Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
QUIRANTE, A. et al. Remifentanyl versus epidural central blockade for the management of postoperative pain in emergency vascular surgery. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.8, pp.72-75. ISSN 1134-8046.
Introduction: The appropriate management of postoperative pain is a priority among the objectives of the anesthesiologist. In patients with severe surgical vascular pathology, an effective analgesic treatment is usually provided with epidural continuous blockade. However, the intravenous administration of analgesics, either opiates or non opiates, is an alternative to the epidural route when this has to be dismissed. Clinical case: We present the case of a 63-years old male patient carrying a femoro-popliteus bypass in the first portion of the left lower limb that underwent emergency surgery after being diagnosed of a false septic aneurysm in the left iliac artery with breakage of the femoro-popliteus anastomosis. General anesthesia based on remifentanyl was decided instead of epidural central blockade due to the urgent nature of the surgery and the regular intake of antiplatelet aggregants. The administration of fentanyl at sedoanalgesic doses (<0,2 µg.kg-1.min-1) was planned as postoperative analgesic strategy . The patient entered in the APPU extubated, with spontaneous ventilation and a VAS score of 2-3. Twelve hours after his admittance to the APPU, the patient underwent surgery due to the presence of clinical signs that clearly suggested an acute ischemia in MM.II. Despite this, the degree of comfort and the VAS score did not changed during that period. Discussion: Remifentanyl chlorhidrate is an opiate with an extremely short action and a great analgesic power. Due to its pharmacokinetic properties, it is a predictable drug in terms of the onset of its action and the end of its effects, regardless the infusion or the total dose administered. Given the lack of a residual analgesic effect after the general anesthesia with this drug, an appropriate postoperative analgesic plan must be established. Remifentanyl at doses < 0,2 µg.kg-1.min-1 allows to optimize the analgesia and comfort of patients in the APPU and, hence, it is an alternative to epidural central blockade for the management of postoperative pain in emergency vascular surgery.
Palabras clave : Vascular surgery; Remifentanyl; Postoperative pain; Epidural analgesia.