Estudio de dolor multimodal en pacientes con colgajo libre

Ensayo prospectivo controlado aleatorio para comparar dos estándares de atención para el manejo del dolor en la cirugía de cabeza y cuello. El brazo A incluirá:

• Tylenol programado 1000 mg IV una dosis intraoperatoria, luego 650 mg a través de un tubo PEG o PO Q4H hasta una dosis máxima de 4 g/24 horas
• Prn de opioides basado en la escala numérica del dolor (0-10, donde 0 indica que no hay dolor y 10 indica que el dolor es peor):
• 0-3: sin medicamentos prn, tranquilidad, escuchar música, ver televisión.
• 4-7: Oxicodona 5 mg q4h prn vía tubo PEG o PO con un máximo de 30 mg/24 horas.
• 8-10 Morfina 2 mg IV q2h prn dolor irruptivo.

El brazo B incluirá:

• Armar Una descripción con adición..
• Ketorolaco programado a partir del día postoperatorio n.º 1, 15 mg cada 6 horas (máx. 120 mg/día), durante un total de 5 días
• Gabapentina programada comenzando 7 días antes de la operación para continuar después de la operación
• Bloqueo regional por protocolo de anestesia - Bloqueo inicial: bupivacaína al 0,5 %, 20 ml Infusión continua: bupivacaína al 0,125 % a 6 ml/h con un bolo de 5 ml disponible cada 30 minutos

Pain was measured on a Likert scale from 0 to 10 (i.e. 0 being the lowest and 10 being the greatest amount of pain). Baseline pain (P0) was measured on this scale for each patient in the preoperative setting. Pain was similarly assessed at regular intervals post-operatively during hospitalization (Pn).

Patient pain percentage was subsequently defined as follows:

{ 100*[(P_n/P_0) -1]│ n∈N, n≥1}

Where:

P_0: the baseline (initial) measurement taken at time t=0. P_n: the measurement taken at the nth time interval after baseline, where n∈N, n≥1

Interpretation of "pain percentage compared to baseline":

• A value of 0% indicates no change from baseline pain
• Negative values indicate lower pain than baseline
• Positive values indicate higher pain than baseline
• Therefore, lower values represent a better outcome and higher values represent a worse outcome

Each of the domain of ABC pain index is weighted (mult_D) based on relative importance.

For each domain D ∈{sleep, lying, sitting, oob, walk}, let:

D_able∈{1,2,3}, (1 = able with pain; 2 = unable due to pain; 3 = unable for other reasons) D_pain∈[0, 5] (reported pain score)

Then if:

D_able = 1 numerator_D = D_pain × mult_D denominator_D = 1 +(5×mult_D) D_able=2 numerator_D = 1 + (5×mult_D) denominator_D= 1 + (5×mult_D ) D_able=3 numerator_D = 1 denominator_D = 1

For the site-specific domains D ∈{h&n,flap,graft}, let:

D_present∈{1,2} (1=present; 2=absent) D_pain∈[0, 5] (reported pain score)

Then if:

D_present=1:

numerator_D = D_pain × mult_D denominator_D = 5 × mult_D

D_present=2:

numerator_D = 0 denominator_D = 0

Patient Pain Assessment Percentage:

ABC_numerator = sum(numerator_D) ABC_denominator = sum(denominator_D) ABC_percentage = ABC_numerator / ABC_denominator This ranges from 0-100%. Lower values are better, higher values are worse.