Analgesia pósoperatória imediata por infiltração de bupivacaína 0,25% com epinefrina em ferida de aberta: um ensaio clínico randomizado

(1)

A A

ŶĂůŐĞƐŝĂƉſƐͲŽƉĞƌĂƚſƌŝĂŝŵĞĚŝĂƚĂƉŽƌŝŶĮůƚƌĂĕĆŽĚĞďƵƉŝǀĂĐĂşŶĂ

Ϭ͕ϮϱйĐŽŵĞƉŝŶĞĨƌŝŶĂĞŵĨĞƌŝĚĂĚĞĐŽůĞĐŝƐƚĞĐƚŽŵŝĂĂďĞƌƚĂ͗Ƶŵ

ĞŶƐĂŝŽĐůşŶŝĐŽƌĂŶĚŽŵŝǌĂĚŽ

ŶĂůŐĞƐŝĂŝŶƚŚĞŝŵŵĞĚŝĂƚĞƉŽƐƚŽƉĞƌĂƟǀĞƉĞƌŝŽĚĂƐƐŽĐŝĂƚĞĚǁŝƚŚƚŚĞ

ǁŽƵŶĚŝŶĮůƚƌĂƟŽŶǁŝƚŚďƵƉŝǀĂĐĂŝŶĞϬ͘ϮϱйƉůƵƐĞƉŝŶĞƉŚƌŝŶĞŝŶŽƉĞŶ

ĐŚŽůĞĐǇƐƚĞĐƚŽŵǇ͗ĂƌĂŶĚŽŵŝǌĞĚĐůŝŶŝĐĂůƚƌŝĂů

Í !"#$% & F &'%&' 1

.G'&&(!C &%) % *! (' M' *' +') N' ! ,

.-! b' & ! V% *i0%$) ('C &3 4! L% 5 6

.V% 0' *'(' P$ !P% *!T'%7'% &

8 .

9:;<= >?p@B DUE= H @IJ= < D< @K @< @ IDB<?O@DIQS UKOWXp@J YZ= J D<? IDJJ= Ja @ Ea @EDJQ I @DJ< @[ E@Ja @J= ?B ?\= DX] Da ?B ?\= DO = I^I\= > D@ _ `a DB c?B ?\= D< Df DEa DO DJ D< @:=J @ I= >g I<= D< @f ?hI DB XO@DIQ Xj IDJ= B kl:@Ja I@@cO = m E>= DJ< DfD^< @>? cJZhQI@D@c[ E@Ja @J= ?B ?\= D X n oa ZB?fZp@I= ? I@c[E@Ja @J= ?B?\= Dp@B Df ? >= @< D< @j IDJ= B @= ID< @[ E@Ja @J= ?B ?\= D X<?> @Ea @< D<= J >= pB = ED< @KD Ic D>?B ?\= DO B o E= >D< D UE= H @IJ= < D< @K @< @ IDB<?O@D IQ X f? hI DB X O@D IQ XjI DJ= B k q:;<= >?`? Ic D<? p@B DUE= H @IJ= < D< @K @< @I DB <?O @ DIQS UKO WXf? hI DB X O @DIQ XjI DJ= B krs? Za ? I@cj=? YZo c= >Dp@B DUE= H @ IJ=< D< @K @< @I DB<?O@D IQ@UE= H @IJ=a ;< @Jf>= @E> @J@an@>t E?B?\= @J< @u= B B @X K IDEv Dk

wxyz{|

} ~

DH DB = D IDD EDB \ @J= D@DB \Zc DJH D I= QH @= JDJJ? >= D< DJD?

h@c@Ja D IpgJ? p@I Da g I= ?

>? c?EQ ZJ @DJ@

Hc=a ?J

@cpD>= @ Ea @J

VXEPHWLGRVjLQ¿OWUDomRGHEXSLYDFDtQDFRPHSLQHIULQDHPIHULGDRSHUDWyULDGHFROHFLVWHFWRPLDDEHUWDFRPSDUDGRVDRJUXSR

LQ¿OWUDGRFRPVROXomRVDOLQD

WUDWDVHGHXPHQVDLRFOtQLFRUDQGRPL]DGRHGXSORFHJRHQYROYHQGRSDFLHQWHV

FRPLQGLFDomRGHFROHFLVWHFWRPLDDEHUWD2VHVFRUHVREWLGRVGD(VFDOD9LVXDO1XPpULFDGHGRUIRUDPVXEPHWLGDVDRPpWRGR

GH)LVKHUĮ TXHHQIRFDYDPXPLQWHUYDORGHKRUDVQRSyVRSHUDWyULR2FRQVXPRGHPRU¿QDRVWHPSRVGHUHVJDWH

DQDOJpVLFRWHVWHGH0DQQ:KLWQH\Į HDIUHTXrQFLDGHQiXVHDVHY{PLWRVWDPEpPIRUDPREVHUYDGRV

D

LQWHQVLGDGHGHGRUHDIUHTXrQFLDGHVROLFLWDo}HVGHDQDOJHVLDGHUHVJDWHQRJUXSRLQ¿OWUDGRFRPEXSLYDFDtQDIRLHVWDWLVWLFDPHQWH

PHQRUTXHDGRJUXSRLQ¿OWUDGRFRPVROXomRVDOLQDSRUpPRFRQVXPRGHRSLRLGHQmRIRLGLIHUHQWHTXDQGRFRPSDUDGRVS!

