Análisis de las trayectorias de dolor posoperatorio, primera hora vs. 24 horas. Estudio observacional en 234 pacientes

Introducción: El dolor posoperatorio no controlado es un predictor de dolor severo. La trayectoria de dolor durante la primera hora podría predecir el curso del dolor durante las primeras 24 horas. El control temprano del dolor posoperatorio facilita el manejo analgésico durante el primer día y mejora la experiencia del paciente, facilitando su recuperación y rehabilitación. Objetivo: Determinar la relación entre la trayectoria del dolor en la primera hora y durante las 24 horas post-operatorias. Material y métodos: Estudio analítico observacional prospectivo de 234 pacientes llevados a procedimientos quirúrgicos bajo anestesia general. Se registraron 8 intesidades de dolor durante las 24 horas. Se calcularon las pendientes y se estableció la relación entre ellas. Resultados: El 31,3% de pacientes tenían dolor no controlado al ingreso a recuperación. La intensidad del dolor al inicio se correlaciona de forma negativa con la trayectoria de la primera hora P1 rS= -0,657 (p=0.000). La intensidad de dolor inicial tiene una asociación negativa con P2 de rS= -0.141 (p=0.032). Al compararse las pendientes P1 y P2 y se encontró una correlación negativa muy baja rS= -0.126 (p=0.056). Conclusiones: Uno de cada tres pacientes presenta dolor severo durante el posoperatorio agudo. La trayectoria del dolor en la primera hora no permite predecir el comportamiento de la trayectoria durante el primer día posoperatorio. El comportamiento del dolor está relacionado con la intensidad al final de la anestesia. Cuando el dolor inicial es severo alcanzar la meta analgésica tarda más tiempo.

Introduction: uncontrolled post operative pain is a predictor of severe pain. The trayectory of the pain during the first hour could predict the intensity of pain felt during the first 24 hours after surgery. Early postoperative pain control facilitates the analgesic management during the first day and improves the patients experience, facilitating its recovery and rehabilitation. Objective: To determine the relationship between the trayectory of pain during the first hour and during the the following 24 hours after surgery. Materials and Method: We performed a prospective observational analytical study including 234 patients undergoing surgical procedures under general anesthesia who were hospitalized for at least one day. 5 intensities of pain were registered in the first hour and 3 were registered during the following 24 hours after being hospitalized. Both slopes were calculated, and the relationship between them was established. Results: 31.3% of patients had uncontrolled pain on admission to the recovery room, at the end of the follow-up only 5.5% of patients had severe pain. Pain intensity at the beginning is negatively correlated with the trajectory of pain during the first hour P1 rS= -0,657 (p=0.000). Initial pain intensity has a negative association with P2 of rS= -0.141 (p=0.032). Comparing the slopes of P1 and P2 a very low negative correlation rS = -0.126 (p = 0.056) was found. Conclusions: One in three patients have severe pain during the acute postoperative period. The trayectory of the pain during the first hour doenst allow the prediction of the pains trayectory during the first day afetr surgery. Pain behavior is related to its intensity at the end of the anesthesia. When the initial pain is severe, achieving the analgesic goal takes longer.