Intervenciones quirúrgicas para el tratamiento del neuroma doloroso: un metaanálisis comparativo.: Artículo pubicado en PAIN 2018;159(2):214-23.Traducido por: Pablo Pino-Lozano

Louis H. Poppler; Rajiv P. Parikh; Miles J. Bichanich; Kelsey Rebehn; Carrie R. Bettlach; Susan E. Mackinnon; Amy M. Moore

doi:10.47924/neurotarget201896

Autores/as

Louis H. Poppler División de Cirugía Plástica y Reconstructiva, Universidad de Washington en la Escuela de Medicina St. Louis, St. Louis, MO, EE. UU.
Rajiv P. Parikh División de Cirugía Plástica y Reconstructiva, Universidad de Washington en la Escuela de Medicina St. Louis, St. Louis, MO, EE. UU.
Miles J. Bichanich División de Cirugía Plástica y Reconstructiva, Universidad de Washington en la Escuela de Medicina St. Louis, St. Louis, MO, EE. UU.
Kelsey Rebehn Departamento de Cirugía Ortopédica, Universidad de Saint Louis, St. Louis, MO, EE. UU.
Carrie R. Bettlach División de Cirugía Plástica y Reconstructiva, Universidad de Washington en la Escuela de Medicina St. Louis, St. Louis, MO, EE. UU.
Susan E. Mackinnon División de Cirugía Plástica y Reconstructiva, Universidad de Washington en la Escuela de Medicina St. Louis, St. Louis, MO, EE. UU.
Amy M. Moore División de Cirugía Plástica y Reconstructiva, Universidad de Washington en la Escuela de Medicina St. Louis, St. Louis, MO, EE. UU.

DOI:

https://doi.org/10.47924/neurotarget201896

Palabras clave:

neuroma, cirugía, operación, operado, reconstrucción, restauración, procedimiento, intervención quirúrgica, alodinia, ardor, hiperalgesia, extremidad, periférico, mano, brazo, pierna, pie, neurectomía, transposición, exéresis, alivio del dolor, manejo del dolor, resultado, analgesia, resultado del tratamiento, terapia, escala visual analógica, EVA, escala del dolor facial, calidad de vida, calidad de vida relacionada con la salud, cuestionario DASH, puntuación DASH, discapacidad del brazo, hombro y mano

Resumen

No existe un consenso sobre el tratamiento óptimo de los neuromas dolorosos. Nuestro objetivo fue identificar los datos disponibles y examinar el papel de la técnica quirúrgica en los resultados posteriores al tratamiento quirúrgico de los neuromas dolorosos. De acuerdo con las directrices de PRISMA, realizamos una búsqueda exhaustiva en la literatura para identificar a los estudios que midan la eficacia del tratamiento quirúrgico de los neuromas dolorosos en las extremidades (excluyendo el neuroma de Morton y las neuropatías por compresión). Los tratamientos quirúrgicos se clasificaron como solo exéresis, exéresis y transposición, exéresis y «capuchón», exéresis y reparación o neurólisis y cobertura. Los datos sobre la proporción de pacientes que tuvieron una reducción significativa del dolor se agruparon y se realizó un metaanálisis de los efectos aleatorios. Los efectos de la confusión, la calidad del estudio y el sesgo de publicación se examinaron con estratificación, metarregresión y análisis de sesgo. Cincuenta y cuatro artículos cumplieron con los criterios de inclusión, muchos de ellos con múltiples grupos de tratamiento. El informe de los resultados varió significativamente y pocos estudios controlaron la confusión. En general, el tratamiento quirúrgico del dolor producido por el neuroma fue efectivo en el 77% de los pacientes [intervalo de confianza del 95%: 73-81]. No se observaron diferencias significativas entre las técnicas quirúrgicas. Entre los estudios con una duración media del dolor mayor de 24 meses, o un promedio de dos operaciones previas a la cirugía definitiva para el dolor producido por el neuroma, la exéresis y transposición o la neurólisis y cobertura tienen significativamente mayor probabilidad que otras técnicas quirúrgicas de proporcionar una reducción significativa del dolor (p < 0,05). Es necesario la estandarización en el reporte de las técnicas quirúrgicas, resultados y factores de confusión en los futuros estudios para permitir que los proveedores puedan realizar comparaciones entre las diferentes técnicas en el tratamiento quirúrgico del dolor del neuroma.

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