RESUMEN
Introduction: The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. Methods: Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. Results: 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. Conclusion: In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.
Introducción: La aplicación de la recuperación acelerada en cirugía de hombro no ha tenido una aceptación tan favorable. Por ello, el objetivo de este estudio fue presentar y describir el uso de bloqueo interescalénico para favorecer la recuperación acelerada en una serie de pacientes sometidos a cirugía artroscopica de hombro. Métodos: Se incluyeron 35 pacientes sometidos a cirugía artroscópica de hombro, en quienes se administró bloqueo interescalénico y sedación. Posteriormente se evaluó la intensidad del dolor, náuseas, vómito, disnea, presencia de síndrome de Horner, visión borrosa, ronquera, tiempo transcurrido hasta el alta, reingresos no planeados, satisfacción del paciente y cumplimiento de los criterios de alta hospitalaria en las primeras 12 horas siguiendo los criterios de una recuperación acelerada. Resultados: En total, 27 pacientes (77,1%) tuvieron clasificación de la (ASA) I y 8 pacientes (22,9%) ASA II. Además, 97,1% fueron reparaciones de manguito rotador. Previo al alta, dos pacientes (5,7%) presentaron náuseas. Al momento del alta ningún paciente presentó disnea o visión borrosa, dos pacientes (5,7%) presentaron ronquera y la mediana de intensidad del dolor fue de 1,0 (0,0 a 7,0). Entre las 24 y 48 horas solo un (2,8%) paciente presentó náuseas y la mediana de intensidad del dolor fue de 1,0 (0,0 a 8,0). Todos los pacientes se mostraron satisfechos con disposición a repetir la experiencia. El 100% de pacientes cumplió los criterios médicos de alta a las 12 horas y 30 pacientes (85,7%) se dieron de alta el mismo día. La estancia fue de 12 (11,5 a 12,5) horas y ningún paciente reingresó. Conclusión: En pacientes seleccionados, con un equipo quirúrgico-anestésico comprometido, capacitado y con experiencia, hay una alta posibilidad de que el bloqueo interescalénico favorezca la realización de programas de recuperación acelerada en cirugía artroscópica de hombro.
Asunto(s)
Bloqueo del Plexo Braquial , Hombro , Humanos , Hombro/cirugía , Ronquera , Dolor Postoperatorio , NáuseaRESUMEN
INTRODUCCIÓN: La aplicación de la recuperación acelerada en cirugía de hombro no ha tenido una aceptación tan favorable. Por ello, el objetivo de este estudio fue presentar y describir el uso de bloqueo interescalénico para favorecer la recuperación acelerada en una serie de pacientes sometidos a cirugía artroscópica de hombro. MÉTODOS: Se incluyeron 35 pacientes sometidos a cirugía artroscópica de hombro, en quienes se administró bloqueo interescalénico y sedación. Posteriormente se evaluó la intensidad del dolor, náuseas, vómito, disnea, presencia de síndrome de Horner, visión borrosa, ronquera, tiempo transcurrido hasta el alta, reingresos no planeados, satisfacción del paciente y cumplimiento de los criterios de alta hospitalaria en las primeras 12 horas siguiendo los criterios de una recuperación acelerada. RESULTADOS: En total, 27 pacientes (77,1%) tuvieron clasificación de la (ASA) I y 8 pacientes (22,9%) ASA II. Además, 97,1% fueron reparaciones de manguito rotador. Previo al alta, dos pacientes (5,7%) presentaron náuseas. Al momento del alta ningún paciente presentó disnea o visión borrosa, dos pacientes (5,7%) presentaron ronquera y la mediana de intensidad del dolor fue de 1,0 (0,0 a 7,0). Entre las 24 y 48 horas solo un (2,8%) paciente presentó náuseas y la mediana de intensidad del dolor fue de 1,0 (0,0 a 8,0). Todos los pacientes se mostraron satisfechos con disposición a repetir la experiencia. El 100% de pacientes cumplió los criterios médicos de alta a las 12 horas y 30 pacientes (85,7%) se dieron de alta el mismo día. La estancia fue de 12 (11,5 a 12,5) horas y ningún paciente reingresó. CONCLUSIÓN: En pacientes seleccionados, con un equipo quirúrgico-anestésico comprometido, capacitado y con experiencia, hay una alta posibilidad de que el bloqueo interescalénico favorezca la realización de programas de recuperación acelerada en cirugía artroscópica de hombro.
INTRODUCTION: The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. METHODS: Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. RESULTS: 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. CONCLUSION: In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.
