Eficacia y efectos secundarios de 3 técnicas analgesicas en el control del dolor postoperatorio en artroplastia de rodilla / Efficacy and side effects of three analgesic techniques for postoperative pai management after total knee arthroplasty

RESUMEN

Objetivo El dolor postoperatorio en artroplastia total de rodilla, a¨²n consider¨¢ndose uno de los m¨¢s severos, es un reto por resolver. Con nuestro estudio pretendemos analizar y comparar la eficacia analg¨¦sica, incidencia y severidad de efectos secundarios de una pauta epidural, otra consistente en bloqueo femoral y una pauta intravenosa con morfina. Material y m¨¦todos Se trata de un estudio observacional retrospectivo en el que se revisan 359 hojas de seguimiento de pacientes sometidos a artroplastia total de rodilla. Seg¨²n la pauta analg¨¦sica que recibieron en el postoperatorio fueron asignados a tres grupos diferentes a) Grupo Femoral (n=56) a los que se realiz¨® bloqueo femoral continuo con ropivacaina al 0,2 %. En todos los casos se asoci¨® un bloqueo del nervio ci¨¢tico mediante punci¨®n ¨²nica medio-femoral con ropivacaina al 0,2%. b) Grupo epidural (n=135) a los que se coloca cat¨¦ter epidural lumbar mediante el cu¨¢l se administra bupivacaina bal 0,07%+ fentanilo 2 ¦Ìg/ml. c) Grupo intravenoso (n=168) a los que se administra morfina intravenosa. En todas las pautas el modo de administraci¨®n es mediante perfusi¨®n continua con PCA. Todos los pacientes recibieron como analgesia complementaria Paracetamol IV 1g/6h. Valoramos el grado de analgesia en reposo, n¨¢useas y v¨®mitos, bloqueo motor, sedaci¨®n, prurito y necesidad de analgesia de rescate en las primeras 24 horas del postoperatorio. Resultados No se encontraron diferencias significativas en cuanto a eficacia analg¨¦sica entre las 3 pautas analizadas. Igualmente, no encontramos diferencias significativas respecto a sedaci¨®n ni na¨²seas y v¨®mitos, siendo el bloqueo motor y el prurito superiores en los casos de bloqueo femoral y epidural respectivamente. Conclusiones Aunque el perfil de efectos secundarios sea discretamente mayor en cuanto a prurito en el grupo epidural y bloqueo motor en el grupo femoral, no podemos afirmar la superioridad en cuanto a eficacia analg¨¦sica de ninguna estrategia con respecto a otra

ABSTRACT

Purpose Despite the fact that it is expected and intense, postoperative pain after knee arthroplasty is still an unresolved challenge. In our study we intend to analyse and compare analgesic efficacy, incidence and severity of adverse effects resulting from three different techniques a )Epidural analgesia , b)Femoral block, and c) intravenous analgesia with morphine. Patients and Methods An observational and retrospective study is presented, reviewing data obtained from 359 patients who had a total knee arthroplasty Patients were assigned to three different groups, according to the method of pain relief that was prescribed for each of them a) Femoral group (n=56).A continuous femoral block was performed using ropivacaine 0.2%. Sciatic block was associated on each patient (single injection at middle femoral point with ropivacaine 0.2%). b) Epidural group (n=135).This figure includes patients in whom an epidural catheter was inserted and bupivacaine 0.07% plus fentanyl 2 mc./ml was administered through the catheter. c) Intravenous group (n=168). Intravenous morphine was administered to this group of patients. Each analgesic plan included continuous perfusion of drugs via PCA devices, and paracetamol (1g iv every 6 hourly) was prescribed as complementary analgesia in all the cases. Parameters to evaluate analgesia obtained at rest, nausea and vomiting, motor blockade, sedation, pruritus and complementary analgesia given in the first 24 hours postoperatively. Results. Significative differences were not appreciated at the moment of evaluation of the analgesic efficiency of the three analgesic plans. Equally, sedation, nausea and vomiting had the same incidence in all groups. Motor blockade and pruritus appeared more frequently in the cases treated with femoral block and epidural catheter respectively. Conclusion We can not assert that any of the analgesic strategies was superior to the others as to its analgesic effectiveness, although pruritus appeared in the epidural group and motor blockade did in the femoral group, as adverse effects in few cases