Análisis de la eficacia y seguridad de la administración de cloruro mórfico epidural para el dolor postoperatorio tras cesárea / No disponible

Objetivo: el control del dolor postcesárea es un punto importante, pues se ha tratado de implementar una técnica analgésica que ocasione mínimos efectos secundarios pero que provea de una buena calidad y duración de la misma, para tener un rápido alivio del dolor, buena recuperación y disminución de los costes de hospitalización. El objetivo de este estudio fue analizar la eficacia y seguridad de la administración de un único bolo de dos miligramos de cloruro mórfico por catéter epidural como coadyuvante analgésico tras cesárea. Material y métodos: estudio multicéntrico prospectivo aleatorio observacional de casos y controles a lo largo de tres años, en 400 pacientes, ASA I-II, con edades comprendidas entre 18 y 39 años, intervenidas de cesárea bajo anestesia epidural. Las pacientes se distribuyeron en dos grupos, un primer grupo denominado GM formado por 200 pacientes a las que se administró dos miligramos de cloruro mórfico, diluidos hasta 10 cm³ con suero fisiológico, a través del catéter epidural, posteriormente a la finalización de la cesárea y tras recuperación de bloqueo sensitivo y motor. El otro grupo denominado GC constituido por las 200 pacientes restantes y a las que no se administró morfina peridural. Ambos grupos recibieron el mismo protocolo analgésico con paracetamol y metamizol pautados, y rescate con bolos de morfina intravenosa en la Unidad de Recuperación Postoperatoria y Ketorolaco en planta. Se utilizó t-Student para comparar las variables cuantitativas. Se consideró significativo p < 0,05. Resultados: el GM tuvo menos dolor medido a través de la Escala Visual Analógica a las 6, 12, 24 y 48 horas de la intervención, que el GC. El consumo de analgesia suplementaria fue similar en ambos grupos. El prurito fue el efecto secundario más frecuente (35% de las pacientes de GM) y sólo excepcionalmente fue molesto. No hubo diferencias entre ambos grupos en estancia hospitalaria ni en satisfacción. Existió una mejor calidad de sueño en el grupo al que se administró la morfina epidural. Discusión: en nuestro estudio, la administración de una sola dosis de dos miligramos de cloruro mórfico por vía epidural junto con fármacos convencionales por vía sistémica ofrecen una analgesia superior con mínimos efectos adversos en comparación a la obtenida cuando se administran únicamente fármacos convencionales por vía sistémica en pacientes sometidas a cesárea bajo anestesia epidural. En base a nuestros resultados consideramos que la administración de un bolo de dos miligramos de morfina epidural parece ser una técnica efectiva y segura, por lo que podría incorporarse al protocolo analgésico de cesárea (AU)

Objective: pain control after cesarean section is an important point, as it has tried to implement an analgesic technique that causes minimal side effects while still providing a good quality and duration of it, to have a quick pain relief, good recovery and decreased hospitalization costs. The aim of this study was to analyze the effectiveness and safety of a single bolus administration of two milligrams of morphine epidural catheter as an adjuvant analgesic after cesarean delivery. Matherial and methods: multicenter randomized prospective observational controlled trial along three years in 400 patients, ASA I-II, aged between 18 and 39, for cesarean section with epidural technique. Patients were divided into two groups, one group called GM made up of 200 patients who were given two milligrams of morphine, diluted to 10 cm³ with saline through the epidural catheter, after the completion of the caesarean section and after recovery of sensory and motor block. The other group called GC constituted by the remaining 200 patients and who did not receive epidural morphine. Both groups received the same analgesic protocol with paracetamol and metamizol ruled, and rescue boluses of intravenous morphine in the postoperative recovery unit and ketorolac on the ground. T-Student was used to compare quantitative variables. P < 0.05 was considered significant. Results: the GM had less pain, measured by Visual Analog Scale, at 6, 12, 24 and 48 hours after surgery, than the GC. Supplementary analgesic consumption was similar in both groups. Pruritus was the most common side effect (35% of GM patients) and only exceptionally was annoying. There were no differences between groups in hospital stay or satisfaction. The group with epidural morphine had a better quality of sleep. Discussion: in our study, administration of a single dose of two milligrams of epidural morphine with conventional drugs provides a better post-cesarean analgesia with minimal side effects compared to that obtained when only conventional drugs are administered. According to our results we think that the administration of a bolus of two milligrams of morphine epidural seems a safe and effective technique, so we could join to the analgesic protocol of cesarean (AU)

[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)