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2001, Number 4

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Rev Mex Anest 2001; 24 (4)

Uso de bupivacaína y morfina espinal para manejo del dolor postoperatorio en cirugía ginecológica

Torres HJC, Cabrera MGI, Martínez AR, Tenopala VS

Language: Spanish
References: 25
Page:
PDF size: 44.50 Kb.


ABSTRACT

Objetive: to evaluate the analgesic effectiveness, duration and side effects upon administrating hyperbaric bupivacaine and spinal morphine in the gynecological surgery. Material and methods: 30 patients ASA I-II undergoing gynecological surgery were studied. Pain clinical assessment is based on the Verbal Analogue Scale (VAS)ranging fron 0 to 10 (0=no pain and 10=acutest pain). Patients were on lateral recumbent position; previous to a 10 ml/kg doses of saline solution, the L2-L3 intervertebral space was located and such space was punctuated with a 16 Weiss needle up until reaching peridural space using the Dogliotti´s technical; a 25 needle was introduced through the 16 Weiss needle in order to reach the subarachnoid space. And cerebrospinal fluid (CSF)leakage was corroborated thus a 10 mg of hyperbaric bupivacaine and a sole 300 mcgr of morphine were administered. The vital signs registered are blood pressure (BP), heart rate (HR), breath rate (BR)and SaO2% every 15 minutes during 8 hours after surgery while in postoperative care room. Side effects after the surgery were also assessed. The resulting data were analyzed using an average standar deviation.Results: The total studied population was of 30 patients aging from 20 to 60 years, averaging 40.4 ? 14.4. The VAS registered during their stay en postanesthesia care unit was of 2.0 ? 1.4 in average. And analgesic average time of 5.9 ?1.15 hours was registered. The resulting side effects were 90% (27)of patients had pruritus, 70% (21) had nausea and vomit. Conclusions: Administering hyperbaric bupivacaine and spinal morphine in gynecological postoperated patients is concluded to be a efficient alternative in the clinical pain management.


REFERENCES

  1. Husain SW. "Intrathecal diamorphine compared with morphine for postoperative analgesia after caesarean section under spinal anestesia" Br. J. Anaesth, 1998; 81:135-9.

  2. Rawal N. "Epidural and spinal agents for postoperative analgesia" Surg. Clin. North Am. 1999 Apr; 79 (2):313. 44.

  3. Rawal N. "Present state of epidural and intrathecal opiate analgesia: A nationwide follow up survey in Sweden" Br. J. Anaesth 59:791-99.1987.

  4. Naulty JS. "Caesarean delivery analgesia with subarachoid bupivacaine fetanyl and morphine". Anesthesiology 1989; 71:864.

  5. Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science 1976; 192:1357-8.

  6. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in human. Anesthesiology 1979; 50:149-51.

  7. Behar M, Magora F, Olshwang D, Davidson JT. Epidural morphine in treatment of pain. Lancet 1979; 1:527-8.

  8. Merskey H. Pain 1986; (suppl) 3:345-356.

  9. Brasseur L, Boukhatem B. Épidémiologie de la douleur postopératoire. Ann. Fr. Anesth. Réanim. 1998; 17:534-9.

  10. Feng J, Chung F. Postoperative pain-a challenge for anaesthetists in ambulatory surgery. Can. J. Anaesth. 1998; 45:293-96.

  11. Beaussier M. Fréquence, intensité, evolution etretentissements de la douleur postopératoire en fonction du type de chirurgie. Ann. Fr. Anesth. Réanim. 1998; 17:471-93.

  12. Chaney MA. Side effects of intrathecal and epidural opioids. Can. J. Anaesth. 1995; 42 (10): 891-903.

  13. Palmer CM, Emerson S, Volgoropolous D. Dose-respose relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology, 1999; 90:437-44.

  14. Gerancher JC, Floyd H, Eisenach J. Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery. Anesth. Analg. 1999; 88:346-51.

  15. Yang T, Breen TW, Archer D. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after cesarean section. Can. J. Anesth. 1999; 46:856-60.

  16. Rawal N, Holmstrom B, Crowhurts J. The combined spinal-epidural technique. Anesthesiol Clin. North. Am. 2000 Jun; 18(2);267-295.

  17. Jorgen BD, Inge SJ, Henrik J. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia. A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology, 1999;91 (6):1919-27.

  18. Austrup ML, Korean G. Analgesic agents for the postoperative period, Opioids. Surg Clin North Am 1999; 79 (2):253-73.

  19. Mandabach MG. Intrathecal and epidural analgesia. Crit Care Clin. 1999; 15 (1):105-18,Vii.

  20. Smith G. Pain after surgery (editorial). Br. J. Anaesth. 1991; 67:233-34.

  21. Loesser JD. Bonica´s management of pain. Third ed. Philadelphia; 2001.

  22. Beilin, Yaakov, Howard H, Zucker-Pinchoff B, Zahn J. Subhypnotic Doses of Propofol Do not Relieve Pruritus Induced by Intrathecal Morphine After Cesarean Section. Anesth. Analg. 1998; 86:310–3.

  23. Ö zalp G; Güner F, Kuru N; Kadiogullari N. Postoperative patient-controlled epidural analgesia with opioid bupivacaine mixtures. Can J. Anaesth. 1998; 45:938-942.

  24. Alhashemi J A., Crosby ET, Grodecki W, Duffy PJ, Hull KA. Treatment of intrathecal morphine-induced pruritus following Caesarean section: nalbuphine vs diphenhydramine. Can J. Anaesth. 1997; 44 (10): 1060-1065.

  25. Kendrick WD, Woods AM, Daly MY, Birch RF, DiFazio C. Naloxone Versus Nalbuphine Infusion for Prophylaxis of Epidural Morphine-Induced Pruritus. Anesth. Analg. 1996; 82:641-7.




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