Eficacia de la ropivacaína 0, 1 % intraperitoneal en el control del dolor postoperatorio en cirugía ginecológica laparoscópica / Effectiveness of intraperitoneal 0.1% ropivacaine to control postoperative pain after undergoing gynaecological laparoscopic surgery

Introduccion: Determinar la eficacia de la administration pre-incisional de ropivacaina al 0,1 % intraperitoneal en el control del dolor abdominal y/o de hombro, durante la primera semana de la cirugia laparoscopica ginecologica benigna. Diseho: Ensayo clinico aleatorizado y doble ciego. Material y metodos: Se realizo un ensayo clinico aleatorizado y doble ciego donde participaron 64 pacientes ASA I-III sometidas a cirugia laparoscopica ginecologica por patologia benigna. Tras la realization del neumoperitoneo, se administraron 100 ml de ropivacaina 0,1 % o suero fisiologico intraperitoneal, dependiendo del grupo al que pertenecieran. Las pacientes recibieron, ademas, AINE junto con una bomba de PCA con option de morfina de rescate como analgesia multimodal asociada. Se evaluo el dolor abdominal y/o de hombro al despertar, en reposo y en movimiento, a los 5, 30, 60 y 120 minutos, asi como a las 24 horas. Se registro el consumo de morfina en las primeras 24 horas y la incidencia de nauseas y/o vomitos postoperatorios. A la semana, mediante encuesta telefonica, se registro la presencia de dolor de hombro a partir de las 24 horas, asi como de dolor abdominal persistente al 1° dia. Resultados: No se observaron diferencias significativas en el ENV durante las primeras 24 horas. Tampoco se observaron diferencias en el consumo de morfina, en la incidencia de nauseas y/o vomitos o en el dolor de hombro. Se evidenciaron diferencias estadisticamente significativas en la incidencia de dolor abdominal persistente al 7a dia (18,52 % en grupo tratamiento vs. 57,58 % en grupo control con p = 0,04). Conclusiones: La administration intraperitoneal preincisional de 100 ml de ropivacaina 0,1 % en comparacion con la administration de suero fisiologico, en el contexto de una tecnica anestesica y analgesica multimodal, no ha demostrado reducir el dolor postoperatorio, el consumo de opioides ni la incidencia de nauseas y vomitos postoperatorios en las primeras 24 horas. Tampoco ha demostrado reduction del dolor de hombro a partir del primer dia tras cirugia laparoscopica ginecologica. El uso de ropivacaina al 0,1 % intraperitoneal preincisional presenta una diminution estadisticamente significativa en la incidencia de dolor abdominal persistente al septimo dia de postoperatorio (AU)

Introduction: Determine the efficacy of preincisional ropivacaine 0,1 % intraperitoneal administration to control abdominal and/or shoulder pain after gynaecological laparoscopic surgery during the first week. Design: Randomized and double-blinded trial. Material and methods: 64 ASA I-III patients undergoing gy-naecological laparoscopic surgery for benign pathology were selected. After the pneumoperitoneum was done, 100 ml of 0.1 % ropivacaine or saline were administered intraperioteneally. Patients received multimodal analgesia. Besides, a morphine PCA pump with a bolus option was prescribed. Abdominal and/or shoulder pain were assessed, at rest and in motion, on waking up from anaesthesia, to 5,30,60 and 120 minutes and at 24 hours from the surgery. Morphine consumption were recorded in the first 24 hours and the presence of nausea and/or vomiting postoperatively. A week after the surgery, by a telephone survey, the shoulder pain after and the persistent abdominal pain on the seventh day was recorded. Results: No significant differences in the ENV scale during the first 24 hours were observed. No differences in morphine consumption, in the incidence of nausea and/or vomiting or shoulder pain were observed. Statistically significant differences were noted in the incidence of persistent abdominal pain on the seventh day (18.52 treatment group vs. 57,58 % in control group with a p value 0.04). Conclusions: The preincisional intraperitoneal administration of 100 ml of ropivacaine 0.1 % compared to administration of saline, in the context of an anesthetic and analgesic multimodal technique has not been shown to reduce postoperative pain, opioid consumption and the incidence of nausea and postoperative vomiting in the first 24 hours. Nor has it shown reduction of shoulder pain from the first day after undergoing gynecological laparoscopic surgery. Ropivacaine 0.1 % intraperitoneal preincisional may be useful in the control of abdominal pain which persists on the seventh day (AU)

Síndrome de QT prolongado y anestesia regional. A propósito de un caso / Prolonged QT syndrome and regional anesthesia: a case report

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