Año 2023 / Volumen 30 / Número 1

Artículo de la revista EJP

Efecto de la estimulación transcraneal mediante corriente continua sobre el dolor y el consumo de opioides después de la cirugía raquídea
Effects of transcranial direct current stimulation in pain and opioid consumption after spine surgery

Rev. Soc. Esp. Dolor. 2023; 30(1): 49-59 / DOI: 10.1002/ejp.1985

Rasha Hamed, Eman M. Khedr, Nourelhoda A. Haridy, Khaled O. Mohamed, Saeid Elsawy


RESUMEN

Antecedentes: La estimulación transcraneal por corriente continua (ETCC o tDCS, por sus siglas en inglés) ha obtenido resultados prometedores para aliviar distintos tipos de dolor. El presente estudio compara la eficacia de tres sesiones de ETCC anódica aplicada sobre el área motora primaria (M1) o la corteza prefrontal dorsolateral (CPFDL) izquierda, o simulada, para reducir el dolor y el consumo total de opioides en pacientes en el postoperatorio de una cirugía de columna vertebral.
Materiales: Sesenta y siete de 75 pacientes elegibles en el postoperatorio de una cirugía raquídea fueron asignados a uno de tres grupos experimentales. El grupo A recibió ETCC anódica sobre la corteza M1, el grupo B la recibió sobre la CPFDL izquierda (2 mA, 20 min) y el grupo C recibió una ETCC simulada, todos durante 3 días consecutivos del postoperatorio. Los pacientes se evaluaron mediante una escala analógica visual (EAV) y una escala analógica visual dinámica (EAVD) basalmente y en cada uno de los días de tratamiento. Se evaluó el consumo total de morfina durante los 3 días del postoperatorio.
Resultados: El ANOVA de dos vías de medidas repetidas no mostró ninguna diferencia significativa en la EAV de reposo entre los tres grupos. Sin embargo, hubo una mejoría significativa del dolor (P < 0,001) en la EAVD en ambos grupos activos (grupos A y B) frente al grupo con simulación (grupo C) en el postoperatorio, sin diferencias significativas entre los grupos activos. El consumo de morfina se redujo significativamente en ambos grupos activos frente al grupo simulado, pero no hubo diferencias de consumo entre los grupos activos. Conclusión: Hubo una reducción significativa del consumo de morfina y de las puntuaciones de la EAVD en el postoperatorio después de las tres sesiones de ETCC real.
Significación: La ETCC es una herramienta prometedora para aliviar el dolor en el campo de la cirugía raquídea durante el postoperatorio.



ABSTRACT

Background: Transcranial direct current stimulation (tDCS) has shown promising results in alleviating different types of pain. The present study compares the efficacy of three sessions of anodal tDCS applied over primary motor area (M1) or the left dorsolateral prefrontal cortex (DLPFC) or sham on reducing pain and the total opioid consumption in postoperative spine surgery patients.
Materials: Sixty-seven out of 75 eligible patients for postoperative spine surgery were randomly allocated into one of the three experimental groups. Group A received anodal tDCS applied over M1 cortex, group B over left DLPF cortex (2 mA, 20 min) and group C received sham tDCS, all for 3 consecutive postoperative days. Patients were evaluated using a visual analogue scale (VAS) and adynamic visual analogue scale (DVAS) at baseline, and on each of the treatment days. The total morphine consumption over the 3 postoperative days was assessed.
Results: Two-way repeated measures ANOVA showed no statistically significant difference in resting VAS between the three groups. However, there was significant pain improvement (P < 0.001) in DVAS in both active groups (group A and B) compared to the sham group (group C) in the postoperative period, with no significant difference between the active groups. Morphine consumption was significantly reduced in both active groups compared with the sham group,but there was no difference in consumption between the active groups.
Conclusion: There was a significant postoperative reduction in morphine consumption and DVAS scores after three sessions of active tDCS.
Significance: tDCS is a promising tool for alleviating pain in the field of postoperative spine surgery.





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Hamed R, Khedr E, Haridy N, Mohamed K, Elsawy S. Efecto de la estimulación transcraneal mediante corriente continua sobre el dolor y el consumo de opioides después de la cirugía raquídea. Rev Soc Esp Dolor 2023; 30(1): 49-59 / DOI: 101002/ejp1985


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