RESUMEN

Introducción: La artroplastia total de cadera es una de las intervenciones quirúrgicas más frecuentes en el contexto hospitalario. Sin embargo, sigue desconociéndose el método ideal para manejar el dolor postoperatorio. Las técnicas de analgesia multimodal basadas en la anestesia regional se encuentran entre las soluciones más prometedoras. Objetivos: El objetivo de este estudio fue evaluar el dolor postoperatorio tras la artroplastia total de cadera, de acuerdo con si se realizaron, o no, bloqueos del nervio periférico (bloqueo femoral, bloqueo de la fascia iliaca y bloqueo del grupo de nervios pericapsulares). Se midió el consumo de morfina intravenosa durante la estancia del paciente en la unidad de cuidados posanestésicos, así como el número de rescates con opioides transcurridas 24 y 48 h de la intervención. Como objetivos secundarios, se establecieron la prevalencia de la lesión nerviosa, la prolongación del bloqueo cuadricipital y el consumo de morfina, de acuerdo con otras variables de interés. Materiales y métodos: En este estudio retrospectivo observacional, se recopilaron datos de la historia clínica digital de 656 pacientes de cirugía traumatológica de abril de 2018 a agosto de 2020, con los criterios de inclusión siguientes: mayores de 18 años, ASA I-III, artroplastia total de cadera primaria con anestesia general o anestesia subaracnoidea (solo con bupivacaína hiperbárica) y uso de levobupivacaína para el bloqueo del nervio periférico. Resultados: Se seleccionó un total de 362 pacientes. La indicación quirúrgica principal fue coxartrosis (61,3%), seguida de fractura de cadera (22,6%). Se realizaron bloqueos del nervio periférico en 169 pacientes (66,3% femoral, 27,7% PENG, y 6% de fascia ilíaca). El consumo medio postoperatorio de opioides en la UCPA fue inferior en los pacientes que recibieron bloqueo PENG (2,2 mg) o femoral (3,27 mg), en comparación con los que no recibieron ninguno de los dos (6,69 mg)...(AU)

Introduction: Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. Objectives: The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. Materials and methods: In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. Results: A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48h after the procedure...(AU)

Asunto(s)

RESUMEN

INTRODUCTION: Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. OBJECTIVES: The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. MATERIALS AND METHODS: In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. RESULTS: A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). CONCLUSIONS: This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.

Asunto(s)

RESUMEN

La neumonectomía extrapleural, habitualmente asociada a reconstrucción pericárdica y diafragmática con material protésico, es una de las técnicas quirúrgicas empleadas en el tratamiento del mesotelioma pleural maligno. La herniación de vísceras abdominales hacia el tórax a través del material protésico a nivel diafragmático es una complicación rara, pero potencialmente grave de estos procedimientos, que debe de ser diagnosticada rápidamente para su reparación urgente.Presentamos el caso de un paciente que presentó una herniación gástrica en el postoperatorio precoz de una neumonectomía izquierda por un mesotelioma pleural. Los hallazgos clínicos fueron leves, pero apoyados en las pruebas de imagen, confirmaron la hipótesis diagnóstica y facilitaron la solución del cuadro. Se revisan los posibles factores contribuyentes y se incide en la necesidad de un diagnóstico y tratamiento precoz para evitar la isquemia de las vísceras abdominales herniadas en la cavidad torácica, por el riesgo de necrosis y contaminación por material fecaloideo.(AU)

Extrapleural pneumonectomy, usually associated with pericardial and diaphragmatic reconstruction with prosthetic material, is one of the surgical techniques used in the treatment of malignant pleural mesothelioma. Herniation of the abdominal viscera towards the thorax through the prosthetic material at the diaphragmatic level is a rare but potentially serious complication of these procedures, which must be diagnosed quickly for urgent repair.We present the case of a patient who presented with gastric herniation in the early postoperative period of a left pneumonectomy due to pleural mesothelioma. The clinical findings were mild, but supported by imaging tests, they confirmed the diagnostic hypothesis and facilitated the solution of the condition. Possible contributing factors are reviewed and the need for early diagnosis and treatment is emphasized to avoid ischemia of herniated abdominal viscera in the thoracic cavity, due to the risk of necrosis and contamination by fecaloid material.(AU)

Asunto(s)

RESUMEN

Extrapleural pneumonectomy, usually associated with pericardial and diaphragmatic reconstruction with prosthetic material, is one of the surgical techniques used in the treatment of malignant pleural mesothelioma. Herniation of the abdominal viscera towards the thorax through the prosthetic material at the diaphragmatic level is a rare but potentially serious complication of these procedures, which must be diagnosed quickly for urgent repair. We present the case of a patient who presented with gastric herniation in the early postoperative period of a left pneumonectomy due to pleural mesothelioma. The clinical findings were mild, but supported by imaging tests, they confirmed the diagnostic hypothesis and facilitated the solution of the condition. Possible contributing factors are reviewed and the need for early diagnosis and treatment is emphasized to avoid ischemia of herniated abdominal viscera in the thoracic cavity, due to the risk of necrosis and contamination by fecaloid material.

