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 inclusin

de pacientes en CMA / circuitos CMA en HSJD-MB) A-Criterios de inclusin 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 aceptacin 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 hepatica 2- ingreso en UCSI y sala de preoperatorio inmediato 3- Intraaoperatorio: - tecnica anestesica - tecnica quirurgica experta 4- 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 / documentacin / recerca en HSJD-MB con el que podamos / debamos / tengamos que hablar para disear el estudio, consentimientos informados?

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

a.1- DEL PACIENTE: - FISIOLOGICOS: Valorar individualmente a cada paciente - ASA - Comorbilidades - edad - PSICOLOGICOS El paciente entiende y acepta las instrucciones y previsibles molestias - SOCIALES - acompaante - distancia del domicilio al hospital - vivienda adaptada (ascensor) - telefono

a.2- QUIRURGICOS: Colelitiasis Cronica sintomatica no complicada: o Diagnosticada por ecografia o Via biliar permeble no dilatada o 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 -

POSIBILIDADES EN EL MANEJO ANALGESICO 1- Infiltracion intraperitoneal / lecho hepatico con AL: a. Pre-pneumoperitoneo b. Post-pneumoperitoneo c. Post-IQ con cateter extraperitoneal 2- Infiltracion de las incisiones de los trocares con AL: a. Preincisin b. Postincision AUTOR AO Alessandri Anil 2002 TIPO TIPO ESTUDIO DE LPC ANALGESIA RESULTADOS

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

BIBLIOGRAFIA de

A) POSIBILIDADES EN EL MANEJO ANALGESICO 10- Infiltracion intraperitoneal / lecho hepatico con AL: a. Pre-pneumoperitoneo b. Post-pneumoperitoneo c. Post-IQ con cateter extraperitoneal 11- Infiltracion de las incisiones de los trocares con AL: a. Preincisin b. Postincision

12- Bloqueos intercostales 13- Bloqueo paravertebral 14- Bloqueo intrapleural 15- Bloqueo epidural 16- TAPB: Trans-Abdominal-Plane Block 17- 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

A) POSIBILIDADES EN EL MANEJO ANALGESICO ( bibliografia ) 1- Infiltracion intraperitoneal / lecho hepatico con AL en CL: (bibliografia) a. Pre-pneumoperitoneo b. Post-pneumoperitoneo c. 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 103:682The Effect of Intraperitoneal Local Anesthesia in LaparoscopicCholecystectomy: A Systematic Review and META-ANALYSIS Alexander P. Boddy, Samir Mehta, and Michael Rhodes http://www.anesthesia-analgesia.org/content/103/3/682.full.pdf+html?sid=9c332f8ded6b-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, Thrn SE, Axelsson K, Larsson LG, Agren G, Holmstrm B, Rawal N. Department of Anesthesiology, University Hospital, Orebro, Sweden http://www.anesthesia-analgesia.org/content/95/2/450.long - Minimally Invasive Therapy & Allied Technologie, 1999 Intraperitoneal local anaesthetics via subphrenic catheter following laparoscopic cholecystectomy: Pain relief and pulmonary function R. Busley1, M. Blobner1, S. Jelen-esselborn1, H. Feussner2 and E. Kochs1 1Institute for Anaesthesiology, Technical University Munich, Munich, Germany - A & A August 2000 Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gynecologic Surgery: A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine Andrei Goldstein, MD*, Patrick Grimault, MD*, Aude Henique, MD*, Michle Keller, MD*, Anne Fortin, MD and Emile Darai, MD, PhD Departments of Anesthesiology and Gynecology, Hotel-Dieu Hospital Paris, France http://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 function B. M. P. RADEMAKER, M.D., Department of Anaesthesiology, Academic Medical Centre Meibergdreef , Amsterdam

http://bja.oxfordjournals.org/content/72/3/263.abstract - A & A August 1995 Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine 1. J Joris, E Thiry, P Paris, J Weerts and M Lamy Department of Anesthesia and Intensive Care Medicine, University Hospital of Lige, Domaine du Sart Tilman, Belgium. http://www.anesthesia-analgesia.org/content/81/2/379.abstract - Indian J. Anaesth, 2002 INTRAPERITONEAL BUPIVACAINE INSTILLATION FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY Neerja Bhardwaj http://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 2010 Intraperitoneal Ropivacaine Instillation for Postoperative Pain Relief after Laparoscopic Cholecystectomy Departments of Surgery and 1Anesthesiology and Pain Medicine, Korea Tae Han Kim, M.D http://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.com http://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, 2005 Superiority 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

