viernes, 26 de agosto de 2011

Mas de esteroides y dolor postoperatorio


Dosis única de esteroide con infiltración periarticular para el tratamiento del dolor en artroplastia total de rodilla: estudio prospectivo, doble ciego, controlado randomizado.
Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial.
Sean VW, Chin PL, Chia SL, Yang KY, Lo NN, Yeo SJ.
Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
Singapore Med J. 2011 Jan;52(1):19-23.
Abstract
INTRODUCTION: Post total knee replacement pain control using parenteral opioids results in significant side effects like nausea and vomiting. Periarticular injections are used to control pain without these side effects. This study aimed to evaluate the safety and efficacy of periarticular steroid injection in patients undergoing total knee arthroplasty, as well as assess the patient's functional outcomes over a period of two years. METHODS: A total of 100 patients who underwent total knee arthroplasty were randomised into two groups. The treatment group received periarticular infiltration with triamcinolone acetonide, bupivacaine and epinephrine. The control group received only bupivacaine and epinephrine. The postoperative analgesic regime was standardised for all patients. The immediate postoperative outcomes evaluated included pain score, morphine consumption, time to ambulation, straight leg raise, range of motion and duration of hospital stay. Longer-term outcomes were assessed at 1, 3, 6 and 24 months using the SF-36 questionnaire and Oxford Knee Score. RESULTS: Patients in the treatment group had significantly lower pain scores, reduced morphine consumption and earlier discharge. They also had better range of knee motion and were able to regain muscular strength earlier. There was no increase in major complications such as infection or tendon rupture in the treatment group. There was no difference between the groups with regard to the medium-term outcomes of up to two years. CONCLUSION: This modality of pain control is safe and efficacious for post total knee replacement pain control
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http://smj.sma.org.sg/5201/5201a3.pdf  
¿Ondansetron o dexametasona? Tratamiento de náusea y vómito postoperatorios en cirugía abdominal. 
Dra. SA Oriol-López, Dra. PR Arzate-González, Dra. CE Hernández-Bernal, Dr. JA Castelazo-Arredondo
Rev Mex Anest Volumen 32, No. 3, julio-septiembre 2009
RESUMEN
Introducción: La náusea y el vómito postoperatorios, tienen factores inherentes al paciente, anestesia y cirugía; pueden provocar dolor postquirúrgico, alteraciones hidroelectrolíticas y/o dehiscencia de herida quirúrgica. El vómito inicia con un estímulo, que es interpretado por un centro integrador y la respuesta motora que concluye con la expulsión del contenido gastrointestinal. Para la prevención se utilizan esquemas, simples o combinados; la exametasona a nivel intestinal puede prevenir la liberación de serotonina, el ondansetron actúa directamente a nivel de receptores. Metodología: Se incluyeron 124 pacientes, sometidos a cirugía abdominal no oncológica, con dos o más factores de riesgo. Al grupo A se le administró 8 mg de dexametasona, al B 4 mg de ondansetron 20 minutos antes de la inducción anestésica. Se estandarizó el manejo anestésico. Resultados: El riesgo emético se clasificó como leve. Se presentó náusea y vómito en el 12.5% de los pacientes, de A y B, más en mujeres y no fumadores. La ventilación con mascarilla facial fue adecuada, las dosis de opidoide utilizadas fueron estándar, en cirugías de dos horas, no hubo diferencias estadísticamente significativas entre grupos. Conclusión: La dexametasona a dosis de 8 mg es efectiva en cirugía abdominal y con riesgo leve a moderado de presentar esta complicación.
Palabras clave: Náusea, vómito, dexametasona, ondansetron.

http://www.medigraphic.com/pdfs/rma/cma-2009/cma093d.pdf 
 
Dosis efectiva analgésica de dexametasona después de histerectomía laparoscópica 
The effective analgesic dose of dexamethasone after laparoscopic hysterectomy.
Jokela RM, Ahonen JV, Tallgren MK, Marjakangas PC, Korttila KT.
Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki,Finland.
Anesth Analg. 2009 Aug;109(2):607-15.
Abstract
BACKGROUND: Apart from being antiemetic, glucocorticoids have an analgesic property. The optimal dose of dexamethasone in the management of pain after surgery has not been established. In this placebo-controlled, dose-finding study, we evaluated the analgesic effect of three doses of dexamethasone after laparoscopic hysterectomy. METHODS: We randomized 129 women scheduled for laparoscopic hysterectomy to receive placebo, dexamethasone 5 mg (D5), 10 mg (D10), or 15 mg (D15) IV before the induction of anesthesia. The patients were anesthetized with propofol and remifentanil in a standardized manner. Until the first postoperative morning, postoperative pain was managed with IV oxycodone using patient-controlled analgesia. The visual analog scale scores for pain and side effects, and the amounts of the analgesics were recorded for 3 days after surgery. RESULTS: The total dose of oxycodone (0-24 h after surgery) was smaller in the D15 (0.34 mg/kg [0.11-0.87]) group than in the placebo group (0.55 mg/kg [0.19-1.13]) (P = 0.003). The doses of oxycodone during Hours 0-2 after surgery were smaller in the D10 (0.17 mg/kg [0.03-0.36]) and D15 (0.17 mg/kg [0.03-0.35]) groups than in the placebo (0.26 mg/kg [0.10-0.48]) (P = 0.001, D10 versus placebo; P < 0.001, D15 versus placebo) group. During Hours 2-24 after surgery, however, the doses of oxycodone were equal in the placebo, D5, D10, and D15 groups (0.31 mg/kg [0.03-0.78], 0.22 mg/kg [0.03-0.92], 0.24 mg/kg [0.05-0.87], and 0.20 mg/kg [0-0.65], respectively). The visual analog scale scores for pain at rest, in motion, or at cough did not differ in the study groups. The incidence of dizziness was lower in the D15 group than in the placebo group (P = 0.001), the D5 group (P = 0.006), and the D10 group (P = 0.030) during the first 24 h after surgery. During the later course of recovery, the incidence of dizziness did not differ among the four study groups. CONCLUSIONS: IV dexamethasone 15 mg before induction of anesthesia decreases the oxycodone consumption during the first 24 h after laparoscopic hysterectomy. During first 2 h after surgery, dexamethasone 10 mg reduces the oxycodone consumption as effectively as the 15 mg dose
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Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
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