Asunto(s)

RESUMEN

La cirugía sobre la articulación coxofemoral es muy frecuente. Mejorar el manejo del dolor ha sido y es uno de los pilares fundamentales para optimizar la recuperación funcional de los pacientes. Para ello debemos diseñar un plan anestésico-analgésico multimodal que abarque todo el periodo perioperatorio.Los bloqueos nerviosos periféricos y los bloqueos fasciales son un componente importante de las estrategias analgésicas multimodales. Los bloqueos tradicionales tienen una eficacia moderada, afectación motora prolongada y aumento de riesgo de caídas. Como alternativa, recientemente se describieron los bloqueos capsulares (bloqueo del plano del ileopsoas o «ileopsoas plane block» [IPB] y bloqueo del grupo nervioso pericapsular o «PENG block»), que pretenden evitar la afectación motora manteniendo una óptima eficacia analgésica.El objetivo de esta revisión es la descripción de los nuevos bloqueos capsulares y analizar si permiten mejorar la analgesia postoperatoria y favorecer la recuperación funcional con menos complicaciones, con base en la inervación de la cadera. Para realizarlo se ha llevado a cabo una revisión bibliográfica en las bases de datos de PubMed, Embase y Cochrane Library desde enero 2018 hasta junio de 2020.(AU)

Surgery on the hip joint is very common. Improving pain management has been and is one of the fundamental pillars to optimize the functional recovery of patients. To do this, we must design a multimodal anesthetic-analgesic plan that covers the entire perioperative period.Peripheral nerve blocks and fascial blocks are an important component of multimodal analgesic strategies. Traditional blocks have moderate efficacy, prolonged motor impairment, and increased risk of falls. As an alternative, capsular blocks («ileopsoas plane block» or «IPB» and pericapsular nerve group block or «PENG block») have recently been described that aim to avoid motor impairment while maintaining optimal analgesic efficacy.The objective of this review is to describe the new capsular blocks and to analyze whether they allow to improve postoperative analgesia and promote functional recovery with fewer complications, based on the innervation of the hip. To do this, a bibliographic review was carried out in the PubMed, Embase and Cochrane Library databases from January 2018 to June 2020.(AU)

Asunto(s)

RESUMEN

Surgery on the hip joint is very common. Improving pain management has been and is one of the fundamental pillars to optimize the functional recovery of patients. To do this, we must design a multimodal anesthetic-analgesic plan that covers the entire perioperative period. Peripheral nerve blocks and fascial blocks are an important component of multimodal analgesic strategies. Traditional blocks have moderate efficacy, prolonged motor impairment, and increased risk of falls. As an alternative, capsular blocks ("ileopsoas plane block" or "IPB" and pericapsular nerve group block or "PENG block") have recently been described that aim to avoid motor impairment while maintaining optimal analgesic efficacy. The objective of this review is to describe the new capsular blocks and to analyze whether they allow to improve postoperative analgesia and promote functional recovery with fewer complications, based on the innervation of the hip. To do this, a bibliographic review was carried out in the PubMed, Embase and Cochrane Library databases from January 2018 to June 2020.

Asunto(s)

RESUMEN

Los neurolépticos son un grupo de medicamentos ampliamente empleados en el tratamiento de cuadros psicóticos, entre sus efectos adversos cabe destacar la posibilidad de desencadenar un síndrome neuroléptico maligno (SNM). El diagnóstico del SNM se determina por exclusión y su manejo terapéutico inicial será la retirada de los neurolépticos junto a la administración de benzodiacepinas y terapia electroconvulsiva (TEC). La TEC representa una efectiva opción terapéutica en estos pacientes así como en aquellos casos que se obtenga una respuesta escasa al manejo con medicamentos antipsicóticos. Revisamos las alternativas terapéuticas y las implicaciones anestésicas que conlleva manejar un paciente programado para TEC, diagnosticado de esquizofrenia paranoide, en el contexto de SNM (AU)

Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS (AU)

Asunto(s)

RESUMEN

Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS.

Asunto(s)