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espanolIntroduccion: Determinar la eficacia de la administracion preincisional de ropivacaina al 0,1 % intraperitoneal en el control del dolor abdominal y/o de hombro, durante la primera semana de la cirugia laparoscopica ginecologica benigna. Diseno: Ensayo clinico aleatorizado y doble ciego. Material y metodos: Se realizo un ensayo clinico aleatorizado y doble ciego donde participaron 64 pacientes ASA I-III sometidas a cirugia laparoscopica ginecologica por patologia benigna. Tras la realizacion del neumoperitoneo, se administraron 100 ml de ropivacaina 0,1 % o suero fisiologico intraperitoneal, dependiendo del grupo al que pertenecieran. Las pacientes recibieron, ademas, AINE junto con una bomba de PCA con opcion de morfina de rescate como analgesia multimodal asociada. Se evaluo el dolor abdominal y/o de hombro al despertar, en reposo y en movimiento, a los 5, 30, 60 y 120 minutos, asi como a las 24 horas. Se registro el consumo de morfina en las primeras 24 horas y la incidencia de nauseas y/o vomitos postoperatorios. A la semana, mediante encuesta telefonica, se registro la presencia de dolor de hombro a partir de las 24 horas, asi como de dolor abdominal persistente al 7o dia. Resultados: No se observaron diferencias significativas en el ENV durante las primeras 24 horas. Tampoco se observaron diferencias en el consumo de morfina, en la incidencia de nauseas y/o vomitos o en el dolor de hombro. Se evidenciaron diferencias estadisticamente significativas en la incidencia de dolor abdominal persistente al 7o dia (18,52 % en grupo tratamiento vs. 57,58 % en grupo control con p = 0,04). Conclusiones: La administracion intraperitoneal preincisional de 100 ml de ropivacaina 0,1 % en comparacion con la administracion de suero fisiologico, en el contexto de una tecnica anestesica y analgesica multimodal, no ha demostrado reducir el dolor postoperatorio, el consumo de opioides ni la incidencia de nauseas y vomitos postoperatorios en las primeras 24 horas. Tampoco ha demostrado reduccion del dolor de hombro a partir del primer dia tras cirugia laparoscopica ginecologica. El uso de ropivacaina al 0,1 % intraperitoneal preincisional presenta una disminucion estadisticamente significativa en la incidencia de dolor abdominal persistente al septimo dia de postoperatorio. EnglishIntroduction: Determine the efficacy of preincisional ropivacaine 0,1 % intraperitoneal administration to control abdominal and/or shoulder pain after gynaecological laparoscopic surgery during the first week. Design: Randomized and double-blinded trial. Material and methods: 64 ASA I-III patients undergoing gynaecological laparoscopic surgery for benign pathology were selected. After the pneumoperitoneum was done, 100 ml of 0.1 % ropivacaine or saline were administered intraperioteneally. Patients received multimodal analgesia. Besides, a morphine PCA pump with a bolus option was prescribed. Abdominal and/or shoulder pain were assessed, at rest and in motion, on waking up from anaesthesia, to 5,30,60 and 120 minutes and at 24 hours from the surgery. Morphine consumption were recorded in the first 24 hours and the presence of nausea and/or vomiting postoperatively. A week after the surgery, by a telephone survey, the shoulder pain after and the persistent abdominal pain on the seventh day was recorded. Results: No significant differences in the ENV scale during the first 24 hours were observed. No differences in morphine consumption, in the incidence of nausea and/or vomiting or shoulder pain were observed. Statistically significant differences were noted in the incidence of persistent abdominal pain on the seventh day (18.52 treatment group vs. 57,58 % in control group with a p value 0.04). Conclusions: The preincisional intraperitoneal administration of 100 ml of ropivacaine 0.1 % compared to administration of saline, in the context of an anesthetic and analgesic multimodal technique has not been shown to reduce postoperative pain, opioid consumption and the incidence of nausea and postoperative vomiting in the first 24 hours. Nor has it shown reduction of shoulder pain from the first day after undergoing gynecological laparoscopic surgery. Ropivacaine 0.1 % intraperitoneal preincisional may be useful in the control of abdominal pain which persists on the seventh day.

Resumen Objetivo El objetivo de este estudio preliminar es medir la efectividad del bloqueo iliofascial en el control del dolor postoperatorio tras la colocacion de protesis total de cadera, en cuanto a la intensidad del dolor 24 horas tras la intervencion y el consumo de opiaceos de rescate. Material y metodos Estudio observacional, prospectivo, de cohortes, en el que se han incluido a 41 pacientes operados de protesis total de cadera, los cuales fueron divididos en 2 grupos segun se les practicara (grupo bloqueo) o no (grupo control) bloqueo iliofascial con ropivacaina al 0,45%, 0,3 ml/kg (dosis maxima 30 ml). Se realizo un muestreo consecutivo simple segun iban ingresando en la Unidad de Recuperacion Postanestesica. El dolor postoperatorio se midio inmediatamente tras la intervencion y 24 horas despues mediante una escala visual analogica. Otras variables de resultado evaluadas fueron el consumo de opiaceos de rescate y la presencia de efectos secundarios derivados del uso de opiaceos. Resultados Se han encontrado diferencias estadisticamente significativas en las puntuaciones de la escala visual analogica en la unidad de recuperacion postanestesica entre ambos grupos, obteniendo el grupo bloqueo una puntuacion en la escala visual analogica menor que el grupo control (p Conclusiones El bloqueo iliofascial en inyeccion unica es efectivo para el control del dolor postoperatorio inicial en la unidad de recuperacion postanestesica. Posteriormente en la sala es eficaz en las primeras horas de estancia, aunque no llega a cubrir las 24 horas por la limitacion de duracion del bloqueo.

The objective of this pilot study was to evaluate the effectiveness of the fascia iliaca compartment block to control pain following total hip replacement by assessing pain intensity 24 hours after surgery and recording the use of opiates for rescue analgesia.We performed a prospective observational study of 41 patients undergoing total hip replacement surgery. The patients were divided into 2 groups: a group that received a fascia iliaca compartment block with 0.45% ropivacaine at a dosage of 0.3 mL/kg (maximum dose, 30 mL) and a control group in which no block was performed. Patients were enrolled consecutively as they entered the postanesthetic recovery unit. Postoperative pain was assessed on a visual analog scale (VAS) immediately after surgery and 24 hours later. Other variables recorded were opiate use for rescue analgesia and adverse effects due to the use of opiates.The VAS scores recorded in the postanesthetic recovery unit were significantly different in the 2 groups, with lower scores in the group receiving the fascia iliaca compartment block (P.001). However, no significant between-group differences were observed in VAS scores recorded on the ward 24 hours after surgery (P = .57).A single-injection fascia iliaca compartment block was effective in controlling initial postoperative pain in a postanesthetic recovery unit. It was effective on the ward in the first few hours after surgery but not for the entire 24-hour period because of the limited duration of the block.