Infusión paravertebral continua de ropivacaína con o sin fentanilo para alivio del dolor en fracturas costales múltiples unilaterales
Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs.
Mohta M, Ophrii EL, Sethi AK, Agarwal D, Jain BK.
Indian J Anaesth. 2013 Nov;57(6):555-61. doi: 10.4103/0019-5049.123327.
Abstract
BACKGROUND: Continuous thoracic paravertebral block (TPVB) provides effective analgesia for unilateral multiple fractured ribs (MFR). However, prolonged infusion of local anaesthetic (LA) in high doses can predispose to risk of LA toxicity, which may be reduced by using safer drugs or drug combinations. This study was conducted to assess efficacy and safety of paravertebral infusion of ropivacaine and adrenaline with or without fentanyl to provide analgesia to patients with unilateral MFR. METHODS: Thirty adults, having ≥3 unilateral MFR, with no significant trauma outside chest wall, were studied. All received bolus of 0.5% ropivacaine 0.3 ml/kg through paravertebral catheter, followed by either 0.1-0.2 ml/kg/hr infusion of ropivacaine 0.375% with adrenaline 5 μg/ml in group RA or ropivacaine 0.2% with adrenaline 5 μg/ml and fentanyl 2 μg/ml in group RAF. Rescue analgesia was provided by IV morphine. RESULTS: Statistical analysis was performed using unpaired Student t-test, Chi-square test and repeated measures ANOVA. After TPVB, VAS scores, respiratory rate and PEFR improved in both groups with no significant inter-group differences. Duration of ropivacaine infusion, morphine requirements, length of ICU and hospital stay, incidence of pulmonary complications and opioid-related side-effects were similar in both groups. Ropivacaine requirement was higher in group RA than group RAF. No patient showed signs of LA toxicity. CONCLUSION:Continuous paravertebral infusion of ropivacaine 0.375% with adrenaline 5 μg/ml at 0.1-0.2 ml/kg/hr provided effective and safeanalgesia to patients with unilateral MFR. Addition of fentanyl 2 μg/ml allowed reduction of ropivacaine concentration to 0.2% without decreasing efficacy or increasing opioid-related side-effects.
KEYWORDS: Fentanyl, local anaesthetic toxicity, rib fractures, ropivacaine, thoracic paravertebral block
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883389/
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2013;volume=57;issue=6;spage=555;epage=561;aulast=Mohta;type=2
Evaluación de la eficacia y seguridad del bloqueo paravertebral para analgesia postoperatoria en pacientes sometidos a colecistectomía laparoscópica
The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy.
Agarwal A, Batra RK, Chhabra A, Subramaniam R, Misra MC.
Saudi J Anaesth. 2012 Oct-Dec;6(4):344-9. doi: 10.4103/1658-354X.105860.
Abstract
BACKGROUND:Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery.METHODS: FIFTY PATIENTS WERE INCLUDED IN THIS PROSPECTIVE RANDOMIZED STUDY AND ALLOCATED TO TWO GROUPS: Group A (25 patients) receiving general anesthesia alone and Group B (25 patients) receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB) at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg) based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-ControlledAnalgesia (PCA) morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups. RESULTS:Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001). PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals).CONCLUSION:Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.
KEYWORDS:Laparoscopic cholecystectomy, opioid-sparing effect, paravertebral block, pre-emptive analgesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591552/
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2012;volume=6;issue=4;spage=344;epage=349;aulast=Agarwal;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs.
Mohta M, Ophrii EL, Sethi AK, Agarwal D, Jain BK.
Indian J Anaesth. 2013 Nov;57(6):555-61. doi: 10.4103/0019-5049.123327.
Abstract
BACKGROUND: Continuous thoracic paravertebral block (TPVB) provides effective analgesia for unilateral multiple fractured ribs (MFR). However, prolonged infusion of local anaesthetic (LA) in high doses can predispose to risk of LA toxicity, which may be reduced by using safer drugs or drug combinations. This study was conducted to assess efficacy and safety of paravertebral infusion of ropivacaine and adrenaline with or without fentanyl to provide analgesia to patients with unilateral MFR. METHODS: Thirty adults, having ≥3 unilateral MFR, with no significant trauma outside chest wall, were studied. All received bolus of 0.5% ropivacaine 0.3 ml/kg through paravertebral catheter, followed by either 0.1-0.2 ml/kg/hr infusion of ropivacaine 0.375% with adrenaline 5 μg/ml in group RA or ropivacaine 0.2% with adrenaline 5 μg/ml and fentanyl 2 μg/ml in group RAF. Rescue analgesia was provided by IV morphine. RESULTS: Statistical analysis was performed using unpaired Student t-test, Chi-square test and repeated measures ANOVA. After TPVB, VAS scores, respiratory rate and PEFR improved in both groups with no significant inter-group differences. Duration of ropivacaine infusion, morphine requirements, length of ICU and hospital stay, incidence of pulmonary complications and opioid-related side-effects were similar in both groups. Ropivacaine requirement was higher in group RA than group RAF. No patient showed signs of LA toxicity. CONCLUSION:Continuous paravertebral infusion of ropivacaine 0.375% with adrenaline 5 μg/ml at 0.1-0.2 ml/kg/hr provided effective and safeanalgesia to patients with unilateral MFR. Addition of fentanyl 2 μg/ml allowed reduction of ropivacaine concentration to 0.2% without decreasing efficacy or increasing opioid-related side-effects.
KEYWORDS: Fentanyl, local anaesthetic toxicity, rib fractures, ropivacaine, thoracic paravertebral block
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883389/
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2013;volume=57;issue=6;spage=555;epage=561;aulast=Mohta;type=2
Evaluación de la eficacia y seguridad del bloqueo paravertebral para analgesia postoperatoria en pacientes sometidos a colecistectomía laparoscópica
The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy.
Agarwal A, Batra RK, Chhabra A, Subramaniam R, Misra MC.
Saudi J Anaesth. 2012 Oct-Dec;6(4):344-9. doi: 10.4103/1658-354X.105860.
Abstract
BACKGROUND:Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery.METHODS: FIFTY PATIENTS WERE INCLUDED IN THIS PROSPECTIVE RANDOMIZED STUDY AND ALLOCATED TO TWO GROUPS: Group A (25 patients) receiving general anesthesia alone and Group B (25 patients) receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB) at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg) based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-ControlledAnalgesia (PCA) morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups. RESULTS:Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001). PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals).CONCLUSION:Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.
KEYWORDS:Laparoscopic cholecystectomy, opioid-sparing effect, paravertebral block, pre-emptive analgesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591552/
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2012;volume=6;issue=4;spage=344;epage=349;aulast=Agarwal;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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