$LQFLGrQFLDGHQiXVHDVHY{PLWRVQmRIRLHVWDWLVWLFDPHQWHGLIHUHQWHQDFRPSDUDomRGRVJUXSRV

DLQ¿OWUDomRGHIHULGD

RSHUDWyULDFRPEXSLYDFDtQDVHPRVWURXH¿FLHQWHSDUDDQDOJHVLDQRSyVRSHUDWyULRLPHGLDWRGHFROHFLVWHFWRPLDDEHUWD

[ EDB \@J= Dkj Zp= H D >Do EDkO ?B @>=Ja @>a ? c= DkQ ZJ @D@Hc=a ?pgJ? p@ IDa g I= ?k

yw

} ~ a ?@H DB ZDa @at @DEDB \ @J= DDE<J? c@H DI= D hB @JDJJ? >= Da @<= a tp?Ja ?p @IDa= H @@B `DI @DJED ZJ @ DDE<H? c= a = E\= EpDa = @Ea J

XQGHUJRLQJEXSLYDFDLQHZLWKHSLQHSKULQHLQ¿OWUDWLRQLQRSHQFKROHF\VWHFWRP\ZRXQGFRPSDUHGWRLQ¿OWUDWHWKHJURXSZLWK

J DB = E@k

WKLVLVDUDQGRPL]HGGRXEOHEOLQGFOLQLFDOWULDOLQYROYLQJSDWLHQWVUHIHUUHGIRURSHQFKROHF\VWHFWRP\7KH

VFRUHVRI9LVXDO1XPHULFDO6FDOHSDLQZHUHVXEMHFWHGWR)LVKHUPHWKRGĮ WKDWIRFXVHGRQDUDQJHRIKRXUVSRVWRSHUDWLYHO\

7KHPRUSKLQHDQDOJHVLFFRQVXPSWLRQDQGUHFRYHU\WLPHV0DQQ:KLWQH\WHVWĮ DQGIUHTXHQF\RIQDXVHDDQGYRPLWLQJ

@ I@DB J?? hJ @IH @<k

SDLQLQWHQVLW\DQGIUHTXHQF\RIUHVFXHDQDOJHVLDUHTXHVWVLQLQ¿OWUDWLRQZLWKEXSLYDFDLQHJURXSZDV

VWDWLVWLFDOO\ORZHUWKDQWKHJURXSLQ¿OWUDWHGZLWKVDOLQHEXWRSLRLGFRQVXPSWLRQZDVQRWGLIIHUHQWZKHQFRPSDUHGS!7KH

= E>= < @E> @? `EDZJ @ DDE<H? c= a= E\DJE?aJa Da = Ja = >DB B <= `` @I@ Eah@a@@Ea t @\ I? ZpJk

WKHVXUJLFDOZRXQGLQ¿OWUDWLRQ

= a thZp=H D >D= E@pI?H @<@``@>a =H @`? ID EDB \ @J= D= Ea t @= c c@<= Da @p?Ja ?p @IDa= H @p@ I= ?<? `? p@E>t?B @ >Ja @>a? c k

¡[ EDB \ @J= Dkj Zp= H D> D= E@kO t?B @ >Ja @>a? c k]?Ja? p@ IDa = H @ED ZJ @DD E<H? c= a = E\k

¢ £¤ ¥¦§¥¦ ¦ ¨ ©ª ¥«¬¨ «¤ ¨ ®¯ °± d²³´° µ µe µ e¶² e °d·° ° ¯e° ´ µd¸ e± dRd¸ ¹°ºd ¯e»¶ ¶¼ eµ½¾¶¿ d½ µ°± ¶e° µÀ Áe± eÂ deÃ Ä Ä Å ·°± ¯ °± d Æ³·°±¸ d·

&RQÀLWRGHLQWHUHVVHV

1mRKiTXDOTXHUFRQÀLWRGHLQWHUHVVHVSRUSDUWHGHTXDOTXHUXPGRVDXWRUHV

(2)

Ü ÝÞ ßà áâ ãäà

åæçè é æê ëì é æì çíê î îïéð ì îñòå ó ôõíöð çæ é÷ê í éøì çæêð ùðúê æç îí öè îí éøì é ð é îèêûî÷ç éí ì éð ðê ìüðê ç øîæê çøî èý ë éø÷ç

UHVSRQViYHOSRULQWHUQDo}HVQRDQRGHVHJXQGR

÷î÷çë÷çþêë ì éí îÿ øê æ ç ÷éþ îù ÷éñþ(þó

1

$LQGLFDomRPDLV

FRPXPGHVVHWLSRGHRSHUDomRpDLQFDSDFLGDGHGHVHUHDOL]DU

õí îæ çè éæê ë ì éæ ìçí ê î

èî öîð çë æüöê æ î

÷éfçð í îé féìê e îéë é úõð î

HP SDFLHQWH FRP FDOFXORVH ELOLDU VLQWRPiWLFD $LQGD VmR

GHVFULWDVLQGLFDo}HVDEVROXWDVHUHODWLYDVDOpPGDFRQYHUVmR

è îöîðçë æüöê æî

2

H GDV GH¿FLrQFLDV LQIUDHVWUXWXUDLV H WpFQLFDV

÷é î èúõøëë éð eêsçë÷é æê ð õðúê î æçí ç í çìêe çë ÷é éë æçèî ÷ç öð çæ é÷ê í é øì ç

åí îê çðê î÷çëöîæê éøì éëë õïí éìê ÷çëàò åéê úê ðõíì éí öç÷é

LQWHUQDomRGHDGLDVSDUDDVVHJXUDUXPFRQWUROHDGHTXDGR

÷î ÷çð øç öéðç÷ç öüëóçöéð îìüðê ç ñ ó

2

(VWD p GHVFULWD

æçí çúð î ÷îìê e îøîëöðê í éê ð îëçðîëé÷éí ç÷éð î ÷îîéè ée î ÷î ê øì éøëê ÷î ÷éý éë ì îø÷ç ð é èî æê çøî÷î î ée éøì çë ÷é ÷éë æçøfçð ì ç ð éëöê ðîìüðê çéøõë éîëéeví ê ì çë øçöüëóçöéð î ìüð ê çñ NV óý öçð é øe çèe éð ÷ê ð é ìîí éøì é ç qõî ÷ð îøì é ë õöéðê çð ÷ê ð éê ì ç ÷ç îï÷çí é

3

ò çí ç îè ì éð øî ìê e îë öîð î ð é÷õûêð î ê øæê ÷i øæê î é ê øì éøëê ÷î÷é

GH '332 WHPVH DGRWDGR HVWUDWpJLDV TXH YmR DOpP GR

XVR GH DQWLLQÀDPDWyULRV H RSLRLGHV

(í

ééí öè ç ô ç

HPSUHJR GD LQ¿OWUDomR GH DQHVWpVLFRV ORFDLV $/ QR VtWLR

FLU~UJLFRWDQWRDQWHVGDLQFLVmRFRPRGHSRLVGHPRQVWUDQGR

ð éë õè ì î÷çë öð çí ê ëëçðéëý öðê øæê öîèí éøì é øç qõé æ çøæéðøé à øéæ éëëê ÷î÷é ÷é îøîè úéëê î ÷é ð éë úîì é

