| Esteroides para mejorar el dolor postoperatorio |
Steroids to Ameliorate Postoperative Pain
Alparslan Turan, M.D., Daniel I. Sessler, M.D., Department
of Outcomes Research, The Cleveland Clinic, Cleveland,
Ohio. turana@ccf.org, www.OR.org
Anesthesiology 2011; 115:457-9
Surgical tissue injury provokes a neuroendocrine stress response and inflammation. The neuroendocrine response can be moderated by regional or neuraxial anesthesia. However, the inflammatory response results largely from local release of mediators that then act systemically. It is widely believed that the inflammatory response to surgical tissue injury is responsible for serious complications including prolonged fatigue, atrial fibrillation, delirium, and prolonged intensive care unit stay. It is also likely that inflammation contributes to acute postoperative pain. A variety of antiinflammatory medications including lidocaine, selective cyclooxygenase-inhibitors, and other nonsteroidal anti-inflammatory drugs have thus been used in attempts to reduce surgical pain. The ultimate anti-inflammatory drugs, however, are steroids.http://journals.lww.com/anesthesiology/Fulltext/2011/09000/Steroids_to_Ameliorate_Postoperative_Pain.6.aspx
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| Dosis única perioperatoria de dexametasona para el dolor postoperatorio |
Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-analysis of Randomized Controlled Trials
De Oliveira, Gildàsio S. Jr M.D; Almeida, Marcela D. M.D.; Benzon, Honorio T. M.D., McCarthy, Robert J. Pharm.D.
Anesthesiology September 2011 - Volume 115 - Issue 3 - p 575-588
Background: Dexamethasone is frequently administered in the perioperative period to reduce postoperative nausea and vomiting. In contrast, the analgesic effects of dexamethasone are not well defined. The authors performed a meta-analysis to evaluate the dose-dependent analgesic effects of perioperative dexamethasone. Methods: We followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose systemic dexamethasone on postoperative pain and opioid consumption. Meta-analysis was performed using a random-effect model. Effects of dexamethasone dose were evaluated by pooling studies into three dosage groups: low (less than 0.1 mg/kg), intermediate (0.11-0.2 mg/kg) and high (≥0.21 mg/kg). Results: Twenty-four randomized clinical trials with 2,751 subjects were included. The mean (95% CI) combined effects favored dexamethasone over placebo for pain at rest (≤4 h, −0.32 [0.47 to −0.18], 24 h, −0.49 [−0.67 to −0.31]) and with movement (≤ 4 h, −0.64 [−0.86 to −0.41], 24 h, −0.47 [−0.71 to −0.24]). Opioid consumption was decreased to a similar extent with moderate −0.82 (−1.30 to −0.42) and high −0.85 (−1.24 to −0.46) dexamethasone, but not decreased with low-dose dexamethasone −0.18 (−0.39-0.03). No increase in analgesic effectiveness or reduction in opioid use could be demonstrated between the high- and intermediate-dose dexamethasone. Preoperative administration of dexamethasone appears to produce a more consistent analgesic effect compared with intraoperative administration. Conclusion: Dexamethasone at doses more than 0.1 mg/kg is an effective adjunct in multimodal strategies to reduce postoperative pain and opioid consumption after surgery. The preoperative administration of the drug produces less variation of effects on pain outcomes
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| Dexametasona preoperatoria reduce el dolor postoperatorio, la nausea y vomito despues de mastectomía por cáncer de mama |
Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer.
Gómez-Hernández J, Orozco-Alatorre AL, Domínguez-Contreras M, Oceguera-Villanueva A, Gómez-Romo S, Alvarez Villaseñor AS, Fuentes-Orozco C, González-Ojeda A.
Breast Tumor Clinic. Oncologic Institute of Jalisco, Health Secretary, CalleCoronel Calderon 715, Colonia El Retiro, Postal code 44280, Guadalajara, Jalisco, México.
BMC Cancer. 2010 Dec 23;10:692.
Abstract
BACKGROUND: Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.
METHODS: In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (n = 35) or placebo (n = 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded. RESULTS: Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% vs. 60%; p = 0.02) and at 6 h (17.2% vs. 45.8%; p = 0.03). More patients in the placebo group required additional antiemetic medication (21 vs. 8; p = 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 vs. 5.83 ± 2.00; p = 0.004), at 6 h (3.03 ± 1.20 vs. 4.17 ± 1.24; p < 0.0005) and at 12 h (2.09 ± 0.85 vs. 2.54 ± 0.98; p = 0.04). Analgesics were required in more patients of the control group (21 vs. 10; p = 0.008). There were no adverse events, morbidity or mortality. CONCLUSIONS: Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017064/pdf/1471-2407-10-692.pdf
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