martes, 13 de septiembre de 2016

Dolor crónico postoperatorio / Postoperative chronic pain

Septiembre 13, 2016. No. 2447

Dolor crónico postoperatorio persistente. Lo que debemos saber sobre prevención, factores de riesgo y tratamiento
Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment.
Braz J Anesthesiol. 2016 Sep-Oct;66(5):505-12. doi: 10.1016/j.bjane.2014.12.005. Epub 2016 Jul 20.
BACKGROUND AND OBJECTIVES: Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain tochronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. CONTENT: This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively. CONCLUSION: Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.
KEYWORDS: Analgesia; Dor crônica pós-operatória; Fatores de risco; Postoperative chronic pain; Prevention; Prevenção; Risk factors; Tratamento;
Dolor después de esternotomía
Pain after sternotomy - review.
Braz J Anesthesiol. 2016 Jul-Aug;66(4):395-401. doi: 10.1016/j.bjane.2014.09.013. Epub 2016 Apr 23.
BACKGROUND AND OBJECTIVE: Adequate analgesia after sternotomy reduces postoperative adverse events. There are various methods of treating pain after heart surgery, such as infiltration with a local anesthetic, nerve block, opioids, non-steroidal anti-inflammatory drugs, alpha-adrenergic agents, intrathecal and epidural techniques, and multimodal analgesia. CONTENT: A review of the epidemiology, pathophysiology, prevention and treatment of pain after sternotomy. We also discuss the various analgesic therapeutic modalities, emphasizing advantages and disadvantages of each technique. CONCLUSIONS: Heart surgery is performed mainly via medium sternotomy, which results in significant postoperative pain and a non-negligible incidence of chronic pain. Effective pain control improves patient satisfaction and clinical outcomes. There is no clearly superior technique. It is believed that a combined multimodal analgesic regimen (using different techniques) is the best approach for treating postoperative pain, maximizing analgesia and reducing side effects.
KEYWORDS: Analgesia pós-operatória; Dor; Esternotomia; Pain; Postoperative analgesia; Sternotomy
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Octubre a Diciembre 2016

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