6

$OJXQV DGLWLYRV VmR

ì îí ïôí õìê èêûî÷çë øç ê øì õê ì ç ÷é çìêí êûîð éëë î öð çöðê é ÷î ÷é îøî èúôëê æ îý æ çí ç ë çè õséë æ çøì éø÷ç î÷ðéøîèê øîý éë ì éð çê ÷éëý

FHWRURODFRWUDPDGROFORQLGLQDPRU¿QDFHWDPLQDPDJQpVLR

é æî öë îê æê øî

8 11

8PD PHWDQiOLVH UHFHQWH HQYROYHQGR

éë ì õ÷çë é öîæê éøì éë ëõïí é ìê ÷çë î çöéð îséë í îíðê îë

VXJHULXXPDUHGXomRPRGHUDGDGHGRUHFRQVXPRGHRSLRLGHV

QRSyVRSHUDWyULRDSyVLQ¿OWUDomRGH$/

12

%DVHDGRHPHVWXGRVTXHDYDOLDUDPDLQ¿OWUDomRGHDQHVWpVLFRV

è çæîê ë éíçöéð îs éëí îíðê îëýçðìçöô ÷ê æ îëýæ îð ÷ê çì çðæê æîëý ÷é

éðøê çöè îë ìê îý ÷é

ê ë ì éð é æì çí ê î îï÷çí ê øî èý

æ éë îð ê î øî é è îöîðçë æüöê æîë

éí úéð îèý

13

éæçøëê ÷éð î ø÷çî øéæéëëê ÷î ÷é ÷î

GH¿QLomRGHHVWUDWpJLDVTXHVHMDPHIHWLYDVGHFXVWRHULVFRV

ïîêçëöîð îæçíîí éèçðê î÷çæçøìð çè é÷î éNV ÷é æçè éæê ë ìé æì çí ê î î ïéð ì îý öð çöéóë éõí îîøèê ë é÷çë öçëëe éêë

EHQHItFLRV GHVVD WpFQLFD XVDQGRVH EXSLYDFDtQD FRP

e îë çæ çøë ìðê æ ìçð

$EXSLYDFDtQDpXPDQHVWpVLFRORFDOFODVVL¿FDGRFRPRDPLGD

TXHDJHEORTXHDQGRDDomRGRVFDQDLVL{QLFRVQDPHPEUDQD

QHXURQDOLPSHGLQGRDQHXURWUDQVPLVVmRGRSRWHQFLDOGHDomR

2 JUDX GH OLJDomR SURWpLFD GR IiUPDFR p GH FHUFD GH

FRQIHULQGRDVVLPXPDGXUDomRGHDomRGHDKRUDV

1

$ LQ¿OWUDomR ORFDO GH EXSLYDFDtQD LPSOLFD QD UHGXomR GR

HVWtPXOR iOJLFR H QD VXSUHVVmR GD UHVSRVWD LQÀDPDWyULD

PLQLPL]DQGR D VHQVLELOL]DomR GH UHFHSWRUHV QRFLFHSWLYRV H

ë õïë éqõéøì éê öéð î èúéëê î

òçíê ëë çýöð éë õí éóë éqõéî èúõøë éf éê ì çë ë éæõø÷ðê çë à ÷çð ì îí ïôí öçëë îí ë éð í ê øêí êûî ÷çë qõîø÷ççæ çøìðçèé÷î ôçìêí êûî ÷çýæçí çîëNV

2REMHWLYRGHVWHHVWXGRIRLDYDOLDURVHIHLWRVGDLQ¿OWUDomRGH

EXSLYDFDtQDFRPYDVRFRQVWULFWRUHPIHULGDRSHUDWyULD

÷éæçè éæêë ì éæ ì çíê îîïéð ì îýæçøëê ÷éðîø÷çöîðaí éìð çëæçí ç÷çð öüëóçöéð î ìüð ê îý ì éí öç é øéæ éëëê ÷î÷é ÷é ð éë úîì é îøî èúôëê æ çý øõë éîëéevíê ì çë÷çëöîæê é øì éë

MÞTßÜ TM Þà áàO

Ré îèêûçõóë é õí éøë îê ç æ èøê æç ðîø÷çí êûî÷çý ÷õöè îí é øìé

HQFREHUWR RQGH IRUDP VHOHFLRQDGRV SDFLHQWHV GH LGDGHV

YDULDQGR GH D DQRV GH DPERV RV VH[RV H HVWDGR

fëê æ çëI çõ II öéè î þ çæê é÷î ÷éå í éðê æî øî÷éå øéë ì éëê çè çúê î ñå þåó

16

2V SDFLHQWHV IRUDP DGPLWLGRV SDUD UHDOL]DomR GH

æçè éæê ë ì éæ ìçí ê îî ïéð ì îéè éìê e îøçþ éðeêsç÷éò ê ð õðúê î÷îþî øìî

&DVDGH0LVHULFyUGLDGH6REUDO±&(HIRUDPGHYLGDPHQWH

ê øf çðí î÷çë÷îöéë qõê ëîî øì éë÷éë éðî öèê æî ÷ççöð çì çæ çèç÷é

DQHVWHVLDHRVRUWHLRGDLQWHUYHQomRDVHUUHDOL]DGDDVVLQDQGR

R7HUPRGH&RQVHQWLPHQWR/LYUHH(VFODUHFLGR7&/(

ç÷çë çë öî æê éøì éë ÷ç éë ìõ÷ç fçð îí ë õïí éìê ÷çë îç í éëí ç

SURWRFROR GH DQHVWHVLD 3DUD LQGXomR DQHVWpVLFD H EORTXHLR

øéõð çí õë æõè îð fçð îí õëî ÷çëu féøì î øê è ú ú öð çöçfçè

PJNJ H DWUDF~ULR PJNJ$ PDQXWHQomR DQHVWpVLFD IRL

UHDOL]DGD FRP VHYRÀXUDQR D $QDOJHVLD FRP GLSLURQD

VyGLFD PJNJ H FHWRSURIHQR PJ &RPR DQWLHPpWLFR

XVRXVHRQGDQVHWURQDQDGRVHGHPJHSDUDSURWHomRJiVWULFD

XPDGRVHGHPJGHRPHSUD]RO

2VFULWpULRVGHH[FOXVmRIRUDPDUHFXVDDSDUWLFLSDUGRHVWXGR

QmRSHUWHQFHUDRV$6$,RX,,WHUKLVWyULFRGHGRUFU{QLFD

DSUHVHQWDUUHDomRDOpUJLFDDTXDLVTXHUXPGRVFRPSRQHQWHV

õìê èêûî÷çë øç öð çì çæçè ç çõ ì éð î öð éë é øìî ÷ç îè úõí î

LQWHUFRUUrQFLDGXUDQWHDRSHUDomR

åîí çë ìðîfçêð é õøê ÷îöçðîæ éëëê ïê èê ÷î÷éçõæ çøe éøê iøæê îøç ö éðç÷ç÷éeê úi øæê î÷çöðçj é ì çøççë öê ì îèéë æçè îþ îøì îò îëî

