Resumen
Las mujeres refieren dolor más intenso, después de la cirugía, que los hombres. Durante las últimas décadas se registraron apropiadamente diferencias en el dolor entre los sexos en estudios en animales, en ensayos de investigación sobre el dolor agudo en seres humanos y en afecciones clínicas con dolor crónico. Pocos trabajos se centraron en las diferencias entre los sexos en el dolor agudo. Realizamos cuatro ensayos controlados aleatorizados (ECA) acerca de la analgesia local posterior a procedimientos de artroscopia de rodilla. Introdujimos un novedoso diseño de catéter intraarticular, el cual nos permitió observar el curso natural del dolor posoperatorio sin tratamiento, hasta la inclusión de las personas en uno de los cuatro ensayos. Solamente se incluyeron los pacientes con dolor moderado o intenso. No encontramos ningún efecto significativo con la administración intraarticular de ketamina o morfina comparadas con el placebo (solución salina). El resultado más notable fue el hecho de que el sexo femenino constituyó un factor de riesgo significativo para presentar dolor posoperatorio temprano. Otros factores de riesgo posibles, como el tipo de cirugía, su duración o el uso de torniquetes no tuvieron significación estadística. No observamos ninguna diferencia en los efectos terapéuticos de la administración intraarticular de analgésicos o del placebo entre varones y mujeres. El sexo puede constituir un factor de confusión en los ensayos acerca del dolor agudo y debe ser considerado durante la planificación de los estudios.
Palabras clave
Género, dolor agudo, cirugía de rodilla, cirugía ambulatoria
Clasificación en siicsalud
Artículos originales> Expertos del Mundo>
página www.siicsalud.com/des/des050/06911000.htm
Especialidades
Principal: Ortopedia y Traumatología
Relacionadas: Cirugía, Diagnóstico por Imágenes, Epidemiología, Medicina Deportiva, Medicina Interna
Enviar correspondencia a:
Leiv Arne Rosseland, Rikshospitalet University Hospital, NO-0027, Oslo, Noruega
Patrocinio y reconocimiento
Al profesor Harald Breivik y al Dr. Audun Stubhaug, por su importante contribución en todos los ensayos en los cuales se basa la presente revisión y por su colaboración en la preparación de este manuscrito.
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GENDER AND ACUTE PAIN. A REVIEW OF CLINICAL RESEARCH DATA
Abstract
Women report more intense pain after surgery than men do. Sex differences in pain have been well documented during the last decades in animal studies, in experimental human trials of acute pain, and in clinical chronic pain conditions. Few trials have focused on gender differences in acute pain. We have performed four randomised controlled trials (RCT) of local analgesia after knee arthroscopic procedures. We introduced a novel intra-articular catheter design which enabled us to observe the natural course of untreated postoperative pain until inclusion in to one of the four RCTs. Only patients with moderate or severe pain were included. We did not find any significant effect of intra-articular ketamine or morphine compared with placebo (saline). The most striking result was the fact that female gender is a highly significant risk factor for early postoperative pain. Other possible risk factors as type of surgery, duration of surgery, or the use of tourniquet were not significant. We did not observe any difference in treatment effects of intra-articular analgesics or placebo between men and women. Gender may be a confounding factor in acute pain trials and this must be taken into consideration when planning trials.
Key words
Gender, acute pain, knee surgery, ambulatory surgery, intra-articular
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