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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Outpatient intravenous multimodal elastomeric pump with methadone in ambulatory ...
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Vol. 65. Issue 6.
Pages 306-313 (June - July 2018)
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Vol. 65. Issue 6.
Pages 306-313 (June - July 2018)
Original article
DOI: 10.1016/j.redare.2018.01.019
Outpatient intravenous multimodal elastomeric pump with methadone in ambulatory surgery
Analgesia multimodal domiciliaria con metadona en perfusión intravenosa mediante bomba elastomérica en cirugía mayor ambulatoria
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L. Gómez-López
Corresponding author
LGOMEZ2@clinic.ub.es

Corresponding author.
, X. Sala-Blanch, P.L. Gambús Cerrillo, A. López Gutiérrez, M. Agustí Lasús, M.T. Anglada Casas
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
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Figures (2)
Tables (4)
Table 1. Inclusion and exclusion criteria.
Table 2. Intensity of pain and need for rescue analgesia at 24 and 48h.
Table 3. Lattinen test at 24h.
Table 4. Side effects at 24 and 48h.
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Abstract
Background and objective

Analgesia in ambulatory surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included.

Patients and methods

An observational study, physical status ASA I–II, underwent ambulatory surgeries with moderate-severe postoperative pain. Analgesia was administered for 48h by an intravenous multimodal elastomeric pump (methadone, tramadol, dexketoprofen and ondansetron at low doses). Visual analogue scale (VAS) at rest and movement were evaluated at 24 and 48h. Andersen scale, Lattinen test, rescue analgesia and side-effects were recorded at 24h after surgery.

Results

We included 73 patients: 37% abdominal wall surgery, 30% hemorrhoidectomies and 33% perineal surgery. Median VAS score at rest and movement were 0 and 3 at 24h, and 0 and 2 at 48h. At 24h, Andersen's Scale score was ≤1 in 89%, and Lattinen test ≤6 in 90% of patients. Rescue medication was administered in 30% of patients. Two patients had vomiting at 24 and 48h. Minor catheter and pump dysfunctions were observed in 8% of patients.

Conclusions

Multimodal analgesia with intravenous methadone administered by elastomeric perfusion at home is effective and safe. However, monitoring is needed to diagnosis dysfunction of devices.

Keywords:
Methadone
Infusion pumps
Postoperative pain
Outpatient surgery
Resumen
Antecedentes y objetivo

La analgesia en cirugía mayor ambulatoria (CMA) necesita evolucionar paralelamente a la complejidad quirúrgica. Diseñamos un estudio para intentar mejorar la analgesia en cirugía dolorosa mediante elastómera intravenosa. Como novedad, se incluyó metadona.

Pacientes y métodos

Estudio observacional en pacientes ASA I-II, intervenidos en CMA de cirugías con dolor postoperatorio moderado-severo. Se administró analgesia durante 48h mediante elastómera intravenosa de metadona, tramadol, dexketoprofeno y ondansetrón a dosis bajas, y paracetamol oral. A las 24 y 48h se evaluó la eficacia analgésica en reposo y en movimiento (Escala Visual Analógica [EVA], Escala de Andersen y Test de Lattinen), la necesidad de analgesia de rescate y los efectos adversos.

Resultados

Se incluyeron 73 pacientes: un 37% de ellos intervenidos de cirugía de pared abdominal, un 30% de hemorroidectomías y un 33% de cirugía del periné. La mediana en reposo a las 24 y 48h fue EVA=0, y en movimiento, fue de 3 a las 24h y de 2 a las 48h. En la Escala de Andersen, a las 24h el 89% presentó puntuación ≤1. En el Test de Lattinen, el 90% presentó una puntuación ≤6. Precisó rescate el 30%. Dos pacientes presentaron vómitos a las 24 y 48h. Se observaron problemas menores con el catéter y la elastómera en el 8% de los pacientes.

Conclusiones

La analgesia multimodal con metadona intravenosa administrada mediante bomba elastómera para cirugía ambulatoria dolorosa es eficaz y segura. Sin embargo, es necesaria vigilancia para identificar disfunciones del dispositivo.

Palabras clave:
Metadona
Bomba elastomérica
Dolor postoperatorio
Cirugía mayor ambulatoria

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