Propuesta de protocolo analgésico multimodal con implementación de crioanalgesia para pacientes sometidos a técnica de Nuss en el Hospital Calderón Guardia
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Abstract
El pectus excavatum es la deformidad congénita más frecuente de la pared torácica y su corrección mediante la técnica de Nuss se asocia con uno de los dolores postoperatorios más intensos en cirugía de tórax. Esto convierte su manejo analgésico en un reto trascendental para los anestesiólogos, ya que el dolor mal controlado incrementa significativamente la morbilidad, favoreciendo complicaciones respiratorias, limitación funcional y riesgo de dolor crónico. En este contexto, la crioanalgesia intercostal ha surgido como una herramienta eficaz para reducir la intensidad del dolor y el consumo de opioides, ofreciendo un bloqueo prolongado y reversible que optimiza la recuperación.
Este trabajo tiene como objetivo diseñar un protocolo analgésico multimodal con integración de la crioanalgesia para pacientes sometidos al procedimiento de Nuss en el Hospital Rafael Ángel Calderón Guardia. Por lo que se realizó una revisión narrativa de la literatura reciente, analizando evidencia clínicamente relevante sobre fisiopatología del dolor, efectividad de las estrategias multimodales y beneficios comparativos de la crioanalgesia en este contexto.
A partir de la información recopilada, se propone un protocolo estructurado que define criterios de selección, aspectos técnicos de la crioanalgesia e integración con analgesia sistémica y coadyuvantes. Su implementación pretende optimizar el control del dolor postoperatorio, disminuir complicaciones relacionadas, prevenir la cronificación y mejorar la recuperación funcional de los pacientes.
Pectus excavatum is the most common congenital deformity of the anterior chest wall, and its correction through the Nuss procedure is associated with severe postoperative pain. This makes analgesia a significant challenge for anesthesia providers, as inadequate pain control increases morbidity by contributing to respiratory complications, delayed mobilization, and a higher risk of chronic postoperative pain. Intercostal cryoanalgesia has gained attention as a technique that offers prolonged and reversible nerve blockade, potentially reducing opioid requirements and improving recovery. A narrative review of the recent literature was conducted, including clinical studies, systematic reviews, and practice guidelines published in the past ten years. Searches were performed in PubMed, Scopus, Cochrane, and UpToDate. The review focused on the pathophysiology of pain in the Nuss procedure, current multimodal analgesic strategies, and the clinical performance, safety profile, and feasibility of implementing intercostal cryoanalgesia. These findings informed the development of a multimodal analgesic protocol for use at Hospital Rafael Ángel Calderón Guardia. The evidence indicates that cryoanalgesia consistently reduces postoperative pain scores, opioid consumption, and length of hospital stay when used as part of a multimodal regimen. Studies also describe improved respiratory function, earlier mobilization, and a lower incidence of chronic postoperative pain. These benefits support its integration into perioperative management for the Nuss procedure. The proposed protocol outlines patient selection criteria, technical considerations for cryoanalgesia, and its incorporation into a multimodal analgesic strategy. Its implementation may optimize postoperative pain control, reduce morbidity associated with inadequate analgesia, and enhance functional recovery in patients undergoing the Nuss procedure.
Pectus excavatum is the most common congenital deformity of the anterior chest wall, and its correction through the Nuss procedure is associated with severe postoperative pain. This makes analgesia a significant challenge for anesthesia providers, as inadequate pain control increases morbidity by contributing to respiratory complications, delayed mobilization, and a higher risk of chronic postoperative pain. Intercostal cryoanalgesia has gained attention as a technique that offers prolonged and reversible nerve blockade, potentially reducing opioid requirements and improving recovery. A narrative review of the recent literature was conducted, including clinical studies, systematic reviews, and practice guidelines published in the past ten years. Searches were performed in PubMed, Scopus, Cochrane, and UpToDate. The review focused on the pathophysiology of pain in the Nuss procedure, current multimodal analgesic strategies, and the clinical performance, safety profile, and feasibility of implementing intercostal cryoanalgesia. These findings informed the development of a multimodal analgesic protocol for use at Hospital Rafael Ángel Calderón Guardia. The evidence indicates that cryoanalgesia consistently reduces postoperative pain scores, opioid consumption, and length of hospital stay when used as part of a multimodal regimen. Studies also describe improved respiratory function, earlier mobilization, and a lower incidence of chronic postoperative pain. These benefits support its integration into perioperative management for the Nuss procedure. The proposed protocol outlines patient selection criteria, technical considerations for cryoanalgesia, and its incorporation into a multimodal analgesic strategy. Its implementation may optimize postoperative pain control, reduce morbidity associated with inadequate analgesia, and enhance functional recovery in patients undergoing the Nuss procedure.
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Keywords
Cryoanalgesia, Postoperative Pain, Pectus Excavatum, Nuss Procedure, Multimodal Analgesia, Thoracic Surgery, Regional Anesthesia