Uso de la estimulación neural eléctrica transcutánea como un adyuvante de la analgesia epidural en el manejo del dolor agudo post toracotomía
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Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain.
Chandra A, Banavaliker JN, Das PK, Hasti S.
Department of Anaesthesiology, Rajan Babu Institute of Pulmonary Medicine and TB, New Delhi, India.
Indian J Anaesth. 2010 Mar;54(2):116-20.
Abstract
The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15-40 years scheduled to undergo elective posterolateral thoracotomy were divided into two groups of 30 each. Patients were alternatively assigned to one of the groups. In group I, only thoracic epidural analgesia with local anaesthetics was given at regular intervals; however, an identical apparatus which did not deliver an electric current was applied to the control (i.e. group I) patients. While in group II, TENS was started immediately in the recovery period in addition to the epidural analgesia. A 0-10 visual analog scale (VAS) was used to assess pain at regular intervals. The haemodynamics were also studied at regular intervals of 2 h for the first 10 h after the surgery. When the VAS score was more than three, intramuscular analgesia with diclofenac sodium was given. The VAS score and the systolic blood pressure were comparable in the immediate postoperative period (P = NS) but the VAS score was significantly less in group II at 2, 4, 6, 8 h (P < 0.01, P < 0.05, P < 0.05, P < 0.05, respectively), and at 10 h the P value was not significant. Similarly, the systolic blood pressure was significantly less in group II at 2, 4, 6 h after surgery, that is P < 0.02, P < 0.01, P < 0.01, respectively, but at 8 and 10 h the pressures were comparable in both the groups. Adding TENS to epidural analgesia led to a significant reduction in pain with no sequelae. The haemodynamics were significantly stable in group II compared to group I. TENS is a valuable strategy to alleviate postoperative pain following thoracic surgery with no side effects and with a good haemodynamic stability; however, the effects are short lasting
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| Estudio prospectivo, randomizado y controlado de analgesia torácica epidural o analgesia opioide controlada por el paciente en la calidad perioperatoria de vida |
Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.
Ali M, Winter DC, Hanly AM, O'Hagan C, Keaveny J, Broe P.
Department of Surgery, Beaumont Hospital, Institute for Clinical Outcomes and Education (iCORE), St Vincent's University Hospital, Elm Park, Dublin 9, Ireland.
Br J Anaesth. 2010 Mar;104(3):292-7. Epub 2010 Feb 1.
Abstract
BACKGROUND: Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery. METHODS: Sixty patients undergoing thoracic or thoraco-abdominal surgery were studied prospectively. Patients were randomly assigned to receive either thoracic epidural analgesia or patient-controlled i.v. opiate analgesia (PCA) after operation. Visual analogue pain and sedation scores were recorded for the period of the study. QOL health surveys at 24 h (SF-8 acute form) and at 1 week (SF-36) were recorded. Results were examined by uni- and multivariate analyses corrected for the effect of multiple comparisons. RESULTS: Mean pain scores were significantly lower in the epidural group at most time points. Physical and mental scores in the epidural group were significantly better than the PCA group for both SF-8 and SF-36 QOL health surveys (P<0.001). CONCLUSIONS: Epidural analgesia with local anaesthetic and opioid improves QOL and delivers better analgesia compared with PCA in patients undergoing major thoraco-abdominal surgery http://bja.oxfordjournals.org/content/104/3/292.full.pdf+html
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| Problemas del tratamiento del dolor post toracotomía |
Postthoracotomy pain management problems.
Gerner P.
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.pgerner@partners.org
Anesthesiol Clin. 2008 Jun;26(2):355-67
Abstract
Pain after thoracotomy is very severe, probably the most severe pain experienced after surgery. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the standard for pain management after thoracotomy. This view has been challenged recently by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the postthoracotomy pain syndrome remain the most important challenges for management of postthoracotomy pain.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453516/pdf/nihms52295.pdf
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| Analgesia epidural torácica y tratamiento del dolor agudo |
Thoracic epidural analgesia and acute pain management.
Manion SC, Brennan TJ.
Assistant in Anesthesia, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Wang Ambulatory Care Center, Boston, Massachusetts. Samir Gergis Professor and Vice Chair for Research, Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Anesthesiology. 2011 Jul;115(1):181-8. PAIN continues to be a significant problem for many patients after major surgery. In addition to improving patient satisfaction and decreasing pain scores, enhanced perioperative pain control can improve clinical outcomes. Thoracic epidural analgesia (TEA) remains a critical tool for
anesthesiologists to use in acute pain management. TEA is particularly effective for reducing pain after thoracic and upper abdominal surgery and likely permits major surgical procedures
to be performed on patients with moderate to severe comorbid diseases, who several years ago may have been determined to be too great a risk for surgery. In the past 10 yr, peripheral nerve blockade has improved perioperative analgesia for patients undergoing extremity surgery. Although nerve blocks have reduced the use of continuous lumbar epidural analgesia, anesthesiologists must understand the indications, placement techniques, solutions
administered, potential complications, and evidence-based outcomes for TEA in acute pain management.
http://journals.lww.com/anesthesiology/
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