Ketamine for analgesia of lumbosacral plexopathy secondary to the repair of an abdominal aortic aneurysm

Revista Salud Bosque

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Title Ketamine for analgesia of lumbosacral plexopathy secondary to the repair of an abdominal aortic aneurysm
Ketamina para analgesia de la plexopatía lumbosacra secundaria a la reparación de un aneurisma de aorta abdominal
 
Creator Moyano, Jairo
Acosta, Eduardo
 
Subject aneurisma; isquemia; polineuropatía; dolor; ketamina.
 
Description Introduction: Acute postoperative pain after abdominal aortic aneurysm is of high intensity; intraoperative complications may occur that increase nociception. Although opioids are the basis of analgesic treatment, their use is limited by the risk of respiratory depression and its potential for abuse. Ketamine is an option that provides analgesia and decreases the use of opioids.
Case presentation: 62-year-old male patient with abdominal aortic aneurysm who underwent endovascular and open repair. In the postoperative period he developed contralateral distal embolism with severe pain in the right buttock that required the stent explant and new revascularization. The pain was described as severe, incidental, with plantar allodynia, decreased proprioception and absence of pulses; electromyography reported moderate to severe axonal polyneuropathy with asymmetric compromise suggestive of plexus injury.
Discussion: Bilateral lumbosacral plexus ischemia was suspected, and ketamine was started (bolus = 1mg / kg plus infusion 0.5 mg / kg / hour), with significant improvement.
Conclusion: multimodal analgesia with ketamine is useful for postoperative analgesia in abdominal aneurysm repair surgery with improved analgesia and reduced opioid requirements.
Introducción. El dolor agudo posoperatorio luego de una cirugía abierta de reparación de un aneurisma de la aorta abdominal usualmente es de gran intensidad; adicionalmente, pueden presentarse complicaciones intraoperatorias que aumentan la nocicepción. Aunque los opioides son la base del tratamiento analgésico, su utilización está limitada por el riesgo de depresión respiratoria y su potencial de abuso. La ketamina es una opción que proporciona analgesia y disminuye la utilización de opioides.
Presentación del caso. Paciente masculino de 62 años con aneurisma de la aorta abdominal a quien se le realizó reparación endovascular y por laparotomía. En el posoperatorio presentó embolismo distal con dolor severo que requirió explante de endoprótesis y revascularización. El dolor fue descrito como severo a insoportable, de tipo corrientazo e incidental y con alodinia plantar, disminución de la propiocepción y ausencia de pulsos; la electromiografía reportó polineuropatía axonal de expresión moderada a severa con compromiso asimétrico sugestivo de lesión del plexo.
Discusión. Se consideró isquemia bilateral de plexo lumbosacro y se adicionó ketamina en infusión (bolo=1 mg/kg más infusión 0.5 mg/kg/hora), con lo cual se obtuvo mejoría significativa sin efectos secundarios y disminución de la necesidad de opioides.
Conclusión. La analgesia multimodal con ketamina es útil para tratar el dolor posoperatorio en cirugía de reparación de aneurisma abdominal con reducción de las necesidades de opioides.
 
Publisher Universidad El Bosque
 
Date 2019-12-13
 
Type info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
 
Format application/pdf
 
Identifier https://revistasaludbosque.unbosque.edu.co/article/view/2812
10.18270/rsb.v9i2.2812
 
Source Revista Salud Bosque; Vol 9 No 2 (2019): Volumen 9. Número 2. Año 2019
Revista Salud Bosque; ##issue.vol## 9 ##issue.no## 2 (2019): Volumen 9. Número 2. Año 2019
Revista Salud Bosque; Vol. 9 Núm. 2 (2019): Volumen 9. Número 2. Año 2019
2322-9462
2248-5759
 
Language spa
 
Relation https://revistasaludbosque.unbosque.edu.co/article/view/2812/2247
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Rights http://creativecommons.org/licenses/by-nc/4.0
 

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