REVISTA

Hiperalgesia inducida por el tratamiento con dosis bajas de opioides antes de la cirugía ortopédica: estudio observacional de casos y controles

Descripción: Hiperalgesia inducida por el tratamiento con dosis bajas de opioides antes de la cirugía ortopédica: estudio prospectivo observacional

TITULO FUENTE ORIGINAL:

Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case-control study

AUTORES:

Hina N, Fletcher D, Poindessous-Jazat F, Martinez V

REVISTA ABREV.:

European Journal of Anaesthesiology

AÑO:

2015

REFERENCIA:

32(4):255-61

DOI:

10.1097/EJA.0000000000000197

RESUMEN ORIGINAL:

BACKGROUND:
Chronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear.
OBJECTIVES:
To assess preoperative opioid-induced hyperalgesia and its postoperative clinical consequences in patients with chronic pain scheduled for orthopaedic surgery.
DESIGN:
A prospective observational...
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BACKGROUND:
Chronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear.

OBJECTIVES:
To assess preoperative opioid-induced hyperalgesia and its postoperative clinical consequences in patients with chronic pain scheduled for orthopaedic surgery.

DESIGN:
A prospective observational study.

SETTINGS:
Raymond Poincare teaching hospital.

PATIENTS:
Adults with or without long-term opioid treatment, scheduled for orthopaedic surgery.

PRIMARY OUTCOME MEASURE:
Preoperative hyperalgesia was assessed with eight quantitative sensory tests, in a pain-free zone.

SECONDARY OUTCOME MEASURES:
Postoperative morphine consumption and pain intensity were evaluated using a numerical rating scale (NRS) in the recovery room and during the first 72 h.

RESULTS:
We analysed results from 68 patients (28 opioid-treated patients and 40 controls). Mean daily opioid consumption was 42 ± 25 mg of morphine equivalent. The opioid-treated group displayed significantly higher levels of preoperative hyperalgesia in three tests: heat tolerance threshold (47.1°C vs. 48.4°C; P = 0.045), duration of tolerance to a 47°C stimulus (40.2 vs. 51.1 s; P = 0.03) and mechanical temporal summation [1.79 vs. 1.02 (ΔNRS10-1); P = 0.036]. Patients in the opioid-treated group consumed more morphine (19.1 vs. 9.38 mg; P = 0.001), had a higher pain intensity (7.6 vs. 5.5; P = 0.001) in the recovery room and a higher cumulative morphine dose at 72 h (39.8 vs. 25.6 mg; P = 0.02).

CONCLUSION:
Chronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery

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