title: [Infusional therapy: an alternative for shouder pain post-laparoscopy].
abstract: BACKGROUND
  Neuraxial anesthesia in upper abdominal laparoscopic surgery decreases perioperative morbidity and mortality. However, shoulder pain is common and difficult to control. Use of a major opioid (e.g., fentanyl) for the control of this event may depress respiratory function. This is why we believe that a safe and effective therapeutic control of this disease pain is a multimodal analgesic scheme which we have called infusional therapy.
  
  
  OBJECTIVE
  To compare various schemes for controlling shoulder pain secondary to pneumoperitoneum.
  
  
  METHODS
  Nonrandomized clinical trial with 56 patients ASA I-II divided into four groups undergoing laparoscopic cholecystectomy. Group I (n= 15) managed with ketorolac 1 mg kg, group II (n = 12) ketoprofen 100 mg, group III (n = 14) ketoprofen 50 mg + 50 mg tramadol, and group IV (n = 15) ketoprofen 100 mg + 100 mg tramadol. The following ariables were analyzed: presence and intensity of pain, analgesia rescue and operative time.
  
  
  RESULTS
  Group I had more shoulder pain events compared to other groups (p= 0.002) in the same way the group IV required less rescue analgesia (p= 0.034).
  
  
  CONCLUSIONS
  preemptive analgesia to infusional therapy with ketoprofen-tramadol at doses of 100 mg each is safe for laparoscopic surgery.
authors.affiliation: Departamento de Anestesiología, Hospital General de Cerralvo, Cerralvo, Nuevo León, Mexico. cielo_urena@hotmail.com
authors.forename: Cielo Alborada
authors.initials: CA
authors.lastname: Ureña-Frausto
authors.forename: Ricardo
authors.initials: R
authors.lastname: Plancarte-Sánchez
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Reyes-Torres
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Ramírez-Aranda
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D007660:Ketoprofen / Q000008:administration & dosage / Q000627:therapeutic use*; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011229:Preanesthetic Medication; D012120:Respiration Disorders / Q000517:prevention & control; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014147:Tramadol; D007660:Ketoprofen; D005283:Fentanyl; D020910:Ketorolac
keywords: anestesia neuroaxial; cirugía laparoscópica; infusional 
  therapy; laparoscopic surgery; neuraxial anesthesia; terapia infusiona