodynamics/drug effects , Histamine Release/drug effects , Humans , Labor, Obstetric/drug effects , Metabolic Clearance Rate , Pregnancy , Prospective Studies , Ropivacaine , Umbilical VeinsABSTRACT
Objetivo: El objetivo de este estudio fue comprobar la eficacia analgésica de la combinación de morfina y ketamina por vía epidural, y determinar la dosis óptima de ketamina que incrementa la capacidad analgésica de los opiáceos peridurales, en pacientes sometidos a artroplastia total de cadera y rodilla. Material y métodos: Se realizó un estudio prospectivo, de 75 pacientes, a lo largo de un año. La técnica locorregional anestésica realizada fue combinada intradural-epidural, con colocación de catéter epidural para analgesia. Todos los pacientes recibieron 30 mg de ketamina epidural 30 min antes de la intervención. La anestesia intradural se realizó con bupivacaína 0,5 por ciento hiperbara, 2-3 cc, según el paciente tuviera una estatura <170 cm o 170 cm, respectivamente .Los pacientes fueron divididos e 5 grupos: Grupo A: recibieron analgesia i.v. con metamizol (2 g i.v. . 6 h- 1) y tramado l (100 mg i.v./6 h). Grupo B: 10 mg de ketamina epidural, diluidos en 10 ml de suero salino fisiológico (SSF), al llegar al despertar y 12 h después. Grupo C: 2 mg de morfina epidural, diluidos en 10 ml de SSF, a la llegada al despertar y 12 h después. Grupo D: 10 mg de ketamina + 0,5 mg de cloruro mófico epidural, diluidos en 10 ml de SSF, a la llegada al despertar y 12 h después.Grupo E: 5 mg de Ketamina + 0,5 mg de morfina epidural, diluidos en 10 ml de SSF, a la llegada al despertar y 12 h después. Se valoraron la eficacia analgésica (utilizando la Escala Analógica Visual: EVA), la necesidad de analgesia suplementaria y los efectos indeseables (despertar, salida, 12, 24, 48 y 72 h postcirugía).Resultados: Se observó una eficacia analgésica significativamente superior en los grupos C, D y E, respecto a los grupos A y B (p<0,05). La analgesia obtenida en los grupos en los que se administró la asociación ketamina+cloruro mórfico (D,E), fue superior a la del grupo en que se administró sólo cloruro mórfico, pero sin diferencias significativas. El consumo de analgésicos fue significativamente superior (p<0,02) para los grupos A y B, con respecto al resto. Los efectos secundarios fueron significativamente superiores (p<0,03) en el grupo C. Discusión: La administración epidural de ketamina, no se comportó como analgésico eficaz, sin embargo la asociación ketamina+morfina permitió una analgesia eficaz y prolongada, con bajas dosis de ambos fármacos, reduciéndose de forma significativa los efectos secundarios. Ambas dosis de ketamina fueron consideradas como eficaces para la analgesia preventiva (AU)
Subject(s)
Adolescent , Adult , Aged , Female , Male , Middle Aged , Humans , Ketamine/pharmacology , Morphine/pharmacology , Analgesia, Epidural , Ketamine/administration & dosage , Morphine/administration & dosage , Prospective Studies , Drug Therapy, Combination , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the APACHE II and III prognostic assessment systems as predictors of mortality in polytraumatized patients and to compare each system's admission assessments to the patient's quality of life one month, six months and one year later. PATIENTS AND METHODS: A prospective study of 130 polytraumatized patients admitted to the critical care unit was carried out. A polytraumatized patient was defined as "presenting two or more traumatic lesions that were immediately or eventually life-threatening". We studied age, sex, type of trauma, mortality, mean APACHE II and APACHE III scores during the first three days in the critical care unit for patients who survived and those who died, estimating relative risk of mortality by APACHE II and APACHE III, and quality of life one month, six months and one year after admission using Karnofsky scores (KPS). RESULTS: Mean patient age was 46.47 +/- 20.19 years; 78% were men and 