Analgesia multimodal para el postoperatorio en la enfermedad renal crónica: fentanilo transcutáneo, fentanilo oral transmucosa y metamizol

Abstract

Chronic kidney failure (CKF) is a clinical situation with an increasing prevalence due to the high incidence of hypertension and diabetes both of them considered as risk factors, and also due to the rise on life expectancy. These patients need a carefully anaesthetic management in order not to aggravate their renal function. Postoperative analgesia becomes a key point at this end. Fentanyl's pharmacokinetic totally fits in handling pain in CKF's patients. Thanks to the great commercial display on fentanyl's presentation we are able to develop suitable strategies to offer high quality postoperative analgesia. We describe a case of a severe CKD patient undergoing hip arthroplasty following this analgesia plan during the first 48 hours postoperative: Continuous infusion of metamizol (6 g/24 hours) + transdermal fentanyl (25 μg/h) + transmucosal fentanyl (200 μg) if necessary. With this analgesia approach we obtained a satisfactory pain control without vomits, itching or constipation; the patient had a proper rest at night.