Balderas-Peña LMA, Macías-López GG, Zepeda-González A, González-Hernández I, Herrera-Rodríguez R, Fafutis-Morris M

Idioma: Español
Referencias bibliográficas: 28
Paginas: 526-533
Archivo PDF: 273.96 Kb.

RESUMEN

Introducción: La percepción del dolor es controversial. Los donadores renales son un modelo de individuos sanos sin enfermedades asociadas con dolor crónico que modifiquen la percepción. El objetivo de este estudio fue asociar la obesidad preoperatoria, el sexo y los marcadores séricos de la inflamación con la intensidad del dolor posquirúrgico y consumo de analgésicos.
Material y métodos: Se estudiaron 70 donadores renales clasificados en peso normal, sobrepeso y obesidad. Se determinó porcentaje de adiposidad, leptina, adiponectina, IL6, IL1β, TNFα, malondialdehído, velocidad de eritrosedimentación, leucocitos en sangre, glucosa y creatinina en suero, depuración de creatinina y perfil de lípidos una semana previa a la donación. Se evaluó el dolor a través de EVA (escala visual análoga) a las 0, 12, 24 y 48 horas posquirúrgicas. Se calcularon promedios, Anova o Kruskal-Wallis. Se determinó asociación entre EVA, consumo de ropivacaína y niveles preoperatorios de citocinas a través del coeficiente de correlación de Pearson, considerando significativa una p ≤ 0.05.
Resultados: Sujetos con peso normal y sobrepeso presentaron correlación positiva entre EVA y requerimientos anestésicos. La leptina se correlacionó positivamente con el IMC (índice de masa corporal) y adiposidad (rP = 0.574, rP = 0.764, respectivamente). La IL6 sérica fue mayor en varones que en mujeres, independientemente del IMC. El porcentaje de adiposidad y el IMC mostraron una correlación inversa con EVA a las 48 horas (rP = ‒0.442, rP = ‒0.397, respectivamente). La IL1β se correlacionó con EVA a las ocho horas (r = 0.417).
Conclusiones: No se observaron diferencias en niveles preoperatorios séricos de citocinas proinflamatorias y otros marcadores inflamatorios entre grupos. En nuestro estudio los sujetos con obesidad consumieron más ropivacaína.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Jankovic Z. Anaesthesia for living-donor renal transplant. Curr Anaesth Crit Care 2008;19:175-180.

2. Janke A, Collins A, Kozak T. Overview of the relationship between pain and obesity: what do we know? Where do we go next? J Rehabil Res Dev 2007;44:245-262.

3. Georgoudis G, Oldham J. Fat on pain perception threshold. Phys Ther Rev 2003;8;2:93-97.

4. Emery C, Keefe F, France C, Affleck G, Waters S, Fondow M, et al. Effect of a brief coping skills training intervention on nociceptive flexion reflex threshold in patients having osteoarthritic knee pain: a preliminary laboratory of sex differences. J Pain Symptom Manag 2006;31:262-269.

5. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C reactive protein levels in overweight and obese adults. JAMA 1999;282:2131-2135.

6. Hosogai N, Fukuhara A, Oshima K, Miyata Y, Tanaka S, Segawa K, et al. Adipose tissue hypoxia in obesity and its impact on adipocytokine dysregulation. Diabetes 2007;56:901-911.

7. American Society of Anesthesiologists. Practice Guidelines for Acute Pain Management in the Perioperative Setting. An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2004;100:1573-1581. Disponible en http://pain-topics.org/guidelines_reports/current_guidelines2.php#PracticeAUR

8. Brennan TJ, Zahn PK, Pogatzki-Zahn EM. Mechanisms of incisional pain. Anesthesiol Clin North Am 2005;23:1-20.

9. De Jongh R, Vissers K, Meert T, Booij L, De Deyne K, Heylen R. The role of interleukin-6 in nociception and pain. Anesth Analg 2003;96:1096-1103.

10. Edwards RR, Kronfli T, Haythornthwaite JA, Smith MT, McGuire L, Page GG. Association of catastrophizing with interleukin-6 responses to acute pain. Pain 2008;140:135-144.

11. Carvalho B, Clark DJ, Angst MS. Local and systemic release of cytokines, nerve growth factor, prostaglandin E2, and substance P in incisional wounds and serum following cesarean delivery. J Pain 2008;9:650-657.

12. Schäfers M, Svensson C, Sommer C, Sorkin L. Tumor necrosis factor-α induces mechanical allodynia after spinal nerve ligation by activation of p38 MAPK in primary sensory neurons. J Neurosci 2003;23:2517-2521.

13. Rocha A, Fernandes E, Quintao N, Campos M, Calixto J. Relevance of tumor necrosis factor-α for the inflammatory and nociceptive responses evoked by carrageenan in the mouse paw. Br J Pharmacol 2006;148:688-695.

14. Samad T, Moore K, Sapirstein A, Billet S, Allchorne A, Poole S, et al. Interleukin-1β-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 2001;410:471-475.

15. Buvanendran A, Kroin JS, Berger RA, Negrescu C, Moric M, Caicedo MS, et al. Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology 2006;104:403-410.

16. Saltevo J, Vanhala M, Kautiainen H, Kumpusalo E, Laakso M. Gender differences in C-reactive protein, interleukin-1 receptor antagonist and adiponectin levels in the metabolic syndrome: a populationbased study. Diabet Med 2008;25:747-750.

17. Ahonen TM, Kautiainen HJ, Keinänen-Kiukaanniemi SM, Kumpusalo EA, Vanhala MJ. Gender difference among smoking, adiponectin, and high-sensitivity C-reactive protein. Am J Prev Med 2008;35:598-601.

18. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva, Switzerland: World Health Organization, 1995. Disponible en http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf

19. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000. Disponible en https://apps.who.int/nut/documents/obesity_executive_summary.pdf

20. Nightingale JJ, Knight MV, Higgins B, Dean T. Randomized, doubleblind comparison of patient-controlled epidural infusion vs nurseadministered epidural infusion for postoperative analgesia in patients undergoing colonic resection. Br J Anaesth 2007;98:380-384.

21. Gustafson B. Adipose tissue, inflammation and atherosclerosis. J Atheroscler Thromb 2010;17:332-341.

22. Üçeyler N, Sommer C. Cytokine-induced pain: basic science and clinical implications. Rev Analg 2007;9:87-103.

23. Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nat Neurosci 2007;10:1361-1368.

24. Thacker MA, Clark AK, Marchand F, McMahon SB. Pathophysiology of peripheral neuropathic pain: immune cells and molecules. Anesth Analg 2007;105:838-847.

25. Üçeyler N, Schäfers M, Sommer C. Mode of action of cytokines on nociceptive neurons. Exp Brain Res 2009;196:67-78.

26. Guzik T, Mangalat D, Korbut D. Adipocytokines―novel link between inflammation and vascular function? J Physiol Pharmacol 2006;57:505-528.

27. Bravo-Cuéllar A, Romero-Ramos JE, Hernández-Flores G, Romo-Pérez F de J, Bravo-Cuéllar L, Lerma-Díaz JM. Comparison of two types of anesthesia on plasma levels of inflammatory markers. Cir Cir 2007;75:99-105.

28. Loram L, Themistocleous A, Fick L, Kamerman P. The time course of inflammatory cytokine secretion in a rat model of postoperative pain does not coincide with the onset of mechanical hyperalgesia. Can J Physiol Pharmacol 2007;85:613-620.