the use ofa new pca device for fully programmable implantable

the use ofa new pca device for fully programmable implantable

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V CONGRESO DE LASOCIEDAD ESPAÑOLADELDOLOR
THE USE OFA NEW PCA DEVICE FOR FULLY PROGRAMMABLE IMPLANTABLE
PUMPS IN THE TREATMENT OF CHRONIC PAIN
J. P. Van Buyten
Pain Clinic. AZ Maria Middelares Sint-Niklaas. Belgium
Otherwise tolerable or controlled background pain can be
interrupted by transitory pain episodes of increased intensity
(breakthrough pain) associated with the site of chronic pain and
directly related to the background pain. In a study of 164 patients
with well controlled cancer pain, patients experienced 1–60
breakthrough pain episodes per day, with a time from onset to
peak pain ranging from 1 s to 30 min. The duration of breakthrough pain episodes can also vary widely; for example, in a study
of hospice patients experiencing an average of 2.6 episodes per
day, episodes lasted for 1–240 min. It was also found in this
study that caregivers (who usually offer or administer analgesics)
often underestimate patients’ own reports of the number, intensity and duration of their breakthrough pain episodes. Treatment
of chronic pain should therefore address both background and
breakthrough elements. Moreover, as breakthrough pain episodes
can be so variable and unpredictable, the treatment of these may
be controlled most effectively by the patients themselves.
Patient-controlled analgesia (PCA) was first used in the 1960s
for women in labour and in the mid-1980s was incorporated into
the management of postoperative pain. PCAallows flexibility of
dosing according to the patient’s immediate needs. The ability of
the patient to control the pain leads to greater patient satisfaction.
PCA is commonly used via intravenous administration and can
also be via subcutaneous, intramuscular or epidural administration. Recently, PCA has been applied successfully to the spinal
cord via intrathecal delivery using externalized devices.
The SynchroMed Infusion System (Medtronic, Minneapolis,
MN) is an implanted device which has been used for over 15
years to administer medication intrathecally. The battery-powered pump delivers a drug of preprogrammed titration at a flow
rate of between 0.048 and 21.6 ml/day. The SynchroMed pump
has been used successfully in the long-term intrathecal treatment of, for example, spasticity and pain.
The Model 8,831 Personal Therapy Manager has been developed for use with the implanted SynchroMed Infusion System in
order to allow the application of PCAin addition to a baseline infusion.
The Model 8,831 Personal Therapy Manager offers a patientcontrolled analgesia (PCA) option for the SynchroMed Infusion
System. The safety and effective operation of the Personal Therapy Manager activator was evaluated in 45 patients receiving
intrathecal pain therapy via a SynchroMed pump in five European centres. The drug volume delivered over the 4-week follow-up period was calculated. Adverse events were recorded
and pain levels were measured via VAS, Brief Pain Inventory
and SF-12 Quality of Life scores. Patient satisfaction with the
device and its instruction manual was also assessed by questionnaire. The expected and calculated drug volumes were the same,
demonstrating that the device worked as intended. There were
no device-related serious adverse events. Overall, 96% of patients were satisfied with the activator. Patients appreciated controlling their pain and considered the device and its instructions
easy to use. The Personal Therapy Manager was shown to be safe and effective in the intrathecal treatment of pain. The successful addition of a PCA function to the SynchroMed system will
create a new standard in intrathecal pain therapy.
UNIDAD DE DOLOR AGUDO.
TRATAMIENTO YANALGESIA POSTOPERATORIA.
PROTOCOLOS
A. Núñez García
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor
Hospital Universitario de Valme. Sevilla
INTRODUCCIÓN
Como sabemos la idea de incorporar a la Urpa, la Unidad
de Dolor Agudo podríamos definirla como una secuencia de
actividades ordenadas para conseguir la prestación de unos
cuidados de calidad y satisfacer las necesidades y expectativas
razonables del paciente/familia.
Debemos tener presente la confluencia del Dolor, cuya función es la de alertar al individuo de que algo va mal en el organismo, sin embargo el dolor postoperatorio no tiene ninguna
función útil, al contrario, si no se calma adecuadamente unido
al miedo y la ansiedad desencadenan una serie de respuestas
reflejas que pueden producir efectos nocivos e indeseables, de
ahí que nuestra finalidad sea tratar el dolor siempre, proporcionando al paciente sensación subjetiva de confort.
Dolor postoperatorio (DAP)
Podemos definirlo como dolor agudo secundario a una
agresión directa o indirecta, producida en el acto quirúrgico.
Es un dolor que adquiere su máxima intensidad en las primeras 48h, va a depender de aquellos factores que van a influir
en la intensidad, calidad y duración del dolor.