GH0LVHULFyUGLDGH6REUDOGHMXOKRGHDMXOKRGH

WHQGRFRPRSHUGDVXPWRWDOGHSDFLHQWHV

ëöî æê éøì éëfçð îí÷ê ë ìðê ïõ÷çëéí÷çêëúð õöçëîè éî ìçð ê îí éøì éu

*HPTXHHUDLQ¿OWUDGRPOGHEXSLYDFDtQDFRP

KHPLWDUWDUDWRGHHSLQHIULQD*HPTXHHUDLQ¿OWUDGRPO

GHVRUR¿VLROyJLFR$WpFQLFDFRQVLVWLDQDLQ¿OWUDomRGD

ö éè éýë õïæõìaøé çéí ùë æõè çøçí çí éøì ç÷çê øæê ç÷îëõì õð î ÷î î öçøéõð çë é öîð î ç f éæîí é øì ç ÷î öîðé÷é îï÷çí ê øîè

VRUWHLRIRLUHDOL]DGRSRUQmRPHPEURVGDHTXLSHGHSHVTXLVD

PRPHQWRV DQWHV GD RSHUDomR GH IRUPD TXH DV LQIRUPDo

éë

æçøìê ÷îë øç éøe é èçöé ëü

fçð îí ðée éè î÷îë î ç î øéë ì éëê ë ìî

QmRPHPEURGDHTXLSHGHSHVTXLVDTXHIDULDDVHOHomRGR

FRQWH~GRDVHULQ¿OWUDGR

ë

ö îæê éøì éë f çð îí îe î èê î ÷çë øîë qõîìð ç öðê í éê ð îë çðîë

DSyVDH[WXEDomRKRUDHSRUXPPHPEURGDHTXLSH

GH SHVTXLVD FHJDGR )RL XWLOL]DGD XPD ¿FKD GH FROHWD GH

LQIRUPDo}HVSDGURQL]DGDFRPLGHQWL¿FDomRSHVVRDOGXUDomR

(3)

$QDOJHVLDHLQ¿OWUDomRGHEXSLYDFDtQD

3DUD D DYDOLDomR GD GRU SyVRSHUDWyULD IRL XWLOL]DGD D

(VFDOD 9LVXDO 1XPpULFD (91 GH GRU JUDGXDGD GH ]HUR

, d- . - /pl 0 4, d, 5- 7b, l 9- :;- < : n 0:; =0; n d- =: 0> n79 0 .,7 n -:; -:d 0 9-:; nd n> =: 4 0 n:, 9-:; np n7p, 7; -d n?p, 4 0-:; -?@

AB CAD E

¿PGHDYDOLDUDXQLIRUPLGDGHGHHQWHQGLPHQWRGDVLQIRUPDo}HV

7- p,??,d,?-n?p n??o5-0?5 0-?-?p 7n5-: 0-:; -?d 0??n<n?g 7, =?

GH HVFRODULGDGH H SUR¿VVmR GH WRGRV RV SDUWLFLSDQWHV GD

p-? F=0?,> n7, 9d-5 0d, 9-:; -7-g 0?; 7,d n?@G7-?g,; -, :,l gH?0 4n

FRPVXOIDWRGHPRU¿QDHPYLDVXEFXWkQHDIRLIHLWRQRSDFLHQWH

TXHDSUHVHQWDVVH(91PDLRURXLJXDODQXPDGRVHGHPJ

QRVSULPHLURVPLQXWRVHPJQRVRXWURVLQWHUYDORVGH

9 0:=; n?,;Hnp, 40-:; -?-7,l 05 0,d n?,; 0?>,; n70,9- :; -@

Ep J? , 4nl -; , d- d,d n?< n - :5-l np- 4 n:;- :d n n g 7=p n

LQ¿OWUDGRHUDDQH[DGRHDUPD]HQDGRHPXPDUTXLYDGRUVHP

GLVFULPLQDomRGHFRQWUROHRXWHVWH

@

K L PQ SUWWUXKXYUXSZK

3DUDDDQiOLVHHVWDWtVWLFDXVRXVHRSURJUDPD6LJPD3ORW

®

H6LJPD6WDW

®

[\: 05- 7?0d,d- ]-d- 7,ld n^-,7_< ^,9p =?

6REUDO2VGDGRVGHPRJUi¿FRVIRUDPVXEPHWLGRVDRWHVWHW

d- `; =d-:;p, 7, ,

, :_l 0?- d,? 0d,d-?

-, n d- c =0

F=, d 7,d n

p , 7,, 5,l 0, 7,d 0> - 7- :h,d n?g 7=p n?:,?5,70_5-0?F=,l 0; ,; 05,?@ G?9H; nd n?d-]0? k-7-E m GrE> n7, 9=; 0l 0 ., d n?p,7,, :_l

0?-GRVYDORUHVGDHVFDODYLVXDOQXPpULFDGHGRU(91RWHVWHGH

0DQQ:KLWQH\SDUDRFRQVXPRGHVXOIDWRGHPRU¿QD

2 HVWXGR IRL DSURYDGR SHOR HGLWDO GH VHOHomR GH SURMHWRV

d- p-? F=0?, d, `,:; , ^,?, d- t0?-70 4J7d 0, d- ` nb7, l -p -l n ^n9 0; w d- É; 0 4, - 9 x-? F=0?, -9 ?-7-? k=9,: n? d,

