lunes, 18 de enero de 2016

Analgesia pre-emptiva / Pre-emptive analgesia

Enero 18, 2016. No. 2210


Efecto de analgesia pre-emptiva con parecoxib en pacientes con resección radical de cáncer pulmonar
Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer.
Int J Clin Exp Med. 2015 Aug 15;8(8):14115-8. eCollection 2015.
OBJECTIVE: To discuss the effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer. METHODS:115 cases of lung cancer patients with American society of anesthesiologists class (ASA) grade I~II who received selective operation were randomly divided into the research group and the control group. The research group patients were given preoperative parecoxib sodium 40 mg plus postoperative normal saline 2 ml, while the control group patients were treated with preoperative normal saline 2 ml plus postoperative parecoxib sodium 40 mg. The pain condition at postoperative 1, 2, 4, 8, 12, 24 and 48 h were evaluated by visual analogue scale (VAS), and emergence agitation was tested by agitation score. RESULTS: Finally there were 56 cases and 57 cases can be used for evaluation in the research group and control group. The VAS scores after 1, 2, 4, 8, 12, 24 and 48 h in the research group and control group were [2.23±0.45, 2.35±0.48, 2.51±0.51, 2.41±0.45, 2.28±0.42, 2.16±0.39, 2.11±0.40] and [3.80±0.62, 4.01±0.64, 4.31±0.67, 4.10±0.64, 3.65±0.70, 3.12±0.66, 2.46±0.53], respectively. The research group were obviously lower than the control group, the difference were statistically significant (P<0.05). The rate of agitation was 24.44% (11/56) in the research group, significantly lower than the control group of 59.65% (34/57) (P<0.05). CONCLUSION: Preemptive analgesia with parecoxib sodium can obviously relieve acute pain using in patients undergoing radical resection of lung cancer, and is helpful to reduce the incidence of emergence agitation. KEYWORDS: Parecoxib sodium; preemptive analgesia; radical resection of lung cancer; visual analogue scale
Efecto de bolo preinducción de dosis bajas de ketamina sobre la analgesia intraoperatoria y los requerimientos postoperatorios de analgésicos en cirugía ambulatoria.
Effect of preinduction low-dose ketamine bolus on intra operative and immediate postoperative analgesia requirement in day care surgery: A randomized controlled trial.
Saudi J Anaesth. 2015 Oct-Dec;9(4):422-7. doi: 10.4103/1658-354X.159468.
BACKGROUND: Availability of narcotics is an issue in developing countries, and low-dose ketamine offers an alternative to these drugs. OBJECTIVE: The objective of this study is to evaluate the effect of a preemptive dose of low-dose ketamine on intra operative and the immediate postoperative analgesic requirements. DESIGN: Randomized double-blind control trial. SETTINGS: This study has been performed in the operating rooms and postanesthesia care unit at Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: Totally, 60 adult American Society of Anesthesiologists I and II patients undergoing day care surgery were randomly allocated into two groups, Group A (ketamine group) and Group B (saline group). INTERVENTION: All patients underwent general anesthesia. Propofol 2 mg/kg was used as an induction agent; laryngeal mask airway (size 3 for females and 4 for males) was inserted. Following induction patients in Group A received ketamine 0.3 mg/kg and Group B saline bolus in a blinded manner. All patients were administered injection fentanyl 1 μg/kg as an analgesic and anesthesia was maintained with oxygen 40%, nitrous oxide 60% and isoflorane 1-2 minimum alveolar concentration. Patients breathed spontaneously on Lack circuit. Postoperatively rescue analgesia was provided with intravenous morphine 0.1 mg/kg when patient complained of pain. MAIN OUTCOME MEASURES: We observed analgesic effects of low-dose ketamine intra operatively and narcotic requirements in immediate postoperative period for day care surgeries. RESULTS: There was no significant difference in demographic data in between groups. Saline group required more rescue analgesia (morphine) postoperatively (P < 0.001). No significant psychotomimetic symptoms were noted in either group. CONCLUSION:
Low-dose ketamine 0.3 mg/kg provided adequate co-analgesia with fentanyl 1 μg/kg and was effective in a reduction of morphine requirement in the postoperative phase with minimal adverse effects.
KEYWORDS: Day care surgery; low-dose ketamine; postoperative analgesia
Efecto de pregabalina preoperatoria sobre el alivio del dolor postoperatorio en tiroidectomía
Effect of preoperative pregabalin on postoperative pain relief in thyroidectomy patients: A prospective observational study.
Anesth Essays Res. 2015 May-Aug;9(2):161-6. doi: 10.4103/0259-1162.156292.
BACKGROUND: Effective management of postoperative pain leads to increased patient satisfaction, earlier mobilization, reduced hospital stay and costs. One of the methods used for management of postoperative pain is preemptive analgesia-blockade of afferent nerve fibers before a painful stimulus. It modifies peripheral and central nervous system processing of noxious stimuli and reduces postoperative opioid consumption. In this study, we sought to determine whether the preoperative use of pregabalin reduced postoperative pain and morphine consumption in thyroidectomy. MATERIALS AND METHODS: The observation was conducted on patients undergoing thyroidectomy surgery in two groups of 30 each. Of the two groups, one received a single oral dose of pregabalin 1 h preoperatively. Both the group of patients undergoes anesthesia in a similar manner. Following surgery the efficacy of the preoperative dose of pregabalin is observed by measuring the total opioid consumption 6 h postoperatively and assessing verbal numeric pain scales. RESULTS: The mean time to request of rescue analgesia in pregabalin group was 322.07 ± 69.106 min when compared to morphine group 256.33 ± 111.978 min (P < 0.05). The mean pain scores in the postoperative period were also significantly lower in patients receiving pregabalin. CONCLUSION: Single oral dose of pregabalin was effective in reducing acute postoperative pain in thyroidectomy patients. It prolongs the time to the request of rescue analgesia and also results in lower postoperative pain scores in the immediate postoperative period. However a statistically significant low opioid consumption could not be proved.
KEYWORDS: Preemptive analgesia; pregabalin; verbal numeric scores

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