Asunto(s)
Humanos , Hombro/cirugía , Bloqueo del Plexo Braquial , Dolor Postoperatorio , Ronquera , NáuseaRESUMEN
BACKGROUND: Modern anesthesiology has integrated the use of ultrasonography as a tool that has displaced neurostimulation as a technique for locating peripheral nerves. The aim of this study was to determine which procedure is more effective for guiding interscalene block for total shoulder arthroplasty. METHODS: We carried out a comparative, prospective non-randomized study comprised of the group guided by neurostimulation interscalene block and the group guided by ultrasound. All patients in both groups were scheduled for total shoulder arthroplasty. Latency, degree of sensory and motor block, success rate, postoperative pain intensity at 6, 12, and 24 h, patient satisfaction and complications were measured. RESULTS: We included 110 patients, 55 per group. Patients were placed in beach chair position and the deltopectoral approach was used. There were no differences in demographic characteristics. Results for neurostimulation vs. ultrasound group: latency 19.11 ± 2.27 vs. 17.24 ± 1.42 min, p= 0.23. Block sensitivity in both groups was grade 0 motor block grade 0 in 76.4% and grade 1 in 23.6% vs. grade 0 to 100%. There was 100% success rate for both groups. Postoperative pain at 6 h was 0.13 ± 0.54 vs. 0.11 ± 0.13 p= 0.90, at 12 h 1.67 ± 1.15 vs. 1.65 ± 0.59 p= 0.89 and at 24 h 3.15 ± 1.66 vs. 2.99 ± 1.15 p= 0.78. Satisfaction 54.5% very satisfied and 45.5% satisfied 96.36% vs 3.6% very satisfied and satisfied. Complications 18.18% vs. 3.6% p= 0.023. CONCLUSION: Ultrasound-guided interscalene nerve block is the technique of choice in elective total shoulder arthroplasty.
ANTECEDENTES: la anestesiología moderna ha integrado a la ultrasonografía como una herramienta que ha desplazado a la neuroestimulación como técnica de localización de nervios periféricos: ¿cuál es más efectiva para guiar el bloqueo interescalénico en artroplastia total de hombro? OBJETIVO: comparar dos técnicas de localización del plexo braquial bloqueo interescalénico como técnica anestésica en artroplastia total de hombro. MATERIAL Y MÉTODOS: estudio comparativo, prospectivo, sin asignación al azar. Se incluyeron todos los pacientes programados para artroplastia total de hombro; se formaron 2 grupos: grupo neuroestimulación donde el bloqueo interescalénico fue guiado por neuroestimulación, grupo ultrasonido que fue guiado por ultrasonido. Se midió el tiempo de latencia, grado de bloqueo sensitivo y motor, tasa de éxito, intensidad del dolor postoperatorio a las 6, 12 y 24 horas, satisfacción, y complicaciones. RESULTADOS: se incluyeron 110 pacientes, 55 por grupo, posición de silla de playa y abordaje deltopectoral. No hubo diferencias en las características demográficas, neuroestimulación vs ultrasonografía: latencia 19.11 ± 2.27 vs 17.24 ± 1.42 minutos p= 0.23. Bloqueo sensitivo en ambos grupos grado 0, bloqueo motor grado 0 en 76.4% y grado 1 en 23.6%, vs grado 0 en 100%. Tasa de éxito 100% en ambos grupos, dolor postoperatorio 6 horas 0.13 ± 0.54 vs 0.11 ± 0.13 p= 0.90; 12 horas de 1.67 ± 1.15 vs 1.65 ± 0.59 p= 0.89, 24 horas 3.15± 1.66 vs 2.99 ± 1.15 p= 0.78. Satisfacción: 54.5% muy satisfecho, y 45.5% satisfecho vs 96.36% muy satisfecho y 3.6% satisfecho. Complicaciones 18.18% vs 3.6% p= 0.023. CONCLUSIÓN: el ultrasonido es la técnica de localización del plexo braquial de elección en artroplastia total de hombro.
