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Infiltration vs. instillation of ropivacaine 7.5% in radical mastectomies for postoperative analgesia
B. I.. Yolanda-Prietoa, A. L.. Millán-Corralesb, D.. Palacios-Ríosc, B. I.. Garduño-Chávezd, N. G.. López-Cabrerae, G. A.. Millán-Cornejof, B. T.. González-Rochag
a Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
b Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
c Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
d Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
e Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
f Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
g Department of Anesthesiology, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction </span></p><p class="elsevierStylePara"> Preventive analgesia was described by Crile in 1913 as an option to prevent alterations in the autonomic nervous system resulting from postoperative pain&#44; based in regional blocks with local and general anesthetics&#46;<span class="elsevierStyleSup">1</span> Initially&#44; preventive analgesia for postoperative pain treatment was not well accepted&#44; due to controversial results in experimental and clinical research work&#59; however&#44; nowadays its use is being reconsidered&#46;<span class="elsevierStyleSup">2-5</span></p><p class="elsevierStylePara"> Underestimated postoperative pain by medical personnel as well as lack of knowledge and adherence to a multimodal analgesic management&#44; are factors accounting for an inadequate therapeutic management of postoperative patients&#46; This has a direct impact on the patient&#39;s optimal recovery&#44; in addition to allowing the development of chronic complications following the surgical procedure&#46; Studies published in recent years show a prevalence of moderate to unbearable pain of 11&#37; &#40;in a hospital with an acute postoperative pain unit&#41;&#44; and in 70&#37; of the patients who have undergone surgery during the first 24 to 48 hours&#59; nevertheless&#44; prevalence has always exceeded 30&#37;&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara"> There are surgical procedures such as mastectomies in women&#44; which besides producing pain may cause diverse emotional reactions&#46;<span class="elsevierStyleSup">7</span> Breast cancer is one of the 2 most common malignancies in women worldwide and the main treatment for this pathology is surgery&#46;<span class="elsevierStyleSup">7-10</span></p><p class="elsevierStylePara"> Despite different therapeutic approaches with several analgesics and routes of administration to avoid pain&#44; the desired analgesic effect is not accomplished in some patients&#59; a reason for this could be the route of administration used or the fact that the strength of the medication may be insufficient&#46;</p><p class="elsevierStylePara"> Radical mastectomy is an extensive and disfiguring procedure&#44; which causes acute postoperative pain due to soft tissue injury of the anterior wall of the thorax&#46; During dissection&#44; tissue traction takes place producing damage to the axons of the intercostal nerves and brachial plexus emergence&#46; There are several anesthetic strategies&#59; some of the most commonly utilized are intercostal nerve blocks&#44; preoperative thoracic epidural block&#44; thoracic paravertebral block&#44; local infiltration blocks&#44; and direct instillation&#46;<span class="elsevierStyleSup">11-13</span></p><p class="elsevierStylePara"> Instillation is the introduction of a liquid &#40;by pouring or injection&#41;&#44; drop by drop over mucous membranes or the skin&#46; It is a very commonly used method&#46; Postoperative infiltration &#40;direct administration of the analgesic into the surgical area&#41;&#44; as a strategy for pain management in this pathology has not been studied extensively and is underconsidered regarding patient management&#44; hence this study&#46; We carried out a comparison between these 2 local analgesic administration techniques by means of a pain scale and the use of rescue medication&#59; by doing so&#44; we attempted to decrease the endocrine response caused by pain and the side effects in the cardiopulmonary and immunology functions that patients with postoperative pain suffer&#46;<span class="elsevierStyleSup">14</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material and methods </span></p><p class="elsevierStylePara"> We included female patients scheduled for radical mastectomy at <span class="elsevierStyleItalic">&#34;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#34;</span> University Hospital of the <span class="elsevierStyleItalic">Universidad Aut&#243;noma de Nuevo Le&#243;n </span>&#40;UANL&#41;&#44; Mexico&#46; The patients agreed to participate in the study by signing an informed consent form&#46; We obtained demographic variables such as age&#44; weight and relevant background&#46; Patients were divided into 2 groups&#59; in Group 1 infiltration with ropivacaine 7&#46;5&#37; &#40;20 ml&#41; was applied prior to closure of the surgical wound&#44; while in Group 2 ropivacaine 7&#46;5&#37; &#40;20 ml&#41; was instilled into the surgical wound&#46; Inclusion criteria required patients to be between 20 and 60 years of age&#44; to have a weight between 110 and 198 lb &#40;50-90 kg&#41;&#44; ASA I or II&#44; to be scheduled for radical mastectomy&#44; and have preoperative test results within normal limits&#46; Patients