[Effect of the local anesthesia in the response to the pain. Study in the inguinal herniotomy]. / Efecto de la anestesia local en la respuesta al dolor. Estudio en la herniotomía inguinal.

INTRODUCTION: The inguinal hemiotomy is a surgical procedure common in pediatric surgery and as in any operation the control of the pain is fundamental. The aim of this study is to verify the effect of the local anesthesia next to the general anesthesia, in the control of postsurgical pain. MATERIAL AND METHOD: A prospective study is made in 60 patients submitted for unilateral repair of hernia inguinal and hidrocele, under general anesthesia. The patients were designated at random in three equal groups after the anesthetic induction. In group I ilio-inguinal blockade is made, before the surgical incision. In group II local infiltration is made after the closing of the aponeurosis and in group III the anesthetic is not infiltrate. The age of the patients included was between 1 and 13 years. For the valuation of the pain and comparison between the three groups we used: 1) Measurements of conductual type. 2) Measurements of biological type before and after the intervention: Arterial tension, cardiac frequency, respiratory frequency... 3) Laboratory measurements: cortisol levels, prolactose, insulin and glucose. Two extractions are made, first after the anesthetic induction and second 60 minutes after the intervention. The results were analyzed using computer statistical program SPSS. A probability value of < 0,05 was considered significant. RESULTS: 1) Conductual measurements: the differences between groups I and II in relation to the III were significant. This conductual difference also was related to the age of the patients. 2) Measurements of biological type: in groups I and II the postoperative arterial tension average was smaller, but only in group I the difference was significant. The heart rate decreased in the three groups, but was significant only in group I, like the respiratory frequency. 3) Laboratory measurements: in groups I and II the levels of cortisol and glucose diminished in the postoperative period, but only in group I the difference was significant. The values of prolactose diminished in the postoperative period in group I but was not significant. Insulin experienced an increase in the three groups, although smaller in group I. CONCLUSIONS: 1) The results of the study demonstrate specially that the local infiltration of anesthetic diminishes the metabolic answer and reduces the intensity of the postoperating pain, when is made before the beginning of the surgery. 2) In the conductual answer to the pain not only influences the use of the anesthetics but the age of the patient.

Efecto de la anestesia local en la respuesta al dolor. Estudio en la herniotomía inguinal / Effect of the local anesthesia in the response to the pain. Study in the inguinal herniotomy

Introducción. La herniotomía inguinal es un procedimiento quirúrgico común en cirugía pediátrica y como en cualquier intervención quirúrgica es fundamental el control del dolor. El objetivo de este estudio es comprobar el efecto de la anestesia local junto a la anestesia general, en el control del dolor postquirúrgico. Material y método. Se realiza un estudio prospectivo en 60 pacientes sometidos a reparación de hernia inguinal e hidrocele unilateral, bajo anestesia general. Los pacientes fueron designados al azar en tres grupos iguales después de la inducción anestésica. En el grupo I se realiza bloqueo ilio-inguinal, antes de la incisión quirúrgica. En el grupo IIse realiza infiltración local tras el cierre de la aponeurosis y en el grupo III no se infiltra anestésico local. La edad de los pacientes estuvo comprendida entre 1 y 13 años. Para la valoración del dolor y comparación entre los tres grupos utilizamos: 1) Mediciones de tipo conductuales.2) Mediciones de tipo biológico antes y después de la intervención: Tensión arterial, frecuencia cardiaca, frecuencia respiratoria… 3)Mediciones de laboratorio: niveles de cortisol, prolactina, insulina y glucosa. Se realizan dos extracciones, la primera después de la inducción anestésica y la segunda 60 minutos después de la intervención. Los resultados fueron analizados empleando el programa informático-estadístico SPSS. Un valor de probabilidad < 0,05 fue considerado significativo. Resultados. 1) Mediciones de tipo conductuales: Las diferencias entre los grupos I y II en relación con el III fueron significativas. Esta diferencia conductual también estuvo relacionada con la edad de los pacientes. 2) Mediciones de tipo biológico. En los grupos I y II la tensión arterial media postoperatoria fue menor, pero solo en el grupo Il a diferencia fue significativa. La frecuencia cardiaca disminuyó en los tres grupos, pero significativa solo en el grupo I, al igual que la frecuencia respiratoria. 3) Mediciones de laboratorio: En los grupos I y II los niveles de cortisol y glucosa disminuyeron en el postoperatorio, pero sólo en el grupo I la diferencia fue significativa. Los valores de prolactina sólo disminuyeron en el postoperatorio en el grupo I pero no fue significativo. La insulina experimentó un aumento en los tres grupos, aunque menor en el grupo I. Conclusiones. 1) Los resultados del estudio demuestran que la infiltración local de anestésico disminuye la respuesta metabólica y reduce la intensidad del dolor postoperatorio, especialmente cuando se realiza antes del comienzo de la cirugía. 2) En la respuesta conductual al dolor no solo influye la utilización de anestésico local si no también la edad del paciente (AU)

Introduction. The inguinal herniotomy is a surgical procedure common in pediátric surgery and as in any operation the control of the pain is fundamental. The aim of this study is to verify the effect of the local anesthesia next to the general anesthesia, in the control of postsurgicalpain. Material and method. A prospective study is made in 60 patients submitted for unilateral repair of hernia inguinal and hydrocele, undergeneral anesthesia. The patients were designated at random in three equal groups after the anesthetic induction. In group I ilio-inguinal blockade is made, before the surgical incision. In group II local infiltration is made after the closing of the aponeurosis and in group III the anesthetic is not infiltrate. The age of the patients included was between 1and 13 years. For the valuation of the pain and comparison between the three groups we used: 1) Measurements of conductual type. 2) Measurements of biological type before and after the intervention: Arterial tension, cardiac frequency, respiratory frequency… 3) Laboratory measurements: cortisol levels, prolactose, insulin and glucose. Two extractions are made, first after the anesthetic induction and second60 minutes after the intervention. The results were analyzed using computer statistical program SPSS. A probability value of < 0,05 was consideredsignificant. Results. 1) Conductual measurements: The differences between groups I and II in relation to the III were significant. This conductual difference also was related to the age of the patients. 2) Measurements of biological type. In groups I and II the postoperative arterial tension average was smaller, but only in group I the difference was significant. The heart rate decreased in the three groups, but was significant only in group I, like the respiratory frequency. 3) Laboratory measurements: In groups I and II the levels of cortisol and glucose diminished in the postoperative period, but only in group I the difference was significant. The values of prolactose diminished in the postoperative period in group I but was not significant. Insulin experienced an increase in the three groups, although smaller in group I. Conclusions. 1) The results of the study demonstrate specially that the local infiltration of anesthetic diminishes the metabolic answer and reduces the intensity of the post operating pain, when is made before the beginning of the surgery. 2) In the conductual answer to the pain not only influences the use of the anaesthetics but the age of the patient (AU)