Eficacia y complicaciones de las técnicas analgésicas para el tratamiento del dolor agudo postoperatorio moderado a intenso / Efficacy and complications of analgesic techniques for the treatment of moderate to severe postoperative acute pain

Introducción: A pesar de los esfuerzos y la evidencia disponible, el dolor agudo postoperatorio (DAP) moderado a intenso continúa teniendo una prevalencia elevada en nuestro medio. Como parte de una estrategia de analgesia balanceada o multimodal, las técnicas de analgesia regional ofrecen un adecuado control analgésico con menores efectos indeseables (que el uso exclusivo de opioides), aunque no están exentas de complicaciones y no son aplicables a todas las cirugías. El objetivo de este trabajo fue valorar la eficacia de las técnicas analgésicas para el tratamiento del DAP moderado a intenso, la incidencia de complicaciones asociadas a estas técnicas y la relación entre DAP y el antecedente de dolor crónico. Pacientes y métodos: Estudio retrospectivo que incluyó 728 pacientes en los que se indicaron técnicas analgésicas, como analgesia epidural, analgesia perineural continua y analgesia controlada por el paciente (PCA) con morfina intravenosa, para el tratamiento del DAP moderado a intenso entre octubre del 2018 y octubre del 2020. Los pacientes fueron valorados por la Unidad de Dolor Agudo Postoperatorio (UDAP) a las 24 y 48 horas, se registró el dolor con la ENV (Escala Numérica Verbal), la presencia de reacciones adversas y/o complicaciones, empleo de analgesia multimodal y consumo de morfina en equivalentes intravenosos. Los niveles de dolor se clasificaron en leve (ENV: 0-3), moderado (ENV: 4-6) e intenso (ENV mayor o igual a 7). Resultados: Cerca del 60 % de los pacientes presentaron dolor leve a las 24 horas y del 70 % a las 48 horas. Un 71,8 % de los portadores de analgésica continua epidural presentaron dolor leve el primer día y un 83 % al segundo. Las cirugías con niveles más altos de dolor moderado e intenso fueron la cirugía espinal en la que se empleó la PCA de morfina y la artroplastia de rodilla en que se utilizó analgesia a través de bloqueo femoral continuo...(AU)

Introduction: Despite the efforts and the available evidence, moderate to severe acute postoperative pain (APP) continues to have a high prevalence in our setting. As part of a balanced or multimodal analgesia strategy, regional analgesia techniques offer adequate analgesic control with fewer undesirable effects (that the exclusive use of opioids), although they are not free of complications and do not apply to all surgeries. This study aimed to assess the efficacy of analgesic techniques for the treatment of moderate to intense APP, the incidence of complications associated with these techniques, and the relationship between APP and the presence of chronic pain. Patients and methods: This retrospective study included 728 patients in which analgesic techniques such as epidural analgesia, continuous perineural analgesia, and morphine Patient Controlled Analgesia (PCA) were indicated to treat moderate to severe APP between October 2018 and October 2020. The patients were evaluated by the APP service at 24 and 48 hours, the pain was recorded with the NRS (Numerical Rating Scale), and the study also registered the presence of adverse reactions and/or complications, the use of multimodal analgesia, and the consumption of morphine in equivalent intravenous doses. Pain levels were classified as mild (NRS: 0-3), moderate (NRS: 4-6) and intense (NRS greater than or equal to 7). Results: Approximately 60 % of all patients presented mild pain at 24 hours and 70 % at 48. Epidural analgesia in abdominal surgery presented 71.8 % mild pain on the first day and 83 % on the second. The surgeries with the highest levels of moderate and severe pain were spinal surgery using morphine PCA and knee replacement with continuous femoral nerve block. The morphine consumption recorded in the PCA was 25.8 mg (SD 18.4) at 24 hours and 18.6 mg (SD: 14.6) at 48 hours...(AU)

[Usefulness of total and specific IgE in the diagnosis of respiratory allergy]. / Utilidad de la IgE total y específica en el diagnóstico de la alergia respiratoria.

We studied 500 patients with an average age of 36.25 +/- 14.27 years and did the following tests: Intradermoreaction and prick tests, total IgE by PRIST and specific IgE by RAST. The antigens used for the study were the following: Lolium Perenne, Dermatophagoides pteronyssinus, and house dust. Of de 500 patients studied, 104 had a negative skin test and RAST. They also had a negative history of allergy. The other 396 patients presented a clinical history compatible with the diagnosis of allergy and were positive to skin test and/or RAST. A correlative study between the different techniques utilized in the diagnosis of these patients was undertaken. We observed significant higher levels of total IgE in the allergic than in the non-allergic group (p less than 0.001). The normal levels of total IgE in our environment were equal or inferior to 263.33 UI/ml. In the group of allergic patients, levels higher than 263.33 UI/ml were found in 49.27% of RAST positive patients and 46.35% in skin test positive patients. In the 295 patients studied with intradermoreaction, the correlation coefficients (r) were as follows: Lolium perenne r: 0.90; Dermatophagoides Pteronyssinus r: 0.54; house dust r: 0.14. The correlation coefficients (r) in the 101 patients studied with prick tests were the following; Lolium perenne r: 0.86; Dermatophagoides Pteronyssinus r: 0.82; house dust r: 0.48. As can be observed the prick tests gave overall better results than the intradermoreaction. On comparing the skin and RAST tests qualitatively we observed that in those patients studied by prick tests, 86.79% were pollen-positive in both trials.(ABSTRACT TRUNCATED AT 250 WORDS)