Resumen

CARRILLO TORRES, O.; GALLEGOS ALLIER, M.M.  y  JIMENEZ OLVERA, M.. Comparison between dexmedetomidine infusion vs. lidocaine intravenous infusion for treatment of severe pain in palliative care patients under opioid treatment. Rev. Soc. Esp. Dolor [online]. 2015, vol.22, n.1, pp.7-12. ISSN 1134-8046.  https://dx.doi.org/10.4321/S1134-80462015000100002.

Introduction: Refractory pain is defined as that which remains persistent (EVA 6 or more) despite treatment with opioids (with 1 or more previous rotations) + anti-inflammatory drugs (NSAIDs or corticosteroids). Alpha-2 agonists and/or local anesthetics have been used for treating. Analgesic response to the administration of dexmedetomidine appears to occur at the level of dorsal root neuron, where the alpha-2 agonists block the release of substance P in the nociceptive pathway. The central analgesic effect is mediated by the activation of descending inhibitory pathways, by blocking the receptors of aspartate and glutamate. The use of intravenous lidocaine can suppress ectopic neural discharges primary afferents from injured due to its blocking voltage-dependent sodium channels. Furthermore it has been demonstrated activation of endogenous opioid system lidocaine infusion systemically. Objective: To evaluate the analgesic effect of intravenous dexmedetomidine infusion compared with intravenous lidocaine infusion for pain refractory to opioids in palliative care patients. Material and methods: This is a randomized, triple-blind study with consecutive sampling. The analysis of results with measures of central tendency and dispersion. To compare quantitative variables T test was used for independent samples. Contingency tables were constructed and graphics through SPSS version 17. Study population: Patients with refractory pain, hospitalized within the Palliative Care Program randomly assigned to one of 2 groups whose sample number (n = 14) was obtained by difference formula proportions. Results: For both infusions analgesia with no significant differences. Of the 16 patients, 18 % (n = 3) required rescue therapy during infusion and 18 % (n = 3) required rescue within 48 hours post-infusion. During infusion of the 42 % lidocaine group need rescue (n = 3) and time within 48 hours post infusion was administered three rescues: 42 % of patients in the lidocaine group (n = 2), and 14 % of dexmedetomidine group patients (n: 1). Regarding sedation during the infusion were reported significant differences (p -0.01) increased sedation reporting for dexmedetomidine group. No complications cardiovascular and / or respiratory none of the two groups. Conclusions: The dexmedetomidine group required less opioid bailouts during infusion and after it. Sedation was greater in the group of dexmedetomidine without presence of cardiovascular and/or respiratory during or after the infusion.

Palabras clave : Refractory pain; Dexmedetomidine; Lidocaine; Palliative care.

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