CONDICIONES NECESRIAS PARA LA IMPLANTACION, DESARROLLO Y ANALISIS DE UN PROGRAMA-CIRCUITO DE CMA-CCE EN COLECISTECTOMIA LAPAROSCOPICA (CL) EN HSJD-MB

(Buscar protocolos de inclusión de pacientes en CMA / circuitos CMA en HSJD-MB)

A-Criterios de inclusión de pacientes- Del paciente fisiologicos, psicologicos, sociales- De la cirugia

*Criterio de exclusion

B- Protocolos para cada una de las fases del circuito: * Factores a tener en cuenta en cada una de las fases:

- Informacion al paciente y aceptación CI del estudio, CI CMA, CI anestesia, CI cirugia

- Dolor profilaxis y tratamiento-NVPO profilaxis y tratamiento- Infeccion profilaxis ATB- ansiolisis preoperatoria- profilaxis antitrombotica- etc

* Fases del circuito:1- visita preoperatoria analitica con funcion hepatica2- ingreso en UCSI y sala de preoperatorio inmediato3- Intraaoperatorio: - tecnica anestesica

- tecnica quirurgica experta4- Postoperatorio: (criterios rigurosos al alta)

4.1-REA (fase 1)4.2-UCSI (fase 2)4.3- Pauta y recomendaciones en domicilio

C- Valoracion postoperatoria de la asistencia ofrecida- indicadores de morbilidad y calidad percibida por el paciente- Tasa de incidencias-complicaciones / causas-necesidad de ingreso CEE:

- sociales inseguridad del paciente, familiares- dolor

- nauseas (NVPO)- complicaciones: - sangrado

- lesion via biliar / fuga biliar / coleperitoneo- lesion de otas visceras peritoneales

D- CONCLUSIONES / ANALISIS ESTADISTICO Y PROPUESTAS PARA MEJORAR LOS RESULTADOS

-Tasa de ingreso no esperado

¿Hay algun departamento de estadistica / documentación / recerca en HSJD-MB con el que podamos / debamos / tengamos que hablar para diseñar el estudio, consentimientos informados…?

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A- CRITERIOS DE INCLUSION DE PACIENTES(Buscar protocolos de inclusión de pacientes en CMA en HSJD-MB)

a.1- DEL PACIENTE:

- FISIOLOGICOS: Valorar individualmente a cada paciente

- ASA- Comorbilidades- edad

- PSICOLOGICOSEl paciente entiende y acepta las instrucciones y previsibles molestias

- SOCIALES- acompañante- distancia del domicilio al hospital- vivienda adaptada (ascensor)- telefono

a.2- QUIRURGICOS:

- Colelitiasis Cronica sintomatica no complicada:o Diagnosticada por ecografiao Via biliar permeble no dilatadao Enzimas hepaticos y bilirrubina normal

- Equipo quirurgico el mismo, experto

* CRITERIOS DE EXCLUSION- Negativa del paciente- Conversion a cirugia abierta- Prevision de importantes perdidas hematicas- Prevision de necesidad de tratamiento ATB ev prolongado-

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POSIBILIDADES EN EL MANEJO ANALGESICO

1- Infiltracion intraperitoneal / lecho hepatico con AL:a. Pre-pneumoperitoneob. Post-pneumoperitoneoc. Post-IQ con cateter extraperitoneal

2- Infiltracion de las incisiones de los trocares con AL:a. Preincisiónb. Postincision

AUTORAÑO

TIPO ESTUDIO

TIPO DE LPC

ANALGESIA RESULTADOS

AlessandriAnil2002

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3- Bloqueos intercostales

4- Bloqueo paravertebral

5- Bloqueo intrapleural

6- Bloqueo epidural

7- TAPB: Trans-Abdominal-Plane Block

8- Analgesia via oral / parenteral en pre-/post-IQ

9- Analgesia Multimodal

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10- BIBLIOGRAFIA de …

A) POSIBILIDADES EN EL MANEJO ANALGESICO

11- Infiltracion intraperitoneal / lecho hepatico con AL:a. Pre-pneumoperitoneob. Post-pneumoperitoneoc. Post-IQ con cateter extraperitoneal

12- Infiltracion de las incisiones de los trocares con AL:a. Preincisiónb. Postincision

