RESUMEN

OBJECTIVE: Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness. METHODS: MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out. RESULTS: A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], -0.21 mm [95% CI -0.39, -0.02]; p = 0.03). No significant improvement in pain was observed (WMD, -0.51 cm [95% CI -1.04, 0.01]; p = 0.06) compared with non-surgical interventions. CONCLUSIONS: Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.

Asunto(s)

Tratamiento con Ondas de Choque Extracorpóreas , Fascia , Fascitis Plantar , Ensayos Clínicos Controlados Aleatorios como Asunto , Fascitis Plantar/terapia , Humanos , Tratamiento con Ondas de Choque Extracorpóreas/métodos

RESUMEN

The role of adenosine receptors in fascial manipulation-induced analgesia has not yet been investigated. The purpose of this study was to evaluate the involvement of the adenosine A1 receptor (A1R) in the antihyperalgesic effect of plantar fascia manipulation (PFM), specifically in mice with peripheral inflammation. Mice injected with Complete Freund's Adjuvant (CFA) underwent behavioral, i.e. mechanical hyperalgesia and edema. The mice underwent PFM for either 3, 9 or 15 min. Response frequency to mechanical stimuli was then assessed at 24 and 96 h after plantar CFA injection. The adenosinergic receptors were assessed by systemic (intraperitoneal, i.p.), central (intrathecal, i.t.), and peripheral (intraplantar, i.pl.) administration of caffeine. The participation of the A1R was investigated using the 1,3-dipropyl-8-cyclopentylxanthine (DPCPX), a selective A1R subtype antagonist. PFM inhibited mechanical hyperalgesia induced by CFA injection and did not reduce paw edema. Furthermore, the antihyperalgesic effect of PFM was prevented by pretreatment of the animals with caffeine given by i.p., i.pl., and i.t. routes. In addition, i.pl. and i.t. administrations of DPCPX blocked the antihyperalgesia caused by PFM. These observations indicate that adenosine receptors mediate the antihyperalgesic effect of PFM. Caffeine's inhibition of PFM-induced antihyperalgesia suggests that a more precise understanding of how fascia-manipulation and caffeine interact is warranted.

Asunto(s)

Modelos Animales de Enfermedad , Adyuvante de Freund , Hiperalgesia , Inflamación , Receptor de Adenosina A1 , Xantinas , Animales , Receptor de Adenosina A1/metabolismo , Receptor de Adenosina A1/efectos de los fármacos , Ratones , Masculino , Hiperalgesia/tratamiento farmacológico , Hiperalgesia/metabolismo , Inflamación/metabolismo , Inflamación/tratamiento farmacológico , Xantinas/farmacología , Fascia/efectos de los fármacos , Cafeína/farmacología , Cafeína/administración & dosificación , Analgesia/métodos , Médula Espinal/metabolismo , Médula Espinal/efectos de los fármacos , Antagonistas del Receptor de Adenosina A1/farmacología

RESUMEN

Existe en la práctica diaria de los cirujanos plásticos una búsqueda continua de mejores alternativas técnicas para el tratamiento de las deformidades del contorno abdominal. La LADE (Lipoabdominoplastia con defi nición anatómica) da un paso más adelante de la técnica LAP tradicional. Esta técnica incorpora los principios de resaltar la defi nición de la musculatura abdominal, consiguiendo resultados más naturales y con menos estigmas de una intervención quirúrgica. Los resultados estéticos son mucho más armoniosos, con un verdadero aspecto abdominal rejuvenecido. Logramos reducir la morbilidad preservando los vasos sanguíneos perforantes y suspendiendo la fascia de Scarpa. Una correcta selección del paciente asociado a la estandarización de esta técnica hace que el procedimiento sea seguro y reproducible

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There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE ­ Lipoabdominoplasty with Anatomical Defi nition ­ is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the defi nition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The aesthetic results are much harmonious, with a true abdominal rejuvenated appearance. We can reduce morbidity by preservation of perforating blood vessels and suspension of Scarpa's fascia. The correct selection of the patient associated with the standardization of this technique makes the procedure safe and reproducible

Asunto(s)

Lipectomía/métodos , Fascia , Contorneado Corporal/métodos , Lipoabdominoplastía/métodos

RESUMEN

Objective: The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods: This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results: The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion: The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.