with a history of coagulopathy&#44; radiotherapy&#44; neurological alterations&#44; and previous analgesic or antiinflammatory treatment were excluded&#46; Subsequently&#44; we assessed blood pressure&#44; heart rate&#44; respiratory rate&#44; and pain using a visual analogue scale &#40;VAS&#41; in both groups&#59; in addition the presence of nausea and&#47;or vomiting was measured from 0 to 30 minutes postoperatively and 2&#44; 4&#44; 8&#44; and 12 hours afterwards&#46;</p><p class="elsevierStylePara"> Data was inputted into a database created in Excel<span class="elsevierStyleSup">&#174;</span> 2010 and analyzed using IBM<span class="elsevierStyleSup">&#174;</span> Statistic 21&#59; for the quantitative variables&#44; traditional descriptive statistics&#44; measures of central tendency&#44; dispersion and position&#44; as well as the observed frequencies in the qualitative variables were calculated&#46; The values were verified by group through hypothesis tests for median and proportion&#44; according to each variable type &#40;quantitative and qualitative respectively&#41; with a reliability of 95&#37;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results </span></p><p class="elsevierStylePara"> Average age was 49&#46;7 &#177; 7&#46;8 years for Group 1 &#40;infiltration&#41; and 43&#46;8 &#43; 12&#46;5 years in Group 2 &#40;instillation&#41;&#59; there was no significant difference in both groups &#40;<span class="elsevierStyleItalic">p </span>&#61; 0&#46;2234&#41;&#46; Average weight was 71&#46;4 kg &#177; 9&#46;7 for Group 1&#44; and 65&#46;4 &#177; 14&#46;3 for Group 2&#59; we did not find significant differences between the groups &#40;<span class="elsevierStyleItalic">p </span>&#61; 0&#46;2863&#41;&#46;</p><p class="elsevierStylePara"> Regarding ASA classification&#44; 50&#37; of the patients in Group 1 and 60&#37; in Group 2 presented with ASA I&#59; the rest of the patients in both groups were ASA II&#46; We did not observe a statistically significant difference regarding vital signs in either group &#40;Tables 1 and 2&#41;&#46; No presence of nausea in either group was observed&#46;</p><p class="elsevierStylePara"><img alt="Table 1 Systolic blood pressure comparison in both groups&#46;" src="304v16n62-90328366fig1.jpg"></img></p><p class="elsevierStylePara"><img alt="Table 2 Diastolic blood pressure comparison in both groups&#46;" src="304v16n62-90328366fig2.jpg"></img></p><p class="elsevierStylePara"> Regarding the VAS results&#44; Group 2 showed better results in all of the evaluation periods&#44; except at 12 hours when results were better in Group 1&#59; however&#44; such differences did not prove to be statistically significant &#40;Fig&#46; 1&#41;&#46; A higher number of rescue medication &#40;dexketoprofen 50 mg intravenously &#91;IV&#93;&#41; for Group 1 at 30 minutes and 4 hours was required&#46; In addition&#44; 1 patient from Group 1 required buprenorphine as rescue medication&#44; as she failed to show a decrease in pain&#46; Neither group showed side effects&#46;</p><p class="elsevierStylePara"><img alt="Figure 1 Visual analog scale&#46;" src="304v16n62-90328366fig3.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1 </span>Visual analog scale&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion </span></p><p class="elsevierStylePara"> When cross-referencing both groups&#44; no differences were seen&#59; in both cases the behavior of the variables was the same statistically&#44; mainly concerning pain&#44; except for the group managed with infiltration requiring rescue medication&#46; Despite advances in the knowledge of pain and the constitution of Algology as a new specialty&#44; postoperative pain is frequent in patients after a surgical procedure&#59; if avoided&#59; side effects may be prevented&#46;<span class="elsevierStyleSup">15-18</span></p><p class="elsevierStylePara"> Most clinical research studies on preventive analgesia in patients who undergo radical mastectomy refer to spinal blocks&#46; Epidural anesthesia has also been evaluated as anesthesia and management of acute pain during the performance of the mastectomy&#59; yet in the present study we decided not to use it for anesthetic purposes&#44; given the fact that it must be placed in the metamers between C VII y D IV&#46; The puncture of the intervertebral spaces in this region is technically difficult and the position the patient must assume in order to place it may increase the anxiety that involves a morbidity risk due to ventilation problems&#59; this increases if there is a need to sedate the patient&#46;<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara"> Infiltration of the wound and instillation of local anesthetics is another simple and effective technique providing pain relief during the early postoperative period following surgical procedures&#46; There are studies indicating that ropivacaine infiltration on the surgical wound after surgery reduces pain intensity&#44; reducing the requirement of postoperative analgesics and inpatient days&#46; In addition&#44; the amount of applied anesthetics and its absorption through the peritoneal surface provide an additional mechanism of analgesia&#46;</p><p class="elsevierStylePara"> Multiple studies have been performed in order to demonstrate the clinical safety of ropivacaine in animals as well as in humans &#40;5 mg&#47;ml IV infusions&#41;&#46;<span class="elsevierStyleSup">19</span> The