8QLYHUVLGDGH (VWDGXDO9DOH GR$FDUD~ Q~PHUR GR SDUHFHU

GHDFRUGRFRPDVQRUPDVGD'HFODUDomRGH+HOVLQNL

H GDV UHFRPHQGDo}HV GD 5HVROXomR GR &RQVHOKR

m, 40 n:, ld-`, yd-@

zWU{ QXK |}U

8PWRWDOGHSDFLHQWHVHQWUDUDPQRVFULWpULRVGHUHFUXWDPHQWR

GRHVWXGR4XDQWRjLGDGHHPDQRVQmRIRUDPHQFRQWUDGDV

GLIHUHQoDV HVWDWtVWLFDV GDV PpGLDV QRV JUXSRV LQ¿OWUDGRV FRP

EXSLYDFDtQD H VROXomR VDOLQD YV

3

~[9Hd0,±d-?50n

SDGUmR7HVWHW

d-`; =d-:;~<[]0g=7,~@

1mR IRUDP GHPRQVWUDGDV GLIHUHQoDV HVWDWtVWLFDV HQWUH RV

g 7=p n?: n?F=-?0; n?

d-?- / n

--?4nl ,70d,d-[, b-l ,~ @

([FOXtGRVQ

1mRDWHQGHUDPDRVFULWpULRV

Q

3HUGDGHVHJXLPHQWRQ

$QDOLVDGRVQ

([FOXtGRVGDDQiOLVHQ

$QDOLVDGRVQ

$ORFDGRVQRJUXSR*Q

5HFHEHUDPDLQ¿OWUDomRGHEXSLYDFDLQD

FRPHSLQHIULQD

$ORFDGRVQRJUXSR*Q

5HFHEHUDPDLQ¿OWUDomRGHVROXomRVDOLQD

$ORFDomR

¡

¢£¤¥¦

*UXSRLQ¿OWUDGRFRP

§¨¤©ª«¬ ¯°²

*UXSRLQ¿OWUDGRFRP

¦³´µ¶³¦´«¬ ·²

¢´³¸¨

¹º»

¼½¾¿ ¼ÀÁ¾¿Â

ÃÄº ÅÆ» ÁÆ½¿ Â Æ½Ç

È

(QVLQR)XQGDPHQWDO

(QVLQR0pGLR

(QVLQR6XSHULRU

(4)

á

PpGLDGRWHPSRGHRSHUDomRHPPLQXWRV

âãäåãæäçèéêãä ë ìíîï í

QmRIRUDPVLJQL¿FDWLYDPHQWHGLIHUHQWHV

ð

YV3 PpGLDGHVYLRSDGUmR

)RL SRVVtYHO YHUL¿FDU DWUDYpV GD DQiOLVH HVWDWtVWLFD TXH RV

HVFRUHVGD(VFDOD9LVXDO1XPpULFD(91GHGRUVHPDQWLYHUDP

LQIHULRUHV QR JUXSR LQ¿OWUDGR FRP EXSLYDFDtQD HP WRGRV RV

êñèòãåãäãîäñèôìåãäõäñâåãíñâ ãèìåæö ñèñâ÷ìâ ìêèæ íñæèìøãèìù úãèíñæãåãíïë ãåãåñûæäøñèõöãèìíñâüãâë èìåãäôìýãèñäåñ

PpGLDHHUURSDGUmRQDVKRUDVH&RQWUROH

YV %XSLYDFDtQD

þ ñåñÿêüãíôìýãèñä åñð

UHVSHFWLYDPHQWH*Ui¿FR

Oâ ú íñè ãåñêìüæñâëñäq éñäãýæüæëì è ìíìâ ìýçñäæ ìåñèñäçìëñ

IRL PDLRU QR JUXSR LQ¿OWUDGR FRP VROXomR VDOLQD

YV 4XDQWR DR FRQVXPR GH VXOIDWR GH PRU¿QD

RV JUXSRV VROXomR VDOLQD H EXSLYDFDtQD WLYHUDP PpGLDV

HP PJ YV 3 7HVWH GH

0DQQ:KLWQH\*Ui¿FR

0HWDGHGRVSDFLHQWHVTXHUHFHEHUDPVROXomRVDOLQD

âñüñääæëìèìíåñìâìýçñäæìåñèñäçìëññìêñâìäqéìëèãõqéñ

HTXLYDOHDGRJUXSRLQILOWUDGRFRPEXSLYDFDtQD

êèñüæ äìèìí åñ ãêæãæåñä âãêóä-ãêñèìëóèæã ñ ì æâüæåêâüæì åñ âáéäñìä/ôôíæëãä âãä åãæ ä çèéêãä äñçéæé üãâöãèíñ ì Tìîñýì2ù

*Ui¿FR

(VFRUH9LVXDO1XPpULFRGHGRUFRPSDUDWLYRQRV

GRLV JUXSRV PpGLD HUUR SDGUmR $129$ VHJXLGR GH7HVWH GH

)LVKHUS

*Ui¿FR

&RQVXPR GH VXOIDWR GH PRU¿QD PJ PpGLD HUUR

SDGUmR7HVWHGH0DQQ:KLWQH\S

D Ã

á ú úO ñí üãý ñüæäëñüë ãí æì ìêèñäñâë ì ë èêä üãí êãâñâëñä êèæâüæ êì æäa ì åãè æâüæä æãâ ìý ðüãíêãâñâëñ êìèæñë ìý þ ì åãè êèãöéâ åì ð æâë èì-ìîåãí æâ ìý õ üãí êãâñâëñ ôæäü ñè ìý þ ñ ì åãè èñö ñè æåìðqéñïüãíé íäñí ìâ æö ñäë ìèâ ããí îèãõüãí êãâñâëñ èñö ñè æåã ôæäü ñèìý þù

1 1

(P YLVWD GLVVR D H¿FiFLD DQDOJpVLFD

GD WpFQLFD GH LQ¿OWUDomR GH$/ SRVVXL JUDQGHV GHVD¿RV HP

RSHUDo}HVDEGRPLQDLVDEHUWDVMiTXHQmRDWLQJHGHVQHUYDomR

üãí êý ñë ì ñ ëñí é í ì üìêìüæ åìåñ åæí æâéë ì ñí îýãqéñìè ìä

VHTXHODVDXWRQ{PLFDV$LQ¿OWUDomRHPIHULGDRSHUDWyULDFRP

DQHVWpVLFRVORFDLVGHPRQVWURXVHUUHVSRQViYHOSHODUHGXomRG

ñ

ª ª 4 ª

Bv

S

¿VLROyJLFR

V Bv

S

¿VLROyJLFR

V Bv

S

¿VLROyJLFR

V

Nv ! "

