Efectividad y seguridad de tres esquemas analgésicos sin opioide intratecal en cirugía de rodilla bajo anestesia raquídea en un Centro de Referencia del Caribe Colombiano durante el 2025-1
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Fecha
2025
Autores
Salas Carrillo, Abieser Saeed
Humanez Durango, Vladimir José
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
El dolor postoperatorio en cirugía de rodilla es un desafío clínico relevante, asociado con retraso en la movilización, más complicaciones y estancias hospitalarias prolongadas. En este contexto, la analgesia multimodal sin opioides ha cobrado importancia, especialmente en procedimientos con anestesia raquídea sin opioide intratecal por su seguridad. Sin embargo, la evidencia comparativa entre paracetamol solo, paracetamol con AINES y opioides sistémicos sigue siendo limitada, especialmente en Latinoamérica. Objetivo: Evaluar la efectividad y seguridad de tres esquemas analgésicos postoperatorios, paracetamol solo, paracetamol combinado con AINES y opioides en pacientes sometidos a cirugía de rodilla bajo anestesia raquídea sin opioide intratecal, en términos de control del dolor, estabilidad hemodinámica y recuperación funcional. Metodología: Se desarrolló un estudio analítico comparativo, prospectivo y observacional en un centro de referencia del Caribe colombiano durante 2025. Se incluyeron 34 pacientes ≥18 años con cirugía electiva de rodilla y técnica anestésica única. Los desenlaces evaluados fueron: intensidad del dolor (EVA en 24 h), signos vitales posoperatorios (FC, PAS, PAD), eventos adversos (náuseas, emesis), tiempo hasta la deambulación y duración de la estancia hospitalaria. Las comparaciones se realizaron mediante ANOVA, Chi-cuadrado/Fisher y regresión logística multivariada para identificar factores asociados a estancia >48 horas. Resultados: De los 34 pacientes incluidos, 18 recibieron PCM, 12 PCM + AINES y 4 opioides. No hubo diferencias significativas en edad, sexo, ASA ni comorbilidades entre grupos. La intensidad del dolor no mostró variación significativa según el esquema analgésico, aunque PCM + AINES presentó tendencia a menores puntajes EVA. No se observaron diferencias en frecuencia cardíaca, PAS o PAD entre los tres grupos. La incidencia de náuseas y emesis fue baja, predominando en el grupo de opioides. La mayoría de los pacientes logró deambulación en ≤24 horas, sin diferencias significativas por esquema. En el análisis multivariado, la estancia >48 h se asoció principalmente con EVA posoperatoria más alta y presencia de artrosis, no con el tipo de analgesia administrada.
Conclusión: En cirugía de rodilla con anestesia raquídea sin opioide intratecal, los esquemas con paracetamol solo o combinado con AINES mostraron una analgesia comparable a la de los opioides, con mejor tolerabilidad y sin afectar la estabilidad hemodinámica ni la recuperación funcional. Estos resultados respaldan las estrategias multimodales sin opioides como una alternativa eficaz y segura en protocolos de recuperación acelerada en el Caribe colombiano.
