REVISTA DESTACADA

Intensidad de dolor el primer día después de una cirugía

Valoración Valoración: 4 Estrellas

Descripción: Intensidad de dolor postoperatorio según el tipo de cirugía en medicina humana

TITULO FUENTE ORIGINAL:

Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures

AUTORES:

Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W.

REVISTA ABREV.:

Anesthesiology

AÑO:

2013

REFERENCIA:

Apr;118(4):934-44.

DOI:

10.1097/ALN.0b013e31828866b3.

FECHA DE PUBLICACIÓN:

08/05/2013

RESUMEN ORIGINAL:

BACKGROUND:
Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative...
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BACKGROUND:
Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified.
METHODS:
This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared.
RESULTS:
The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major" abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia.
CONCLUSIONS:
Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.

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COMENTARIO DE Delia, Aguado Domínguez

Se trata de un estudio de cohortes retrospectivo donde analis¡zan la intensdad de dolor observada en las primeras 24h en pacientes tras los  distintos porcedimientos quirúrgicos que han sido sometidos. La mayoria de los porcedimientos con alto grado de dolor son cirugías traumatologicas. Curiosamente, muchas cirigías "menores", por ej. cirugía... + Leer más

Se trata de un estudio de cohortes retrospectivo donde analis¡zan la intensdad de dolor observada en las primeras 24h en pacientes tras los  distintos porcedimientos quirúrgicos que han sido sometidos. La mayoria de los porcedimientos con alto grado de dolor son cirugías traumatologicas. Curiosamente, muchas cirigías "menores", por ej. cirugía laparoscópica, asociadas con un menor dolor postoperatorio esperado porducen puntuaciones altas de dolor postquirúrgico, muy porbablemente debido a un escaso tratamiento analgésico. Por otro lado, los porcedimientos mayores, que reciben unataerapia analgésica polimodal más agresiva presentan menores grado de dolor que estas,simplemnte puede ser debido  ala inclusión de analgesia epidural en ellos. 

Po relllo, independientemente del dolor esperado segun el procedimiento quirúrgico que se realice, seria necesario evaluar el dolor de cerca en los pacientes y adecuarla terapia analgésica recibida a la intesidad de dolro que demuestren

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