Bloqueo nervioso en el tratamiento del dolor postoperatorio de pacientes intervenidos de hernia inguinal o crural en una unidad de CMA / Nerve block for postoperative pain relief after inguinal or femoral hernia repair in an ambulatory surgical unit

RESUMEN

OBJETIVO: E éxito de un programa de Cirugía Mayor Ambulatoria depende en gran medida de un correcto tratamiento del dolor postoperatorio. Nuestro objetivo es presentar los resultados obtenidos con el bloqueo nervioso. MATERIAL Y MÉTODOS: Estudio restrospectivo. Se utiliza la anestesia general con mascarilla laringea combinada con la infiltración local de ropivacaína. La analgesia se completa con Metamizol magnésico. Se evalúa el dolor mediante una escala numérica visual y de forma indirecta, la asistencia a urgencias, el estado emocional al regresar al domicilio,e l grado de satisfacción con el tratamiento y el grado de recomendación de nuestra unidad. RESULTADOS: Se han intervenido 167 enfermos, 158 hombres y 9 mujeres. Edad media 50,6 años. Corresponden a hernias inguinales 155, crurales 7, inguinal mas crural 3, recidivas 2. Técnicas Gilbert 21, Lichtenstein 38, Rutkow-Robbins 57, Hernioplastia PHS 44, Lichtenstein crural 7. La valoración del dolor fue Grado 0 7%, 1 19,7%, 2 12,2%, 3 22,5%, 4 12,6%, 11,2%, 6 5,6%, 7 4,2%, 8 4,2%. El 97,1% no necesitó tomar más calmantes. Solo un enfermo necesitó acudir a urgencias por un hematoma. El 95% estuvo tranquilo al alta. El 54,9% se mostraron satisfechos y el 40,8 muy satisfechos con el tratamiento. El 52,!!% no dudarían en recomendar nuestrao programa. Ningún enfermo telefoneó por dolor. Complicaciones 2 (1,1%) bloqueos del nervio femorocutáneo y 5 (2,9%) del obturador. Representaron 4 (2,3%) ingresos (AU)

ABSTRACT

OBJECTIVES: The success of a program for ambulatory surgery depends on the correct management of postoperative pain. The objective of this article is to present our results in the use of nerve blocks. MATERIAL AND METHOD: A restrospective study. The general anaesthesia procedure included laryngeal mask and ropivacaine local infiltration. Postoperative anaesthesia was combined with metamizol. Pain was evaluated by a visual numeric scale from 0 (no pain) to 10 (maximum pain). Other stats were evaluated Emergency attendance required, emotional aspects on reaching home, satisfaction with medical care and if they would recommended our units as a surgical centre to other patients. RESULTS: 167 patients underwent surgery, 158 men and 9 women. Mean age was 50,6 years. We found 71 right inguinal hernias, 84 left inguinal hernias, 7 femoral hernias, 3 right inguinal and femoral combined hernias and 2 right inguinal recurrent hernias. Surgical techniques used for the repair were Gilbert´s technique, 21; Lichtenstein inguinal hernia repair, 38; Rutkow-Robbins technique, 57; PHS hernioplaty, 44 Lechtenstein´s femoral hernia repair, 7. The analogical pain evaluation scale results were grade 0 7%, grade 1 19,7%, grade 3 22,5%, grade 4 12,6%, grade 5 11,2%, grade 6 5,6%, grade 7 4,2%, grade 8 4,2%. No supplementary post-operative analgesia was required in 97,1% of the patients. Just one required emergency assistance due to a haematoma. Almost 95% of the patients stayed calm at home. 54% were satisfied and 40,8% were highly satisfied with the surgical results. Regarding recommending our surgical program 52,11% had no doubt about it. No phone calls were received due to pain. The complications were 2 femoro-cutaneous nerve (1,1%) and 5 obturator (2,9%) blocks. Just 4 of the cases required hospital admission (2,3%). DISCUSSION: The postoperative anaesthesia and grade of comfort obtained with this procedure highly satisfactory. There was no hospital admission due to pain (AU)