Manejo del dolor posoperatorio por cirugía de columna en la población pediátrica. Resultados preliminares.[Pain mangement following spinal surgeries in pediatric patients. Preliminary results]

Lucas Piantoni, Carlos Alberto Tello, Ida Alejandra Francheri Wilson, Rodrigo Remondino, Eduardo Galaretto, Ernesto Salomón Bersusky, Mariano Augusto Noel

Resumen


Introducción: Aproximadamente el 80% de los pacientes pediátricos sometidos a cirugía de columna refiere dolor moderado o severo en el posoperatorio inmediato.

Objetivos: Describir la presencia de dolor y su intensidad durante el posoperatorio de una cirugía de columna en pacientes pediátricos y evaluar la eficacia del tratamiento analgésico actual.

Materiales y Métodos: Se evaluaron pacientes sometidos a cirugía de columna, de entre 10 y 18 años, con capacidad mental para entender el propósito del estudio. Se utilizó el esquema de medicación estándar actual posoperatorio del hospital. Se constataron la presencia del dolor, la hora de comienzo, la localización y la intensidad (escala de valoración numérica), entre otras variables.

Resultados: Se evaluó a 84 pacientes pediátricos, con una edad promedio de 12 años y 9 meses, al momento de la cirugía. Las etiología fueron: idiopática (41 casos), neuropática (14 casos), sindrómica (10 casos), muscular (7 casos) y misceláneas (12 casos). El puntaje promedio en la escala de valoración numérica fue de 2,1 antes de la cirugía; de 7,3 el día 1 posoperatorio y de 3,3 el día 6 posoperatorio/alta. El tiempo promedio de internación fue de 6.3 días, el costo económico global de la internación fue de USD1090 por paciente.


Conclusiones: Un importante porcentaje de pacientes pediátricos refiere dolor moderado o severo en el posoperatorio de una cirugía de columna, tan solo la mitad recibe un esquema de manejo de dolor estandarizado y adecuado. El objetivo ulterior de este estudio será protocolizar el manejo del dolor con un enfoque multimodal.



Abstract

Introduction: Around 80% of pediatric patients who undergo spine surgery report moderate to severe pain in the immediate postoperative (POP) period, and only half of them are treated according to an adequate and standardized pain management scheme.


Objectives: To describe the type and intensity of POP pain in children who underwent spinal surgery and evaluate the effectiveness of the current pain management protocol.

Materials and Methods: We assessed children between 10 and 18 years of age who were able to understand the purpose of the study. We recorded presence of pain, time of POP pain onset, location, and referred intensity of the pain using a numeric rating scale (NRS), among other variables.

Results: Overall, 84 pediatric patients were evaluated. Mean age at surgery: 12 years and 9 months. Etiology: idiopathic (41 patients), neuropathic (14 patients), syndromic (10 patients), muscular (7 patients), and miscellaneous (12 patients). Mean preoperative NRS was 2.1 and 7.3 on POP day 1, 6.6 on POP day 2, 6.2 on POP day 3, 5.1 on POP day 4, 3.7 on POP day 5, and 3.3 on POP day 6/at discharge. Mean hospital stay was
6.3 days. The mean cost of hospital stay was USD 1090 per patient.

Conclusions: A high percentage of pediatric patients who underwent spinal surgery reported moderate to severe pain in the POP period, and just half of them received a standardized pain management protocol. A pain management protocol with a multimodal focus should be considered in a near future.


Palabras clave


dolor posoperatorio; guías prácticas de dolor; analgesia; terapia multimodal; cirugía de columna; pediátría. Postoperative pain; pain management guidelines; pain relief; multimodal therapy; spinal surgery; pediatrics.

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DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.3.931

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Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

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