Postoperative pain following knee surgery is a significant clinical challenge, as it is associated with delayed mobilization, increased complications, and prolonged hospital stays. In this context, multimodal opioid-free analgesia has gained importance, particularly in procedures performed under spinal anesthesia without intrathecal opioids due to its favorable safety profile. However, comparative evidence between paracetamol alone, paracetamol combined with NSAIDs, and systemic opioids remains limited, especially in Latin America. Objective: To evaluate the effectiveness and safety of three postoperative analgesic regimens, paracetamol alone, paracetamol combined with NSAIDs, and opioids in patients undergoing knee surgery under spinal anesthesia without intrathecal opioids, focusing on pain control, hemodynamic stability, and functional recovery. Methods: A prospective, observational, comparative analytical study was conducted in a referral center in the Colombian Caribbean in 2025. A total of 34 patients ≥18 years undergoing elective knee surgery with a single anesthetic technique were included. Outcomes assessed included pain intensity (VAS at 24 h), postoperative vital signs (HR, SBP, DBP), adverse events (nausea, vomiting), time to ambulation, and length of hospital stay. Comparisons were performed using ANOVA, Chi- square/Fisher’s exact tests, and multivariate logistic regression to identify factors associated with stays >48 hours. Results: Among the 34 patients included, 18 received PCM, 12 PCM + NSAIDs, and 4 opioids. No significant differences were observed among groups in age, sex, ASA status, or comorbidities. Pain intensity did not show significant variation between analgesic regimens, although PCM + NSAIDs showed a trend toward lower VAS scores. No group differences were found in heart rate, SBP, or DBP. Nausea and vomiting incidence was low, with a higher proportion in the opioid group. Most patients ambulated within ≤24 hours, with no significant differences by regimen. In multivariate analysis, hospital stays >48 h were mainly associated with higher postoperative VAS scores and presence of osteoarthritis, not with the analgesic regimen used. Conclusion: In knee surgery performed under spinal anesthesia without intrathecal opioids, paracetamol alone or combined with NSAIDs provided analgesia comparable to opioid regimens, with better tolerability and without compromising hemodynamic stability or functional recovery. These findings support opioid-free multimodal strategies as an effective and safe alternative in enhanced recovery protocols in the Colombian Caribbean.
Postoperative pain following knee surgery is a significant clinical challenge, as it is associated with delayed mobilization, increased complications, and prolonged hospital stays. In this context, multimodal opioid-free analgesia has gained importance, particularly in procedures performed under spinal anesthesia without intrathecal opioids due to its favorable safety profile. However, comparative evidence between paracetamol alone, paracetamol combined with NSAIDs, and systemic opioids remains limited, especially in Latin America. Objective: To evaluate the effectiveness and safety of three postoperative analgesic regimens, paracetamol alone, paracetamol combined with NSAIDs, and opioids in patients undergoing knee surgery under spinal anesthesia without intrathecal opioids, focusing on pain control, hemodynamic stability, and functional recovery. Methods: A prospective, observational, comparative analytical study was conducted in a referral center in the Colombian Caribbean in 2025. A total of 34 patients ≥18 years undergoing elective knee surgery with a single anesthetic technique were included. Outcomes assessed included pain intensity (VAS at 24 h), postoperative vital signs (HR, SBP, DBP), adverse events (nausea, vomiting), time to ambulation, and length of hospital stay. Comparisons were performed using ANOVA, Chi- square/Fisher’s exact tests, and multivariate logistic regression to identify factors associated with stays >48 hours. Results: Among the 34 patients included, 18 received PCM, 12 PCM + NSAIDs, and 4 opioids. No significant differences were observed among groups in age, sex, ASA status, or comorbidities. Pain intensity did not show significant variation between analgesic regimens, although PCM + NSAIDs showed a trend toward lower VAS scores. No group differences were found in heart rate, SBP, or DBP. Nausea and vomiting incidence was low, with a higher proportion in the opioid group. Most patients ambulated within ≤24 hours, with no significant differences by regimen. In multivariate analysis, hospital stays >48 h were mainly associated with higher postoperative VAS scores and presence of osteoarthritis, not with the analgesic regimen used. Conclusion: In knee surgery performed under spinal anesthesia without intrathecal opioids, paracetamol alone or combined with NSAIDs provided analgesia comparable to opioid regimens, with better tolerability and without compromising hemodynamic stability or functional recovery. These findings support opioid-free multimodal strategies as an effective and safe alternative in enhanced recovery protocols in the Colombian Caribbean.
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Palabras clave
Analgesia multimodal, Paracetamol, Antiinflamatorios no esteroideos, Opioides, Cirugía de rodilla, Recuperación funcional, Dolor postoperatorio