13- Bloqueos intercostales

14- Bloqueo paravertebral

15- Bloqueo intrapleural

16- Bloqueo epidural

17- TAPB: Trans-Abdominal-Plane Block

18- Analgesia via oral / parenteral en pre-/post-IQ

B) ANALGESIA EN CMA / CCE y/o EN COLECISTECTOMIA LPC (CL) / ANALGESIA MULTIMODAL

C) PROGRAMAS/ CIRCUITOS DE CL EN CMA / CCE

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A) POSIBILIDADES EN EL MANEJO ANALGESICO ( bibliografia )

1- Infiltracion intraperitoneal / lecho hepatico con AL en CL: (bibliografia)a. Pre-pneumoperitoneob. Post-pneumoperitoneoc. Post-IQ con cateter extraperitoneal

- Surg Endosc. 2010 Dec;24(12):3167-76. Epub 2010 May 20.Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and METAANALYSIS.Coughlin SM, Karanicolas PJ, Emmerton-Coughlin HM, Kanbur B, Kanbur S, Colquhoun PH. Department of Surgery, University of Western Ontario, London, ON, Canada. scoughl3@uwo.ca

- Anesth Analg  September 2006 103:682-The Effect of Intraperitoneal Local Anesthesia in LaparoscopicCholecystectomy: A Systematic Review and META-ANALYSIS Alexander P. Boddy,  Samir Mehta,  and Michael Rhodeshttp://www.anesthesia-analgesia.org/content/103/3/682.full.pdf+html?sid=9c332f8d-ed6b-4568-ba28-d0bd90b65875

- Anesth Analg. 2002 Aug;95(2):450-6, table of contents.Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy.Gupta A, Thörn SE, Axelsson K, Larsson LG, Agren G, Holmström B, Rawal N.Department of Anesthesiology, University Hospital, Orebro, Swedenhttp://www.anesthesia-analgesia.org/content/95/2/450.long

- Minimally Invasive Therapy & Allied Technologie, 1999Intraperitoneal local anaesthetics via subphrenic catheter following laparoscopic cholecystectomy: Pain relief and pulmonary functionR. Busley1†, M. Blobner1, S. Jelen-esselborn1, H. Feussner2 and E. Kochs11Institute for Anaesthesiology, Technical University Munich, Munich, Germany

- A & A August 2000Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gynecologic Surgery: A Placebo-Controlled Comparison of Bupivacaine and RopivacaineAndrei Goldstein, MD*, Patrick Grimault, MD*, Aude Henique, MD*, Michèle Keller, MD*, Anne Fortin, MD† and Emile Darai, MD, PhD†Departments of Anesthesiology and Gynecology, Hotel-Dieu Hospital Paris, Francehttp://www.anesthesia-analgesia.org/content/91/2/403.full

- Br. J. Anaesth. (1994)Intraperitoneal local anaesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung functionB. M. P. RADEMAKER, M.D., -Department of Anaesthesiology, Academic Medical Centre Meibergdreef , Amsterdam

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http://bja.oxfordjournals.org/content/72/3/263.abstract

- A & A August 1995Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine1. J Joris, E Thiry, P Paris, J Weerts and M LamyDepartment of Anesthesia and Intensive Care Medicine, University Hospital of Liège, Domaine du Sart Tilman, Belgium.http://www.anesthesia-analgesia.org/content/81/2/379.abstract

- Indian J. Anaesth, 2002INTRAPERITONEAL BUPIVACAINE INSTILLATION FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMYNeerja Bhardwajhttp://medind.nic.in/iad/t02/i1/iadt02i1p49.pdf

- J Laparoendosc Adv Surg Tech A. 2000 Jun;10(3):137-41.Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain?Gharaibeh KI, Al-Jaberi TM. Department of General Surgery, Princess Basma Teaching Hospital, Faculty of Medicine, University of Science & Technology, Irbid, Jordan. http://www.ncbi.nlm.nih.gov/pubmed/10883990

- J Korean Surg Soc 2010Intraperitoneal Ropivacaine Instillation for Postoperative Pain Relief after Laparoscopic CholecystectomyDepartments of Surgery and 1Anesthesiology and Pain Medicine, KoreaTae Han Kim, M.Dhttp://synapse.koreamed.org/Synapse/Data/PDFData/0037JKSS/jkss-79-130.pdf