0#$%

0#&'

() 0#*%

+,.35

,QFLGrQFLDGHVLQWRPDVDVVRFLDGRVDGRUHQHFHVVLGDGHGHUHVJDWHDQDOJpVLFRGHSDFLHQWHVFRQIRUPHRVJUXSRVREVHUYDGRV

LQWHUOHXFLQDHVXEVWkQFLD3%KDVNDUHPUHFHQWHSXEOLFDomR

FLWDTXHRVXFHVVRGDWpFQLFDGHLQ¿OWUDomRHPRSHUDo}HVTXH

UHTXHUHPLQFLV}HVPDLRUHVGHSHQGHGHXPDPDLRUGHSRVLomR

åñáAññíé íí ìæ ãèâú íñè ãåñêýìâ ãäêìèìäñèñö ñë æôìù 8

1R HVWXGR UHDOL]DGR KRXYH XP HIHLWR EHQp¿FR QD UHGXomR

GRVHVFRUHVGHGRUQRVSDFLHQWHVVXEPHWLGRVjLQ¿OWUDomRGH

EXSLYDFDtQDSGHTXDQGRFRPSDUDGRV

ìãç èé êãüãâë èãý ñõüãèèãîãè ìâ åãìöìôãèåñãéë è ãäë è ìîìý øãä

HQYROYHQGR LQ¿OWUDomR HP SURFHGLPHQWRV RUWRSpGLFRV

GH KHUQLRSODVWLD GH PDPD GH UHVVHFomR FRORUUHWDO H GH

(5)

7 9

$QDOJHVLDHLQ¿OWUDomRGHEXSLYDFDtQD

2 Q~PHUR GH HVWXGRV UHJLVWUDGRV SDUD DYDOLDomR GD WpFQLFD

GHLQ¿OWUDomRHPFROHFLVWHFWRPLDVDEHUWDVpUHVWULWRHPSDUWH

PRWLYDGRVSHODGLPLQXLomRGDDSOLFDomRGHVVHSURFHGLPHQWR

SHODSRSXODUL]DomRGDWpFQLFDODSDURVFySLFD%DVHDGRQLVVR

KRXYH GL¿FXOGDGH PHWRGROyJLFD SDUD VH UHDOL]DU FRQH[}HV

c MPQUW XWXP m YU PMXWYZ [WMXWXZ \]MX^j_`\WXWc MP pb[bQbP Z U pMd MoU bXcU[ f[oUc b X]U gW [WYZ WXh

ig[ W`\kYcU b]WXM d U c U Z bç õWX]W[ WXo bZ Wb Y bd oéXU cMg M UPWY M[

QR JUXSR LQ¿OWUDGR FRP EXSLYDFD

m Yb WP Z M ]M M pW [m M ]M

b Yb d U Xb ]MhiX` \b YZU ]b ]WXPé] U b

VGHPRU¿QDFRQVXPLGDQRV

JUXSRV WHVWH H FRQWUROH QmR WLYHUDP GLIHUHQoD HVWDWtVWLFD S

SRUPDLVTXHVHWHQKDREVHUYDGRPHQRUFRQVXPR

YM X pbcUWYZ WX ` \W YW c W X XUZb[ b P ]W b Y b d oWX U b ]W [WX obZ W

QR JUXSR LQ¿OWUDGR FRP EXSLYDFDtQD PJ YV PJ

8PD UHYLVmR GD &RFKUDQH FRQWHQGR HQVDLRV FOtQLFRV

UDQGRPL]DGRV HQYROYHQGR LQ¿OWUDomR GH$/ HP FHVDULDQDV

WP ` \W b pWY b X \ P Z U Yl b WP XW\ p[MZ McMd M b YWXZ WXU b oW [bd nb d bYc Wb ]b^ cM Ycd \ U \ \ P WgWUZM [ W]\Z M[ YM c M YX \P M ]W Mp U M U ]WXh

rs

tWo \Y] M uU QWYX W cMd^

rw

D LQ¿OWUDomR GD IHULGD

RSHUDWyULDGHFHVDUHDQDFRPEXSLYDFDtQDWDPEpPVH

PRVWURX H¿FLHQWH QR PHQRU FRQVXPR GH RSLRLGHV TXDQGR

cMP pb[b ]bb Mo[\pMcM YZ [ M dW h

x UXob b[ ]

cMY]\y U \\PW XZ \]M`\W[W\YU bz{WYXb U MXcdm YUc MX W YQMd QW Y]M c MdWc U XZ Wc Z MP U bXd b pb[ MXc |pUcbX^]W YZ [WMX `\b UX

RLWRDYDOLDYDPDH¿FLrQFLDDQDOJpVLFDGDLQ¿OWUDomRGH$/

Yb

gW [ U ]bMpW[ bZ |[ U b^c MYc d \U Y]M`\WbpW Yb XPW Z b ]W]MXPWXPMX

Z U Yl bP [WX\dZ b]MX c MYXU XZ W YZ W X `\bYZ M bM W gW UZ M pM\pb ]M[ ]W Mp UMU ]W Xh i Qb[ U bnU d U ]b]W ]W p[ MZ Mc Md MX^ ]W ]MXW X W ]W

GURJDV XWLOL]DGDV IRUDP IDWRUHV TXH GL¿FXOWDUDP D WRPDGD

]W c MYc d \XõW XP bU X pbd p_ QWUX `\b Y]M cMPpb[ b]MX MW XZ \]M [W b dUyb]Mc MPMX]W P bU Xh

