ABSTRACT
Introducción: El dolor es un motivo de ausentismo laboral, en especial el dolor irruptivo secundario a canal lumbar estrecho. La dexmedetomidina como analgésico actúa inhibiendo la liberación de sustancia P en la vía nociceptiva y bloquea los receptores de aspartato y glutamato. Por otro lado, la lidocaína también previene y alivia el dolor mediante la interrupción de la neuroconducción, uniéndose a su receptor específico dentro de los canales de sodio. Objetivo: Evaluar la eficacia analgésica de la dexmedetomidina versus lidocaína en perfusión endovenosa como tratamiento del dolor irruptivo secundario a canal lumbar estrecho. Material y métodos: Ensayo clínico controlado, aleatorizado, triple ciego, realizado en la clínica del dolor del HGM, se evaluaron dos grupos de pacientes con diagnóstico de dolor irruptivo secundario a canal lumbar estrecho; un grupo tratado con dexmedetomidina (0,3 mcg/kg) y otro grupo tratado con lidocaína (2 mg/kg) en perfusión endovenosa. Se realizó medición de la intensidad del dolor y el estado de sedación antes de iniciar el tratamiento y posteriormente a los 30, 60 y 120 minutos. También se evaluó la funcionalidad de los pacientes a través del índice de discapacidad de Oswestry antes y a los siete días del tratamiento. Se evaluó de forma secundaria el efecto de los tratamientos sobre los signos vitales. Resultados: No hubo diferencia estadísticamente significativa en la reducción de la intensidad del dolor a los 120 minutos entre los pacientes tratados con dexmedetomidina (EVA 1,29 ± 1,63) comparados con los tratados con lidocaína (EVA 1 ± 1,19, p = 0,594). Se observó que al final de la perfusión de los fármacos, la dexmedetomidina produjo mayor sedación a diferencia de la lidocaína (p = 0,003). Ambos tratamientos mejoran la funcionalidad en todos los pacientes sin haber diferencia estadísticamente significativa entre los tratamientos (p = 0,508) no se observaron efectos depresores sobre los signos vitales. Conclusiones: La dexmedetomidina y la lidocaína son igual de eficaces para el tratamiento del dolor irruptivo, con inicio de acción en los primeros 30 minutos de iniciada la perfusión hasta las siguientes 2 horas. No se observaron eventos adversos medicamentosos a las dosis recomendadas
Introduction: The pain is a reason for absenteeism labour, especially breakthrough pain secondary to narrow lumbar canal. Dexmedetomidine is an analgesic, act by inhibiting the release of substance P in the nociceptive pathway and blocks the aspartate and glutamate receptors. On the other hand, lidocaine also prevents and relieves pain by interrupting neuroconduction, binding to its specific receptor within the sodium channels. Objective: To evaluate the analgesic efficacy of dexmedetomidine versus lidocaine in intravenous perfusion as a treatment for breakthrough pain secondary to narrow lumbar canal. Material and methods: Controlled clinical trial, randomized, triple-blind, performed at the HGM pain clinic, two groups of patients with diagnosis of breakthrough pain secondary to narrow lumbar canal were evaluated; group one was treated with dexmedetomidine (0.3 mcg/kg) and the other group was treated with lidocaine (2 mg/kg) in intravenous infusion. Measurement of pain intensity and sedation status was made before starting the treatment and after 30, 60 and 120 minutes. The functionality of the patients was also assessed through the Oswestry disability index before and seven days after treatment. Secondarily evaluated the effect of treatments on vital signs. Results: There was not any statistically significant difference in the reduction of pain intensity at 120 minutes between patients treated with dexmedetomidine (EVA 1.29 ± 1.63) compared with those who were treated with lidocaine (EVA 1 ± 1.19, p = 0.594), it was observed that at the end of drugs perfusion, dexmedetomidine produced greater sedation, unlike lidocaine (p = 0.003), both treatments improved functionality in all patients without having a statistically significant difference between treatments (p = 0.508), they were not observed depressant effects on vital signs. Conclusions: Dexmedetomidine and lidocaine are just as equally effective for the treatment of breakthrough pain, with onset of action in the first 30 minutes after the infusion started until the next 2 hours, no adverse drug events were observed at the recommended doses
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Dexmedetomidine/pharmacokinetics , Lidocaine/pharmacokinetics , Breakthrough Pain/drug therapy , Low Back Pain/drug therapy , Pain Management/methods , Administration, Intravenous/methods , Constriction, Pathologic/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Cardiovascular disease accounts for 35% to 50% of the causes of mortality in chronic kidney disease. The majority of patients in substitution therapy in Mexico are subdialyzed owing to limited economic resources. This produces more cardiac deterioration than described in the statistics and has a direct impact on the prognosis of kidney transplantation. The aim of this work was to demonstrate and to quantify the improvement in the echocardiographic parameters 6 months after renal transplantation in patients with stable renal function. METHODS: This was an observational, analytic, prospective study of 23 patients with chronic kidney disease who received transplants in 2016 and had a glomerular filtration rate ≥80 mL/min (Chronic Kidney Disease-Epidemiology Collaboration) 6 months after transplantation. RESULTS: Echocardiographic results showed an increase in the left ventricular ejection fraction from 57.17 ± 10.46% to 64.09 ± 9.8%, an increase in the right ventricular ejection fraction from 0.56 ± 0.09% to 0.60 ± 0.08% and a reduction of the pulmonary arterial systolic pressure from 44.57 ± 13.88 mm Hg to 39.74 ± 11.04 mm Hg. There were also decreases in mitral regurgitation from 1.0 to 0.43, tricuspid insufficiency from 1.35 to 0.43, pulmonary insufficiency from 0.48 to 0.04, and aortic insufficiency from 0.35 to 0.04, all of these significant with P < .05. CONCLUSIONS: There was a significant improvement in cardiovascular function in our population 6 months after transplantation, despite the fact that renal transplantation is performed with greater cardiac deterioration than described in patients in other countries.
