Echevarría HAT, Toledo CF, Rodríguez BT, González ME, Crespo GA

Language: Spanish
References: 15
Page:
PDF size: 170.41 Kb.

ABSTRACT

Introduction: Decompressive surgery is relatively common in shoulder pain syndrome. Postsurgical pain hampers the early rehabilitation of these patients and their reincorporation to work and social life.
Objective: Evaluate and demonstrate the efficacy of the use of the bupivacaine-morphine combination vs. bupivacaine alone, administered through an intra-articular catheter, for postoperative analgesia and rehabilitation in shoulder surgery.
Methods: An analytical prospective longitudinal study was conducted with 80 patients of both sexes aged 40-65 cared for at "Dr. Luis Diaz Soto" Central Military Hospital in Havana, which extended from October 2009 to May 2010. The patients were randomly distributed into 2 groups, each with 40 members. In Group I, 2 mg of lyophilized morphine were added to the local anesthetic every 24 hours. In Group II, only 0.25 % bupivacaine (20 mL) was added every 6 hours. Postoperative analgesia was evaluated with the Analog Visual Scale (AVS). Results were compared by means of a chi-square test with a 95 % confidence degree.
Results: On average, prolongation of combined postoperative analgesia in Group I was 13.5 hours vs. 4.55 hours in Group II, where only bupivacaine was used during the first 24 hours. A better evolution of pain was also observed in Group I during the next 24 to 48 hours.
Conclusions: Administration of the anesthetic mixture combined with the analgesic through an intra-articular catheter to relieve postoperative pain in shoulder surgery is more effective, with mild, easily manageable side effects, thus enabling early rehabilitation.

REFERENCES

1. Covarrubias-Gómez A. Manejo farmacológico del dolor perioperatorio. Rev Mexicana Anest. 2007 [consultado 20 de diciembre 2010];30(1): Disponible en: http://www.medigraph.com

2. McDonald J, Lambert D. Opioid receptors. Continuing Education in Anaesthesia. Critical Care & Pain. 2005;5(1):22-5.

3. Zollner C. Opioid Receptor Ligands and Sites of Action. En: Stein C. Analgesia. Berlin: Verlag Berlin Heidelberg Ed; 2007. pp. 32-40.

4. Guevara López U, Covarruvias Gómez A. Parámetros de práctica para el manejo del dolor agudo posoperatorio. Cirugía y Cirujanos. 2005;73(3):31-5.

5. Simões de Almeida MC, de Figueiredo Locks G, Pereira Gomes H, Muriano Brunharo G, Colle Kauling AL. Analgesia posoperatoria: Comparación entre la infusión continua de anestésico local y opioide vía catéter epidural e infusión continua de anestésico local vía catéter en la herida operatoria. Rev Brasileira de Anest. 2011;61(3):201-15.

6. Ramón JM. El tratamiento del dolor agudo posoperatorio, una oportunidad de mejora. Revista de la Sociedad Española del Dolor. 2007;14(1):1-2.

7. Yera Nadal JL, Guillen Vargas M, Hernández Luaces LF. Analgesia posoperatoria en cirugía artroscópica de rodilla. Estudio multicéntrico. Rev Cubana Anestesiol Reanim. 2003;2(2):31-6.

8. Woolf C. Central mechanisms of acute pain. Proceedings of the 6th World Congress on Pain. 1991;3:25-7.

9. Mugabure B, Echaniz E, Marín M. Fisiología y farmacología clínica de los opioides epidurales e intratecales. Rev Soc Esp Dolor. 2005;12:33-45.

10. Yanagidate F, Strichartz GR. Local Anesthetics. En: Stein C. Analgesia. Berlin: Verlag Berlin Heidelberg Ed; 2007. pp. 96-115.

11. Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative review of randomized controlled trials. J Am Coll Surg. 2006;203:914-32.

12. Aréchiga-Ornelas G, Mille-Loera JE, Portela-Ortiz JM. Analgesia periférica. Nuevos dispositivos, viejos fármacos. Rev Mexicana Anest. 2011;34(Suppl 1):S98-S101.

13. Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102:248-57.

14. Quiroga B, Altermatt C. Impacto de la anestesia regional periférica en cirugía ambulatoria. Rev Chil Anest. 2011;40:214-23.

15. Mejía-Terrazas GE, Zaragoza-Lemus G. Anestesia para cirugía de hombro. Rev Mexicana Anest. 2011 [consultado 20 de diciembre 2010];34(2): Disponible en: http://www.medigraph.com