Asunto(s)

Neoplasias de la Mama , Mamoplastia , Mastectomía , Dolor Postoperatorio , Colgajos Quirúrgicos , Humanos , Femenino , Estudios Prospectivos , Mastectomía/efectos adversos , Persona de Mediana Edad , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Mamoplastia/efectos adversos , Adulto , Fascia/trasplante , Medición de Resultados Informados por el Paciente , Resultado del Tratamiento , Implantación de Mama/métodos

RESUMEN

PURPOSE: Despite various existing surgical techniques, treatment of facial nerve palsy remains difficult. The purpose of this report is to present the cerclage sling technique using temporalis fascia to manage paralytic lagophthalmos. METHODS: A series of six patients underwent a cerclage sling technique using temporalis muscle fascia to treat paralytic lagophthalmos. The technique is presented in detail. Symptoms, palpebral fissures, and lagophthalmos were assessed pre- and postoperatively. Data were submitted for statistical analysis. RESULTS: After surgery, all patients achieved a reduction in clinical symptoms. The upper eyelids had lowered, and the inferior eyelids had elevated, reducing ocular exposure even if mild residual lagophthalmos was present. CONCLUSION: Cerclage using the temporalis muscle fascia sling technique is a safe and effective procedure to treat facial nerve paralytic lagophthalmos. A reduction in ocular exposure and lagophthalmos provides improvement in clinical symptoms and eyelid function.

Asunto(s)

Enfermedades de los Párpados , Parálisis Facial , Lagoftalmos , Humanos , Enfermedades de los Párpados/etiología , Enfermedades de los Párpados/cirugía , Párpados/cirugía , Parálisis Facial/complicaciones , Parálisis Facial/cirugía , Fascia/trasplante , Músculos

RESUMEN

Abstract Background: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. Methods: Forty-one ASA III-IV patients who underwent SIFIB + PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. Results: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p < 0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p < 0.001) and during movement (p < 0.001 for the 1st and 3rd hours, and p = 0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p = 0.01). Conclusion: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Asunto(s)

Humanos , Persona de Mediana Edad , Anciano , Fracturas de Cadera/cirugía , Fracturas de Cadera/complicaciones , Analgésicos Opioides , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Estudios Retrospectivos , Extremidad Inferior , Fascia

RESUMEN

Abstract Background: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. Methods: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. Conclusion: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO registration: CRD42022339628 PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID=339628

Asunto(s)

Humanos , Adolescente , Adulto , Nervio Femoral , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Fascia/lesiones

RESUMEN

BACKGROUND: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. METHODS: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. CONCLUSION: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO REGISTRATION: CRD42022339628 PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339628.

Asunto(s)

Nervio Femoral , Bloqueo Nervioso , Humanos , Adolescente , Adulto , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Bloqueo Nervioso/métodos , Fascia/inervación

RESUMEN

BACKGROUND: Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control. METHODS: Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL. RESULTS: The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001). CONCLUSION: This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).

Asunto(s)

Traumatismos Abdominales , Hipernatremia , Humanos , Laparotomía/métodos , Hipernatremia/etiología , Estudios Retrospectivos , Fascia , Traumatismos Abdominales/cirugía

RESUMEN

BACKGROUND: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. METHODS: Forty-one ASA III...IV patients who underwent SIFIB...+...PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. RESULTS: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p...<...0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p...<...0.001) and during movement (p...<...0.001 for the 1st and 3rd hours, and p...=...0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p...=...0.01). CONCLUSION: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Asunto(s)

Analgésicos Opioides , Fracturas de Cadera , Humanos , Anciano , Estudios Retrospectivos , Extremidad Inferior , Fracturas de Cadera/complicaciones , Fracturas de Cadera/cirugía , Fascia , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control

RESUMEN

Using the serratus anterior fascia may be a safe and effective option to recreate the lateral breast profile during subpectoral breast reconstruction, with minimal functional impact on the donor site. However, the literature is scarce when it comes to studies on this fascia flap in implant-based reconstruction. This article aimed to review the use of the serratus anterior fascia in immediate implant-based breast reconstruction, searching the electronic databases PubMed, Embase, Lilacs, and SciELO. The search was carried out by combining the following keywords: 'breast reconstruction' and 'serratus anterior fascia'. In the Pubmed and Embase databases, the search yielded a total of 12 and 15 articles, respectively, of which seven were selected according to the scope of this article. We found no studies on serratus anterior fascia and breast reconstruction in the Lilacs and SciELO databases. All works have results favorable for the use of the serratus anterior fascia flap and agree that this technique can be considered in the algorithm for the coverage of the inferolateral portion during subpectoral breast reconstruction