} bd m QU M]b]M[p |X~ MpW[ bZ |[UbbdéP]WgM[ YW cW[c MYgM[ Z Mb M

SDFLHQWHDWHQXDLQLEHRVUHÀH[RVQRFLFHSWLYRVSRVVLELOLWDQGR

GHDPEXODomR UHDOL]DomR GH ¿VLRWHUDSLD GLPLQXLomR QD

LQFLGrQFLDGH1932HDFHLWDomRGHQXWULomRRUDO1RHVWXGR

QmRIRUDPSHUFHELGDVGLPLQXLomRGDVLQFLGrQFLDVGH1932

QRJUXSRTXHUHFHEHXLQ¿OWUDomRGHEXSLYDFDtQD

(VWXGRV SRVWHULRUHV FRQIHULQGR FDVXtVWLFDV PDLRUHV SRGHP

VHU PDLV FRQFOXVLYRV HP UHODomR D TXDQWLGDGH GH RSLRLGHV

c MYX\PU ]MXYMXo[ \pMXc UZ b]MXh

$ LQ¿OWUDomR GH EXSLYDFDtQD FRP HSLQHIULQD HP

gW[U ]b M p W[b Z|[U b ]W cMd WcU X Z WcZM PU b bnW [Zb XW P M X Z [M \

H¿FD] QD UHGXomR GRV HVFRUHV GH GRU QDV SULPHLUDV

lM[bX ] M p |X ~M p W[b Z| [U M p| X~ MpW[b Z| [UM UP W] U b ZM ^ bdéP

GH UHGX]LU VLJQL¿FDWLYDPHQWH D IUHTXrQFLD GH VROLFLWDo}HV

]W b Ybd o WXU b ]W [ WXo b Z Wh

mR IRL GHPRQVWUDGD GLIHUHQoD

WX Zb ZmXZU cb`\ bY ZMà

U YcU]kYcUb

]W Y _\ XWbXQ P U ZM X WYZ[WM X o[\ pM XcM Pp b [b] MXh

%UDVtOLD 0LQLVWpULR GD 6D~GH >FLWDGR HP DJR @

¡«¬®¯°¯±±« ²««²³´±

>SODFH XQNQRZQ@ 8S7R'DWH >FLWDGR HP DJR @

¡«¬® ¯ °¯±±¸¸¸²¢±¢«± ¥

FKROHF\VWHFWRP\"6RXUFH VHDUFKBUHVXOW VHDUFK 2SHQFKROHF\VWHF

WRP\ VHOHFWHG7LWOH a

º£°°»¦ ·¼² ¡¦£ ·¦°½ ·¾ ¡£ ¿ ¡® ² ¡ ²® ¶² ¢ ¡««¡®«¢ ¡¢¢°® ¢¶« ¢ ¶

-.3UDFW

)DLUVKWHU 5' :LOOLDPV -+ -U 3XOPRQDU\ SK\VLRORJ\ LQ WKH

SRVWRSHUDWLYHSHULRG&ULW&DUH&OLQ

0RWD9%%ULWR150RUDHV$08VRGHGH[WURFHWDPLQDFRPR

À ² ® ³«¡ Á«¥Á ¡ ¢¡ « ²´ ¡

WRUDFRWRPLD5HY'RU

0DULDQR(50DQDJHPHQWRIDFXWHSHULRSHUDWLYHSDLQ>,QWHUQHW@

>SODFH XQNQRZQ@ 8S7R'DWH >FLWDGR HP DJR @

¡«¬®¯°« ¯±± ³³®±Â´Ä§º

&DUYDOKR$/&DVWHOODQD)%*DWWR%(0XUDUR6.6FKLDYX]]R

)$ $VKPDZL +$ HW DO $WLYLGDGH SUHHPSWLYD GD LQ¿OWUDomR GD

LQFLVmR FRP URSLYDFDtQD D HP SDFLHQWHV VXEPHWLGRV j

KHUQLRUUD¿DLQJXLQDO5HY'RU

%KDVNDU6%&DVHIRUORFDOLQ¿OWUDWLRQDQDOJHVLD,VDOOWKHHYLGHQFH

LQEODFNDQGZKLWH",QGLDQ-$QDHVWK

$DVYDQJ(.+DQVHQ-%0DOPVWURP-$VPXVVHQ7*HQQHYRLV

· £²¶« ¾¾ · ® §° ¢ ¸² ¡« ¡®® ¡ ®

SXUL¿HG FDSVDLFLQ IRUPXODWLRQ RQ SRVWKHUQLRWRP\ SDLQ D GRXEOH

´ ®¡ · ¡Å · ® ¢´ ¥¢®® «² ¶ ¦«° ¦® ³

2]NDQ'6HNHU'(UJLO-<DOFLQGDJ$+DQ8*LQLV=HWDO

7KHHIIHFWVRIWUDPDGROLQ¿OWUDWLRQRQZRXQGKHDOLQJLQUDWV$FWD

&KLU%HOJ

7DX]LQ)LQ 3 6HVD\ 0 6YDUW] / .URO+RXGHN 0& 0DXUHWWH

3 :RXQG LQ¿OWUDWLRQ ZLWK PDJQHVLXP VXOSKDWH DQG URSLYDFDLQH

¡Æ² ²¢« « ¡®Ç²¡« ¡¢®

SURVWDWHFWRP\$FWD$QDHVWKHVLRO6FDQG

%\DJHU 1 +DQVHQ 06 0DWKLHVHQ 2 'DKO -%7KH DQDOJHVLF

HIIHFW RI ZRXQG LQ¿OWUDWLRQ ZLWK ORFDO DQDHVWKHWLFV DIWHU EUHDVW

« ²³ ¶¯Ç²®¡ ¡«¶« ¡¢¡¸¦ ¢¦«°«¡®£ ¢

6FRWW 1% :RXQG LQ¿OWUDWLRQ IRU VXUJHU\ $QDHVWKHVLD

(GJFRPEH++RFNLQJ*)DUPDFRORJLDGRVDQHVWpVLFRVORFDLV

² ¡®

««¡

£¨©¨È¡ É ¡©¯

£ ¢¡

%UDVLOHLUD GH $QHVWHVLRORJLD >FLWDGR HP PDU @

'LVSRQtYHO HP KWWSJURIVFQHWZSZSFRQWHQWXSORDGV

Ê ¢®³¡ ¥«¥««¡¢«¥® ¢¡«

(6)

