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2002, Número 4

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Rev Mex Anest 2002; 25 (4)


Dolor abdominopélvico y su tratamiento.

Plancarte SR

Idioma: Español
Referencias bibliográficas: 57
Paginas: 289-297
Archivo PDF: 190.53 Kb.


RESUMEN

El dolor pélvico crónico es una entidad médica poco reconocida,aunque para las pacientes el dolor pélvico no relacionado a trastornos menstruales puede ocasionar incapacidad y requerir largos tratamientos médicos o quirúrgicos. Este tipo de dolor suele acompañarse de hiperactividad simpática y trastornos psicológicos como anorexia, apatía, e insomnio. Este tipo de dolor podrá presentarse ante una etiología bien definida, pero en otros casos hay una ausencia de evidencias que expliquen la causa del dolor; existiendo una mezcla de componentes somático, simpático y neuropático. La mayoría de la inervación de las estructuras pélvicas ocurre a través del plexo hipogástrico superior.Como en otras situaciones el valor de los bloqueos neurales para el tratamiento del dolor crónico es poco reconocido. Las técnicas intervencionistas neurolíticas o neuroquirúrgicas deben ser consideradas como un complemento de las terapias farmacológicas. En este reporte se consideran los diferentes bloqueos intervencionistas como: Bloqueo simpático lumbar, bloqueo del plexo hipogástrico superior, bloqueo del ganglio de Walther, bloqueo perimedular y terapia con opioides intra espinales y los bloqueos nerviosos periféricos. En la situación del dolor de origen no oncológico y oncológico estos procedimientos tienen valor diagnóstico, pronóstico y terapéutico, particularmente las intervenciones en el Plexo Hipogástrico Superior y el Ganglio de Walter que han sido validadas y reconfirmadas por diferentes grupos de investigadores en diferentes países, considerándo las en el momento actual como parte del armamentario para el tratamiento del dolor crónico de la pelvis.


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