literature reports few studies on instillation and infiltration of ropivacaine 7&#46;5&#37;&#59; thus&#44; having found similar results with this route of administration in the present study&#44; it is recommended as an alternative for optimal postoperative analgesia in patients who undergo radical mastectomy&#46; Incidence of nausea and vomiting&#44; if any&#44; is low&#46;</p><p class="elsevierStylePara"> We found that ropivacaine infiltration or instillation in the surgical wound prior to skin closure showed no significant difference on postoperative pain &#40;except for the necessity of using rescue medication in the infiltrated analgesic group&#41;&#59; this was proven when cross-referencing VAS recordings at 2&#44; 4&#44; 8 and 12 postoperative hours between each group &#40;<span class="elsevierStyleItalic">p </span>&#62; 0&#46;05 in every crossing&#41;&#59; however&#44; when looking at the numerical behavior&#44; lower values of pain in the &#34;infiltration&#34; group were found&#46; Nevertheless&#44; this could also be caused by the use of rescue medications&#59; in addition&#44; the patient&#39;s resistance to the analgesic can also be a variable presented at random&#46; Consequently&#44; the use of a larger sample for future related studies should be the next step&#44; with the purpose of increasing the statistical value in search of establishing whether or not there is a significant difference&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions </span></p><p class="elsevierStylePara"> No statistical difference was found between the use of ropivacaine 7&#46;5&#37; infiltrated or instilled in patients undergoing radical mastectomy&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara"> The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Funding </span></p><p class="elsevierStylePara"> No financial support was provided&#46;</p><hr></hr><p class="elsevierStylePara"> Received&#58; June 2013&#59; <br></br> Accepted&#58; October 2013</p><p class="elsevierStylePara"> &#42; Corresponding author&#58; <br></br> Department of Anesthesiology&#44; <br></br> University Hospital &#34;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#34;&#46; <br></br> Francisco I&#46; Madero&#44; Mitras Centro&#44; Z&#46;P&#46; <br></br> 64460&#44; Monterrey&#44; N&#46; L&#46;&#44; Mexico&#46; <br></br> Telephone&#58; &#40;&#43;01&#41; 8389 1136&#46; <span class="elsevierStyleItalic"><br></br> E-mail address</span>&#58; <a href="mailto&#58;albamillan&#64;hotmail&#46;com" class="elsevierStyleCrossRefs">albamillan&#64;hotmail&#46;com</a>&#44; <a href="mailto&#58;blancaprieto2002&#64;yahoo&#46;com&#46;mx" class="elsevierStyleCrossRefs">blancaprieto2002&#64;yahoo&#46;com&#46;mx</a> &#40;B&#46; I&#46; Yolanda-Prieto&#41;&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> <span class="elsevierStyleItalic">Objective</span>&#58; Determining the effectiveness of infiltration versus instillation with 7&#46;5&#37; ropivacaine in reducing the intensity of postoperative pain in patients undergoing a radical mastectomy&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Material and methods</span>&#58; Clinical&#44; prospective&#44; and comparative analytical study in a sample of 20 female patients between 20 and 60 years of age&#44; ASA I and II&#44; weight 50-90 kg&#44; who were divided into 2 groups &#40;10 patients each&#41;&#46; In Group 1 infiltration with ropivacaine 7&#46;5&#37; &#40;20 ml&#41; was applied prior to closure of the surgical wound&#44; meanwhile in Group 2 ropivacaine 7&#46;5&#37; &#40;20 ml&#41;&#44; was instilled into the surgical wound&#46; Pain intensity was assessed by a visual analog scale &#40;VAS&#41; upon extubation&#46; The need for rescue medication and the incidence of nausea and vomiting were measured from 0 to 30 minutes postoperatively and at 2&#44; 4&#44; 8 and 12 hours&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Results</span>&#58; There was no statistical difference between the groups &#40;only the group managed through infiltration required rescue medications&#41;&#44; but the infiltration group had a lower perception of pain&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Conclusions</span>&#58; This study reported the same efficacy of preventive treatment of postoperative pain in patients who underwent radical mastectomy for instillation and infiltration with 7&#46;5&#37; ropivacaine and little need for rescue medication postoperatively&#46;</p>"
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      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Opciones analgésicas para el control del dolor posterior a mastectomía radical. Cir Ciruj 2004;72:363-368. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Opciones analg&#233;sicas para el control del dolor posterior a mastectom&#237;a radical&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Gonz&#225;lez ML"
                            1 => "Mart&#237;nez MA"
                            2 => "Ram&#237;rez ML&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Cir Ciruj 2004"
                        "volumen" => "72"
                        "paginaInicial" => "363"
                        "paginaFinal" => "368"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Preemptive analgesia. Anesthesiology 2002;77:439-446. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Preemptive analgesia&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Katz J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Anesthesiology 2002"
