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Comparative study of the topical treatment with Etofenamato combined with Iontoforesis versus Fonoforesis, for handling the post surgery pain.
Estudio Comparativo de Tratamiento tpico con Etofenamato, combinado con Iontoforesis versus Fonoforesis, en el manejo del dolor postoperatorio. Yadira Del Valle Franco Espinoza, Arcngel Lpez Mata, Antonio Franco Espinoza.

Tipo de Trabajo: Original ABSTRACT The first goal of treatment in the


post surgery rehabilitation is the handling the pain as well as the reduction of inflammation, improvement of the function. This study is a contribution to the specialist in Physical Medicine and Rehabilitation in the knowledge of application of medication and its effectiveness combining it with different modalities of electrotherapy in handling of the pain.Objective: To know if there is a difference in the effectiveness of the topical treatment of Etofenamato combined with electrotherapy in case of Iontoforesis versus fonoforesis, in the handling of the post surgery pain patients who enter to Physiatrist treatment. Method: The intensity of the pain, edema and function to articulate was measured and compared in both group in study to the entrance, the 5 and 10 days of treatment: Group A (20 cases) was treated with topical Etofenamato 10% with the technique of Iontoforesis, 3,0 mA during 10 minutes time and a Group B (20 cases) these patients were treated with topical Etofenamato 10% with the technique of Sonoforesis with 1 w/cm2, direct current during 10 minutes.Results: The cases that entered with less time of evolution post-operative showed significant improvement in the first and fifth day of treatment. There was no significant relation between the type of surgical technique and the handling of the pain. As well there was no significant difference between the two modalities of electrotherapy. Conclusions: The effectiveness of topical Etofenamato to 10% in the handling of the post-operative somatic pain with both techniques of electrotherapy is demonstrated enters 80 90% The application with Sonoforesis is better in the remission from edema and with Iontoforesis in the early remission of the post-operative somatic pain. The improvement of the amplitude to articulate is directly proportional to the remission of the pain and edema. Key Words: post surgery pain, Etofenamato, Sonoforesis, Iontoforesis

RESUMEN El manejo del dolor es el primer


objetivo de tratamiento en la rehabilitacin postoperatoria, as como la reduccin de la inflamacin, mejora de la funcin y del riego sanguneo. Este estudio es un aporte al Mdico Fisiatra en el conocimiento de la aplicacin de medicamentos y su eficacia combinndolo con diferentes modalidades de electroterapia en el manejo del dolor. Objetivo: Conocer si existe una diferencia efectiva en el tratamiento tpico con Etofenamato combinado con electroterapia, como es el caso de electroforesis versus en el manejo fisitrico del dolor postoperatorio. Mtodo: la intensidad del dolor, el edema y la funcin articular fueron comparadas en dos grupos al inicio del tratamiento, al quinto y decimo da de tratamiento: El grupo A (20 casos) recibi tratamiento tpico con Etofenamato 10% con la tcnica de Iontoforesis, 3,0 mA durante un tiempo de10 minutes y el Grupo B (20 casos) tratados igualmente con Etofenamato tpico al 10% con la tcnica de Sonoforesis, 1 w/cm2, corriente continua durante 10 minutos. Resultados: los casos que tenan menos tiempo de de evolucin postoperatoria, presentaron mejora significativa el primer y quinto da de tratamiento. No se encontr una relacin significativa entre las dos modalidades de electroterapia en el manejo del dolor, as como en relacin al tipo de tratamiento quirrgico. Conclusin: La efectividad del tratamiento tpico con Etofenamato al 10% en el dolor somtico postoperatorio, con las tcnicas de electroterapia es de un 80 - 90%, la aplicacin de Sonoforesis result mejor en la remisin del edema y la Iontoforesis en la remisin del dolor. La amplitud articular mejora directamente proporcional a la remisin del dolor y el edema. Palabras Claves: dolor Etofenamato, Sonoforesis, postoperatorio, Iontoforesis

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INTRODUCTION:
The pain is a disease itself, the IASP Taxonomy Committee (1979-1994) defines it as ...." important to study the effectiveness of different physical media techniques which combined with drugs, enhances its penetration . This is the case of Iontophoresis and Phonophoresis,
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unpleasant sensory and emotional experience related to an existing or potential tissue damage described in terms of the injury ". It is regarded as the fifth vital sign by the Accreditation Committee of the Organization of Health Care
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where drugs of topical application are used. This combination effectiveness management allow of the of us to to increase use in the the pain.

drug

It is the duty of the physician and a patient's right to be treated his pain quickly and effectively. Most acute pain and the mediate or immediate postoperative pain are of somatic origin and therefore are easy to handle, if treated early and properly. If the pain persists, it evolves into a chronic or neuropathic pain of more complexity. Which means the use of the lasts steps of the therapeutic ladder.
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postoperative

When choosing a drug for the management of inflammation and resulting pain after surgery is necessary to consider the following features: good level of skin penetration, adequate

concentration in the inflamed tissue, powerful anti-inflammatory and analgesic effect, well systemic and skin tolerance, adequate profile risk benefit.
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The postoperative patient who has constant pain of increasing intensity, has limited functions of the region or regions of the body involved, and implies the associated This interferes
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For the present study Etofenamate was chosen Different experimental research studies have been developped and they demosntrates the effectiveness of Etofenamate and also that it meets the requirements we mentioned before.
11, 12, 13,14 10,

psychosocial with their

consequences.

treatment of rehabilitacin.