Asunto(s)

Humanos , Femenino , Neoplasias de la Mama/cirugía , Procedimientos de Cirugía Plástica/métodos , Fascia/trasplante , Músculos Intermedios de la Espalda/trasplante , Mastectomía

RESUMEN

SUMMARY: The goal of ultrasound-guided suprainguinal fascia iliaca block (USG-SFIB) is anesthetic spread to three nerves, which are lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON). The 90 % minimum effective volume (MEV90) for USG-SFIB is each result of studied showed the successful block and effect in various volume for block. So, Thus, the study purposes to demonstrate the efficiency of the effective volume (MEV90,62.5 ml) for USG-SFIB and confirm the staining of dye in connective tissue of nerve (nerve layer) that focused on the obturator nerve by histological examination in cadavers. The histological result showed the dye staining on the nerve layer of the ON in epineurium (100 %) and un-staining perineurium & endoneurium. Therefore, the minimal effective volume (MEV) is effective for USG-SFIB. Moreover, dye stain at the epineurium of stained obturator nerve only.

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RESUMEN: El objetivo del bloqueo de la fascia ilíaca suprainguinal guiado por ecografía (USG-SFIB) es la propagación anestésica a tres nervios, cutáneo femoral lateral, femoral y obturador. El volumen efectivo mínimo del 90 % (MEV90) para USG-SFIB en cada uno de los resultados mostró el bloqueo exitoso y el efecto en varios volúmenes por bloqueo. Por lo tanto, el estudio tuvo como objetivo demostrar la eficiencia del volumen efectivo (MEV90,62.5 ml) para USG-SFIB y confirmar la tinción de tinte en el tejido conectivo del nervio, el cual se centró en el nervio obturador a través del examen histológico en cadáveres. El resultado histológico mostró tinción de colorante en el epineuro (100 %) del nervio obturador, sin embargo no hubo tinción del perineuro y endoneuro. Por lo tanto, el volumen efectivo mínimo (MEV) es efectivo para USG-SFIB.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Fascia/efectos de los fármacos , Anestésicos/administración & dosificación , Bloqueo Nervioso , Cadáver

RESUMEN

SUMMARY: The local anesthetic volume for a single-shot suprainguinal fascia iliaca block (SFIB) is a key factor of a block success because the courses of the three target nerves from the lumbar plexus (LP), the lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON), at the inguinal area are isolated and within striking distance. Thus, this cadaveric study aims to demonstrate the distribution of dye staining on the LFCN, FN, ON, and LP following the ultrasound-guided SFIB using 15-50 ml of methylene blue. A total of 40 USG-SFIBs were performed on 20 fresh adult cadavers using 15, 20, 25, 30, 35, 40, 45, and 50 ml of methylene blue. After the injections, the pelvic and inguinal regions were dissected to directly visualize the dye stained on the LFCN, FN, ON, and LP. All FN and LFCN were stained heavily when the 15-50 ml of dye was injected. Higher volumes of dye (40-50 ml) spread more medially and stained on the ON and LP in 60 % of cases. To increase the possibility of dye spreading to all three target nerves and LP of the SFIB, a high volume (≥40 ml) of anesthetic is recommended. If only a blockade of the FN and LFCN is required, a low volume (15-25 ml) of anesthetic is sufficient.