M. Barczyski, A. Konturek and R. M. Herman http://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, Greece http://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, Greece http://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 G Department of Surgery, Anaesthsiology, and Radiology, University of Ferrara, Italy. http://www.ncbi.nlm.nih.gov/pubmed/11988800

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

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 1987 Does 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 postcholecystectomy pain Maidatsi, P.; Gorgias, N.; Zaralidou, A.; Ourailoglou, V.; Giala, M. http://journals.lww.com/ejanaesthesiology/Abstract/1998/09000/Intercostal_nerve_bloc kade_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 METAANALYSIS of randomized controlled trials A. Schnabel1 Department of Anaesthesiology and Intensive Care, University Hospital of Mu nster, Germany http://bja.oxfordjournals.org/content/105/6/842.full.pdf+html - A & A June 2010 Paravertebral Block for Anesthesia: A Systematic REVIEW Prema Thavaneswaran, BSc (Hons), Australia. http://www.anesthesia-analgesia.org/content/110/6/1740.abstract - A & A September 2003 Continuous Paravertebral Catheter and Outpatient Infusion for Breast Surgery Chester C., Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina http://www.anesthesia-analgesia.org/content/97/3/715.full - Br. J. Anaesth. (2011) 106(2): 164-171 doi:10.1093/bja/aeq378 Bilateral thoracic paravertebral block: potential and practice. REVIEW ARTICLE J. Richardson, Department of Pain and Anaesthetics, Bradford Royal Infirmary, UK 2 Karolinska Institute, Stockholm, Sweden 3 Makassed General Hospital, Beirut, Lebanon http://bja.oxfordjournals.org/content/106/2/164.full.pdf+html?sid=7b845e02-9d5d48e1-81dd-a4067118b540 - Br. J. Anaesth. (1989) 63(1): 129 doi:10.1093/bja/63.1.129-a PARAVERTEBRAL BLOCK FOR POST-CHOLECYSTECTOMY PAIN RELIEF C. M. KUMAR, Middlesbrough http://bja.oxfordjournals.org/content/63/1/129.2.full.pdf+html?sid=f5b844bc-8cfc-4209b327-3208e27c62dc - Br. J. Anaesth. Lateral ultrasound-guided paravertebral blockade: an anatomical-based description of a new technique Marhofer, S. C. Kettne 2. Department of Anaesthesia, Intensive Care Medicine and Pain Therapy and 2Department of Surgery, Medical University of Vienna, Austria http://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_c ombined_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_paravert ebral_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.; Lnnqvist, 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 2010 Ultrasound-Guided Thoracic Paravertebral Blockade: A Cadaveric Study Brian Cowie, MBBS, FANZCA Department of Anaesthesia, St. Vincent's Hospital; University of Melbourne, Australia. http://www.anesthesia-analgesia.org/content/110/6/1735.abstract - A & A January 2010 Thoracic Paravertebral Block Using Real-Time Ultrasound Guidance 3. Seosamh C. 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 634640 Clinical Investigation Intraperitoneal Versus Interpleural Morphine or Bupivacaine for Pain after Laparoscopic Cholecystectomy Schulte Steinberg, Hans MD; Weninger, Ernst MD; Jokisch, Dominik BS; Hofstetter, Bernhard BS; Misera, Axel BS; Lange, Volker MD; Stein, Christoph MD http://journals.lww.com/anesthesiology/Abstract/1995/03000/Intraperitoneal_Versus_In terpleural_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 cholecystectomy Fujii, Y.; Toyooka, H.; Tanaka, H. http://journals.lww.com/ejanaesthesiology/Abstract/1998/05000/Efficacy_of_thoracic_e pidural_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 2010 The role of TAP block in laparoscopic cholecystectomy http://www.alexaic.com/alexaicfiles/presentation2010/day3/041003.pdf - ClinicalTrials.gov Pain After Laparoscopic Cholecystectomy With Bilateral Tranversus Abdominis Plane (TAP) Block Versus Local Anesthetic Infiltration This study is currently recruiting participants. Verified by Baylor College of Medicine, September 2010 http://clinicaltrials.gov/ct2/show/NCT01204892 - European Journal of Anaesthesiology: 12 June 2010 - Volume 27 - Issue 47 - p 222 Acute and Chronic Pain Management Trans-abdominal plane (TAP) block analgesia in day case laparoscopic cholecystectomy - A prospective study: 14AP12-6 El 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/aep067 Ultrasound-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, Austria http://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 Svign, Paris, France http://www.ncbi.nlm.nih.gov/pubmed/21177284

