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2009, Número 4

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Rev Mex Anest 2009; 32 (4)


Diclofenaco vs metamizol en analgesia preventiva para cirugía ginecológica

Paz-Estrada C, Céspedes-Cuenca Y

Idioma: Español
Referencias bibliográficas: 66
Paginas: 209-213
Archivo PDF: 58.71 Kb.


RESUMEN

Antecedentes: Una de las técnicas de analgesia preventiva para tratar el dolor postoperatorio incluye el uso de analgésicos no opioides. Objetivo: Comparar la eficacia analgésica postoperatoria de diclofenaco frente a metamizol en cirugía ginecológica. Material y método: Se realizó un estudio prospectivo y comparativo, en el Hospital «Guillermo Luis Fernández Hernández-Baquero», Holguín, Cuba, durante un período de diez meses. Se seleccionaron 108 pacientes, los cuales se dividieron al azar en dos grupos de 54 pacientes cada uno: Grupo I: diclofenaco 75 mg y Grupo II: metamizol 2 g ambos vía intravenoso, posterior a inducción de la anestesia. Se premedicaron con midazolam 0.02 mg/kg IV. Aplicamos anestesia general orotraqueal y registramos tensión arterial media y frecuencia cardíaca en varias etapas del perioperatorio así como los efectos adversos más frecuentes. Se midió la intensidad del dolor en el postoperatorio a través de la escala visual análoga. Resultados: Se observó una disminución del dolor en el postoperatorio en ambos grupos, más marcado con los pacientes del Grupo I, no siendo significativo a las 6 horas (p = 0.13). No obtuvimos efectos adversos asociados a ambos medicamentos. Conclusiones: La administración de diclofenaco y metamizol resultó eficaz al ser utilizados como analgesia preventiva en cirugía ginecológica.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Mc Quay HJ. Preemptive analgesia a systematic review of clinical studies. Ann-Med 1995;27:249-52.

  2. Gottin L, Finco G, Polati E. The preemptive analgesia in the treatment of postoperative pain. Chir Ital 1995;47:12-9.

  3. Wall PD. The prevention of acute pain. Pain 1988;33:289-290.

  4. Woolf CJ. Central mechanisms of acute pain. In: MR Bord, Charttan JE, Woolf CJ (eds). Proc of the IV World Congress of Pain, Elseiver. Amsterdan 1991:25-34.

  5. Ramírez-Guerrero A, Burlch-Bonechi J. Dolor agudo postoperatorio, su frecuencia y manejo. Rev Mex Anest 1992;15:16.

  6. Katz J, Kavavagh B. Preventive analgesia: Clinical evidence of neuroplasticy contributing to postoperatives Pain Anesth 1992;77:439-446.

  7. Bannwarth B, Demotes-Mainard F. Central analgesic effect of aspirin- like drugs. Fundam-Clin Pharmacol 1995;9:1-7.

  8. Tatsuhico M, Shuji D, Hiroyuki SH. Spinal antinociceptive effects of epidural nonsteroidal antiinflammatory drugs on nitric oxide-induced hyperalgesia in rat. Anesthesiology 1999;91:198-206.

  9. Ganem EM, Thadeu P, Marcodes Y. Effects of different doses of tenoxicam on spinal cord and meninges experimental study in dogs. Brazz J. Anesthesiol Int Issue 2000;50:60-62.

  10. Nishira J, Minami T. Effect of NMDA receptor antagonist on prostaglandin E2-induced hiperalgesia in concious mice. Brain Res 1995;677:138-44.

  11. Ohta Y. Inhibition of the spinal nociceptive transmission by NSAIDs in the neonatal rat spinal cord in vitro. Anesth Analg 1997;84:S1-S599.

  12. De Nicola Aniello. The Virtual Textbook. Postoperative Pain Management. 1997.

  13. Arenoso H. Cicloxigenasa. Dynia. 1997;II:33-38.

  14. Gorka Y, Kilickan L, Buluc L. Effect of diclofenac and intra-articular morphine/bupivacaine on postarthroscopic pain control. Minerva Anesthesiol 1999:741-5.

  15. Schmidt A, Bjorkman S, Akeson J. Preoperative diclofenac vs paracetamol in tonsillectomy effects on pain and bleeding. EJA. 2000;19:181-185.

  16. Vanegas H, Schaible HG. Prostaglandins and cyclooxygenases in the spinal cord. Prog Neurobiol 2001;64:327-363.

  17. Yaksh TL, Dirig DM, Conway CM. The acute antihyperalgesic action of nonsteriodal antiinflammatory drugs and released of spinal prostaglandin E2 is mediated by the inhibition of constitutive spinal cyclooxygenase-2 (COX-2) but not COX-1. J Neurosci 2001;21:5847-5853.

