Estudio comparativo de dos esquemas: fentanyl - bupivacaína simple y buprenorfina vía peridural, en el manejo del dolor postquirúrgico en prótesis de cadera, Hospital Regional 2 IESS Dr. Teodoro Maldonado Carbo, 2011 - 2012
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2014
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El dolor postoperatorio de artroplastia de cadera, es intenso y sostenido. El objetivo de esta investigación fue determinar por comparación y observación indirecta la eficacia de dos esquemas analgésicos Fentanyl - Bupivacaína simple y Buprenorfina, por vía peridural en el manejo del dolor postquirúrgico de prótesis de cadera del Hospital Regional 2 IESS Dr. Teodoro Maldonado Carbo 2011- 2012, para sugerir un protocolo de manejo de dolor postquirúrgico en el servicio. El presente trabajo aplico el método descriptivo, comparativo, retrospectivo. Se incluyeron 60 pacientes, operados de cirugía de prótesis de cadera. Resultados: 29% a las edades ente 49-58 y 69-78 años para el esquema 1, y 31% entre 5968años para el esquema 2; ASA II 73,4% y 58.6% respectivamente para el Esquema 1 y 2. Predominó sexo masculino en 67% y 59% respectivamente. La valoración del EVA fue similar: 6H: 90% y 97% presentaron EVA 0 respectivamente para esquema 1 y 2; 48h – 72h, finalizada la infusión de dolor peridural el 87 - 97%; y 97 - 100% respectivamente con un EVA LEVE para el esquema 1y 2, el medicamento de rescate, usado más frecuentemente fue el Paracetamol, con un 61% - 64% seguido del 26% - 23% de Ketorolaco + Paracetamol, para el esquema 1. El 77-73% de paracetamol esquema 2. El 48, 55% no presentaron efectos colaterales para el esquema 1 y 2, náusea 22 - 7%, respectivamente para el esquema 1 y 2; retención urinaria 12%, somnolencia 14%. Se concluye: el uso de opioides fuertes en monoterapia y anestésicos más opioides en infusión continua por vía peridural, es igualmente beneficioso y provee adecuada analgesia en cirugía de prótesis de cadera, pero al emplearse como monoterapia presentan menos dolor, dosis de rescate y efectos colaterales
Postoperative hip replacement, pain is intense and sustained. The objective of this research was to determine and indirect observation by comparing the effectiveness of two painkillers Fentanyl - simple Bupivacaine and Buprenorphine schemes, epidural in the management of postoperative pain hip Regional Hospital 2 Dr. Teodoro Maldonado Carbo IESS 2011- 2012, to suggest a protocol for postoperative pain management service. This paper applied the descriptive, comparative, retrospective method. 60 patients operated on for hip replacement surgery were included. Results: 29% of the body ages 49-58 and 69-78 years for Scheme 1, and 31% between 59-68años for Scheme 2; ASA II 73.4% and 58.6% respectively for Scheme 1 and 2. Male predominance in 67% and 59% respectively. Assessment of EVA was similar: 6H: 90% and 97% respectively for 0 EVA presented scheme 1 and 2; 48h - 72h, once the pain the epidural infusion of 87-97%; and 97-100%, respectively, with an EVA MILD scheme for 1 and 2, rescue medication most commonly used was Paracetamol, with 61% - 64% followed by 26% - 23% of Ketorolac and Paracetamol, for scheme 1. 77-73% of Paracetamol scheme 2. 48, 55% had no side effects for scheme 1 and 2, nausea 22-7% respectively for scheme 1 and 2; urinary retention 12%, drowsiness 14%. The conclusion: the use of strong opioids alone and opioid anesthetic continuous infusion epidural is equally beneficial and provides adequate analgesia for surgery of hip, but when used as monotherapy have less pain, rescue doses and side effects.
Postoperative hip replacement, pain is intense and sustained. The objective of this research was to determine and indirect observation by comparing the effectiveness of two painkillers Fentanyl - simple Bupivacaine and Buprenorphine schemes, epidural in the management of postoperative pain hip Regional Hospital 2 Dr. Teodoro Maldonado Carbo IESS 2011- 2012, to suggest a protocol for postoperative pain management service. This paper applied the descriptive, comparative, retrospective method. 60 patients operated on for hip replacement surgery were included. Results: 29% of the body ages 49-58 and 69-78 years for Scheme 1, and 31% between 59-68años for Scheme 2; ASA II 73.4% and 58.6% respectively for Scheme 1 and 2. Male predominance in 67% and 59% respectively. Assessment of EVA was similar: 6H: 90% and 97% respectively for 0 EVA presented scheme 1 and 2; 48h - 72h, once the pain the epidural infusion of 87-97%; and 97-100%, respectively, with an EVA MILD scheme for 1 and 2, rescue medication most commonly used was Paracetamol, with 61% - 64% followed by 26% - 23% of Ketorolac and Paracetamol, for scheme 1. 77-73% of Paracetamol scheme 2. 48, 55% had no side effects for scheme 1 and 2, nausea 22-7% respectively for scheme 1 and 2; urinary retention 12%, drowsiness 14%. The conclusion: the use of strong opioids alone and opioid anesthetic continuous infusion epidural is equally beneficial and provides adequate analgesia for surgery of hip, but when used as monotherapy have less pain, rescue doses and side effects.
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Prótesis de cadera, Dolor posoperatorio, Anestesia epidural, Estudio comparativo, Fentanyl, Bupivacaína, Buprenorfina, Epidemiología descriptiva, Estudios retrospectivos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador