PROJ, Orozco OP, Fuente LM

Language: Spanish
References: 20
Page: 128-133
PDF size: 61.62 Kb.

ABSTRACT

Objective: To evaluate the advantages and feasibility of multimodal analgesia in Laparoscopic Cholecystectomy with trans op cholangiography and posterior funduplication in patients (ptes) with GERD. Wound infiltration with bupivacaine 0.5% and the use of COX2 inhibitors as the only analgesic drug. Methods: From July 2002 to July 2003 we performed 38 laparoscopic cholecystectomies with trans op cholangiography and 32 laparoscopic posterior funduplications (270°), in patients with GERD at the ABC hospital (surgical department) in a 23-24 h stay regimen. 100% of our patients were managed with general anesthesia and the use of bupivacaine 0.5% for wound infiltration before the incision was made, the use of COX2 inhibitors for 7 days. The post-op pain was assessed on a visual analog scale (VAS) 0-100 mm, with measures of morphine consumption. Results: Patients with Cholecystectomy with trans-op cholangiography. At 0 hours the VSA was: 20 ptes (52.6%) # 2-3, 7 ptes (18.4%) # 4-5, 4 ptes (10.5%) # 5-6, 7 ptes (18.4%) # 8-3. At 3 hours with VSA: 4 ptes (10.5%) # 3, 30 ptes (78.9%) # 4-5, 4 ptes (10.5%) # 5-6. At 6 hours with VSA: 32 ptes (84.2%) # 3, 6 ptes (15.7%) # 4-5. At 12 hours with VSA: 4 ptes (10.5%) # 2, 28 ptes (73.6%) # 3, 6 ptes (15.7%) # 4-5. At 23 hours with VSA: 32 ptes (84.2%) # 2-3, 6 ptes (15.7%) # 4-5. At 36 hours and by phone the VSA was: 30 ptes (78.9%) # 3, 7 ptes (18.4%) # 4 y 1 ptes (2.6%) # 5. At 48 hour and by phone the VSA was: 32 ptes (84.2%) # 3, 6 ptes (15.7%) # 4. At the seventh day on their first post-op office visit the VSA was: 34 ptes (89.4%) # 2, 3 ptes (7.9%) # 3 y 1 pte (2.6%) # 4. Ptes with 270° posterior funduplication Toupet type with GERD: At 0 hours the VSA was: 20 ptes (62.5%) # 2-3, 5 ptes (15.6%) # 3-4, 4 ptes (12.5%) # 5-6, 3 ptes (9.3%) # 9-10. At 3 hours the VSA was: 23 ptes (71.8%) # 2-3, 5 ptes (15.6%) # 3-4, 4 ptes (12.5%) # 5-6. At 6 hours the VSA was: 26 ptes (81.2%) # 2-3, 5 ptes (15.6%) # 3-4, 1 patient (3.1%) # 5. At 12 hours the VSA was: 26 ptes (81.2%) # 2-3, 6 ptes (18.7%) # 3-4. At 23 hours the VSA was: 29 ptes (90.6%) # 2-3, 3 ptes (9.3%) # 3-4. At 36 hours by phone the VSA was: 28 ptes (87.5%) # 2-3, 3 ptes (9.3%) # 3-4 y 1 pte (3.1%) # 5. At 48 hours by pone the VSA was: 30 ptes (93.7%) # 2-3, y 2 ptes (6.2%) # 3-4. At the seventh day on their first post-op office visit the VSA was: 32 ptes (100%) # 2-3. Four mg morphine was administrated on 10 ptes (14.3%) at 0 hours, seven of those ptes where from the group of the cholecistectomy and three from the posterior funduplication. Conclusion: Management in acute perioperatory pain in laparoscopic cholecystectomy with trans op. Cholangiography and posterior 270° funduplication in GERD ptes with multimodal analgesia is not only feasible but possible and very effective.

REFERENCES

1. Kehlet H. Surgical stress response dose endoscopic surgery conference an advantage? World J Surg 1999; 23: 801-7.

2. Holte K, Kehlet H. Postoperative ileus a preventable event. Br J Surg 2000; 87: 1480-93.

3. Kehlet H, Wilmore D. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630-641.

4. Car DB, Goudas LC. Acute pain management. Programs in US hospitals and experiences and attitudes among US adults. Anesthesiology 1995; 83: 1090-4.

5. Mc Quay HJ, Moore RA, Justings D. Treating acute pain in hospital. BMJ 1997; 314: 1531-5.

6. Mc Quay HJ, Moore RA. An evidence based resource for pain relief. Oxford University Press: 1998: 1-264.

7. Kehnet H, Werner M, Perkings F. Balanced Analgesia. What is it and what are its advantages in postoperative pain? Drugs 1999; 58: 793-7.

8. Koala RJ, Ransik M, Briggs L, Baum D. Comparison of wound created by Non-blade trocars and pyramidal tip trocars in the pig. J Lap Endos & Adv Surg Tech 1999; 9: 465-61.

9. Dahl JB, Kehlet H. Non steroidal anti-inflammatory drugs rationale for use in severe postoperative pain. Br J Anéese 1991; 66: 703-12.

10. Haynes TK, Epidural IR, Power I, Rosen M, Grant A. Intra Articular morphine and bupivacaine analgesia after arthroscopic knee surgery. Anesthesia 1994; 49: 54-6.

11. Reuben SS, Connelly NR. Postoperative analgesia for outpatient arthroscopic knee surgery with intra articular bupivacaine and ketorolac. Anesth Analg 1995; 80: 1154-7.

12. Tuerskoy M, Oren M, Vaskovich M, Dashkovisky I, Kissin I. Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanism; a study in postoperative patients. Neurosc Lett 1996; 215: 5-8.

13. Laurent SC, Nolan JP, Pozo JL, Jones CJ. Addition of morphine to intra articular bupivacaine does not improve analgesia after day case arthroscopy. Br J Anesth 1994; 72: 170-3.

14. Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anaesth 2001; 13: 524-539.

15. Ho KS, Eu KW, Seow-Choen F, Chan YW. Randomized clinical trail of hemorrhoidectomy under a mixture of local anesthesia versus general anesthesia. Br J Surg 2000; 87: 410-3.

16. Chester JF, Stanford BJ, Gazet JC. Analgesics benefits of locally injected bupivacaine after hemorrhoidectomy. Dis Colon Rectum 1990; 33: 487-9.

17. Erichsen CJ, Vibits H, Dazhl JB, Kehlet H. Wound infiltration with rupivacaine and bupivacaine for pain after inguinal herniotomy. Acta Anaesthesiol Scand 1995; 39: 67-70.

18. Petterson N, Emanuelson BM, Reventlid H, Hahn RG. High dose rupivacaine wound infiltration for pain relief after inguinal hernia repair. Reg Anesth Pain Med 1998; 23: 189-96.

19. Dahl JB, Hijortso NC, Satge JG et al. Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on posoperative pain, pulmonary and endocrine metabolic function after mini laparotomy cholecystectomy. Reg Anesth 1994; 19: 199-205.

20. Rosaeg OP, Lui AC, Cicutti NJ, Bragg PR, Crosson ML, Krepski B. Perioperative multimodal pain therapy for caesarean sectioanalgesia and fitness for discharge. Can J Anaesth 1997; 44: 803-9.