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8- Analgesia parenteral / via oral en CL, pre-/ post-IQ ( bibliografia ) - SURGICAL ENDOSCOPY, 2008 Preoperative administration of controlled-release OXYCODONE as a transition opioid for total intravenous anaesthesia in pain control after laparoscopic cholecystectomy Fanelli 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.it http://www.springerlink.com/content/1h28774352248j1q/ - European Journal of Anaesthesiology: June 2006 Comparative study of presurgical intravenous DEXKETOPROFEN or PARACETAMOL plus wound local infiltration for pain management after laparoscopic cholecystectomy: A-913 Hernndez-Palazn, J. Department of Anesthesiology, Virgen de la Arrixaca University Hospital, Murcia, Spain http://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 ketoprofen 5. G. Boccara1,*, 1Department of Anaesthesiology and Critical Care, Hospital Saint Joseph, Paris, France. http://bja.oxfordjournals.org/content/94/3/347.abstract - Ann Surg. 2003 November Preoperative DEXAMETHASONE improves Surgical Outcome After Laparoscopic Cholecystectomy. A Randomized Double-Blind Placebo-Controlled Trial Thue 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, 2001 Preincisional intravenous low-dose ketamine and local infiltration with ropivacaine reduces postoperative pain after laparoscopic cholecystectomy B. Papaziogas, Greece http://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-ANALYSIS Cliff 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/aeq322 Continuous peripheral nerve blocks in acute pain management J. E. Chelly, D. Ghisi, and A. Fanelli http://bja.oxfordjournals.org/content/105/suppl_1/i86.full.pdf+html?sid=7b845e029d5d-48e1-81dd-a4067118b540 - Rev Soc Esp Dolor 16 (2009);4 :239 245 Analgesia postoperatoria en ciruga mayor: es hora de cambiar nuestros protocolos?. Ferrer , A. ; Baena Nadal, M. ; Montero Snchez, F. ; Gimnez Jimnez, I. ; del Rosario Usoles, E. ; Esteve Prez, N. ; : http://revista.sedolor.es/articulo.php?ID=620 - Anesthesiology: April 2006 - Review Article Analgesic Treatment after Laparoscopic Cholecystectomy: A Critical Assessment of the Evidence Bisgaard,. Glostrup University Hospital, Glostrup, Denmark. 2004 http://journals.lww.com/anesthesiology/Fulltext/2006/04000/Preemptive_Analgesia__In traperitoneal_Local.30.aspx - Indian Journal of Anaesthesia , 2006 POSTOPERATIVE PAIN RELIEF FOR AMBULATORY SURGERY Dr. Mukherji S.1 Dr. Rudra A.2 http://medind.nic.in/iad/t06/i5/iadt06i5p355.pdf - Rev Cubana Cir 2006; 45 (2) Anestesia para colecistectoma laparoscpica. Nuestra experiencia Dr. Ral Garca Rojas,1 Dra. Marilt Murads Augier,2 Dra. Marta S. Lpez Rodrguez3 y Dra. Yanet Prez Delgado4 http://bvs.sld.cu/revistas/cir/vol45_2_06/cir03206.pdf - NYSORA : The Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain http://www.nysora.com/pain_management/3105-The-Role-Non-Opioid-AnalgesicTechniques-the-Management-Postoperative-Pain.html

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

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