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RESUMEN: El volumen de anestésico local para un bloqueo de la fascia ilíaca suprainguinal (FISI) de una sola inyección es un factor clave para el éxito del bloqueo, debido a que los cursos de los tres nervios objetivo del plexo lumbar (PL), el nervio cutáneo femoral lateral (NCFL), femoral (NF) y el nervio obturador (NO), en el área inguinal están aislados y dentro de la distancia de abordaje. Por lo tanto, este estudio cadavérico tiene como objetivo demostrar la distribución de la tinción de tinte en NCFL, NF, NO y PL siguiendo el FISI guiado por ultrasonido usando 15-50 ml de azul de metileno. Se realizaron un total de 40 USG-FISI en 20 cadáveres adultos frescos utilizando 15, 20, 25, 30, 35, 40, 45 y 50 ml de azul de metileno. Después de las inyecciones, se disecaron las regiones pélvica e inguinal para visualizar directamente el tinte teñido en NCFL, NF, NO y PL. Todos los NF y NCFL se tiñeron intensamente cuando se inyectaron los 15- 50 ml de colorante. Volúmenes mayores de colorante (40-50 ml) se esparcen más medialmente y tiñen el NO y la PL en el 60 % de los casos. Para aumentar la posibilidad de que el colorante se propague a los tres nervios objetivo y al PL del FISI, se recomienda un volumen elevado (≥40 ml) de anestésico. Si solo se requiere un bloqueo de NF y NCFL, un volumen bajo (15-25 ml) de anestésico es suficiente.

Asunto(s)

Humanos , Persona de Mediana Edad , Anciano , Fascia/anatomía & histología , Fascia/efectos de los fármacos , Azul de Metileno/administración & dosificación , Bloqueo Nervioso , Cadáver , Ultrasonografía Intervencional , Inyecciones , Azul de Metileno/farmacocinética

RESUMEN

Medial hip rotation is typically attributed to the tensor fascia latae (TFL) and lateral rotation, to the gluteus maximus. However, experimental studies in cadavers suggest that the TFL lacks a moment arm for medial rotation and that the gluteus maximus may act as hip medial rotator depending on the hip flexion angle. In order to address this contradictory thinking, we measured the myoelectric activity of TFL, gluteus medius and gluteus maximus (superior portion, GMaxS, and inferior portion, GMaxI) for increasing levels of medial rotation torque applied to the hip. To keep frontal and sagittal plane hip joint net torques constant during the experiments, the medial hip rotation torque was changed by displacing standard weights along an aluminum bar device, thereby producing pure medial hip rotation torques. The effect of increasing medial hip rotation torque was investigated for a fully extended hip (0°), and at 45° and 90° of flexion. We found an increase in the myoelectric activity of the TFL (∼90%↑, p = 0.002) at 90° of flexion and of the GMaxS (∼7%↑, p = 0.048) at the extended position with an increase in medial hip torque application (from 0 to 7.4 N.m.). For the GMed (regardless of hip position) and for the 45° position (regardless of muscle), no systematic changes across torque conditions were observed. In contrast to the common clinical assumption and current practice thinking, our results indicate that an increase in TFL activity is required to control for an increase in external torque towards hip medial rotation.

Asunto(s)

Articulación de la Cadera , Músculo Esquelético , Nalgas , Electromiografía/métodos , Fascia , Articulación de la Cadera/fisiología , Músculo Esquelético/fisiología , Torque

RESUMEN

BACKGROUND AND OBJECTIVE: Pain control is one of the major concerns after major hip surgeries. Suprainguinal fascia iliaca compartment block (S-FICB) is an alternative analgesic technique that can be considered as an effective and less invasive method than epidural analgesia (EA). In this retrospective study, we compared postoperative analgesic efficacy of single shot ultrasound guided S-FICB and EA after major hip surgery. METHODS: We retrospectively examined 150 patients who underwent major hip surgeries and who received S-FICB or EA. Seventy-two patients submitted to EA and 78 patients who received S-FICB were included and their medical records retrospectively reviewed. Morphine consumptions, VAS scores, and side effects were recorded. Patients under antiplatelet or anticoagulant theraphy were also registered. Morphine consumption and VAS scores were the primary endpoints, succes rate and complications were the secondary endpoints of our study. P-values less than 0.05 were considered statistically significant. RESULTS: Morphine consumption was lower at the emergence in the EA group but there was no statistically significant difference between the two groups according to total opioid consumption (0 [0-0] vs 0 [0-0]; p = 0.52). There was no difference between VAS scores in the first 18 hours. Hypotension was significantly higher in the EA group (9 vs 21; p = 0.04). CONCLUSION: In conclusion, S-FICB can provide comparable analgesia with EA in the early postoperative period after hip surgery but VAS scores were found lower in the EA group than S-FICB group after 18th hour. Hypotension has occured more frequently in patients receiving EA.