- Surg Endosc. 2010 Jul;24(7):1524-7. Epub 2010 Jan 28.Bupivacaine use in the Insuflow device during laparoscopic cholecystectomy: results of a prospective randomized double-blind controlled trial.Zimmer PW, McCann MJ, O'Brien MM.Department of Surgery, Penrose-St. Francis Health Services, 2222 North Nevada Avenue, Colorado Springs, CO 80907, USA. zimmerpw@hotmail.comhttp://www.ncbi.nlm.nih.gov/pubmed/20108156

- Surg Endosc. 1996 Jan;10(1):44-8.A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy.Szem JW, Hydo L, Barie PS.Department of Surgery, New York Hospital-Cornell Medical Center, NY 10021, USA.http://www.ncbi.nlm.nih.gov/pubmed/8711605

- Surgical endoscopy, 2005Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study

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M. Barczyński, A. Konturek and R. M. Hermanhttp://www.springerlink.com/content/80j66w1r74583881/

- Surg Endosc. 2005 Nov;19(11):1503-6. Epub 2005 Oct 3.Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%.Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP.Anesthesia Department, Hippocration General Hospital, Athens, Greecehttp://www.ncbi.nlm.nih.gov/pubmed/16328673

- Surg Endosc. 2008 Sep;22(9):2036-45. Epub 2008 Feb 13.Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial.Pappas-Gogos G, Tsimogiannis KE, Zikos N, Nikas K, Manataki A, Tsimoyiannis EC.Department of Surgery, G. Hatzikosta General Hospital, Greecehttp://www.ncbi.nlm.nih.gov/pubmed/18270769

- Surg Endosc. 2002 Sep;16(9):1336-40. Epub 2002 May 7.A new method of preemptive analgesia in laparoscopic cholecystectomy.Maestroni U, Sortini D, Devito C, Pour Morad Kohan Brunaldi F, Anania GDepartment of Surgery, Anaesthsiology, and Radiology, University of Ferrara, Italy.http://www.ncbi.nlm.nih.gov/pubmed/11988800

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2- Infiltracion de incisiones de los trocares con AL en CL: ( bibliografia )a. Preincisiónb. Postincision

- Surg Endosc. 2009 Apr 9. Prospective randomized double-blind placebo-controlled trial of postoperative elastomeric pain pump devices used after laparoscopic ventral hernia repair.Rosen MJ, Duperier T, Marks J, Onders R, Hardacre J, Ponsky J, Ermlich B,Department of General Surgery, Case Medical Center, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA, http://www.ncbi.nlm.nih.gov/pubmed/19357918

- Surg Endosc. 2003 Dec;17(12):1961-4. Epub 2003 Oct 28.Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy.Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F.Department of Anesthesiology, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Ethnikis Aminis 41, 546 35 Thessaloniki, Greece.http://www.ncbi.nlm.nih.gov/pubmed/14577025

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3- Bloqueos intercostales en CL ( bibliografia )

- Surgery 1989; 105: 166-9.Survey of Anesthesiology: October 1989 - Volume 5 - Issue 2 - ppg 311, Spinal & Regional Anesthesia

- Surgery. 1989 Feb;105(2 Pt 1):166-9.Intercostal blockade and pulmonary function after cholecystectomy.Ross WB, Tweedie JH, Leong YP, Wyman A, Smithers BM.http://www.ncbi.nlm.nih.gov/pubmed/2644719

- British Journal of Surgery, Volume 74, Issue 1, page 63, January 1987Does intercostal blockade improve patient comfort after cholecystectomy?Mr. W. B. Ross, J. H. Tweedie, Y. P. Leong, A. Wyman, B. M. Smithers

- Br J Anaesth. 1980 Mar;52(3):253-60.Posterior intercostal nerve block for pain relief after cholecystectomy. Anatomical basis and efficacy.Nunn JF, Slavin G.http://www.ncbi.nlm.nih.gov/pubmed/7370141

- European Journal of Anaesthesiology. 15(5):529-534, September 1998.Intercostal nerve blockade with a mixture of bupivacaine and phenol enhance the efficacy of intravenous patient-controlled analgesia in the control of post-cholecystectomy painMaidatsi, P.; Gorgias, N.; Zaralidou, A.; Ourailoglou, V.; Giala, M.http://journals.lww.com/ejanaesthesiology/Abstract/1998/09000/Intercostal_nerve_blockade_with_a_mixture_of.4.aspx

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4- Bloqueo paravertebral en CL ( bibliografia )