Asunto(s)
Anestésicos Locales/administración & dosificación , Artroplastia de Reemplazo , Plexo Braquial , Estimulación Eléctrica , Bloqueo Nervioso/métodos , Articulación del Hombro/cirugía , Ultrasonografía Intervencional , Anciano , Plexo Braquial/diagnóstico por imagen , Plexo Braquial/efectos de los fármacos , Plexo Braquial/fisiología , Femenino , Síndrome de Horner/etiología , Humanos , Masculino , Persona de Mediana Edad , Parestesia/etiología , Satisfacción del Paciente , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Tiempo de Reacción , SensaciónRESUMEN
Objetivo: Medir el conocimiento bioético de los médicos de base y residentes de cirugía general. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, comparativo y observacional. Análisis estadístico: Prueba t de Student y Kruskal-Wallis. Metodología: Se evaluaron 22 médicos de base y 61 residentes de los cuatro años de la especialidad de cirugía general, a los cuales se les aplicó un cuestionario basado en cuatro casos clínicos, elaborado por la Universidad de Toronto, para evaluar la capacidad de reconocer problemas bioéticos. Resultados: Se recabaron un total de 52 cuestionarios contestados (62%), 15 médicos de base con una edad promedio de 48.6 años y 37 residentes con una edad promedio de 26.5 años. Se reconoció el 12% de los problemas bioéticos presentes en los cuatro casos clínicos. El 53% de problemas relacionados a justicia, el 30% en autonomía y el 28% en beneficencia. El grupo que presentó mayor promedio total de conocimiento bioético fueron los residentes de cuarto año, seguidos de los de segundo y primer año y en último lugar los médicos de base y los residentes de tercer año. Los médicos con formación bioética previa a la respuesta de los casos clínicos reconocieron un mayor número de problemas. Conclusión: El bajo puntaje obtenido en el cuestionario se traduce en una deficiente capacidad para reconocer problemas bioéticos, tanto por médicos de base como por residentes de cirugía general.
Objective: To measure the bioethical knowledge in tenure physicians and general surgery residents. Setting: General Hospital of Mexico. Design: Prospective, cross-sectional, comparative, and observational study. Statistical analysis: Student's t and Kruskal-Wallis tests. Methodology: We evaluated 22 physicians and 61 residents of the four years of the General Surgery speciality, to whom a questionnaire based on four clinical cases, elaborated by the University of Toronto, was applied to assess their ability to recognize bioethical conflicts. Results: We obtained a total of 52 answered questionnaires (62%), 15 graduated surgeons with an age average of 48,6 years and 37 surgical residents with an age average of 26,5 years. Only 12% of the bioethics problem in the four clinical cases was clear. 53% of problems related to justice, 30% in autonomy and 28% in charity. The fourth year resident group has the major average of bioethics knowledge, followed of those of second and first year and last was the graduated surgeons and the residents of third year. The surgeons with bioethics formation recognized a greater number of problems. Conclusion: The low score obtained in the questionnaire is translated in a deficient capacity to recognize bioethics problems, as much by graduated surgeons as by residents of general surgery.
RESUMEN
BACKGROUND: Preventing anatomic failure after rotator cuff repair (RCR) remains a challenge. Augmentation with a surgical mesh may permanently reinforce the repair and decrease failure rates. The purpose of this study is to assess the postoperative outcomes of open RCR augmented with a novel reticulated polycarbonate polyurethane patch. MATERIALS AND METHODS: Ten patients with supraspinatus tendon tears underwent open RCR augmented with a polycarbonate polyurethane patch secured in a 6-point fixation construct placed over the repaired tendon. Patients were evaluated with preoperative and postoperative outcome measures, including the Simple Shoulder Test, visual analog pain scale, American Shoulder and Elbow Surgeons shoulder score, Cumulative Activities of Daily Living score, and University of California, Los Angeles shoulder scale, as well as range of motion. Postoperative magnetic resonance imaging was used to evaluate repair status. RESULTS: Patients showed significant improvements in visual analog pain scale, Simple Shoulder Test, and American Shoulder and Elbow Surgeons shoulder scores at both 6 and 12 months postoperatively (P < .05 and P < .01, respectively). The University of California, Los Angeles postoperative score was good to excellent in 7 patients at 6 months and in 8 patients at 12 months. Range of motion in forward flexion, abduction, internal rotation, and external rotation was significantly improved at both 6 and 12 months postoperatively (P < .05 and P < .01, respectively). Magnetic resonance imaging at 12 months showed healing in 90%; one patient had a definitive persistent tear. We found no adverse events associated with the patch, including the absence of fibrosis, mechanical symptoms, or visible subacromial adhesions. DISCUSSION: The polycarbonate polyurethane patch was designed to support tissue in growth and enhance healing as shown by preclinical animal studies. Clinically, the patch is well tolerated and shows promising efficacy, with a 10% retear rate at the 12-month time point.
