Utilización de la monitorización analgésica intraoperatoria mediante pupilometría en el consumo de analgésicos durante las primeras 12 horas del postoperatorio / The use of pupillometry as monitoring of intraoperative analgesia in the consumption of analgesics during the first 12 hours after surgery

Introducción. Habitualmente, la analgesia intraoperatoria se controla empíricamente con base en las variaciones hemodinámicas del paciente. Un manejo incorrecto durante este proceso puede incrementar la morbimortalidad quirúrgica y también el dolor agudo postoperatorio. El objetivo de este estudio fue valorar si la monitorización intraoperatoria de la analgesia mediante pupilometría tenía algún efecto sobre la intensidad del dolor y el consumo de analgésicos en planta, en las primeras 12 h del postoperatorio de cirugía mayor ginecológica. Pacientes y métodos. Estudio de cohortes, prospectivo con asignación de grupos de forma secuencial según programación de quirófano. Pacientes ASA I-III sometidas a cirugía electiva de histerectomía abdominal por laparotomía o laparoscopia mediante anestesia general intravenosa. Los grupos de estudio fueron: grupo pupilometría (P-1), cuya analgesia intraoperatoria se monitorizó mediante pupilómetro, y grupo hemodinámico (H-2), a partir de valores de presión arterial y frecuencia cardíaca. En la sala de hospitalización se registraron rutinariamente los valores de la escala visual analógica (EVA) con 3 cortes para el estudio: a las 3, 8 y 12 h del postoperatorio. Según protocolo se administró un analgésico si la EVA era ≥ 3 o si la paciente lo solicitaba expresamente. A posteriori, se valoró la eficacia del tratamiento y si continuaba con dolor se prescribía el siguiente fármaco pautado hasta conseguir una EVA < 3. Se controló el consumo de analgésicos administrados en las 12 h del postoperatorio en planta y se registró cualquier incidencia o efectos adversos relacionados con el estudio. Resultados. Fueron incluidas 59 pacientes: 30 en el grupo P-1 y 29 en el grupo H-2. El grupo P-1 experimentó menos dolor que el grupo H-2, con una significación estadística en cada una de las fases (EVA 3 h, EVA 8 h y EVA 12 h). Se observó una diferencia estadísticamente significativa (p < 0,001) en la media (DE) del número de fármacos analgésicos empleados por paciente entre el grupo P-1 (1,80 [0,99]; mediana 2, intervalo de confianza 95% 1,43-2,17) y el grupo H-2 (5,66 [1,58]; mediana 6, intervalo de confianza 95% 5,05-6,26). Conclusiones. La monitorización de la analgesia intraoperatoria mediante pupilometría resultó un método simple y fiable que consiguió reducir la intensidad del dolor y el consumo de analgésicos en planta las primeras 12 h del postoperatorio tras cirugía mayor ginecológica (AU)

Introduction. Intraoperative evaluation of analgesia remains today often based on heart rate and arterial pressure fluctuations. None of these parameters is specific. Incorrect handling during this process may increase surgical morbi-mortality of the patients and their acute postoperative pain. The aim of this study was to evaluate the impact of intraoperative analgesia controlled by pupillometry on postoperative analgesic consumption and the pain intensity in the first 12 h in the hospital room, after major gynecological surgery. Patients and methods. A prospective, cohort study with allocation of groups of sequentially according to programming of operating room was designed. ASA I-III patients scheduled for elective surgery of abdominal hysterectomy by laparotomy or laparoscopy through intravenous general anesthesia were included. Patients were divided into 2 groups: pupillometry group (P-1), in which intraoperative analgesia was guided by pupillometry, and hemodynamic group (H-2) according to values of blood pressure and heart rate. In the hospitalization room the values of visual analogue scale (VAS) were routinely registered with 3 courts for the study: 3, 8 and 12 h of the postoperative period. Postoperative analgesia was standardized as follows: NSAIDs was administered if VAS was ≥ 3 or if the patient expressly requested an analgesic. After this, the efficacy of treatment was assessed. If the patient had pain, the next scheduled drug was given up to an VAS < 3. Data for total analgesic consumption administered in the hospital room, VAS and adverse effects were collected within 12 h postoperatively. Results. A total of 59 patients, 30 group P-1 and 29 group H-2, were included. Group P-1 experienced less pain than group H-2, with statistical significance in each phase (VAS 3 h, VAS 8 h and VAS 12 h). These data are consistent with the consumption of analgesics for patients. There was a statistically significant reduction (p < 0.001) in the group P-1 (1.80 [DE 0.99]; medium 2, 95% confidence interval 1.43-2.17) compared with group H-2 (5.66 [1.58]; medium 6, 95% confidence interval 5.05-6.26). Conclusions. Monitoring of the intraoperative analgesia by pupillometry was able to reduce the intensity of the acute postoperative pain and analgesic consumption in the first 12 h in the hospital room after major gynecological surgery (AU)

The use of pupillometry as monitoring of intraoperative analgesia in the consumption of analgesics during the first 12 hours after surgery.