- Br. J. Anaesth. (2010)Efficacy and safety of paravertebral blocks in breast surgery: a META-ANALYSIS of randomized controlled trialsA. Schnabel1 Department of Anaesthesiology and Intensive Care, University Hospital of Mu ̈nster, Germanyhttp://bja.oxfordjournals.org/content/105/6/842.full.pdf+html

- A & A June 2010Paravertebral Block for Anesthesia: A Systematic REVIEWPrema Thavaneswaran, BSc (Hons), Australia.http://www.anesthesia-analgesia.org/content/110/6/1740.abstract

- A & A September 2003Continuous Paravertebral Catheter and Outpatient Infusion for Breast SurgeryChester C., Department of Anesthesiology, Duke University Medical Center, Durham, North Carolinahttp://www.anesthesia-analgesia.org/content/97/3/715.full

- Br. J. Anaesth.  (2011) 106(2): 164-171 doi:10.1093/bja/aeq378Bilateral thoracic paravertebral block: potential and practice. REVIEW ARTICLEJ. Richardson, Department of Pain and Anaesthetics, Bradford Royal Infirmary, UK 2 Karolinska Institute, Stockholm, Sweden 3 Makassed General Hospital, Beirut, Lebanonhttp://bja.oxfordjournals.org/content/106/2/164.full.pdf+html?sid=7b845e02-9d5d-48e1-81dd-a4067118b540

- Br. J. Anaesth.  (1989) 63(1): 129 doi:10.1093/bja/63.1.129-aPARAVERTEBRAL BLOCK FOR POST-CHOLECYSTECTOMY PAIN RELIEFC. M. KUMAR, Middlesbroughhttp://bja.oxfordjournals.org/content/63/1/129.2.full.pdf+html?sid=f5b844bc-8cfc-4209-b327-3208e27c62dc

- Br. J. Anaesth.  Lateral ultrasound-guided paravertebral blockade: an anatomical-based description of a new techniqueMarhofer, S. C. Kettne2. Department of Anaesthesia, Intensive Care Medicine and Pain Therapy and2Department of Surgery, Medical University of Vienna, Austriahttp://bja.oxfordjournals.org/content/105/4/526

- European Journal of Anaesthesiology. 21(6):489-495, June 2004. General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs.

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general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial

Naja, M. Z.; http://journals.lww.com/ejanaesthesiology/Abstract/2004/06000/General_anaesthesia_combined_with_bilateral.12.aspx

- European Journal of Anaesthesiology. 21():113-114, June 2004.

Evaluation of paravertebral nerve blockade (PVB), as an element of anaesthesia and postoperative analgesia for different types of surgical procedures, concerning organs with unilateral nerve supply: A-466

Blaszczyk, B.; Jedrzejewski, M.; Mayzner-Zawadzka, E.

http://journals.lww.com/ejanaesthesiology/Fulltext/2004/06002/Evaluation_of_paravertebral_nerve_blockade__PVB_,.413.aspx

- European Journal of Anaesthesiology. 19(3):197-202, March 2002.

Bilateral paravertebral somatic nerve block for ventral hernia repair

Naja, Z.; Ziade, M. F.; Lönnqvist, P. A.

http://journals.lww.com/ejanaesthesiology/Abstract/2002/03000/Bilateral_paravertebral_somatic_nerve_block_for.8.aspx

- Anesth Analg. 1989 Jan;68(1):32-9.Paravertebral somatic nerve block: a clinical, radiographic, and computed tomographic study in chronic pain patients.Purcell-Jones G, Pither CE, Justins DM.Department of Anaesthetics, St. Thomas' Hospital, London.http://www.ncbi.nlm.nih.gov/pubmed/2910135

- A & A June 2010Ultrasound-Guided Thoracic Paravertebral Blockade: A Cadaveric StudyBrian Cowie, MBBS, FANZCADepartment of Anaesthesia, St. Vincent's Hospital; University of Melbourne, Australia.http://www.anesthesia-analgesia.org/content/110/6/1735.abstract

- A & A January 2010Thoracic Paravertebral Block Using Real-Time Ultrasound Guidance3. Seosamh C. Ó Riain, 4. Department of Anaesthesia, Mid-Western Regional Hospitals, Ireland.http://www.anesthesia-analgesia.org/content/110/1/248.full

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5- Bloqueo intrapleural /interpleural en CL ( bibliografia )

- Anesthesiology: March 1995 - Volume 82 - Issue 3 - p 634–640 Clinical InvestigationIntraperitoneal Versus Interpleural Morphine or Bupivacaine for Pain after Laparoscopic CholecystectomySchulte‐Steinberg, Hans MD; Weninger, Ernst MD; Jokisch, Dominik BS; Hofstetter, Bernhard BS; Misera, Axel BS; Lange, Volker MD; Stein, Christoph MDhttp://journals.lww.com/anesthesiology/Abstract/1995/03000/Intraperitoneal_Versus_Interpleural_Morphine_or.4.aspx

- Anaesth 1991; 38: 71-4.Interpleural analgesia improves pulmonary function after cholecystectomy. Frenette L, Boudreault D, Guay J. 

