Eficacia de la analgesia postoperatoria en pacientes sometidos a hernioplastia inguinal con anestesia espinal: bupivacaina/fentanil mas neostigmina vs bupivacaina/fentanil

Abstract

Objetivo: Comparar la eficacia de la analgesia postoperatoria en pacientes sometidos a hernioplastia inguinal con anestesia espinal: bupivacaína/fentanil más neostigmina vs bupivacaína/fentanil. Métodos: Estudio prospectivo, comparativo, cuasi-experimental, con 30 pacientes ASA I ó II entre 18 y 70 años, los pacientes fueron divididos en dos grupos: 15 pacientes recibieron vía espinal Bupivacaína 0,5 % 10 mg, fentanil 25 mcg (Grupo 1) y 15 recibieron Bupivacaína 0,5 % 10 mg, fentanil 25 mcg y neostigmina 50 mcg (Grupo 2). La población estuvo representada por pacientes que acudieron al Servicio de Cirugía II programados para hernioplastia inguinal durante agosto a diciembre de 2017. Resultados: Los parámetros hemodinámicos posterior a técnica neuroaxial mostraron diferencias intergrupales de FC durante minutos 3, 9 y 11 con p=0,018 p=0,033 p=0,026. PAS en minutos 9 y 11, con p=0,001 p=0,004. PAD en minutos 3, 6 y 9 con p=0,006 p=0,004 0,034. Durante periodo intraoperatorio la FC mostró diferencias intergrupales en minuto 3 con p=0,050. PAS en minutos 3, 6, 9 y 11, con p=0,016 p=0,017, p=0,001 p=0,007. PAM en minuto 3 y 9, con p=0,032 p=0,021. En SCPA se observó FC y PAM con diferencias en minutos 180 y 240 con p=0,021 p=0,002 en la FC y p=0,007, p=0,001 en PAM. Período de latencia menor en Grupo 1 con respecto al Grupo 2, con p=0,000. Bloqueo motor posterior a técnica mostró diferencia con p=0,047, y nivel sensitivo sin diferencia con p=0,439. Ambos grupos, ingresaron a SCPA con EVA de 0 puntos sin diferencias con p=0,343, en SCPA a 45, 60 y 120 minutos con p=0,002, p=0,000 p=0,006. Al egresar de SCPA con p=0,003. Primer rescate analgésico se requirió en menor tiempo en Grupo 1 que en el Grupo 2 con p=0,000. Náuseas y vómitos postoperatorios sin diferencias. SatO2 en periodo intraoperatorio hubo diferencias en minutos 3, 6, 9 y 11 con p=0,006, p=0,003, p=0,001 p=0,003. En SCPA a 30 y 45 minutos, con p= 0,000 p=0,002. Conclusión: El uso de neostigmina vía espinal es eficaz para producir analgesia postoperatoria en pacientes sometidos a hernioplastia inguinal, con baja incidencia de efectos adversos, y menores requerimientos de analgesia de rescate. Objective: To compare the efficacy of postoperative analgesia in patients undergoing inguinal hernioplasty with spinal anesthesia: bupivacaine / fentanyl plus neostigmine vs bupivacaine / fentanyl. Methods: Prospective, comparative and quasi-experimental study, with 30 ASA I or II patients between 18 and 70 years of age, the patients divided into two groups of 15 patients who received spinal instillation of 0.5% Bupivacaine 10mg, fentanyl 25mcg (Group 1) and 15 to which they were instilled a mixture of 0.5% Bupivacaine 10 mg, 25 mcg fentanyl and 50 mcg neostigmine (Group 2). The study population was represented by all those patients who attended the service of Surgery II that were scheduled for inguinal hernioplasty during August to December 2017. Results: Hemodynamic parameters after neuraxial technique showed intergroup differences of HR during minutes 3, 9 and 11 with p = 0.018 p = 0.033 p = 0.026. PAS in minutes 9 and 11, with p = 0.001 p = 0.004. PAD in minutes 3, 6 and 9 with p = 0.006 p = 0.004 0.034. During the intraoperative period, HR showed intergroup differences at minute 3 with p = 0.050. PAS in minutes 3, 6, 9 and 11, with p = 0.016 p = 0.017, p = 0.001 p = 0.007. MAP at minute 3 and 9, with p = 0.032 p = 0.021. In SCPA, FC and MAP were observed with differences in minutes 180 and 240 with p = 0.021 p = 0.002 in the FC and p = 0.007, p = 0.001 in the MAP. Latency period lower in Group 1 with respect to Group 2, with p = 0.000. Motor block after technique showed difference with p = 0.047, and sensory level not without difference with p = 0.439. Both groups entered SCPA with EVA of 0 points without differences with p = 0.343, in SCPA in 45, 60 and 120 minutes with p = 0.002, p = 0.000 and p = 0.006. Upon graduation from SCPA with p = 0.003. First analgesic rescue was required in less time in Group 1 than in Group 2 with p = 0.000. Postoperative nausea and vomit without differences. SatO2 in intraoperative period there were differences in minutes 3, 6, 9 and 11 with p = 0.006, p = 0.003, p = 0.001 p = 0.003. In SCPA at 30 and 45 minutes, with p = 0.000 p = 0.002.Conclusion: The use of spinal neostigmine is effective to produce postoperative analgesia in patients undergoing inguinal hernioplasty with a low incidence of adverse effects, and lower requirements for rescue analgesia.