Analgesia PO en cardiocirugía / PO analgesia in cardiac surgery

No.1873                                                                                   5 de Febrero 2015 Diplomado en Terapia Respiratoria Inscripciones abiertas Curso Virtual Enero- Julio 2015 Avalado por: Universidad Autónoma del Estado de México Asociación Mexicana de Terapia Respiratoria Medicina Respiratoria Hospital Ángeles Mocel México, DF cuidadosneurocriticos.com

Efecto analgésico de la infusión continua de bupivacaína pre esternal a través de un catéter después de cirugía cardiaca The analgesic efficacy of continuous presternal bupivacaine infusion through a single catheter after cardiac surgery. Nasr DA, Abdelhamid HM, Mohsen M, Aly AH. Ann Card Anaesth. 2015 Jan-Mar;18(1):15-20. doi: 10.4103/0971-9784.148314. ABSTRACT BACKGROUND: Median sternotomy, sternal spreading, and sternal wiring are the main causes of pain during the early recovery phase followingcardiac surgery. AIM: This study was designed to evaluate the analgesic efficacy of continuous presternal bupivacaine infusion through a single catheter after parasternal block following cardiac surgery. MATERIALS AND METHODS: The total of 40 patients (American Society of Anesthesiologist status II, III), 45-60 years old, undergoing coronary - artery bypass grafting were enrolled in this prospective, randomized, double-blind study. A presternal catheter was inserted with continuous infusion of 5 mL/h bupivacaine 0.25% (Group B) or normal saline (Group C) during the first 48 postoperative hrs. Primary outcomes were postoperativemorphine requirements and pain scores, secondary outcomes were extubation time, postoperative respiratory parameters, incidence of wound infection, Intensive Care Unit (ICU) and hospital stay duration, and bupivacaine level in blood. STATISTICAL METHODS: Student's t-test was used to analyze the parametric data and Chi-square test for categorical variables. RESULTS: During the postoperative 48 h, there was marked reduction in morphine requirements in Group B compared to Group C, (8.6 ± 0.94 mg vs. 18.83 ± 3.4 mg respectively, P = 0.2), lower postoperative pain scores, shorter extubation time (117 ± 10 min vs. 195 ± 19 min, respectively, P = 0.03), better respiratory parameters (PaO 2 /FiO 2, PaCO 2 and pH), with no incidence of wound infection, no differences in ICU or hospital stay duration. The plasma concentration of bupivacaine remained below the toxic threshold (at T24, 1.2 ug/ml ± 0.3 and T48 h 1.7 ± 0.3 ug/ml). CONCLUSION: Continuous presternal bupivacaine infusion has resulted in better postoperative analgesia, reduction in morphine requirements, shorter time to extubation, and better postoperative respiratory parameters than the control group. PDF Analgesia multimodal versus analgesia tradicional con opioides después de cirugía cardiaca. Estudio randomizado controlado Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial. Rafiq S, Steinbrüchel DA, Wanscher MJ, Andersen LW, Navne A, Lilleoer NB, Olsen PS. J Cardiothorac Surg. 2014 Mar 20;9:52. doi: 10.1186/1749-8090-9-52. Abstract BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. .....CONCLUSIONS: In patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced. No safety issues were observed with the multimodal regimen. PDF

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