- Anesth Analg 1991; 72: 516-21.

Continuous infusion of interpleural bupivacaine maintains effective analgesia after

cholecystectomy.

Laurito CE, Kirz LI, VadeBoncouere TR, et al. 

- Acta Anaesthesiol Scand 1991; 35: 108-12.

Effects of interpleurally administered bupivacaine 0.5% on opioid analgesic

requirements and endocrine response during and after cholecystectomy: A

randomized double-blind controlled study.

Rademaker BM, Sih IL, Kalkman CJ, et al. 

- Aust N Z J Surg 1990; 60: 689-94.

Interpleural catheter for analgesia after cholecystectomy: The surgical perspective.

Schroeder D, Baker P. http://onlinelibrary.wiley.com/doi/10.1111/j.1445-2197.1990.tb07457.x/abstract

- Reg Anesth 1990; 15: 26-30.

Interpleural bupivacaine for postoperative analgesia following cholecystectomy: A

randomized prospective study.

Frank ED, McKay W, Rocco A, Gallo JP. 

- Anaesth Intensive Care 1989; 17: 440-3.

 Post-cholecystectomy pulmonary function following interpleural bupivacaine and

intramuscular pethidine.

Oxorn DC, Whatley GS.

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6- Bloqueo epidural en CL ( bibliografia )

- European Journal of Anaesthesiology. 15(3):342-344, May 1998.Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomyFujii, Y.; Toyooka, H.; Tanaka, H.http://journals.lww.com/ejanaesthesiology/Abstract/1998/05000/Efficacy_of_thoracic_epidural_analgesia_following.17.aspx

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7- TAPB: Trans-Abdominal-Plane Block en CL ( bibliografia )

- Diploma in biostatistics. Lecturer at Anesthesia Department Faculty of Medicine, University of Menoufia ,September 2010The role of TAP block in laparoscopic cholecystectomyhttp://www.alexaic.com/alexaicfiles/presentation2010/day3/041003.pdf

- ClinicalTrials.govPain After Laparoscopic Cholecystectomy With Bilateral Tranversus Abdominis Plane (TAP) Block Versus Local Anesthetic InfiltrationThis study is currently recruiting participants.Verified by Baylor College of Medicine, September 2010http://clinicaltrials.gov/ct2/show/NCT01204892

- European Journal of Anaesthesiology: 12 June 2010 - Volume 27 - Issue 47 - p 222Acute and Chronic Pain ManagementTrans-abdominal plane (TAP) block analgesia in day case laparoscopic cholecystectomy - A prospective study: 14AP12-6El Bayoumy, R.; Khan, O.; King, E.; Wainwright, D.; Sadek, S.http://journals.lww.com/ejanaesthesiology/Fulltext/2010/06121/Trans_abdominal_plane__TAP__block_analgesia_in_day.718.aspx

- Br. J. Anaesth. (2009) 102 (6): 763-767. doi: 10.1093/bja/aep067Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy†A. A. El-Dawlatly1, Kettner2, 1Department of Anaesthesia and Intensive Care Medicine, King Saud University, College of Medicine, Riyadh, Saudi Arabia. 2Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austriahttp://bja.oxfordjournals.org/content/102/6/763.full.pdf+html

- Br J Anaesth. 2011 Mar;106(3):380-6. Epub 2010 Dec 21.Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair.Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, Tison C, Bonnet F.Department of Anaesthetics and. Policlinique Sévigné, Paris, Francehttp://www.ncbi.nlm.nih.gov/pubmed/21177284

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8- Analgesia parenteral / via oral en CL, pre-/ post-IQ ( bibliografia )