  18. Samad TA, Moore KA, Sapirstein A. Interleukin-1 beta mediated induction of COX-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 2001;410:471-475.

  19. Oberhofer D, Skok J, Nesek-Adam V. Intravenous ketoprofen in postoperative pain treatment after major abdominal surgery. Word J Surg 2005;29:446-9.

  20. Landwehr S, Kiencke P, Giesecke T, Eggert D, Thumann G, Kampe S. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery. Curr Med Res Opin 2005;21:1569-75.

  21. Grundmann U, Wornie C, Biedler A, Kreuer S, Wrobel M, Wilhelm W. The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg 2006;103: 217-22.

  22. Stamer UM, Hothker F, Lehnen K, Stuber F. Postoperative analgesia with tramadol and metamizol. Continual infusion versus patient controlled analgesia. Anaesthesist 2003;52:33-41.

  23. Montes A, Warner W, Puig MM. Use of intravenous patient-controlled analgesia for the documentation of synergy between tramadol and metamizol. Br J Anaesth 2000;85:217-23.

  24. Lehmann KA, Paral F, Sabatowski R. Postoperative pain therapy with hydromorphone and metamizole. A prospective randomized study in intravenous patient-controlled analgesia (PCA). Anaesthesist 2001;50:750-6.

  25. DeLoach LJ, Higgins MS, Caplan AT, et al. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg, 1998;86:102-106.

  26. Hiller A, Silvanto M, Savolainer S, Tarkkila P. Propacetamol and diclofenac alone in combination for analgesia after elective tonsillectomy. Acta Anaesthesiol Scand 2004;48:1185-9.

  27. Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E. Postoperative sensitization and pain after cesarean delivery and the effects of single in doses of tramadol and diclofenac alone and in combinations. Anesth Analg 2003;97:526-33.

  28. Yilmaz I, Sener M, Yavuz H, Yilmazer C, Erkan AN, Cagici CA, et al. Postoperative pain management in clinics of otolaryngology. Kulak Burun Bogaz Ihtis Derg 2006;16:1-6.

  29. Kaufmann J, Yesiloglu S, Patermann B, Krombach J, Kiencke P, Kampe S. Controlled-release oxycodone in better tolerated than intravenous tramadol/metamizol for postoperative analgesia after retinal-surgery. Curr Eye Res 2004;28:271-5.

  30. Torres LM, Rodríguez MJ, Montero A, Herrera J, Calderón E, Cabrera J, et al. Efficacy and safety of dipyrone versus tramadol in the management of pain alter hysterectomy: a randomized, double-blind, multicenter study. Reg Anesth Pain Med 2001;26:118-24.

  31. Kampe S, Warm M, Landwehr S, Dagtekin O, Haussmann S, Paul M, et al. Clinical equivalence of IV paracetamol compared to IV dipyrone for postoperative analgesia after surgery for breast cancer. Curr Med Res Opin 2006;22:1949-54.

  32. Legeby M, Sandelin K, Wickman M, Olofsson C. Analgesic efficacy of diclofenac in combination with morphined and immediate breast reconstruction. Acta Anaesthesiol Scand 2005; 49:1360.

  33. Forrest JB, Camu F, Greer IA, Kehlet H, Abdalla M, Bonnet F, et al. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. Br J Anaeth 2002;88:227-33.

  34. Mc Quay HJ. Preemptive analgesia a systematic review of clinical studies. Ann-Med 1995;27:249-52.

  35. Gottin L, Finco G, Polati E. The preemptive analgesia in the treatment of postoperative pain. Chir Ital 1995;47:12-9.

  36. Wall PD. The prevention of acute pain. Pain 1988;33:289-290.

  37. Woolf CJ. Central mechanisms of acute pain. In: MR Bord, Charttan JE, Woolf CJ (eds). Proc of the IV World Congress of Pain, Elseiver. Amsterdan 1991:25-34.

  38. Ramírez-Guerrero A, Burlch-Bonechi J. Dolor agudo postoperatorio, su frecuencia y manejo. Rev Mex Anest 1992;15:16.

  39. Katz J, Kavavagh B. Preventive analgesia: Clinical evidence of neuroplasticy contributing to postoperatives Pain Anesth 1992;77:439-446.

  40. Bannwarth B, Demotes-Mainard F. Central analgesic effect of aspirin- like drugs. Fundam-Clin Pharmacol 1995;9:1-7.

  41. Tatsuhico M, Shuji D, Hiroyuki SH. Spinal antinociceptive effects of epidural nonsteroidal antiinflammatory drugs on nitric oxide-induced hyperalgesia in rat. Anesthesiology 1999;91:198-206.

  42. Ganem EM, Thadeu P, Marcodes Y. Effects of different doses of tenoxicam on spinal cord and meninges experimental study in dogs. Brazz J. Anesthesiol Int Issue 2000;50:60-62.

