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2006, Número 1

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Rev Mex Anest 2006; 29 (1)


Analgesia epidural postoperatoria. Estudio comparativo doble ciego entre fentanyl/bupivacaína vs morfina/bupivacaína

Ramírez-Guerrero JA, Gutiérrez-Sougarret B

Idioma: Español
Referencias bibliográficas: 42
Paginas: 15-19
Archivo PDF: 63.40 Kb.


RESUMEN

Objetivo: Se realizó un estudio prospectivo, doble ciego para comparar la analgesia y los efectos adversos de la analgesia epidural con fentanyl/bupivacaína vs morfina/bupivacaína. Método: Se incluyeron 57 pacientes sometidos a cirugía abdominal mayor manejados con anestesia epidural o mixta. Veintiocho recibieron un bolo de 50 µg de fentanyl seguido 120 ml de una infusión continua con fentanyl 6 µg/ml y bupivacaína al 0.065% a 5 ml/h. A 29 pacientes se les aplicó un bolo de 2 mg de morfina seguido de 120 ml en infusión con bupivacaína al 0.0625% más 3 mg de morfina, a 5 ml/h. Se evaluaron en forma doble ciego: dolor con la escala visual análoga en reposo e inspiración, prurito (leve, moderado e intenso), náusea que requería de tratamiento y vómito. Resultados: En ambos grupos el dolor fue bien controlado. El grupo de morfina mostró una frecuencia significativamente mayor de náusea (48% vs 18%), vómito (38% vs 3.5%) y prurito (31% vs 7%). Conclusión: La analgesia epidural con fentanyl/bupivacaína se asocia a menos efectos adversos que la analgesia epidural con morfina/bupivacaína, probablemente por las diferencias farmacocinéticas a nivel espinal entre fentanyl y morfina.


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