Síndrome de dolor miofascial como causa de dolor agudo postoperatorio en la cirugía de cadera

Abstract

Myofascial pain syndrome (MPS) is a regional pain of muscular origin, usually presents as a cause of chronic pain, being a pathology not uncommon in the consultations of the Pain Unit. The present work refers to the case of a patient undergoing hip arthroplasty who developed an MDS in the immediate postoperative period, thus generating a situation of acute postoperative pain. In this clinical case reference is made to the great importance of a correct differential diagnosis for the treatment of a painful syndrome As is known, patients undergoing joint replacement surgery experience intense and sustained postoperative pain if adequate perioperative analgesia is not carried out. Poor pain control would prevent early recovery and discharge from the patient. In the case in question, the control of perioperative pain was carried out satisfactorily, and it was not until the third day postintervention when an inguinal pain irradiated to the thigh and knee appeared that it was accompanied by muscular spasms to the mobilization. Coinciding this fact with the beginning of the rehabilitation of the member Until the final diagnosis was reached, first the causes attributable to the prosthesis itself (dislocation, friction, malposition ...) were discarded, later a possible nerve injury that could have occurred during the surgical act was ruled out and finally, after the evaluation for the Pain Unit, a possible myofascial syndrome with involvement of the right psoas muscle was suspected and treated as such. For the treatment of the condition, a muscle infiltration was performed with 40 mg of Triamcinilone and 5 ml of 0.25% levobupivacaine. The location was made by fluoroscopy and water-soluble contrast. After the procedure, a clear symptomatic improvement was obtained.