Ureña-Frausto Cielo Alborada, Plancarte-Sánchez Ricardo, Reyes-Torres Juan Ignacio, Ramírez-Aranda José Manuel
Departamento de Anestesiología, Hospital General de Cerralvo, Cerralvo, Nuevo León, Mexico.
Cir Cir. 2013 May-Jun;81(3):187-95.
Neuraxial anesthesia in upper abdominal laparoscopic surgery decreases perioperative morbidity and mortality. However, shoulder pain is common and difficult to control. Use of a major opioid (e.g., fentanyl) for the control of this event may depress respiratory function. This is why we believe that a safe and effective therapeutic control of this disease pain is a multimodal analgesic scheme which we have called infusional therapy.
To compare various schemes for controlling shoulder pain secondary to pneumoperitoneum.
Nonrandomized clinical trial with 56 patients ASA I-II divided into four groups undergoing laparoscopic cholecystectomy. Group I (n= 15) managed with ketorolac 1 mg kg, group II (n = 12) ketoprofen 100 mg, group III (n = 14) ketoprofen 50 mg + 50 mg tramadol, and group IV (n = 15) ketoprofen 100 mg + 100 mg tramadol. The following ariables were analyzed: presence and intensity of pain, analgesia rescue and operative time.
Group I had more shoulder pain events compared to other groups (p= 0.002) in the same way the group IV required less rescue analgesia (p= 0.034).
preemptive analgesia to infusional therapy with ketoprofen-tramadol at doses of 100 mg each is safe for laparoscopic surgery.
上腹部腹腔镜手术中的椎管内麻醉可降低围手术期发病率和死亡率。然而，肩部疼痛很常见且难以控制。使用主要的阿片类药物（如芬太尼）来控制这种情况可能会抑制呼吸功能。这就是为什么我们认为对这种疾病疼痛进行安全有效的治疗控制是一种多模式镇痛方案，我们称之为输注疗法。
比较控制气腹后肩部疼痛的各种方案。
对56例ASA I-II级患者进行非随机临床试验，将其分为四组接受腹腔镜胆囊切除术。第一组（n = 15）用酮咯酸1 mg/kg治疗，第二组（n = 12）用酮洛芬100 mg，第三组（n = 14）用酮洛芬50 mg + 50 mg曲马多，第四组（n = 15）用酮洛芬100 mg + 100 mg曲马多。分析以下变量：疼痛的存在和强度、镇痛补救措施和手术时间。
与其他组相比，第一组肩部疼痛事件更多（p = 0.002），同样第四组所需的补救镇痛较少（p = 0.034）。
对于腹腔镜手术，预先镇痛至采用各100 mg剂量的酮洛芬-曲马多输注疗法是安全的。
