Hematoma hepático espontáneo y gestación / Spontaneous hematoma of the liver in pregnancy

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Comentarios al artículos "Neumoencéfalo como complicación de punción dural inadvertida en analgesia epidural" / No disponible

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[Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy]. / Eficacia analgésica de la infusión continua de anestésico local en la herida quirúrgica tras histerectomía abdominal.

OBJECTIVE: To assess the quality of postoperative analgesia provided by intravenous administration of paracetamol and ketorolac plus morphine in bolus doses with or without continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. Patient satisfaction was included among the outcomes assessed. MATERIAL AND METHODS: Prospective pilot study in ASA 1-2 patients randomized to 2 groups: women in the subcutaneous catheter group received intravenous analgesics plus a continuous infusion (2 mL/h) of 0.25% bupivacaine whereas women in the control group received only the intravenous analgesics. The outcome measures were pain intensity assessed on a verbal numerical scale at rest and with movement, morphine requirements in the first 48 hours after surgery, and complications related to the drugs used or the technique. RESULTS: Twenty-six patients were enrolled; 10 were randomized to the catheter group and 16 to the control group. Statistically significant between-group differences in pain both at rest and with movement were found while the women were in the postoperative recovery unit. Postoperative pain with movement was also significantly different at 24 hours (P<.004) and 48 hours (P<.02). Similarly, mean (SD) morphine requirements in the recovery unit were significantly greater in the control group, at 8 (2.27) mg, compared with 3.20 (1.79) mg in the catheter group (P<.002). Walking began earlier in the catheter group. No differences were found in the incidences of complications. CONCLUSIONS: Postoperative pain is effectively relieved by continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. This technique provides good analgesia with less morphine consumption and scarce adverse effects. Patient satisfaction and the sense of receiving quality pain management are high.

Eficacia analgésica de la infusión continua de anestésico local en la herida quirúrgica tras histerectomía abdominal / Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy

OBJETIVO: Evaluar la calidad de la analgesia postoperatoriaen mujeres sometidas a histerectomía abdominal,valorando dos técnicas diferentes de analgesia intravenosa(paracetamol, ketorolaco y bolos de morfina) con osin infusión continua de anestésico local en la herida quirúrgica.Se valoró además el índice de satisfacción experimentadopor las pacientes.MATERIAL Y MÉTODO: Estudio preliminar, prospectivoy aleatorio, en pacientes ASA I-II, divididas en dos grupos:grupo catéter, mujeres que recibieron analgésicosintravenosos y bupivacaína (0,25%) en infusión continua(2 ml/h) a través de un catéter subcutáneo; grupo control,recibieron exclusivamente analgesia intravenosa.Las variables de estudio fueron la intensidad del dolor(evaluado mediante escala verbal numérica) en reposo ymovimiento, requerimientos de morfina durante las primeras48 horas y complicaciones relacionadas con losfármacos utilizados y con la técnica.RESULTADOS: Se incluyeron 26 pacientes, 10 pacientesen el grupo catéter y 16 en el grupo control. Las diferenciasencontradas con respecto al dolor, tanto en reposocomo en movimiento, fueron estadísticamente significativasen la URPA. También existieron diferencias significativasen el dolor al movimiento a las 24 h (p < 0,004) y alas 48 h (p < 0,020). Asimismo los requerimientos de morfinaen la URPA fueron significativamente mayores en elgrupo control (3,20 ± 1,79 mg frente a 8 ± 2,27 mg,p < 0,002). La deambulación fue más temprana en el grupocatéter. No hallamos diferencias en las complicaciones.CONCLUSIONES: El tratamiento del dolor postoperatoriomediante infusión continua de anestésico local en la heridaquirúrgica tras histerectomía abdominal es una técnicaanalgésica eficaz, que proporciona un muy buen control delmismo con un reducido consumo de morfina, escasos efectosadversos, un alto índice de satisfacción de las mujeres yla percepción de éstas de recibir una analgesia de calidad(AU)

OBJECTIVE: To assess the quality of postoperativeanalgesia provided by intravenous administration ofparacetamol and ketorolac plus morphine in bolus doseswith or without continuous infusion of local anestheticinto the surgical wound after abdominal hysterectomy.Patient satisfaction was included among the outcomesassessed.MATERIAL AND METHODS: Prospective pilot study inASA 1-2 patients randomized to 2 groups: women in thesubcutaneous catheter group received intravenousanalgesics plus a continuous infusion (2 mL/h) of 0.25%bupivacaine whereas women in the control groupreceived only the intravenous analgesics. The outcomemeasures were pain intensity assessed on a verbalnumerical scale at rest and with movement, morphinerequirements in the first 48 hours after surgery, andcomplications related to the drugs used or the technique.RESULTS: Twenty-six patients were enrolled; 10 wererandomized to the catheter group and 16 to the controlgroup. Statistically significant between-group differencesin pain both at rest and with movement were found whilethe women were in the postoperative recovery unit.Postoperative pain with movement was also significantlydifferent at 24 hours (P<.004) and 48 hours (P<.02).Similarly, mean (SD) morphine requirements in therecovery unit were significantly greater in the controlgroup, at 8 (2.27) mg, compared with 3.20 (1.79) mg inthe catheter group (P<.002). Walking began earlier in thecatheter group. No differences were found in theincidences of complications.CONCLUSIONS: Postoperative pain is effectivelyrelieved by continuous infusion of local anesthetic intothe surgical wound after abdominal hysterectomy. Thistechnique provides good analgesia with less morphineconsumption and scarce adverse effects. Patientsatisfaction and the sense of receiving quality painmanagement are high(AU)