  43. Nishira J, Minami T. Effect of NMDA receptor antagonist on prostaglandin E2-induced hiperalgesia in concious mice. Brain Res 1995;677:138-44.

  44. Ohta Y. Inhibition of the spinal nociceptive transmission by NSAIDs in the neonatal rat spinal cord in vitro. Anesth Analg 1997;84:S1-S599.

  45. De Nicola Aniello. The Virtual Textbook. Postoperative Pain Management. 1997.

  46. Arenoso H. Cicloxigenasa. Dynia. 1997;II:33-38.

  47. Gorka Y, Kilickan L, Buluc L. Effect of diclofenac and intra-articular morphine/bupivacaine on postarthroscopic pain control. Minerva Anesthesiol 1999:741-5.

  48. Schmidt A, Bjorkman S, Akeson J. Preoperative diclofenac vs paracetamol in tonsillectomy effects on pain and bleeding. EJA. 2000;19:181-185.

  49. Vanegas H, Schaible HG. Prostaglandins and cyclooxygenases in the spinal cord. Prog Neurobiol 2001;64:327-363.

  50. Yaksh TL, Dirig DM, Conway CM. The acute antihyperalgesic action of nonsteriodal antiinflammatory drugs and released of spinal prostaglandin E2 is mediated by the inhibition of constitutive spinal cyclooxygenase-2 (COX-2) but not COX-1. J Neurosci 2001;21:5847-5853.

  51. Samad TA, Moore KA, Sapirstein A. Interleukin-1 beta mediated induction of COX-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 2001;410:471-475.

  52. Oberhofer D, Skok J, Nesek-Adam V. Intravenous ketoprofen in postoperative pain treatment after major abdominal surgery. Word J Surg 2005;29:446-9.

  53. Landwehr S, Kiencke P, Giesecke T, Eggert D, Thumann G, Kampe S. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery. Curr Med Res Opin 2005;21:1569-75.

  54. Grundmann U, Wornie C, Biedler A, Kreuer S, Wrobel M, Wilhelm W. The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg 2006;103: 217-22.

  55. Stamer UM, Hothker F, Lehnen K, Stuber F. Postoperative analgesia with tramadol and metamizol. Continual infusion versus patient controlled analgesia. Anaesthesist 2003;52:33-41.

  56. Montes A, Warner W, Puig MM. Use of intravenous patient-controlled analgesia for the documentation of synergy between tramadol and metamizol. Br J Anaesth 2000;85:217-23.

  57. Lehmann KA, Paral F, Sabatowski R. Postoperative pain therapy with hydromorphone and metamizole. A prospective randomized study in intravenous patient-controlled analgesia (PCA). Anaesthesist 2001;50:750-6.

  58. DeLoach LJ, Higgins MS, Caplan AT, et al. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg, 1998;86:102-106.

  59. Hiller A, Silvanto M, Savolainer S, Tarkkila P. Propacetamol and diclofenac alone in combination for analgesia after elective tonsillectomy. Acta Anaesthesiol Scand 2004;48:1185-9.

  60. Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E. Postoperative sensitization and pain after cesarean delivery and the effects of single in doses of tramadol and diclofenac alone and in combinations. Anesth Analg 2003;97:526-33.

  61. Yilmaz I, Sener M, Yavuz H, Yilmazer C, Erkan AN, Cagici CA, et al. Postoperative pain management in clinics of otolaryngology. Kulak Burun Bogaz Ihtis Derg 2006;16:1-6.

  62. Kaufmann J, Yesiloglu S, Patermann B, Krombach J, Kiencke P, Kampe S. Controlled-release oxycodone in better tolerated than intravenous tramadol/metamizol for postoperative analgesia after retinal-surgery. Curr Eye Res 2004;28:271-5.

  63. Torres LM, Rodríguez MJ, Montero A, Herrera J, Calderón E, Cabrera J, et al. Efficacy and safety of dipyrone versus tramadol in the management of pain alter hysterectomy: a randomized, double-blind, multicenter study. Reg Anesth Pain Med 2001;26:118-24.

  64. Kampe S, Warm M, Landwehr S, Dagtekin O, Haussmann S, Paul M, et al. Clinical equivalence of IV paracetamol compared to IV dipyrone for postoperative analgesia after surgery for breast cancer. Curr Med Res Opin 2006;22:1949-54.

  65. Legeby M, Sandelin K, Wickman M, Olofsson C. Analgesic efficacy of diclofenac in combination with morphined and immediate breast reconstruction. Acta Anaesthesiol Scand 2005; 49:1360.

  66. Forrest JB, Camu F, Greer IA, Kehlet H, Abdalla M, Bonnet F, et al. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. Br J Anaeth 2002;88:227-33.




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