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Revista de la Sociedad Española del Dolor
Print version ISSN 1134-8046
Abstract
PEREZ HERRERO, M A; LOPEZ ALVAREZ, S; GALINDO MENENDEZ, S and LOPEZ GARCIA, A. Efficacy of a preincisional analgesic strategy with ibuprofen, paracetamol and dexamethasone in laparoscopic cholecystectomy. Prospective observational study. Rev. Soc. Esp. Dolor [online]. 2020, vol.27, n.2, pp.104-112. Epub May 25, 2020. ISSN 1134-8046. https://dx.doi.org/10.20986/resed.2020.3778/2019.
Aims:
To evaluate efficacy and security with a multimodal preventive analgesic technique (intravenous paracetamol, ibuprofen, dexametasone and local anesthetic infiltration incision) in postoperative pain management after laparoscopic cholecystectomy.
Methodology:
Observational prospective study in laparoscopic cholecystectomy under common anesthetiå(c)using intravenous ibuprofen (800 mg), paracetamol (1 g), dexamethasone (0.1 mg/kg) and 0.5 % bupivacaine portals infiltration. Analgesic rescue with metamizole (2 g) and morphine clorure (1 mg boluses). We noted pain grade, rescue analgesia, anesthetic-chirurgic complications and satisfaction level at five moments: in UCPA stay (20 min and 2 h after surgery and before discharge) and 24 h after surgery.
Results:
112 patients: 71 women and 41 men, 61.15 ± 16.23 aged; 76.20 ± 12.68 kg weight, surgery time of 92.11 ± 30.64 minutes; 1.91 ± 15,78 microgrames/kg/h fentanyl doses; ASA I (34,8 %), II (40,2 %), III (22,3 %) y IV (2,7 %). Two maximum pain peaks: at 20 min and at 24 h after the intervention and during movement. Severe pain and additional analgesia in 23 cases, and need for morphine chloride boluses in 6. Thirty cases complications were documented: emesis in 17 people (15.18 %), venous irritability in 10 cases (8.93 %) and hemodynamic instability in 3 cases (2.68 %).
Conclusions:
The multimodal analgesic strategy used in this study provided effective analgesia with fast, high-quality anesthetic-surgical recovery in most patients. In case it was need, low perioperative opioid requirements. Low rate and severity of perioperative complications, which facilitated high outpatient surgery rates.
Keywords : Multimodal analgesia; postoperative pain; laparoscopic cholecystectomy.