Rev. Soc. Esp. Dolor. 2021; 28(4): 232-238 / DOI: 10.20986/resed.2021.3917/2021
Hermann Josef Ribera, Antonio Montes, María del Mar Monerris, María Anunciación Pérez, Sabela del Río, Pablo López
ABSTRACT
Annually, a 5 % rise has been observed in surgical interventions performed worldwide, together with an increase in their complexity as well as in patient comorbidities.
However, between 30-80 % of patients experience moderate-intense acute postoperative pain (APD) after the first 24 postoperative hours, despite better pathophysiological knowledge, use of new techniques and analgesic drugs, publication of new guidelines and the creation of the Acute Pain Units (UDA).
In addition, we must bear in mind vulnerable patients (pediatric population, pregnant women, the elderly, ...) and chronic opioid users who are usually deviations from analgesic protocols and, therefore, place us in a scenario in which the management of Postoperative pain is more difficult and requires the design of personalized strategies for each patient.
It must also be borne in mind that inadequate PDA control can lead to chronic postoperative pain, posing a real therapeutic challenge for Chronic Pain Units, together with a deterioration in the patient's quality of life due to its physical repercussions, psychological and economic.
Through this manuscript, we intend to carry out a critical analysis and propose points for improvement in the way we currently manage DAP based on scientific evidence to obtain better postoperative results in the coming years.
RESUMEN
Anualmente se ha observado un ascenso del 5 % en la intervenciones quirúrgicas realizadas mundialmente, junto con un incremento en la complejidad de las mismas, así como en la comorbilidades de los pacientes.
No obstante, entre el 30-80 % de los pacientes experimentan dolor agudo postoperatorio (DAP) moderado-intenso tras las primeras 24 horas de postoperatorio, a pesar de un mejor conocimiento fisiopatológico, el empleo de nuevas técnicas y fármacos analgésicos, la publicación de nuevas guías y la creación de las Unidades de Dolor Agudo (UDA).
Además, hemos de tener presente a los pacientes vulnerables (población pediátrica, gestantes, ancianos, etc.) y a los consumidores crónicos de opioides, que habitualmente son desviaciones de los protocolos analgésicos y, por tanto, nos sitúan en un escenario en el que el manejo del dolor postoperatorio es más difícil y obliga al diseño de estrategias personalizadas a cada paciente.
Se ha de tener también presente que un inadecuado control del DAP puede dar lugar a una cronificación del dolor postoperatorio, suponiendo un auténtico reto terapéutico para las unidades de dolor crónico, junto con un deterioro de la calidad de vida del paciente debido a sus repercusiones físicas, psicológicas y económicas.
A través de este manuscrito, pretendemos realizar un análisis crítico y proponer puntos de mejora en la forma en la que gestionamos actualmente el DAP, basándonos en la evidencia científica para la obtención de mejores resultados postoperatorios en los próximos años.
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