Estudio del fentanyl vs buprenorfina vía subaracnoidea para control del dolor postoperatorio en cirugía de región lumbar Hospital SOLCA 2014 y una guía práctica clínica
Fecha
2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La anestesia subaracnoidea de la región lumbar constituye una técnica utilizada en cirugías de abdomen bajo. El problema es que no se ha encontrado el analgésico ideal que controle el dolor post-operatorio inmediato, la destreza para controlar el dolor postquirúrgico es la combinación de analgésicos locales con fármacos opioides agonistas totales y parciales como es el caso de fentanilo y buprenorfina vía intratecal, esto dará una analgesia suficiente en el postoperatorio contiguo.
El principal objetivo de este estudio fue evaluar por observación directa a través de una escala la analgesia postoperatoria inmediata de la buprenorfina vía subaracnoidea como adyuvante a bupivacaína hiperbárica 0,5% en pacientes del servicio de quirófano del ION SOLCA Dr. Juan Tanca Marengo, que requirieron de anestesia raquídea durante el año 2014, y proponer una guía de práctica clínica en la población susceptible en anestesias de región lumbar. El presente estudio que se propuso fue en el campo de la anestesiología fue de tipo descriptivo, retrospectivo, analítico, observacional y diseño no experimental siendo tutorizado, que incluyo a pacientes mayores de 18 años, clasificados como Sociedad Americana de Anestesiólogos (ASA) Estado Físico I / II programados para cirugías abdominales inferiores electivas.
La recolección de datos se llevó a cabo mediante el método de fuentes documentales. Las principales conclusiones fueron: Las mujeres representaron el 36% y varones el 64%, con una edad promedio de 62 años; los efectos secundarios fueron mínimos, ambos grupos presentaron estabilidad hemodinámica y que el empleo de 100 microgramos de buprenorfina vía subaracnoidea es eficaz y segura en el manejo de dolor en pacientes sometidos a cirugías de abdomen bajo, ya que permite mejor el control del dolor postoperatorio inmediato, disminuyendo el uso de analgesia de rescate durante el procedimiento y alivio del dolor dinámico durante este lapso. Así mismo, la menor presencia de efectos colaterales.
Subarachnoid anesthesia of the lumbar region is a technique used in surgeries on lower abdomen. The problem is not found the ideal analgesic to control pain immediately post-operative, the ability to control the postoperative pain is the combination of local analgesic with total agonist opioid drug and partial such as the case of fentanyl and buprenorphine intrathecal, this will give sufficient analgesia in the next postoperative. The main objective of this study is to evaluate by direct observation the immediate postoperative analgesia of the subarachnoid buprenorphine as adjuvant hyperbaric bupivacaine 0.5% and propose a clinical practice guideline in the susceptible population of anesthesia lumbar region. The present study proposed in the field of anesthesiology is of technic type since a scale is used and a descriptive level, being prospective, randomized, supervised, including patients over 18 years, classified as American Society of Anesthesiologists (ASA ) Physical State I / II scheduled for elective lower abdominal surgery. Data collection was performed by the method of documentary sources. The main findings were: Women accounted for 36% and men 64%, with an average age of 62 years; Side effects were minimal, both groups had hemodynamic stability and that the use of 100 micrograms of buprenorphine subarachnoid is effective and safe in the management of pain in patients undergoing surgery of the lower abdomen, as it allows better control of postoperative pain reducing the use of rescue analgesia during the procedure and dynamic pain relief during this time. Also, the presence of minor side effects.
Subarachnoid anesthesia of the lumbar region is a technique used in surgeries on lower abdomen. The problem is not found the ideal analgesic to control pain immediately post-operative, the ability to control the postoperative pain is the combination of local analgesic with total agonist opioid drug and partial such as the case of fentanyl and buprenorphine intrathecal, this will give sufficient analgesia in the next postoperative. The main objective of this study is to evaluate by direct observation the immediate postoperative analgesia of the subarachnoid buprenorphine as adjuvant hyperbaric bupivacaine 0.5% and propose a clinical practice guideline in the susceptible population of anesthesia lumbar region. The present study proposed in the field of anesthesiology is of technic type since a scale is used and a descriptive level, being prospective, randomized, supervised, including patients over 18 years, classified as American Society of Anesthesiologists (ASA ) Physical State I / II scheduled for elective lower abdominal surgery. Data collection was performed by the method of documentary sources. The main findings were: Women accounted for 36% and men 64%, with an average age of 62 years; Side effects were minimal, both groups had hemodynamic stability and that the use of 100 micrograms of buprenorphine subarachnoid is effective and safe in the management of pain in patients undergoing surgery of the lower abdomen, as it allows better control of postoperative pain reducing the use of rescue analgesia during the procedure and dynamic pain relief during this time. Also, the presence of minor side effects.
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Anestesia raquídea, Dolor postoperatorio, Fentanilo, Buprenorfina, Región lumbar, Epidemiología descriptiva, Epidemiología analítica, Estudios retrospectivos, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador