Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría

• Lucas Piantoni ^[1] ; Carlos A. Tello ^[1] ; Rodrigo G. Remondino ^[1] ; Eduardo Galaretto ^[1] ; Mariano A. Noel ^[1]
  1. [1] Servicio de Patología Espinal, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 87, Nº. 6, 2022, págs. 825-837
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2022.87.6.1490
• Títulos paralelos:
  • Multimodal Perioperative Pharmacological Protocol in Pediatric spine surgery
• Enlaces
  • Texto completo  1    2  
• Resumen
  • español

    Introducción: La cirugía de columna es uno de los procedimientos con mayor morbimortalidad dentro de la población pediátrica; el manejo farmacológico del dolor en dicha población aún no se encuentra estandarizado. La analgesia multimodal trata de responder a esta problemática.

    Objetivo: Sobre la base de una revisión sistemática de la bibliografía, desarrollar un detallado protocolo multimodal farmacológico para el manejo del dolor pre- y posoperatorio intra/extrahospitalario para la cirugía de columna en niños.

    Materiales y Métodos: Se realizó una revisión sistemática de textos completos en inglés o español en PubMed, Embase, Cochrane Library y LILACS Database publicados entre 2000 y 2021; se aplicó el diagrama de flujo PRISMA.

    Resultados: De 756 artículos preseleccionados, 38 fueron incluidos en la evaluación final. Dada la dificultad bioética de desarrollar trabajos en formato de ensayos clínicos con fármacos y combinaciones de ellos en la población pediátrica, desarrollamos un protocolo detallado de manejo del dolor pre- y posoperatorio por vía intravenosa/oral, intra- y extrahospitalario, para aplicar en niños sometidos a cirugía de columna.

    Conclusión: Logramos desarrollar un detallado protocolo multimodal farmacológico para el perioperatorio intra- y extrahospitalario de cirugía de columna en niños, sencillo y reproducible, tendiente a acelerar la recuperación funcional del paciente y disminuir los costos socioeconómicos globales. Nivel de Evidencia: II

  • English

    Introduction:Spine surgery has one of the highest morbimortality rates in the pediatric population. Pain management has not been standardized on said population. Multimodal analgesia (MMA) was developed to resolve that problem. Objective: To develop, based on a systematic review, a detailed and original pain management multimodal pharmacology protocol for pre and post-operative (intra and extra-hospital) periods for the pediatric population undergoing spine surgery. materials and methods: We conducted a systematic review of full texts in English and Spanish from PubMed, Embase, Cochrane Library, and LiLacs Database from 2000 to 2021. We used the PRISMA flow diagram. Results: From a total of 756 papers, 38 were included in the final evalu-ation. Considering the bioethical difficulties to develop a manuscript from clinical trials with drugs and drug combinations in the pediatric population, we developed an original and detailed pain management protocol for pre and post-operative (intra and extra-hospital) periods for the pediatric population undergoing spine surgery. Conclusion:Based on a systematic review, we succeeded in developing a simple and easily reproducible perioperative multimodal pain management protocol (intra and extra-hospital), intending to expedite the patient’s functional recovery and reduce global socioeconomic costs.

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