Palabras clave
Hemorroides
Dolor postoperatorio
Anestesia procedure for prolapse and hemorrhoids
Hemorrhoids
Postoperative pain
Anesthesia
Cómo citar
Resumen
El propósito es evaluar la plausibilidad del desarrollo de procedimientos para hemorroides prolapsadas (PPH) bajo anestesia local y sedación consciente. Métodos: 155 casos de pacientes seleccionados de manera consecutiva fueron incluidos desde marzo de 2002 hasta septiembre de 2008. 65% de ellos eran mujeres. La edad promedio era de 47 años de edad. Todos los pacientes fueron diagnosticados con hemorroides grado III o IV. El PPH fue realizado luego del bloqueo del nervio pudendo con infiltración perianal de una mezcla de bupivacaína al 0.5% (20 cc) con lidocaína al 1% (10 cc) + 0.9% de solución salina (10cc) más hialuronidasa y epinefrina. Todos los pacientes fueron tratados de manera ambulatoria. La salida fue realizada cuatro horas después de la cirugía. Las evaluaciones de seguimiento fueron hechas al día siete, a la tercera semana, a los dos meses y al año de la cirugía. Las evaluaciones se enfocaron en dolor postoperatorio (usando escala de dolor de caras de Wong Baker), sangrado, continencia y el tiempo para el retorno al trabajo y a las actividades sociales. Resultados: el promedio de dolor postoperatorio fue de 4-5. Aproximadamente 20 pacientes refirieron dolor leve, presión perineal transitoria y en cinco casos se reportó urgencia fecal durante las dos semanas postoperatorias. Todos los pacientes retornaron al trabajo y a sus actividades sociales dentro de los días 7 a 15. Las complicaciones encontradas incluían sangrado (cuatro casos), estenosis anal (cuatro casos), úlceras tratadas con cirugía (dos casos) y úlceras manejadas con dilataciones (dos casos). Conclusiones: la realización del PPH con anestesia general, espinal o epidural se encuentra bien descrita. Este estudio sugiere que el uso de anestesia local y sedación consciente para el PPH equivale al uso de anestesia general o conductive evitándose los costos y riesgos adicionales.
Citas
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