Posso-Sierra JJ, Carrillo-Torres O, Carrillo-Ruiz JD, La VV, Gutiérrez-Román CI

Language: Spanish
References: 24
Page: 98-104
PDF size: 300.72 Kb.

ABSTRACT

Introduction: Posterior pain in thoracoscopy has an 80% incidence. These procedures are done under general anesthesia or sedoanalgesia. The buprenorphin in dosage of 4 μg/kg it's the foundation for post-operatory pain treatment, nevertheless, smaller dosage can be sufficient. The objective of this study is to demonstrate that a dosage of buprenorphin from 1-3 μg/kg provides suitable analgesia with less side effects during post-operatory in patients who underwent thoracoscopic surgery. Material and methods: We conducted a double-blind, prospective, transversal study, in 48 patients which underwent a thoracoscopy divided in 3 groups: A (1 μg/kg), B (2 μg/kg), and C (3 μg/kg) treated with buprenorphin. We studied side effects, pain intensity (NVE), and sedative effect (RASS) from 0 to 120 minutes postanesthesia. Results: Dosage from 1 to 3 μg/kg did not generate side effects. The analgesia effect is higher with 2 μg/kg (p = 0.019) and 3 μg/kg (p = 0.045). Dosage of 1 and 2 μg/kg have lower sedative effect. Conclusion: The multimodal analgesia was diminished by 200% inmidiate postsurgical pain. Dosage from 2-3 μg/kg of buprenorphine are effective for pain control with less side effects and a superficial sedative effect during post-operatory.

REFERENCES

1. Dahl JB, Kehlet H. Postoperative pain and its management. Elsevier Churchill Livingstone; 2006: 635-651.

2. Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic postsurgical pain (CPSP): a systematic review. Eur J Pain. 2009;13:719-730.

3. Martínez VA, Rodríguez BN. Posoperative pain: specific procedure approach. Revista de Ciencias Biomédicas 2012: 360-372.

4. Martínez-Vázquez CJ, Torres LM. Prevalencia del dolor posoperatorio. Alteraciones fisiopatológicas y sus repercusiones. Rev Soc Esp Dolor. 2000;7:465-476.

5. Chistopher L, Srinivasa N. Treatment of acute posoperative pain. Lancet. 2011;377:2215-2225.

6. Brennan T. Pathophysiology of posoperative pain. Pain. 2011;152:33-40.

7. Ji R, Kohno T, Moore K, Woolf C. La sensibilización central y LTP: hacer del dolor y la memoria comparten mecanismos similares? Trends Neurosci. 2003;26:696-705.

8. Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ. A prospective study of chronic pain after thoracic surgery. Anesthesiology. 2017;126:938-951.

9. González de Mejia N. Analgesia multimodal posoperatoria. Rev Soc Esp Dolor. 2005;12:112-118.

10. Serrano-Atero, Caballero J, Cañas A, García-Saura, Serrano-Álvarez C y Prieto J. Valoración del dolor. Rev Soc Esp Dolor. 2002;9:94-108.

11. Ferreira M, Pais J, Jensen M. Validity of four pain intensity rating scales. Pain. 2011;152:2399-2404.

12. Neguss SS, Mello NK, Lisenmayer DC, Jones RM, Portoghese PS. Kappa opioid antagonist effects of the novel antagonist 5'-guanidionaltrindole (GNTI) in an assay of shedule-controlled behavior in Rhesus monkeys. Psychopharmacology (Berl). 2002;163:412-419.

13. Kobayashi T, Chiba K, Tani M, Shimada N, Ishizaki T, Kuroiwa Y. Human buprenorphine N-dealkylation, is catalyzed by cytochrome P450 3ª4. Drug Metabo Dispos. 1998;26:818-821.

14. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non–small–cell lung cancer. N Engl J Med. 2010;363:733.

15. Covarrubias-Gómez A. La necesidad de contar sistemas para la educación en dolor agudo. Rev Mex Anest. 2016;39:173-174.

16. Fields HL, Heinricher MM, Mason P. Neurotransmitters in nociceptive modulatory circuits. Annu Rev Neurosci. 1991;14:219-245.

17. Pergolizzi JR, Taylor R, Plancarte R, Bashkansky D y Muniz E. ¿Es la buprenorfina una buena opción en el manejo de dolor postoperatorio? Rev Soc Esp Dolor. 2012;19:281-292.

18. Grendelmeier P, Tamm M, Jahn K, Pflimlin E, Stolz D. Propofol versus Midazolam in Medical Thoracoscopy: A Randomized, Noninferiority Trial. Resp. 2014;88:126-136.

19. Bautista S, Guzmán O, Bojórquez-Sepúlveda HA, Sandoval-Virgen FG, Toracoscopía con anestesia local como procedimiento diagnóstico y terapéutico. Rev Med Md. 2012;3:217-222.

20. Licker M, Diaper J, Tschopp JM. Propofol: is it really worse than midazolam in medical thoracoscopy? Respiration. 2015;89:436.

21. Lu Yi-F, Hui HM, Hsu HH, Chen JS. Non-intubated thoracoscopic segmentectomy for second primary lung cancer in a patient with previous contralateral lobectomy and emphysematous bullae. J Cardiothorac Vasc Anesth. . 2016;30:1639-1640.

22. Ming-Hui Hung, Hsao-Hsun Hsu. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg. 2014;46:620-625.

23. Heel RC, Brogden RN, Speight TM, Avery GS. Buprenorphine: a review of its pharmacological properties and therapeutic efficacy. Drugs. 1979;17:81-110.

24. Hand C, Sear J, Uppington J, Ball MJ, McQuay HJ, Moore RA. Buprenorphine disposition in patients with renal impairment: single and continuous dosing, with special reference to metabolites. Br J Anesth. 1990;64:276-282.