Dolor crónico postcesárea / Chronic pain post C-Section

Mayo 22, 2016. No. 2334

Morfina intratecal reduce dolor persistente post cesárea. Estudio prospectivo observacional Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study. Moriyama K1, Ohashi Y1, Motoyasu A1, Ando T1, Moriyama K1, Yorozu T1. PLoS One. 2016 May 10;11(5):e0155114. doi: 10.1371/journal.pone.0155114. eCollection 2016. Abstract PURPOSE: Chronic pain after cesarean section (CS) is a serious concern, as it can result in functional disability. We evaluated the prevalence of chronic pain after CS prospectively at a single institution in Japan. We also analyzed perioperative risk factors associated with chronic pain using logistic regression analyses with a backward-stepwise procedure. MATERIALS AND METHODS: Patients who underwent elective or emergency CS between May 2012 and May 2014 were recruited. Maternal demographics as well as details of surgery and anesthesia were recorded. An anesthesiologist visited the patients on postoperative day (POD) 1 and 2, and assessed their pain with the Prince Henry Pain Scale. To evaluate the prevalence of chronic pain, we contacted patients by sending a questionnaire 3 months post-CS. RESULTS: Among 225 patients who questionnaires, 69 (30.7%) of patients complained of persistent pain, although no patient required pain medication. Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months. The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%. In addition, 51.6% of patients had abnormal wound sensation, suggesting the development of neuropathic pain. Also, 6% of patients with abnormal wound sensation required medication, yet no patients with persistent pain required medication. CONCLUSION: Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS. PDF Dolor crónico después de cesárea. Influencia de la técnica de anestesia/cirugía y analgesia postoperatoria Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. de Brito Cançado TO1, Omais M, Ashmawi HA, Torres ML. Rev Bras Anestesiol. 2012 Nov-Dec;62(6):762-74. doi: 10.1016/S0034-7094(12)70177-0. Abstract BACKGROUND AND OBJECTIVES: Brazil ranks second among countries with the highest rates of cesarean section in the world. Little is known about the future consequences of this procedure on maternal health. This study investigated the influence of anesthetic/surgical technique and postoperative analgesia on the onset of chronic pain after three months of cesarean section. METHOD: This is a prospective randomized study of 443 patients undergoing cesarean section (elective and emergency), with different doses of hyperbaric bupivacaine 0.5% and opioids in spinal anesthesia. Patients were alocated into five groups as follow: G1 received hyperbaric bupivacaine (8 mg), sufentanil (2.5 μg), and morphine (100 μg); G2 received hyperbaric bupivacaine (10 mg), sufentanil (2.5 μg), and morphine (100 μg); G3 received hyperbaric bupivacaine (12.5 mg) and morphine (100 μg); G4 received hyperbaric bupivacaine (15 mg) and morphine (100 μg); G5 received hyperbaric bupivacaine (12.5 mg) and morphine (100 μg), without perioperative anti-inflammatory. Pain at rest and in movement were evaluated in the immediate postoperative period. Phone contact was made after three months of surgery for identification of patients withchronic pain. RESULTS: The incidence of chronic pain in the groups was G1=20%; G2=13%; G3=7.1%; G4=2.2%, and G5=20.3%. Patients who reported higher pain scores in the postoperative period had a higher incidence of chronic pain (p<0.05). CONCLUSION: The incidence of chronic pain decreases with higher doses of local anesthetics and use of anti-inflammatory drugs. The higher pain scores in the postoperative period were associated with chronic pain development after three months of cesarean section. PDF en Español  English PDF VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Dolor crónico postcesárea / Chronic pain post C-Section