INTRODUCTION: Intraoperative evaluation of analgesia remains today often based on heart rate and arterial pressure fluctuations. None of these parameters is specific. Incorrect handling during this process may increase surgical morbi-mortality of the patients and their acute postoperative pain. The aim of this study was to evaluate the impact of intraoperative analgesia controlled by pupillometry on postoperative analgesic consumption and the pain intensity in the first 12h in the hospital room, after major gynecological surgery. PATIENTS AND METHODS: A prospective, cohort study with allocation of groups of sequentially according to programming of operating room was designed. ASA I-III patients scheduled for elective surgery of abdominal hysterectomy by laparotomy or laparoscopy through intravenous general anesthesia were included. Patients were divided into 2 groups: pupillometry group (P-1), in which intraoperative analgesia was guided by pupillometry, and hemodynamic group (H-2) according to values of blood pressure and heart rate. In the hospitalization room the values of visual analogue scale (VAS) were routinely registered with 3 courts for the study: 3, 8 and 12h of the postoperative period. Postoperative analgesia was standardized as follows: NSAIDs was administered if VAS was ≥ 3 or if the patient expressly requested an analgesic. After this, the efficacy of treatment was assessed. If the patient had pain, the next scheduled drug was given up to an VAS<3. Data for total analgesic consumption administered in the hospital room, VAS and adverse effects were collected within 12h postoperatively. RESULTS: A total of 59 patients, 30 group P-1 and 29 group H-2, were included. Group P-1 experienced less pain than group H-2, with statistical significance in each phase (VAS 3h, VAS 8h and VAS 12h). These data are consistent with the consumption of analgesics for patients. There was a statistically significant reduction (p<0.001) in the group P-1 (1.80 [DE 0.99]; medium 2, 95% confidence interval 1.43-2.17) compared with group H-2 (5.66 [1.58]; medium 6, 95% confidence interval 5.05-6.26). CONCLUSIONS: Monitoring of the intraoperative analgesia by pupillometry was able to reduce the intensity of the acute postoperative pain and analgesic consumption in the first 12h in the hospital room after major gynecological surgery.

[Efficacy of the ilioinguinal and iliohypogastric block in the treatment of the postoperative pain of inguinal herniorrhaphy]. / Eficacia del bloqueo ilioinguinal e iliohipogástrico en el tratamiento del dolor postoperatorio de la herniorrafia inguinal.

INTRODUCTION: The ileoinguinal-ileohypogastric block (IHB) improves pain control in inguinal hernioplasty. OBJECTIVE: To determine the efficacy of the IHB on the treatment of postoperative pain in inguinal herniorrhaphy, and to compare the effect of its use before and after incision for diminishing pain and postponing the first dose of analgesia. PATIENTS AND METHODS: Sixty-eight patients scheduled for inguinal herniorrhaphy with mesh were enrolled and distributed randomly in 4 groups as follows: 1) IHB before incision using 0.25 ml/kg bupivacaine 0.5% with no vasoconstrictor; 2) IHB after incision with the same dose of bupivacaine; 3) IHB before incision with 0.25 ml/kg of serum; and 4) IHB after incision with 0.25 ml/kg of serum. Pain was evaluated on visual analog scales employing facial expressions and verbal description, a patient questionnaire and time elapsing between surgery and the first dose of analgesia. The evaluations were performed in the postoperative recovery unit and on the ward 8 and 24 hours after surgery. RESULTS: The total overall score for postoperative pain was lower in the bupivacaine group than in the placebo group (9.2 +/- 4.4 and 1.5 +/- 3.9, respectively; p = 0.026). The first dose of analgesia was given to those who received placebo between the second and third hour after surgery, whereas it was given between the fourth and fifth hour to the bupivacaine group. No significant differences were found between infiltration before and after incision. CONCLUSIONS: IHB decreases pain, delaying the need for a first dose of analgesic and improving patient comfort. Its use is therefore recommended for relief of postoperative pain.