22% women. Overall mortality was 20%. The most frequent trauma was craniocerebral (70.76%), followed by injuries ot the chest (53.8%) and extremities (46.15%). Mean APACHE II and APACHE III scores during the first three days were 10.22 +/- 5.33 and 32.75 +/- 16.42, respectively. Mean APACHE II and III scores were significantly higher (p = 0.02) in patients who died than in survivors (14.33 +/- 5.43 and 9.7 +/- 5.2, respectively, for APACHE II; and 43.27 +/- 17.68 and 30.16 +/- 15.79, respectively, for APACHE III). For each point increase of APACHE II or III scores, relative risk of mortality increased 1.09% (p = 0.03) and 1.02% (p = 0.03), respectively. Patients with APACHE II scores over 12 were 3.53 times more likely to die (p = 0.02). Patients with APACHE III scores over 35 were 3.05 times more likely to die (p = 0.02). One month after admission, 6.4% of patients had a KPS of 100 (normal, as before trauma), 35.8% achieved this score six months after admission and 82% after one year (p = 0.01). Mean APACHE III upon admission was significantly lower (p = 0.045) in patients who achieved KPS 100. CONCLUSIONS: The APACHE II and APACHE III prognostic systems predict relative risk of death in polytraumatized patients. APACHE III, but not APACHE II, at admission is significantly related to quality of life one year later.
Subject(s)
APACHE , Multiple Trauma/mortality , Adult , Critical Care , Female , Humans , Male , Middle Aged , Multiple Trauma/psychology , Prognosis , Prospective Studies , Quality of LifeABSTRACT
To assess thoracic analgesia by continuous infusion in surgery to repair pectus excavatum and carinatum in children. This prospective study enrolled 14 children aged 6 to 14 years old scheduled for surgery to correct pectus excavatum and carinatum. After induction of general anesthesia, the T8-T9 epidural space was accessed and a catheter was inserted to T3-T7 with radioscopic monitoring. A loading dose of 0.03-0.04 ml/kg per segment to be blocked (5 segments: T3-T8) of 0.125% bupivacaine and 3 micrograms/ml fentanyl was given to children under 7 years of age; a dose of 0.02-0.03 ml/kg per segment was administered to children over the age of 7 years. A continuous perfusion of 0.1-0.4 ml/kg/h was maintained, with the possibility of additional boluses of 1 ml at 20 min intervals during surgery and the first three days thereafter. An intraoperative bolus was given when the level of blockade was not reached or when mean blood pressure and heart rate increased 15% over baseline. Pain relief was assessed on a numerical scale of 0 to 5 or on a scale of facial icons, depending on the patient's age. During the postoperative period, the pediatric ICU nurse administered a bolus if pain was [symbol see text]3 or heart rate increased 75% over age-based reference values. Top-up analgesia was provided with Metamizole at a dose of 25 mg/kg. No complications attributable to the technique or to sympathetic blockade were observed. All tubes were removed in the operating room. The thoracic epidural catheter was left in place for 70.3 +/- 2.6 h. Mean initial doses of analgesia were 0.45 microgram/kg of fentanyl and 0.2 mg/kg of bupivacaine. The mean number of complementary boluses was 3 +/- 1 during surgery, 5 +/- 2 on the first postoperative day and 4 +/- 1 on the second day. No patient required top-up analgesia on the third day. Hemodynamic stability during surgery and the postoperative period was good. Analgesia was excellent (< 2) for 78.5% of the patients on the first day after surgery, for 85.7% on the second day and for all patients on the third day. We recorded one case of pruritus (7.1%), three of nausea (21.4%) that subsided when butorphanol was given epidurally (20 micrograms/kg), and two cases of light sedation. Thoracic epidural analgesia is effective for alleviating postoperative pain from corrective thoracic surgery in children. Side effects were minimal and no anesthetic complications were observed.