Mayo 22, 2016. No. 2334

Morfina intratecal reduce dolor persistente post cesárea. Estudio prospectivo observacional Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study. Moriyama K1, Ohashi Y1, Motoyasu A1, Ando T1, Moriyama K1, Yorozu T1. PLoS One. 2016 May 10;11(5):e0155114. doi: 10.1371/journal.pone.0155114. eCollection 2016. Abstract PURPOSE: Chronic pain after cesarean section (CS) is a serious concern, as it can result in functional disability. We evaluated the prevalence of chronic pain after CS prospectively at a single institution in Japan. We also analyzed perioperative risk factors associated with chronic pain using logistic regression analyses with a backward-stepwise procedure. MATERIALS AND METHODS: Patients who underwent elective or emergency CS between May 2012 and May 2014 were recruited. Maternal demographics as well as details of surgery and anesthesia were recorded. An anesthesiologist visited the patients on postoperative day (POD) 1 and 2, and assessed their pain with the Prince Henry Pain Scale. To evaluate the prevalence of chronic pain, we contacted patients by sending a questionnaire 3 months post-CS. RESULTS: Among 225 patients who questionnaires, 69 (30.7%) of patients complained of persistent pain, although no patient required pain medication. Multivariate analyses identified lighter weight (p = 0.011) and non-intrathecal administration of morphine (p = 0.023) as determinant factors associated with persistent pain at 3 months. The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%. In addition, 51.6% of patients had abnormal wound sensation, suggesting the development of neuropathic pain. Also, 6% of patients with abnormal wound sensation required medication, yet no patients with persistent pain required medication. CONCLUSION: Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS. PDF Dolor crónico después de cesárea. Influencia de la técnica de anestesia/cirugía y analgesia postoperatoria Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. de Brito Cançado TO1, Omais M, Ashmawi HA, Torres ML. Rev Bras Anestesiol. 2012 Nov-Dec;62(6):762-74. doi: 10.1016/S0034-7094(12)70177-0. Abstract BACKGROUND AND OBJECTIVES: Brazil ranks second among countries with the highest rates of cesarean section in the world. Little is known about the future consequences of this procedure on maternal health. This study investigated the influence of anesthetic/surgical technique and postoperative analgesia on the onset of chronic pain after three months of cesarean section. METHOD: This is a prospective randomized study of 443 patients undergoing cesarean section (elective and emergency), with different doses of hyperbaric bupivacaine 0.5% and opioids in spinal anesthesia. Patients were alocated into five groups as follow: G1 received hyperbaric bupivacaine (8 mg), sufentanil (2.5 μg), and morphine (100 μg); G2 received hyperbaric bupivacaine (10 mg), sufentanil (2.5 μg), and morphine (100 μg); G3 received hyperbaric bupivacaine (12.5 mg) and morphine (100 μg); G4 received hyperbaric bupivacaine (15 mg) and morphine (100 μg); G5 received hyperbaric bupivacaine (12.5 mg) and morphine (100 μg), without perioperative anti-inflammatory. Pain at rest and in movement were evaluated in the immediate postoperative period. Phone contact was made after three months of surgery for identification of patients withchronic pain. RESULTS: The incidence of chronic pain in the groups was G1=20%; G2=13%; G3=7.1%; G4=2.2%, and G5=20.3%. Patients who reported higher pain scores in the postoperative period had a higher incidence of chronic pain (p<0.05). CONCLUSION: The incidence of chronic pain decreases with higher doses of local anesthetics and use of anti-inflammatory drugs. The higher pain scores in the postoperative period were associated with chronic pain development after three months of cesarean section. PDF en Español  English PDF VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

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Raquianestesia torácica / Thoracic spinal anesthesia

Mayo 20, 2016. No. 2332

Anestesia espinal torácica Thoracic Spinal Anesthesia. LE, Gouveia MA J Anesth Crit Care Open Access (2016)  4(5): 00160. DOI: 10.15406/ jaccoa.2016.04.00160 Abstract In 1909 Thomas Jonnesco published his interesting paper under the title General spinal anesthesia through an approach of the subarachnoid space at a thoracic level, providing condition for surgery on the skull, head, neck and thorax. Etherington-Wilson proposed explaining the various possibilities for the spinal anesthesia. Leonardo da Vinci was considered the discoverer of Human and animal Anatomy. Image techniques have opened a gret new field for the study of anatomy in the living man. The modern means of image, associated to computed means have facilitated the evaluation of the CSF volume, through antero-posterior and height measures of the subarachnoid space based on bi-dimentional studies of MRI. The studies of the thoracic column with MRI show that exist a space between the dura-mater and the spinal cord (medula). Thoracic ouncture performed with needles proved safe and without neurological injury. Thoracic spinal anesthesia is a viable procedure, with a low incidence of PDF Anestesia combinada espinal-peridural torácica para laparotomía laparoscópica.Estudio de viabilidad Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy: A feasibility study Mehta N, Dar MR, Sharma S, Mehta KS. J Anaesthesiol Clin Pharmacol 2016;32:224-8 Abstract Background and Aims: The use of regional anesthesia for laparoscopic cholecystectomy has been reserved for patients who are at high-risk under general anesthesia (GA). The aim of this study was to assess whether thoracic combined spinal epidural (CSE) anesthesia is a feasible option for American Society of Anesthesiologists (ASA) physical status I and II patients undergoing elective laparoscopic cholecystectomy. Material and Methods: Thirty ASA physical status I and II patients undergoing elective laparoscopic cholecystectomy received thoracic CSE anesthesia at T9-T10 or T10-T11 interspinous space using the midline approach. Two ml of isobaric levobupivacaine 0.5% with 25 μg of fentanyl was given intrathecally. Results: Surgery was conducted successfully in all except one patient. Thoracic CSE was performed at T9-T10 interspace in 25 patients and T10-T11 interspace in five patients. Paresthesia occurred in two patients (6.6%) transiently on Whitacre needle insertion that disappeared spontaneously. Dural puncture on epidural needle insertion occurred in one patient, and intrathecal placement of epidural catheter occurred in one. Ten patients (33%) complained of shoulder pain. Conversion to GA was done in one patient due to severe shoulder pain and anxiety. Hypotension occurred in 11 patients (36%) and all responded to single dose of mephenteramine 6 mg and fluid bolus. Bradycardia occurred in six patients (20%) which was managed in all with a single dose of atropine. Conclusion: Thoracic CSE anesthesia can be used effectively for ASA I and II patients undergoing laparoscopic cholecystectomy with significant postoperative benefits. Keywords: laparoscopic cholecystectomy, levobupivacaine hydrochloride, regional anesthesia, thoracic combined spinal epidural anesthesia PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015