- SURGICAL ENDOSCOPY, 2008Preoperative administration of controlled-release OXYCODONE as a transition opioid for total intravenous anaesthesia in pain control after laparoscopic cholecystectomyFanelli G, Ghisi D, Berti M, Troglio R, Ortu A, Consigli C, Casati A.Department of Anaesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, viale Gramsci 14, 43100 Parma, PR, Italy. guido.fanelli@unipr.ithttp://www.springerlink.com/content/1h28774352248j1q/

- European Journal of Anaesthesiology: June 2006Comparative study of presurgical intravenous DEXKETOPROFEN or PARACETAMOL plus wound local infiltration for pain management after laparoscopic cholecystectomy: A-913Hernández-Palazón, J. Department of Anesthesiology, Virgen de la Arrixaca University Hospital, Murcia, Spainhttp://journals.lww.com/ejanaesthesiology/Fulltext/2006/06001/Comparative_study_of_presurgical_intravenous.848.aspx

- Br. J. Anaesth. (2005) The preoperative administration of KETOPROFEN improves analgesia after laparoscopic cholecystectomy in comparison with PROPACETAMOL or postoperative ketoprofen5. G. Boccara1,*, 1Department of Anaesthesiology and Critical Care, Hospital SaintJoseph, Paris, France. http://bja.oxfordjournals.org/content/94/3/347.abstract

- Ann Surg. 2003 NovemberPreoperative DEXAMETHASONE improves Surgical Outcome After Laparoscopic Cholecystectomy. A Randomized Double-Blind Placebo-Controlled TrialThue Bisgaard, MD, Department of Surgical Gastroenterology 435, University of Copenhagen, H:S Hvidovre Hospital, Hvidovre, Denmark.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356141/

- Surgical endoscopy, 2001Preincisional intravenous low-dose ketamine and local infiltration with ropivacaine reduces postoperative pain after laparoscopic cholecystectomyB. Papaziogas, Greecehttp://www.springerlink.com/content/8ytl2v8fx6hern7x/

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B) ANALGESIA EN CMA / CCE y/o COLECISTECTOMIA ( bibliografia ) / ANALGESIA MULTIMODAL

- The Efficacy of Preemptive Analgesia for Acute Postoperative Pain Management: A META-ANALYSISCliff K.-S. Ong, DDS*, Philipp Lirk, MD†, Robin A. Seymour, http://www.anesthesia-analgesia.org/content/100/3/757.full

- Br. J. Anaesth.  (2010) 105(suppl 1): i86-i96 doi:10.1093/bja/aeq322Continuous peripheral nerve blocks in acute pain managementJ. E. Chelly, D. Ghisi, and A. Fanellihttp://bja.oxfordjournals.org/content/105/suppl_1/i86.full.pdf+html?sid=7b845e02-9d5d-48e1-81dd-a4067118b540

- Rev Soc Esp Dolor 16 (2009);4 :239 – 245Analgesia postoperatoria en cirugía mayor: ¿es hora de cambiar nuestros protocolos?. Ferrer , A. ; Baena Nadal, M. ; Montero Sánchez, F. ; Giménez Jiménez, I. ; del Rosario Usoles, E. ; Esteve Pérez, N. ; :http://revista.sedolor.es/articulo.php?ID=620

- Anesthesiology: April 2006 - Review ArticleAnalgesic Treatment after Laparoscopic Cholecystectomy: A Critical Assessment of the EvidenceBisgaard,. Glostrup University Hospital, Glostrup, Denmark. 2004http://journals.lww.com/anesthesiology/Fulltext/2006/04000/Preemptive_Analgesia__Intraperitoneal_Local.30.aspx

- Indian Journal of Anaesthesia , 2006POSTOPERATIVE PAIN RELIEF FOR AMBULATORY SURGERYDr. Mukherji S.1 Dr. Rudra A.2   http://medind.nic.in/iad/t06/i5/iadt06i5p355.pdf

- Rev Cubana Cir 2006; 45 (2)Anestesia para colecistectomía laparoscópica. Nuestra experienciaDr. Raúl García Rojas,1 Dra. Marilét Muradás Augier,2 Dra. Marta S. López Rodríguez3 y Dra. Yanet Pérez Delgado4http://bvs.sld.cu/revistas/cir/vol45_2_06/cir03206.pdf

- NYSORA  : The Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Painhttp://www.nysora.com/pain_management/3105-The-Role-Non-Opioid-Analgesic-Techniques-the-Management-Postoperative-Pain.html

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C) PROGRAMAS / CIRCUITOS DE CL EN CMA / CCE ( bibliografia )

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