RESUMO
Objetivo. Evaluar la estabilidad de parecoxib en un sistema de infusión continua elastomérica portátil IV para 24 horas, en dilución con opiáceos (cloruro mórfico, meperidina ó tramadol), antieméticos y suero fisiológico, durante las 24 horas del postoperatorio; así como, comprobar el resultado analgésico, la aparición de efectos secundarios y el grado de satisfacción de pacientes intervenidos de cirugía mayor susceptibles de tratamiento con dichos fármacos. Material y Métodos. El infusor es un dispositivo desechable y ligero con un depósito elastomérico para administrar medicación. Se realizaron varias pruebas mezclando parecoxib, opiáceos, antieméticos y suero fisiológico y se observó su estabilidad durante 24 horas. Procedimos a observar la mezcla en repetidas ocasiones y la dilución siempre permaneció estable, clara, sin partículas y transparente; por lo que se decidió utilizar dicha mezcla en el infusor IV para el tratamiento del dolor postoperatorio, siempre bajo la supervisión de un anestesiólogo. Se estudiaron un total de 118 pacientes, 46 mujeres (39%) y 72 hombres (61%), ASA I-IV, edad media 59,75 +/- 14,25 (18-89), 92 (78%) fueron intervenidos de cirugía general y 26 (22%) de urología. El llenado del infusor según ASA, edad y tipo de intervención del paciente, se realizó con: parecoxib 80 mg + metoclopramida Cl H 20 ó 30 mg + suero fisiológico en los 118 pacientes, se añadió cloruro mórfico en 65 pacientes, meperidina en 30 y tramadol en 23, a administrar en 24 horas tras la intervención quirúrgica. Se valoró la intensidad del dolor según EAV a la llegada a la Sala de Despertar y a las 24 horas, resultado analgésico, efectos secundarios y grado de satisfacción. Resultados. El resultado analgésico fue muy bueno en 60 pacientes (50,85%); bueno en 40 (33,90%); regular en 12 (10,17%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Los efectos secundarios aparecieron en 30 casos (25%): 4 con sudoración (3%), 1 con desorientación (0,8%) y 7 con somnolencia y mareo (6%) 3 de ellos con interrupción del tratamiento. En cuanto a las náuseas y/o vómitos: 18 pacientes necesitaron rescate antiemético, y en 3, hubo que suspender el tratamiento. El grado de satisfacción del paciente fue: muy satisfactorio en 56 pacientes (47,5%); satisfactorio en 46 (39%), deficiente en 10 (8,5%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Conclusiones. La posibilidad de utilizar parecoxib sólo o unido a otros fármacos en perfusión continua IV para el tratamiento del dolor agudo postoperatorio, es una opción a considerar
Objective. To evaluate the stability of parecoxib in a portable elastomeric pump system for IV infusion in dilution with opioids (morphine chloride, pethidine or tramadol), antiemetics and saline solution during 24 hours in the postoperative period; as well as to verify the analgesic result, the incidence of side effects and the degree of satisfaction in patients undergoing major surgery that were eligible for treatment with these drugs. Material and Methods. The infuser pump is a light disposable device with an elastomeric deposit to administer the medication. Several tests combining parecoxib, opioids, antiemetics and saline solution were carried out and its stability was demonstrated during 24 hours. The mixture was then observed in several occasions and was shown that the dilution always remained stable, clear, with no particles and transparent; therefore it was decided to use that combination in the IV infuser for the treatment of postoperative pain, always under the anaesthesiologist supervision. A total of 118 patients were studied, 46 women (39%) and 72 men studied (61%), ASA I-IV, mean age 59.75 +/- 14.25 (18-89); 92 (78%) underwent general surgery procedures and 26 (22%) urologic ones. The filling of infuser according to ASA, age and type of surgery of the patient, was made with: parecoxib 80 mg + metoclopramide CL H 20 or 30 mg + saline solution for the 118 patients, morphine chloride was added in 65 patients, petidine in 30 and tramadol in 23, during 24 hours after surgery. Pain was assessed using a VAS in both at arrival in the PACU and 24 hours after the surgical procedures. Analgesic outcome, side effects and degree of satisfaction were recorded. Results The analgesic outcome was very good in 60 patients (50.85%); good in 40 (33.90%); regular in 12 (10.17%) and the treatment was interrupted 6 (5%) due to side effects. Side effects were present in 30 (25%) cases: 4 with perspiration (3%), 1 with disorientation (0.8%) and 7 with somnolence and dizziness (6%) 3 of them with interruption of the treatment. For nausea and vomiting, 18 patients needed antiemetics rescue, and in 3 cases it was necessary to suspend the treatment. The degree of satisfaction reported by patients was: very satisfactory in 56 patients (47.5%); satisfactory in 46 (39%), inadequate in 10 (8.5%) and the treatment was suspended in 6 (5%) due to side effects. Conclusions. The possibility of using parecoxib alone or in combination with other drugs in continuous IV perfusion for acute postoperative pain is an important option to be considered
Assuntos
Humanos , Dor Pós-Operatória/tratamento farmacológico , Inibidores de Ciclo-Oxigenase/farmacocinética , Bombas de Infusão , Estabilidade de Medicamentos , Entorpecentes/administração & dosagem , Antieméticos/administração & dosagem , Anti-Inflamatórios não Esteroides/farmacocinéticaRESUMO
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Assuntos
Desenvolvimento Tecnológico/métodos , Cultura Organizacional , Administração Hospitalar/tendências , Sistemas de Comunicação no Hospital/organização & administração , Inovação Organizacional , Redes de Comunicação de Computadores/organização & administração , Informática Médica/organização & administraçãoRESUMO
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Assuntos
Gestão do Conhecimento , Administração de Instituições de Saúde/tendências , Inovação Organizacional , Análise Custo-Benefício , Gestão de Recursos HumanosRESUMO
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Assuntos
Registros Eletrônicos de Saúde/organização & administração , Informática Médica/organização & administração , Tecnologia da Informação , Desenvolvimento Tecnológico , Confidencialidade/normas , Current Procedural TerminologyRESUMO
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