title: [Reduction of omalgia in laparoscopic cholecystectomy: clinical randomized trial ketorolac vs ketorolac and acetazolamide].
abstract: BACKGROUND
  Laparoscopy cholecystectomy for the surgical treatment of cholelithiasis has been considered the gold standard. The referred pain to the shoulder (omalgia) may be present to 63% of the patients and limits outpatient management.
  
  
  OBJECTIVE
  The study was to evaluate the usefulness of acetazolamide associated with ketorolac for reduction of the omalgia to minimally invasive treatment.
  
  
  METHODS
  We performed a clinical trial, randomized, double blind in patients undergoing laparoscopic cholecystectomy to assess the reduction of post-operative omalgia comparing ketorolac and ketorolaco+acetazolamida. 31 patients in each group were studied. The study group: 250 mg of acetazolamide before anesthetic induction and 30 mg of ketorolac in the immediate postoperative period.
  
  
  METHODS
  one tablet of placebo prior to the anesthetic induction and 30 mg of ketorolac in the immediate postoperative. The presence of omalgia was assessed using the analog visual scale. The variables recorded included: age, sex, flow of carbon dioxide intra-abdominal pressure, surgical time, urgent or elective surgery, omalgia, severity of pain evaluated by analog visual scale, addition analgesia.
  
  
  RESULTS
  Both groups were homogeneous and statistical analysis showed no differences in the variables studied. The omalgia in the study group was presented at 9.67% and in the group control was the 58.06% (p < 0.001).
  
  
  CONCLUSIONS
  250 mg oral acetazolamide associated 30 mg of ketorolac reduces significantly the development of omalgia in patients undergoing laparoscopic cholecystectomy.
authors.affiliation: Departamento de cirugía general. Hospital General Rincón de Romos, Ags., Mexico. lfbmed78@hotmail.com.
authors.forename: Lorena
authors.initials: L
authors.lastname: Figueroa-Balderas
authors.affiliation: Departamento de cirugía general. Centenario Hospital Miguel Hidalgo. Aguascalientes, Ags. México.
authors.forename: Francisco
authors.initials: F
authors.lastname: Franco-López
authors.affiliation: Departamento de cirugía general. Centenario Hospital Miguel Hidalgo. Aguascalientes, Ags. México.
authors.forename: Efrén
authors.initials: E
authors.lastname: Flores-Álvarez
authors.affiliation: Departamento de cirugía general. Centenario Hospital Miguel Hidalgo. Aguascalientes, Ags. México.
authors.forename: Jorge Luis
authors.initials: JL
authors.lastname: López-Rodríguez
authors.affiliation: Departamento de cirugía general. Centenario Hospital Miguel Hidalgo. Aguascalientes, Ags. México.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Vázquez-García
authors.affiliation: Departamento de cirugía general. Centenario Hospital Miguel Hidalgo. Aguascalientes, Ags. México.
authors.forename: Claudia Teresa
authors.initials: CT
authors.lastname: Barba-Valadez
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000493:pharmacokinetics; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000453:epidemiology / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D053591:Referred Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011229:Preanesthetic Medication; D020069:Shoulder Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002257:Carbonic Anhydrase Inhibitors; D002245:Carbon Dioxide; D000086:Acetazolamide; D020910:Ketorolac
keywords: Cholecystitis; acetazolamide; colecistectomía; colecistitis litiásica; ketorolac; laparoscopia; laparoscopic cholecystectomy; omalgia