medigraphic.com
ISSN 2992-8036 (Digital)
ISSN 2306-4102 (Impreso)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2009, Número 6

<< Anterior Siguiente >>

Acta Ortop Mex 2009; 23 (6)


Efecto analgésico del fentanyl intraarticular en artroscopía de rodilla para el síndrome de hiperpresión lateral patelofemoral

Gutiérrez-Mendoza I, Pérez-Correa JJ, Serna-Vela F, Góngora-Ortega J, Vilchis-Huerta V, Pérez-Guzmán C, Hernández-Garduño E, Vidal-Rodríguez FA

Idioma: Español
Referencias bibliográficas: 42
Paginas: 336-341
Archivo PDF: 119.32 Kb.


RESUMEN

Introducción: Durante la artroscopía para el tratamiento del síndrome de hiperpresión lateral patelofemoral (SHL) la morfina intra-articular o sus derivados (fentanyl) pueden reducir el dolor postquirúrgico cuando se asocia a anestésicos. Por lo que decidimos valorar si la adición de fentanyl a epinefrina y bupivacaína produce mayor analgesia. Material y métodos: Distribuimos aleatoriamente a 40 pacientes en dos grupos. Al grupo experimental (n = 20) se le administró bupivacaína 0.5% (2 mg/kg), epinefrina (100 mg) y fentanyl (2.5 mg/kg). Al grupo control (n = 20) bupivacaína 0.5% (2 mg/kg) y epinefrina (100 mg). Se les practicó condroplastía y liberación retinacular y evaluamos dolor, tiempo de analgesia y arco de movimiento en el transoperatorio a las 6 y 24 horas postoperatoria. Resultados: La edad y grado de condromalacia patelofemoral (CPF) fueron similares entre ambos grupos (p › 0.05). El dolor y los arcos de movimiento en el transoperatorio a las 6 y 24 horas después de la cirugía no fue diferente entre ambos grupos (p › 0.05). El tiempo de analgesia después de la cirugía fue similar (p › 0.05). Conclusiones: La adición intraarticular de fentanyl a la combinación de epinefrina más bupivacaína no disminuyó el dolor, no aumentó el tiempo de analgesia ni el arco de movimiento en pacientes sometidos a artroscopía de rodilla en pacientes con SHL.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Takagi K: Practical experiences using Takagi’s arthroscope. J Jap 1933; 8: 132.

  2. Fu FH, Maday MG: Arthroscopic lateral release and the lateral patellar compress. Raj N, Sehgal A, Hall JE, Sharma A, Murrin KR, Groves ND. Comparison of the analgesic efficacy and plasma concentrations of high-dose intra-articular and intramuscular morphine for knee arthroscopy. Eur J Anaesthesiol 2004; 21: 932-7.

  3. Fanelli G, Danelli G, Zasa M, Baciarello M, Di Cianni S, Leone S: Intrathecal ropivacaine 5 mg/ml for outpatient knee arthroscopy: a comparison with lidocaine 10 mg/ml. Acta Anaesthesiol Scand 2009; 53: 109-15.

  4. Law BK, Yung PS, Ho EP, Chang JJ, Kwok GK, Fung KY, Chan KM: Review of knee arthroscopy performed under local anesthesia. Sports Med Arthrosc Rehabil Ther Technol 2009; 19: 1-3.

  5. Forssblad M, Jacobson E, Weidenhielm L: Knee arthroscopy with different anesthesia methods: a comparison of efficacy and cost. Knee Surg Sports Traumatol Arthrosc 2004; 12: 344-9.

  6. Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T: The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop Relat Res 1978; 134: 158-67.

  7. Jacobson E, Magnus F, Rosenberg J, Westman L, Weidenhielm L: Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal and general anesthesia. Arthroscopy 2000; l6: 183-90.

  8. Aronowitz ER, Kleinbart FA: Outpatient ACL reconstruction using intraoperative local analgesia and oral postoperative pain medication. Orthopedics 1998; 21: 781-4.

  9. Lorentsen AG, Enggaard TP, Bay M: Ambulatory knee arthroscopy in arthroscopic surgery under local anesthesia. Ugeskr Laeger 1997; 17; 159: 6997-9.

  10. Westman L, Valentin A, Engstrom B, Ekblom A: Local anesthesia for arthroscopic surgery of the ankle using pethidine or prilocaine. Arthroscopy 1997; 13: 307-12.

  11. Kaeding CC, Hill JA, Katz J, Benson L: Bupivacaine use after knee arthroscopy: pharmacokinetics and pain control study. Arthroscopy 1990; 6: 33-9.

  12. Chirwa SS, MacLeod BA, Day B: Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy 1989; 5: 33-5.

  13. Osborne D, Keene G: Pain relief after arthroscopic surgery of the knee: a prospective, randomized and blinded assessment of bupivacaine and bupivacaine with adrenaline. Arthroscopy 1993; 9: 177-80.

  14. Anz A, Smith MJ, Stoker A, Linville C, Markway H, Branson K, Cook JL: The effect of bupivacaine and morphine in a coculture model of diarthrodial joints. Arthroscopy 2009; 25: 225-31.

  15. Stein C, Comisel K, Haimerl E, Yassouridis A, Lehrberger K, Herz A, Peter K: Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991; 17; 325: 1123-6.

  16. Stein C, Yassouridis A: Peripheral morphine analgesia. Pain 1997; 71: 119-21.

  17. Stein C: Peripheral mechanism of opioid analgesia. Anesth and Analg 1993; 76: 182-91.

  18. Dalsgaard J, Felsby S, Juelsgaard P, Froekjaer J: Low-dose intra-articular morphine analgesia in day case knee arthroscopy: a randomized double-blinded prospective study. Pain 1994; 56: 151-4.