                        "volumen" => "77"
                        "paginaInicial" => "439"
                        "paginaFinal" => "446"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Preemptive analgesia: why its effect is not always obvious. Anesthesiology 1996;84:1015-1019. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Preemptive analgesia&#58; why its effect is not always obvious&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Kissin I&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Anesthesiology 1996"
                        "volumen" => "84"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1019"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg 2004;98:1385-1400. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "McCartney CJ"
                            1 => "Sinha A"
                            2 => "Katz J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Anesth Analg 2004"
                        "volumen" => "98"
                        "paginaInicial" => "1385"
                        "paginaFinal" => "1400"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Old ideas, new applications. Br J Anesth Anaesthesiol 1998;89:500-506. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Old ideas&#44; new applications&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Leach A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Br J Anesth Anaesthesiol 1998"
                        "volumen" => "89"
                        "paginaInicial" => "500"
                        "paginaFinal" => "506"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Servicio de farmacia. El dolor postoperatorio en la actualidad: un problema de calidad asistencial. Hospital francesc de Borja de Gandía y Departamento de Farmacología de la Universidad de Valencia. 2000;24:123-135. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Servicio de farmacia&#46; El dolor postoperatorio en la actualidad&#58; un problema de calidad asistencial&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Soler E"
                            1 => "Faus MT"
                            2 => "Montaner MC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hospital francesc de Borja de Gandía y Departamento de Farmacología de la Universidad de Valencia. "
                        "fecha" => "2000"
                        "volumen" => "24"
                        "paginaInicial" => "123"
                        "paginaFinal" => "135"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Psychological impact of cancer and its treatment. Adaptation to radical mastectomy. Cancer 1995;8:652-672. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Psychological impact of cancer and its treatment&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Bard M"
                            1 => "Sutherland AM&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adaptation to radical mastectomy. "
                        "fecha" => "Cancer 1995"
                        "volumen" => "8"
                        "paginaInicial" => "652"
                        "paginaFinal" => "672"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Breast cancer in men. Br Med J 2003;327(7409):238-240. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Breast cancer in men&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Perkins GH"
                            1 => "Middleton L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Br Med J 2003"
                        "volumen" => "327"
                        "paginaInicial" => "238"
                        "paginaFinal" => "240"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dirección General de Estadística e Informática. Incidencia y prevalencia de cáncer en México. Salud Publica Mexico 2006;38:75-81. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Direcci&#243;n General de Estad&#237;stica e Inform&#225;tica&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Secretar&#237;a de Salud&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Incidencia y prevalencia de cáncer en México. "
                        "fecha" => "Salud Publica Mexico 2006"
                        "volumen" => "38"
                        "paginaInicial" => "75"
                        "paginaFinal" => "81"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Current management of male breast cancer: a review of 104 cases. Ann Surg 2002;215:451-459. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Current management of male breast cancer&#58; a review of 104 cases&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Borgen PI"
                            1 => "Wong GY"
                            2 => "Vlamis V&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Ann Surg 2002"
                        "volumen" => "215"
                        "paginaInicial" => "451"
                        "paginaFinal" => "459"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Candidate gene studies of human pain mechanisms. Anesthesiology 2004;100:1562-1572. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Candidate gene studies of human pain mechanisms&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Belfer I"
                            1 => "Wu T"
                            2 => "Kingman A"
                            3 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Anesthesiology 2004"
