Jaime-Córdova A, Hernández-Favela P, Ortiz-Ruiz RN, Nava y LE

Language: Spanish
References: 18
Page: 32-39
PDF size: 93.68 Kb.

ABSTRACT

The postoperative pain is difficult to control; the analgesic therapy failure reaches 70%, mostly because of the dose of analgesic or the route of administration. The patient-controlled analgesia (PCA) infusion pumps delivered epidurally has been successful. Objectives: To identify the minimum efficacious dose of ropivacaine and fentanyl and to evaluate its secondary effects and patient’s comfort. Methods: 114 patients were allocated in four groups receiving different concentrations of the drugs. All groups were similar regarding weight, height and age. Patient’s perception of painwas evaluated by using an analogue visual scale (AVS). Results: There were statistically significant differences among groups regarding the dose and the consumption of analgesics, and the intensity of pain according to the AVS (p ‹ 0.05) Patients of the four groups reported comfort using the PCA to control postoperative pain. Conclusion: Using PCA delivered epidurally showed successful results; plasma levels of analgesic controlled postoperative pain appropriately, thus facilitating the patients to resume its daily activities.

REFERENCES

1. Olivas G, Mata V, Cuellar J, Esparza L, Aldana A. Cesárea: Manejo contemporáneo del dolor agudo postoperatorio. Ginec Obst Mex 2002;70:82-89.

2. Brown AR. Continuous regional Analgesia. Rev Mex Anest Vol 27 Supl 1. 2004. pag S90-94.

3. Wulf H, Biscoping J, Beland B. Bachmann-Mennega B, Motsch J. Ropivacaine epidural and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Anesth Analg 1999;89:111-116.

4. Narinder R, Renèe A, Kjell A, Jan H. Gustav E. Torbjon O, Anders A. Patient- controlled regional analgesia (PCRA) at home. Anesthesiology 2002,96;1290-6.

5. Granot M, Lowentein L, Yarnitsky D, Tamir A, Zimmer E. Postcesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology 2003:98;1422-6.

6. Sharma S, James M, Messick G, Bloom S, Mclntire D, Wiley J, Leveno K. A randomized trial of epidural analgesia versus intravenous meperidina analgesia during labor in nulliparous women. Anesthesiology 2002;96:546-51.

7. Dirks J, Moiniche S, Lisa K, Dahl J. Mechanisms of postoperative pain: Clinical indication for a contribution of central neuronal sensitization. Anesthesiology 2002;97:1591-6.

8. Curatolo M, Steen P, Lars A. Sensory assessment of regional analgesia in humans. Anesthesiology 2000:93;1517-30.

9. Debon R, Chassard D, Duflo F, Boselli E, Bryssine B, Allaouchiche B. Chronobiology of epidural ropivacaine. Anesthesiology 2002;96:542-5.

10. Senard M, Joris J. Use of ropivacaine for peridural postoperative analgesia. Ann Fr Anesth Reanim 2002;21:713-24.

11. Abrahams M, Higgins P, Whyte P, Breen P, Muttu S, Gardiner J. Intact proprioception and control of labour pain during epidural analgesia. Acta Anaesthesiol Scand 1999:43;46-50.

12. Burmeister MA, Gottschalk A, Wilhelm S, Schroeder F, Becker C, Standl T. Ropivacaine 0.2% versus bupivacaine 0.125% plus sufentanil for continuous peridural analgesia following extended abdominal operations. Anaesthesia Intensivmed Notfallmed Schmerzther 2001;36:219-23.

13. Hodgson PS, Spencer SL. A comparison of ropivacaine with fentanyl for postoperative patient controlled epidural analgesia. Anesth Analg 2001;92:1024-28.

14. Scott D, Blake D, Buckland M, Etches R, Halliwell R, Marsland C. A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 µg/ml fentanyl for seventy two hours of postoperative analgesia after major abdominal surgery. Anesth Analg 1999;88:857.

15. Giunta F, Paolichi A, Van Oven H. Quality of the postoperative course and patients satisfaction produced by a system of postoperative pain control: postoperative clinical evidence that influences the quality of the postoperative course. Minerva Anestesiologica 2001;67(9) Suppl 1:187-94.

16. Parker RK, White PF. Epidural patient- controlled analgesia: and alternative to intravenous patient- controlled analgesia for pain relief after cesarean delivery. Anesth & Analg 1992:75:245-51.

17. Mezei M, Mihalik Z, Penzes I. Continuous postoperative epidural analgesia in abdominal surgery using ropivacain. Magy Seb 2002;55:87-91.

18. Guevara L, Covarrubias G, Hernandez O. Desarrollo de los parámetros de práctica para el manejo del dolor agudo. Rev Mex Anestesiología 2004;27:200-4.