[Tramadol in elastomeric continuous perfusion for analgesia after gynecologic surgery]. / Tramadol en perfusión continua mediante elastómeros para analgesia postoperatoria de cirugía ginecológica.

Quality of analgesia provided by continuous infusion of tramadol through an elastomeric infuser (Baxter PC1071) was studied in a group of 40 women undergoing laparotomy to treat non tumoral disease. After a loading dose of 100 mg of tramadol in the recovery room, the elastomeric infuser was connected, loaded with 300 mg of tramadol in 48 ml of saline. The patient was then transferred to the ward. Analgesic quality was assessed on a visual analog scale (VAS) of 1 to 10 and on a semantic scale. Side effects, the need for supplemental analgesia and the opinion of the nurse were all recorded. The highest VAS score in the 24 h period was 2.69. Pain was described as slight by 52.5% of the women, moderate by 12.5% and absent by 35%. The main side effects were nausea and vomiting (12.5%). Three patients needed supplementary analgesia. The technique was described by 85% of the nurses as good (62.5%) or very good (22.5%). Elastomeric infusers are an effective way to deliver analgesics, and tramadol proved to be a valid analgesic for continuous infusion.

[Anesthesiology implications of laparoscopic surgery]. / Implicaciones anestésicas de la cirugía laparoscópica.

Laparoscopic surgery is constantly advancing and has produced a small revolution in how surgery is used in a range of abdominal disease. Against the undisputed advantages laparoscopy brings to surgery (shorter hospital stay, rapid return to normal activity, more comfortable postoperative recovery and so on), we must weight its technical and anesthetic limitations, as well as the possibility of associated complications. At this time, appropriate indications for applying this technique in preference to conventional surgery are still in the process of being established. The solution to this very recently posed problem will come as a result of further developments in laparoscopic procedures, greater experience and larger studies of morbidity and mortality. It seems clear that in spite of their advantages, surgical techniques involving minimal abdominal incisions will be the subject of controversy and debate for some time to come.