                        "volumen" => "100"
                        "paginaInicial" => "1562"
                        "paginaFinal" => "1572"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tratamiento práctico del dolor. Estados Unidos de América. Mosby/Doyma;1995. p. 7. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Tratamiento pr&#225;ctico del dolor&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Prithvi R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Estados Unidos de América. "
                        "fecha" => "Mosby/Doyma"
                        "volumen" => "1995. p. 7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lack of analgesic effect of opioids on neuropathicand idiopathic forms of pain. Pain 1998;33:11-23. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Lack of analgesic effect of opioids on neuropathicand idiopathic forms of pain&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Arner S"
                            1 => "Meyerson BA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Pain 1998"
                        "volumen" => "33"
                        "paginaInicial" => "11"
                        "paginaFinal" => "23"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Anestesia local en cirugía oral y maxilofacial. Parte I, Hospital General Docente "Aleida Fernández Chardiet". Revista de Ciencias Médicas La Habana 1999;5(2). "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Anestesia local en cirug&#237;a oral y maxilofacial&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Rodr&#237;guez OL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "tituloSerie" => "Parte I, Hospital General Docente "Aleida Fernández Chardiet". "
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Does a preemptive block of the great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery? Anesth Analg 2004;98:330-333. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Does a preemptive block of the great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery&#63; Anesth Analg 2004&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Suresh S"
                            1 => "Barcelona SL"
                            2 => "Young NM"
                            3 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "volumen" => "98"
                        "paginaInicial" => "330"
                        "paginaFinal" => "333"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:3 [
                  "referenciaCompleta" => "Preoperative interscalene block for elective shoulder surgery: loss of benefit over early postoperative block after patient discharge to home. Anesth Analg 2003;97:1620-1626. "
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                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Effects of postoperative, nonsteroidal, antiinflammatory drugs on bleeding risk after tonsillectomy. Meta-analysis of randomized, controlled trials. Anesthesiology 2003;98:1497-1502. "
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                    0 => array:3 [
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                        0 => array:2 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Meta-analysis of randomized, controlled trials. "
                        "fecha" => "Anesthesiology 2003"
                        "volumen" => "98"
                        "paginaInicial" => "1497"
                        "paginaFinal" => "1502"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The effects of postoperative pain management on immuneresponse to surgery. Anesth Analg 2003;97:822-827. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The effects of postoperative pain management on immuneresponse to surgery&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Beilin B"
                            1 => "Shavit Y"
                            2 => "Trabekin E"
                            3 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "Anesth Analg 2003"
                        "volumen" => "97"
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                        "paginaFinal" => "827"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Analgesia peridural. España: Editorial Salvat; 1984. p. 335-387. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Analgesia peridural&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:2 [
                        "fecha" => "España: Editorial Salvat"
                        "volumen" => "1984. p. 335-387"
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                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Control of postoperative pain. Nonnarcotic and narcoticalternatives and their effect on pulmonary function. Chest 1987;92:520-527. "
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Control of postoperative pain&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Lewis CD&#46;"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nonnarcotic and narcoticalternatives and their effect on pulmonary function. "
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                        "volumen" => "92"
                        "paginaInicial" => "520"
                        "paginaFinal" => "527"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
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Article information
ISSN: 16655796
Original language: English
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