RESUMO
Objetivo: Comparar dos técnicas perioperatorias, el bloqueo del plano del erector espinal y la infiltración de la herida con analgésicos de vida media larga, para el control del dolor de herida postquirúrgico en pacientes operados de cirugía abierta de columna. Material y métodos: Ensayo clínico prospectivo, simple ciego, realizado en el Hospital de Clínicas, desde julio de 2018 hasta marzo de 2019, donde se randomizaron pacientes sometidos a cirugía de columna lumbosacra abierta sin fijación. Se compararon dos técnicas de infiltración perioperatoria para el manejo del dolor de la herida postoperatorio: la infiltración pre y postoperatoria con analgésicos de vida media larga con el bloqueo del plano del erector espinal. Se evaluó el dolor (VAS promedio), el uso de opioides, los días de inmovilización postoperatorios, los días de internación y las complicaciones. Se consideró como estadísticamente significativo una p<0,05. Resultados: 40 pacientes cumplieron con los criterios de inclusión. 20 (50%) fueron sometidos a la técnica de infiltración estándar y 20 (50%) al bloqueo del plano del erector espinal. De los pacientes operados de discectomías y recalibrajes de 1 nivel se mostró que el bloqueo del erector espinal fue superior en el descenso del VAS postoperatorio en las primeras 7 horas (p=0,000). En los recalibrajes de más de 2 niveles, la técnica nueva demostró ser superior en todas las variables analizadas en forma estadísticamente significativa: VAS (p=0,0004) y número de pacientes con dolor de la herida a las 7 horas de la cirugía (p=0,000), horas de internación (p=0,0007), días de inmovilización (p=0,0004) y consumo de opioides (p=0,000). Conclusión: El bloqueo del plano del erector espinal es superior a la técnica de infiltración estandarizada para la disminución del dolor en la herida en pacientes sometidos a cirugía abierta de columna.
Objective: To compare two perioperative techniques, the erector spinae plane block with the infiltration of the wound with long lasting local analgesics, for the management of postoperative wound pain in spinal surgery. Material and methods: Prospective, single-blind clinical trial was performed at the Hospital de Clínicas, from July 2018 to March 2019. Patients undergoing spinal lumbosacral surgery without fixation were enrolled. Two perioperative infiltration techniques were compared for postoperative wound pain management: pre and postoperative infiltration with long lasting analgesics with the interfascial spinae plane erector block. Postoperative results were analyzed in terms of pain relief (VAS), need for opioids, days of immobilization in bed, hours of hospitalization and complications. A p <0.05 was considered statistically significant. Results: 40 patients were included. 20 (50%) underwent the standard infiltration technique and 20 (50%) the interfascial spinae plane erector block. The spinae plane erector block was superior in pain wound relief in the first 7 postoperative hours in patients who underwent discectomies or one level decompressions (p=0,000). In all the patients with decompressions of 2 or more levels, the new technique proved to be statistically significant superior in all the postoperative variables analyzed: VAS (p = 0.0004) and number of patients with wound pain after 7 hours of the surgery (p = 0.000), hours of hospitalization (p = 0.0007), days of immobilization in bed (p = 0.0004) and use of opioids (p = 0.000). Conclusion: The interfascial spinae erector plane is a better technique compare with the standardized infiltration of the wound for postoperative wound pain relief in patients undergoing open spinal surgery.
Assuntos
Coluna Vertebral , Dor , Cirurgia Geral , Manejo da DorRESUMO
INTRODUCTION: The administration of local anaesthetic in the serratus-intercostal space provides adequate analgesia in non-reconstructive breast surgery. The aim of this study was to evaluate whether the blockage of the last intercostal nerves (T7-T11) can lead to opioid savings in supra-umbilical open surgery procedures. MATERIAL AND METHODS: A prospective observational study was conducted on patients undergoing open supra-umbilical surgery under general anaesthesia and with a serratus-intercostal plane block [modified Blocking the bRanches of IntercostaL nerves in the Middle Axillary line (BRILMA)] as an associated analgesic strategy. Post-operative pain was assessed with the numerical verbal scale (NVS 0 to 10) on admission to the post-anAesthesia recovery unit, at 6, 12, 24, and 48h postintervention and by need for analgesic rescues with opioids (2mg iv of morphine, if values higher than 3 in NVS). Adverse events related to the technique were also recorded. The statistical package used in the analysis of the data was SPSS® for Windows. RESULTS: The study recruited 52 patients. Differences, with a p<.05, were found intra-operatively in the consumption of fentanyl: 400 + 80µg versus 110 + 50µg in patients who underwent pre-incisional blockade. In the first 24hours, only 3 cases (two gastrectomies and one cholecystectomy) required morphine (single bolus of 2mg). Between 24h and 48h it was necessary to administer several morphine boluses (8 + 2mg) in four patients (three gastrectomies and one cholecystectomy). Four patients presented with nausea and / or vomiting and there were no complications related to the analgesic technique. CONCLUSION: The intercostal nerves block (T7-T11) in the serratus-intercostal space may constitute an opioid-sparing analgesic strategy in open supra-umbilical surgery.