Therefore, it is

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Materials and methods:


The intensity of pain is measured accordingly to Prospective, and comparative study. The studied population corresponded to 80 patients who entered to post surgery rehabilitation. A sample of 40 cases was selected. These patients had somatic pain and fulfilled the criterion of inclusion in ages included between the 15 and 65 years. This sample was divided in two groups: Group A (20 cases) was treated with the technique of Iontoforesis and a Group B (20 cases) these patients were treated with the technique of Sonoforesis. Group A (20 cases) was treated with topical Etofenamato 10% (application of 7cm of gel in linear form) with the technique of Iontoforesis, 3,0mA during 10 minutes time and Group B (20 cases) The intensity of the pain, edema and function to articulate was measured, and compared in both groups of study: at the beginning, the 5th day and the 10th day of treatment. patients were treated with topical The edema, and limitation of the articular amplitude (AMA) is evaluated and registered in relation to the postsurgery, by a scale of likert of 4 punts
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the Analog Visual Scale.

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N1 figure).

(N 2 y N 3 Figure).

Etofenamato at 10% (application of 7cm of gel in linear form) with the technique of Sonoforesis with 1 w/cm2, direct current during 10 minutes.

Phisiatric evaluation of each case is done in order to know everything about this type pain.

Results and discussion


An ANOVA of factors with repetitive measures using a level of significance of 0,5% was applied. When analyzing from de statistical point of view our study showed statistically significant differences (p me nor 0,05) between the applied techniques in handling post surgery pain and the best results were found in patients traded winch Iontoforesis.

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it is possible to be appreciated in the N1 table and, N 1, the Graphic evolution of the intensity average of the pain. The average of improvement of the amplitude to articulate active (AMA) and of edema is expressed in the tables N 2 and 3

The cases that entered with less time of evolution post-operative showed significant improvement in the first and fifth day of treatment. There was no significant relation between the type of surgical technique and the handling of the pain.

Conclusions:

It was demonstrated that the effectiveness of topical Etofenamato at 10% in the handling of the post-operative somatic pain with both techniques of electrotherapy fluctuates between 80% and 90%

The application of Etofenamato with Iontoforesis is better in the early remission of the post-operative somatic pain and the application of topic Etofenamato with Sonoforesis is better in the remission of edema. The improvement of the articular amplitude is directly proportional to the remission of the pain and edema.

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Figure Number 1

Figure Number 2

EDEMA SCALE No Edema Mild Edema Moderate Edema 2 CM REGULAR Severe Edema

0 CM VERY GOOD

1 CM GOOD

3 CM OR > BAD

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Figure Number 3

AMA SCALE AMA limited in final grades 95% - 75% GOOD AMA limited in intermediate grades 70% - 50% REGULAR AMA limited in initial grades or immobilization 45% - 0% BAD

Full AMA

100% VERY GOOD

Table N 1

Evolution of the intensity average of the pain both enters groups study

Treatment (T)

Periods of observation To the entrance


T. 1er T. 5to T. 10mo

Averages

IONTOFORESIS SONOFORESIS

6,8 7,2

5,8 6,625

2,5 3,15

1,35 1,35

4,11 4,58

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Graphic N 1 Evolution of the intensity average of the pain

Table N 2 Improvement Average of Amplitude to Articulate Treatment (T)

Periods of observation
T. 1er T. 5to 88,25 87,25 T. 10mo 70,42 73,50

Averages
50,75 54,75

IONTOFORESIS SONOFORESIS

72,25 78,5

Table N 3 Remission of edema average

Treatment (T)

Periods of observation
T. 1er T. 5to 0,675 0,39 T. 10mo 1,59 1,34

Averages
2,55 2,52

IONTOFORESIS SONOFORESIS

1,55 1,09

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following Iontophoresis. 2001 Arzneim Forsch /Drug Res 51: 489-492 9. Beneke M, Blumberger W Clinical study of the efficacy and tolerability of Traumon Gel (TVX 485-09-02) in comparison to Dolo- Arthrosenex in the treatment of inflammatory vertebral syndroms. 1985 Scientific report Study KF 404, Tropon 10. Billigmann P, Pelster B Plazebokontrollierte Doppelblindstudie von Etofenamat-Gel (Rheumon Gel) in Kombination mit Ultraphonophorese bei Sportverletzungen.1992 Praktische Traumatologie Sportmedizin 2: 72-77 11. . Miehle W. Medikamentse Therapie. In: Miehle W [Hrsg] Rheumatologie in Praxis und Klinik. Georg Thieme Verlag, 2000 Stuttgart New York , 2. Aufl, S 253336 12. Patella V, Moretti B, Martucci G, Etofenamat und Ultrashall. 1985 Gazz Med Ital Arch Sci Med 144:575-578 13. Blumberger W Clinical testing of the effectiveness and tolerance of Etofenamate cream in the treatment of epicondylitis in comparison to

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Indomethacin ointment. 1982 Scientific report Study KF 229, Tropon 14. Dreiser RL, Lopez A,Efficacy and acceptability Etofenamato gel 5% in patients with acute sprains of the ankle.1989, Scientific report No 515 p, 77 Bayer Pharma France. 15. Kottke F, Lehemann J. Krusen, Medicina Fsica Y Rehabilitacin 4ta edicin Madrid, Espaa: Panamericana; 2002. p 1204-1210 16. Rehabilitacion en Salud 2 edicin. Salinas F., Lugo L., Restrepo R. Colombia: Editorial Universidad de Antioquia. 2008 Capitulo Dolor y Problemas Dolorosos.p.185-201 17. Reville SI, Robinson JO, Rosen M, Hogg MI. The Rehability of linear analogue scale for evaluation of pain. Anesthesia 1977;36: 186-187 18. Hernandez R, Fernandez C, Batista p, Methodology of Investigation 4 edition, Mxico: Mc Graw Hill; 2006. P. 341-351
ta a

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