&RPRFLWDU

)UHLUH,$0HQH]HV*&1HWR/LPD597HL[HLUD93$QDOJHVLDSyVRSHUDWyULDLPHGLDWDSRULQ¿OWUDomRGH%XSLYDFDtQDFRPHSLQHIULQDHP

IHULGDGHFROHFLVWHFWRPLDDEHUWDXPHQVDLRFOtQLFRUDQGRPL]DGR5HY0HG8)&PDLDJR

$6$3K\VLFDO&ODVVL¿FDWLRQ6\VWHP>,QWHUQHW@6FKDXPEXUJ,/

$PHULFDQ6RFLHW\RI$QHVWKHVLRORJLVWV>FLWDGRHPPDU@

'LVSRQtYHOHPKWWSZZZDVDKTRUJ+RPH)RU0HPEHUV&OLQLFDO

,QIRUPDWLRQ$6$3K\VLFDO6WDWXV&ODVVL¿FDWLRQ6\VWHP

0DUWLQH]-(UDVVL'&0DUTXHV/$QiOLVHGDDSOLFDELOLGDGH

GH WUrV LQVWUXPHQWRV GH DYDOLDomR GH GRU HP GLVWLQWDV XQLGDGHV

Þß âãßäÞåæßäãèë âæ ìíîâã ïðåè ñ ßä òß ðæâ ðåâ ß íðö÷ä øåâù ûß ü ýðâ þ

5HXPDWRO

&ROOLQV6/0RRUH5$0F4XD\+-7KHYLVXDODQDORJXHLQWHQVLW\

VFDOHZKDWLVPRGHUDWHSDLQLQPLOOLPHWHUV"3DLQ

ÿ1ùCß îå AñF ðâãNñCß îß ìåFñG íßD ñKâp îâäûñýå ðè îñßãâ îù Lâpâ ðè þøèpå øøcè îß ø þãß øãèæâäÞpè þãèpß ðâãå üßpâåäëå þåãâ òòß øãßÞ

E\LQWUDDEGRPLQDOSUHVVXUH"6XUJ/DSDURVF(QGRVF3HUFXWDQ7HFK

%LVJDDUG7.HKOHW+5RVHQEHUJ-3DLQDQGFRQYDOHVFHQFHDIWHU

ODSDURVFRSLFFKROHF\VWHFWRP\(XU-6XUJ

2ÿùâäÞcíTñYâæâÞâñAðåâ âøcèäVñCcâ ðâìâäÞcíTñCcèäöðí þíã Wñ Kè-åâæ Wù Lèw-pðßþþíðß päß íæèpßðåãèäßíæ üßðþíþ þãâäÞâðÞ päßíæèpßðåãèäßíæ åä îâpâ ðèþøèpåø øcèîßøþãßøãèæñ â pðèþpßøãåüß

UDQGRPL]HGFOLQLFDOWULDO6XUJ(QGRVF

22ùPßãß ðþßäPL ñMâãcåß þßäOñã jß ðäcè îæPñKðå þãåâäþßäVýñTè ðíp

++DQVHQ(*HWDO7KHHIIHFWRIWUDQVYHUVXVDEGRPLQLVSODQHEORFN

RUORFDODQDHVWKHWLFLQ¿OWUDWLRQLQLQJXLQDOKHUQLDUHSDLUDUDQGRPLVHG

FOLQLFDOWULDO(XU-$QDHVWKHVLRO

2ù

âßßÞMñAäÞ ðâ ìå Wñ

ûâ ììâäåñZâc íðñMâcæèèÞKñAäÞ ðâ ìå ñßãâ îùTcßåæpâ øãè òp ðßßæpãå üßðèpå üâ øâåäßåäåä öíåäâ îcß ðäåèp îâ þã

±DUDQGRPL]HGFRQWUROOHGWULDO,QW-6XUJ

LYHQV 9$ /LSVFRPE + 0H\HU 1/$ UDQGRPL]HG WULDO RI

pèþãèpß ðâãå üßwè íäÞå ððå öâãåèäwåãcîè øâ îâäß þãcßãå øòè ð pâåä â òãß ð

FHVDUHDQGHOLYHU\$P-2EVWHW*\QHFRO

9HQWKDP 17 +XJKHV 0 2¶1HLOO 6 -RKQV 1 %UDG\ 55

Wå öæè ðß Sù þãßæâãå ø ðß üåßw âäÞæßãâ-âäâ î þå þ è ò øèäãåä íè íþ

ORFDO DQDHVWKHWLF ZRXQG LQ¿OWUDWLRQ YHUVXV HSLGXUDO DQDOJHVLD

òè ð pè þãèpß ðâãå üß pâåä òè îîèwåä ö â ìÞèæåäâ î þíðöß ðù ýð S íðöù

9HQWKDP 17 2¶1HLOO 6 -RKQV 1 %UDG\ 55 )HDURQ .&

(YDOXDWLRQ RI QRYHO ORFDO DQHVWKHWLF ZRXQG LQ¿OWUDWLRQ WHFKQLTXHV

òè ð pè þãèpß ðâãå üß pâåä òè îîèwåä ö øè îè ðß øãâ î ðß þß øãåèä þíðöß ðë â

PHWDDQDO\VLV'LV&RORQ5HFWXP

.RQJ 7: 3DUN + &KHRQJ -< 0LQ 6. 5\X +6 (I¿FDF\ RI

FRQWLQXRXVZRXQGLQ¿OWUDWLRQRIORFDODQHVWKHWLFIRUSDLQUHOLHIDIWHU

J\QHFRORJLFODSDURVFRS\,QW-*\QDHFRO2EVWHW

(VVYLQJ3$[HOVVRQ..MHOOEHUJ-:DOOJUHQ2*XSWD$/XQGLQ

Aù ûßÞ íøßÞ æè ðpcåäß øèä þíæpãåèä âäÞpâåä åäãßä þåã wåãc îè øâ î

LQ¿OWUDWLRQ DQDOJHVLD /,$ IROORZLQJ WRWDO NQHH DUWKURSODVW\$FWD

2UWKRS

%DPLJER\H $$ +RIPH\U *- /RFDO DQDHVWKHWLF ZRXQG

LQ¿OWUDWLRQ DQG DEGRPLQDO QHUYHV EORFN GXULQJ FDHVDUHDQ VHFWLRQ

òè ð pèþãèpß ðâãå üß pâåä ðß îåß òù Cè øc ðâäß Dâãâ ìâ þß þã ûß üù

&'

%LVJDDUG 7 $QDOJHVLF WUHDWPHQW DIWHU ODSDURVFRSLF

øcè îß ø þãß øãèæë â øðåãå øâî â þþß þþæßäã è ò ãcß ß üåÞßä øßù