  19. Dierking GW, Ostergaard HT, Dissing CK, Kristensen JE, Dahl JB: Analgesic effect of intra-articular morphine after arthroscopic meniscectomy. Anaesthesia 1994; 49: 627-9.

  20. Björnsson A, Gupta A, Vegfors M, Lennmarken C, Sjoberg F: Intra-articular morphine for postoperative analgesia following knee arthroscopy. Reg Anesth 1994; 19: 104-8.

  21. Uysalel A, Kecik Y, Kirdemir P, Sayin M, Binnet M: Comparison of intra-articular bupivacaine with the addition of morphine or fentanyl for analgesia after arthroscopic surgery. Arthroscopy 1995; 11: 660-3.

  22. Altunkaya H, Ozer Y, Demirel CB, Ozkocak I, Keser S, Bayar A: Preoperative multimodal administration of morphine in arthroscopic surgery. Arch Orthop Trauma Surg 2005; 125: 609-13.

  23. Pooni JS, Hickmott K, Mercer D, Myles P, Khan Z: Comparison of intra-articular fentanyl and intra-articular bupivacaine for post-operative pain relief after knee arthroscopy. Eur J Anaesthesiol 1999; 16: 708-11.

  24. Raja SN, Dickstein RE, Johnson CA: Comparison of postoperative analgesic effects of intra-articular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 1992; 77: 1143-7.

  25. Cepeda MS, Uribe C, Betancourt J, Rugeles J, Carr DB: Pain relief after knee arthroscopy: intra-articular morphine, intra-articular bupivacaine or subcutaneous morphine? Reg Anesth 1997; 22: 233-8.

  26. Boden BP, Fassler S, Cooper S, Marchetto PA, Moyer RA: Analgesic effect of intra-articular morphine, bupivacaine and morphine/bupivacaine after arthroscopic knee surgery. Arthroscopy 1994; 10: 104-7.

  27. De Andres J, Bellver J, Barrera L, Febre E, Bolinches R: A comparative study of analgesia after knee surgery with intra-articular bupivacaine, intra-articular morphine and lumbar plexus block. Anesth Analg 1993; 77: 727-30.

  28. Aasbo V, Raeder JC, Grogaard B, Roise O: No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy. Acta Anaesthesiol Scand 1996; 40: 585-8.

  29. Lawrence AJ, Joshi GP, Michalkiewicz A, Blunnie WP, Moriarty DC: Evidence for analgesia mediated by peripheral opioid receptors in inflammed synovial tissue. Eur J Clin Pharmacol 1992; 43: 351-5.

  30. Elsharnouby NM, Eid HE, Abou Elezz NF, Moharram AN: Intra-articular injection of magnesium sulphate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesth Analg 2008; 106: 1548-52.

  31. Zeidan A, Kassem R, Nahleh N, Maaliki H, El-Khatib M, Struys MM, Baraka A: Intra-articular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg 2008; 107: 292-9.

  32. Dunn WR, Cordasco FA, Flynn E, Jules K, Gordon M, Liguori G: A prospective randomized comparison of spinal versus local anesthesia with propofol infusion for knee arthroscopy. Arthroscopy 2006; 22: 479-83.

  33. Goodwin RC, Parker RD. Comparison of the analgesic effects of intra-articular injections administered preoperatively and postoperatively in knee arthroscopy. J Knee Surg 2005; 18: 17-24.

  34. Vranken JH, Vissers KC, de Jongh R, Heylen R: Intra-articular sufentanyl administration facilitates recovery after day-case knee arthroscopy. Anesth Analg 2001; 92: 625-8.

  35. Goodwin RC, Amjadi F, Parker RD: Short-term analgesic effects of intra-articular injections after knee arthroscopy. Arthroscopy 2005; 21: 307-12.

  36. Stein C, Millan MJ, Shippenberg TS, Peter K, Hertz A: Peripheral opioid receptors mediating antinociception in inflammation. Evidence for involvement of mu, delta and Kappa receptors. J Pharmacol and Exp Ther 1989; 248: 1269-75.

  37. Stein C: The control of pain in peripheral tissue by opioids. New England J Med 1995; 332: 1685-90.

  38. Cohen S, Lowenwirt I, Pantuck CB, Amar D, Pantuck EJ: Bupivacaine 0.01% and/or epinephrine 0.5 microg/ml improve epidural fentanyl analgesia after cesarean section. Anesthesiology 1998; 89: 1354-61.

  39. Priston MJ, Hughes JM, Santillo M, Christie IW: Stability of an epidural analgesic admixture containing epinephrine, fentanyl and bupivacaine. Anaesthesia 2004; 59: 979-83.

  40. Gupta S, Rathore P, Raiger LK: Epidural for labour analgesia-bupivacaine + fentanyl vs bupivacaine + fentanyl + epinephrine. Middle East J Anesthesiol 2005; 18: 611-22.

  41. Goring-Morris J, Russell IF: A randomized comparison of 0.5% bupivacaine with a lidocaine/epinephrine/fentanyl mixture for epidural top-up for emergency caesarean section after «low dose» epidural for labour. Int J Obstet Anesth 2006; 15: 109-14.

  42. Goodman SR, Kim-Lo SH, Ciliberto CF, Ridley DM, Smiley RM: Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia. Reg Anesth Pain Med 2002; 27: 374-9.




2020     |     www.medigraphic.com