Asunto(s)
Procedimientos de Cirugía Plástica/métodos , Cemento de Policarboxilato , Poliuretanos , Manguito de los Rotadores/cirugía , Lesiones del Hombro , Técnicas de Sutura/instrumentación , Traumatismos de los Tendones/cirugía , Adulto , Anciano , Artroscopía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Rango del Movimiento Articular , Lesiones del Manguito de los Rotadores , Rotura , Hombro/cirugía , Traumatismos de los Tendones/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To determine the resistance to cyclic stress and load-to-failure strength of several suture anchors suitable for hip arthroscopy. METHODS: Ten polyetheretherketone (PEEK) PushLock, PEEK SutureTak, and Bio-SutureTak anchors (Arthrex, Naples, FL); Lupine Loop BR anchors (DePuy Mitek, Norwood, MA); Bio-Mini Revo anchors (ConMed Linvatec, Largo, FL); and BioRaptor 2.9 AB anchors (Smith & Nephew, Andover, MA) were inserted in rotation into different locations on the rim of 4 matched pairs of potted acetabula clamped to the base of a servohydraulic testing machine. The anchors' sutures were cyclically pulled in line with the insertion angle. Displacement at 100 and 500 cycles, yield load, ultimate failure load, and failure mode were recorded. Statistical analysis was performed. RESULTS: Most of the displacement observed during cyclic loading occurred in the first 100 cycles, except for the BioRaptor 2.9 AB, which showed twice as much displacement at 500 cycles as at 100 cycles. The Lupine Loop BR cyclic displacement was greater than that of the PEEK PushLock (at 100 cycles also), Bio-SutureTak, and PEEK SutureTak at 500 cycles (P < .05). The BioRaptor 2.9 AB cyclic displacement was significantly greater at 100 and 500 cycles than that of the PEEK PushLock and Bio-SutureTak (P < .05). The mean ultimate failure loads for these anchors ranged from 154 N (PEEK SutureTak) to 255 N (Bio-Mini Revo) and was statistically equivalent (P = .139). Correlation analysis showed no significant associations between anchor stiffness, cyclic load displacement, or failure load. CONCLUSIONS: Anchors with specific indications for hip arthroscopy showed very little displacement and had consistent failure loads under cyclic conditions in the acetabular rim. All hip anchors except the BioRaptor 2.9 AB showed less than 2.0 mm of displacement after 500 cycles. CLINICAL RELEVANCE: Biomechanical testing of suture anchors designated for hip arthroscopy should be performed in the acetabular rim before their use. Suture anchors used for shoulder arthroscopy may not perform as well in the hip.
Asunto(s)
Acetábulo/cirugía , Anclas para Sutura , Anciano , Falla de Equipo , Humanos , Masculino , Ensayo de Materiales , Persona de Mediana Edad , Soporte de PesoRESUMEN
PURPOSE: To show how open treatment of the elbow stiffness offers an improvement in the range of motion, pain control, and patient's satisfaction. METHODS: We present a case series analysis of patients who suffer elbow stiffness and were treated with open surgery. We analyzed the range of motion (ROM), visual analogue scale (VAS) for pain and satisfaction, and the Mayo Score. Statistical analysis was performed using Student's t-test, Fisher's exact and Pearson correlation coefficient. RESULTS: 33 patients were included mean, age was 30.3 +/- 13.4. Twenty patients were male and 13 female, 32 patients had an articular fracture of the elbow and 1 with ectopic ossification. In 90.9% the column procedure was the option and in 9.1% open reduction and internal fixation was made. Compared with preoperative ROM was 58.8 degrees +/- 28.6 degrees, postoperative 96.10 +/- 25.5 (p < 0.001). Pain versus registered 5.06 points in the Preoperative 1.7 points in the postoperative period (p = 0.001). 75% of the patients were satisfied. Preoperative Mayo score was 47.2 +/- 17.8 versus 89.2 +/- 13.4 in the postoperative (p < 0.0001). CONCLUSION: The open treatment of the stiff elbow offers the patient pain relief; increased motion and most patients report final results as satisfactory.
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Lesiones de Codo , Artropatías/cirugía , Adolescente , Adulto , Femenino , Humanos , Artropatías/etiología , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Adulto JovenRESUMEN
Successful postoperative pain management after arthroscopic shoulder surgery allows patients to go home earlier, decreases the potential for hospital readmission, and facilitates rehabilitation. Optimal pain control considers the physiological and psychological states of the patient, the resulting alterations due to the surgery, and the technical and economic resources available during recovery. A comprehensive approach to pain control should include preoperative, intraoperative, and postoperative efforts. Efforts at postoperative pain reduction should begin preoperatively with the establishment of an excellent patient/physician relationship. Preoperative analgesia should be administered. Intraoperative efforts should include the administration of anesthetic medication intra-articularly. Postoperative management should include sleep medication, continuous cold-flow therapy, oral analgesics, and, if necessary, the use of narcotics.