medigraphic.com

2013, Número 5

<< Anterior Siguiente >>

Cir Cir 2013; 81 (5)


Eficacia analgésica de la infiltración incisional de ropivacaína vs ropivacaína con dexametasona en la colecistectomía laparoscópica electiva

Evaristo-Méndez G, García de Alba-García JE, Sahagún-Flores JE, Ventura-Sauceda FA, Méndez-Ibarra JU, Sepúlveda-Castro RR

Idioma: Español
Referencias bibliográficas: 40
Paginas: 383-393
Archivo PDF: 471.97 Kb.


RESUMEN

Antecedentes: el dolor incisional es el principal obstáculo para la colecistectomía laparoscópica electiva ambulatoria.
Objetivo: evaluar la eficacia analgésica de la infiltración local de ropivacaína con dexametasona (Rop/Dx) en comparación con ropivacaína (Rop) sola, durante las primeras 24 horas del postoperatorio de esta cirugía.
Material y métodos: ensayo clínico aleatorizado, controlado y doble ciego, efectuado en 80 pacientes que para fines de estudio se dividieron en dos grupos. El grupo Rop (n= 40) recibió infiltración pre y post-incisional con 150 mg de ropivacaína en 8 mL de solución salina 0.9%, mientras que el grupo Rop/Dx (n= 40) recibió 150 mg de ropivacaína con 8 mg de dexametasona en 6 mL de solución salina 0.9%. La intensidad del dolor durante el reposo y el movimiento se evaluó a las 2, 4, 8, 12 y 24 horas del postoperatorio con una escala de clasificación numérica de 11 puntos. La hipótesis es que la intensidad del dolor incisional será menor en los pacientes del grupo Rop/Dx.
Resultados: las puntuaciones del dolor incisional en el grupo Rop/Dx fueron significativamente menores, comparadas con el grupo Rop, a las 12 horas (p= 0.05) y 24 horas (p= 0.01) durante el reposo y a las 12 horas (p= 0.04) y 24 horas (p= 0.01) durante el movimiento postoperatorio.
Conclusiones: la evidencia inicial es que la ropivacaína con dexametasona, por infiltración local, disminuye la intensidad del dolor incisional a partir de las 12 horas post-colecistectomía laparoscópica electiva con un buen perfil de seguridad.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001;90:261-269.

  2. Gilron I, Orr E, Tu D, Mercer CD, Bond D. A Randomized, Double- Blind Controlled Trial of Perioperative Administration of Gabapentin, Meloxicam and Their Combination for Spontaneous and Movement- Evoked Pain After Ambulatory Laparoscopic Cholecystectomy. Anesth Analg 2009;108:623-630.

  3. White PF, Kehlet H. Improving Postoperative Pain Management: What Are the Unresolved Issues? Anesthesiology 2010;112:220-225.

  4. Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc 2003;17:1961-1964.

  5. Salerno A, Hermann R. Efficacy and Safety of Steroid Use for Postoperative Pain Relief: Update and Review of the Medical Literature. J Bone Joint Surg Am 2006;88:1361-1372.

  6. Montazeri K, Okhovat A, Honarmand A, Safavi MR, Ashrafy L. Preincisional infiltration of tonsils with dexamethasone dose not reduce posttonsillectomy vomiting and pain in children. Saudi J Anaesth 2009;3:53-56.

  7. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative Dexamethasone Improves Surgical Outcome After Laparoscopic Cholecystectomy. A Randomized Double-Blind Placebo-Controlled Trial. Ann Surg 2003;238:651-660.

  8. Lehr R. Sixteen S-squared over D-squared: A relation for crude sample size estimates. Stat Med 1992;11:1099-1102.

  9. Matthews JN, Altman DG, Campbell MJ, Royston P. Analysis of serial measurements in medical research. BMJ 1990;300:230-235.

  10. Hernández IRS, Rivero SJL, Quezada AI, Castillo GR, Flores RJF, Ávila RJL. Colecistectomía laparoscópica ambulatoria en un hospital de segundo nivel de atención. Cir Gen 2008;30:13-16.

  11. Strichartz GR. Novel ideas of local anaesthetic actions on various ion channels to ameliorate postoperative pain. Br J Anaesth 2008;101:45- 47.

  12. Sarac AM, Aktan AÖ, Baykan N, Yegen C, Yalin R. The Effect and Timing of Local Anesthesia in Laparoscopic Cholecystectomy. Surg Laparosc Endosc 1996;6:362-366.

  13. Dávila FSA, Chávez CRH. Dolor postoperatorio en colecistectomía laparoscópica. Ropivacaína vs placebo. Ensayo clínico. Cir Gen 2010;32:96-99.

  14. Skjelbred P, Løkken P. Post-Operative Pain and Inflammatory Reaction Reduced by Injection of a Corticosteroid. A Controlled Trial in Bilateral Oral Surgery. Eur J Clin Pharmacol 1982;21:391-396.

