Neostigmina intratecal en la analgesia Preventiva de la artroscopia Terapéutica de rodilla. Ensayo clínico
Abstract
Las algias postoperatorias constituyen un problema que carece de solución defintiva. Investigaciones contemporáneas demuestran una acción analgésica preventiva de la neostigmina administrada intratecalmente (NEOIT).Tal práctica se encuentra en plena etapa investigativa y se necesita incrementar la experiencia clínica con su utilización. OBJETIVOS: Identificar el grado de analgesia postoperatoria alcanzado con la NEOIT,impacto en los requerimientos anlgésicos postoperatorios y ocurrencia de efectos adversos. METODO: Cuatro grupos de pacientes recibieron aleatoriamente NEOIT, 100, 50, 25 μg o
un placebo (NaCl 0,9%) al practicarse una anestesia subaracnoidea para artroscopia de rodilla. Variables de respuesta: intensidad del dolor según escala visual-análoga 0-10
(EVA) con intervalos de cuatro horas hasta cumplidas 24, requerimientos suplementarios de dipirona y efectos adversos. Pruebas de Kruskal-Wallis, t de student y Chi-cuadrado se
aplicaron para identificar las posibles diferencias entre los grupos (p<0,05 significativo). RESULTADOS: Valores promedio de EVA fueron significativamente menores entre todos los grupos (en todos los momentos) tratados con NEOIT con un comportamiento
dosis dependiente. Análogamente los requerimientos de dipirona fueron significativamente menores. (p<0,05). Náuseas y vómitos alcanzaron proporciones que obligaron a detener el
ensayo. Los porcentajes respectivos para estos dos síntomas fueron: Grupo I, 69-58%, Grupo II, 47-41%, Grupo III, 32-24%, Grupo IV,12-12% (p<0,05). CONCLUSIONES: NEOIT por sus resultados analgésicos constituiría una alternativa atractiva para el tratamiento del dolor postoperatorio de las artroscopias pero la incidencia de náuseas y vómitos con dosis de 50 μg o más hacen desestimar su empleo. 25μg no eliminan totalmente el dolor.
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