  15. De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-analysis of Randomized Controlled Trials. Anesthesiology 2011;115:575-588.

  16. Jacobs J. How to perform local soft-tissue glucocorticoid injections. Best Pract Res Clin Rheumatol 2009;23:193-219.

  17. Rhen T, Cidlowski JA. Antiinflammatory Action of Glucocorticoids - New Mechanisms for Old Drugs. N Engl J Med 2005;353:1711- 1723.

  18. Johansson A, Hao J, Sjölund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand 1990;34:335-338.

  19. De Bosscher K, Vanden Berghe W, Haegeman G. The Interplay between the Glucocorticoid Receptor and Nuclear Factor-kB or Activator Protein-1: Molecular Mechanisms for Gene Repression. Endocr Rev 2003;24:488-522.

  20. Norman AW, Mizwicki MT, Norman DPG. Steroid-hormone rapid actions, membrane receptors and a conformational ensemble model. Nat Rev Drug Discov 2004;3:27-41.

  21. Jakobsson J. Preoperative single-dose intravenous dexamethasone during ambulatory surgery: update around the benefit versus risk. Curr Opin Anesth 2010;23:682-686.

  22. Farrar JT, Berlin JA, Strom BL. Clinically Important Changes in Acute Pain Outcome Measures: A Validation Study. J Pain Symptom Manage 2003;25:406-411.

  23. Vieira PA, Pulai I, Tsao GC, Manikantan P, Keller B, Connelly NR. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesth 2010;27:285-288.

  24. Holte K, Werner MU, Lacouture PG, Kehlet H. Dexamethasone Prolongs Local Analgesia after Subcutaneous Infiltration of Bupivacaine Microcapsules in Human Volunteers. Anaesth 2002;96:1331-1335.

  25. Cummings KC 3rd, Napierkowski DE, Parra-Sanchez I, Kurz A, Dalton JE, Brems JJ, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth 2011;107:446-453.

  26. Ikeuchi M, Kamimoto Y, Izumi M, Fukunaga K, Aso K, Sugimura N, et al. Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2013 (consultado 2013 jun 1). Disponible en http://link.springer.com/content/pdf/10.1007%2 Fs00167-013-2367-5#

  27. Shantiaee Y, Mahjour F, Dianat O. Efficacy comparison of periapical infiltration injection of dexamethasone, morphine and placebo for postoperative endodontic pain. Int Dent J 2012;62:74-78.

  28. Tiippana E, Bachmann M, Kalso E, Pere P. Effect of paracetamol and coxib with or without dexamethasone after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2008;52:673-680.

  29. Bjune K, Stubhaug A, Dodgson MS, Breivik H. Additive analgesic effect of codeine and paracetamol can be detected in strong, but not moderate, pain after Caesarean section. Baseline pain-intensity is a determinant of assay-sensitivity in a postoperative analgesic trial. Acta Anaesthesiol Scand 1996;40:399-407.

  30. Wang JJ, Ho ST, Tzeng JI, Tang CS. The Effect of Timing of Dexamethasone Administration on Its Efficacy as a Prophylactic Antiemetic for Postoperative Nausea and Vomiting. Anesth Analg 2000;91:136-139.

  31. Lim SH, Jang EH, Kim MH, Cho K, Lee JH, Lee KM, et al. Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia. Korean J Anaesth 2011;61:315-319.

  32. Hval K, Thagaard KS, Schlicting E, Raeder J. The Prolonged Postoperative Analgesic Effect When Dexamethasone Is Added to a Nonsteroidal Antiinflammatory Drug (Rofecoxib) Before Breast Surgery. Anesth Analg 2007;105:481-486.

  33. Romundstad L, Stubhaug A. Glucocorticoids for Acute and Persistent Postoperative Neuropathic Pain: What Is The Evidence? Anaesth 2007;107:371-373.

  34. Maestroni U, Sortini D, Devito C, Pour Morad Kohan Brunaldi F, Anania G, Pavanelli L, et al. A new method of preemptive analgesia in laparoscopic cholecystectomy. Surg Endosc 2002;16:1336-1340.

  35. Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain 1994;58:387- 392.

  36. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The Visual Analogue Scale in the Immediate Postoperative Period: Intrasubject Variability and Correlation with a Numeric Scale. Anesth Analg 1998;86:102- 106.

  37. Karanicolas PJ, Smith SE, Kanbur B, Davies E, Guyatt GH. The Impact of Prophylactic Dexamethasone on Nausea and Vomiting After Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Ann Surg 2008;248:751-762.

  38. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002;195:694-712.

  39. Kuczkowski KM. Perineal pruritus and dexamethasone Anaesth 2004;59:308.

  40. Papadopoulos PJ, Edison JD. Soft tissue atrophy after corticosteroid injection. Cleve Clin J Med 2009;76:373-374.




2020     |     www.medigraphic.com