Asunto(s)

Analgesia Epidural , Hipotensión , Bloqueo Nervioso , Analgésicos/uso terapéutico , Fascia , Humanos , Morfina/uso terapéutico , Bloqueo Nervioso/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Estudios Retrospectivos

Asunto(s)

Humanos , Anciano , Anciano de 80 o más Años , Cuidados Preoperatorios , Manejo del Dolor , Fracturas de Cadera , Anestésicos Locales/administración & dosificación , Dimensión del Dolor , Ultrasonografía Intervencional , Fascia , Nervio Femoral/efectos de los fármacos

RESUMEN

SUMMARY: The variations in the serratus anterior (SA) muscle are common. Here, we report a rare variation of the muscle origin with a potentially great clinical implication. We found an aberrant SA variation in an 81-year-old Korean male cadaver during a routine dissection for medical students. Additional slip (AS) of the SA originated from the clavipectoral fascia and the pectoralis minor. It traveled inferiorly and merged to the typical SA part. Precise knowledge about SA variations is clinically valuable; therefore, clinicians should be aware of the possible variation.

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RESUMEN: Las variaciones en el músculo serrato anterior (MSA) son comunes. En este trabajo informamos una variación rara del origen muscular con una implicación clínica potencialmente importante. Encontramos una variación aberrante del MSA en un cadáver masculino, coreano de 81 años, durante una disección de rutina para estudiantes de medicina, con un fascículo adicional del MSA originado en la fascia clavipectoral y el músculo pectoral menor. Este fascículo se dirigió inferiormente y se fu- sionó con la parte común de MSA. El conocimiento preciso sobre las variaciones de MSA es útil clínicamente; por lo tanto, los médicos deben ser conscientes de esta posible variación.

Asunto(s)

Humanos , Masculino , Anciano de 80 o más Años , Músculo Esquelético/anatomía & histología , Variación Anatómica , Cadáver , Fascia

RESUMEN

La tuberculosis de la pared torácica es excepcional y puede presentarse en forma de un absceso frío o una masa seudo tumoral. En ausencia de lesiones pulmonares o extra pulmonares sugerentes de TB, es difícil diferenciar un absceso tuberculoso de un tumor de la pared torácica. Se debe evaluar el diagnóstico de TB de la pared torácica, ante signos clínicos y radiológicos, especialmente en regiones de alta incidencia y prevalencia de la enfermedad. El pronóstico es muy bueno con el tratamiento actual para la TB Si se asocia cirugía para efectuar la resección del absceso, se reducen las complicaciones y/o recurrencias. Si bien su presentación es muy poco frecuente, la Peripleuritis deberá tenerse en consideración Habitualmente se asocia a lesiones pulmonares, linfáticas o costales en actividad Siempre que se conozcan sus caracteres anatomoclínicos, la clínica y la radiología permiten sospechar su diagnóstico.

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Tuberculosis of the chest wall is rare and can present in the form of a cold abscess or a pseudo-tumor mass. In the absence of pulmonary or extrapulmonary lesions suggestive of TB, it is difficult to differentiate a tuberculosis abscess from a chest wall tumor. The diagnosis of TB of the chest wall should be evaluated, given clinical and radiological signs, especially in regions of high incidence and prevalence of the disease. The prognosis is very good with the current treatment for TB. If surgery is associated to perform abscess resection, complications and / or recurrences are reduced. Although its presentation is very rare, Peripleuritis should be taken into consideration. Associated with active lung, lymphatic or rib lesions As long as its anatomical-clinical characteristics are known, the clinic and radiology allow suspecting its diagnosis.

Asunto(s)

Tuberculosis , Neumología , Fascia

RESUMEN

El colgajo de fascia temporal superficial es muy versátil para la reconstrucción de defectos tisulares localizados en los tercios superior y medio de la cara, en la región orbito-palpebral, en la cavidad oral, en la base del cráneo y a nivel mandibular. En nuestra experiencia, constituye una opción segura para reconstrucciones complejas de cavidades. En el presente artículo los autores exponen el caso de una paciente en quien se reconstruyó un defecto de órbita con un colgajo de fascia temporal superficial prelaminado

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The superficial temporal fascia flap is versatile for the reconstruction of tissue defects located in the upper and middle thirds of the face, in the orbital-palpebral region, in the oral cavity, at the base of the skull and at the mandibular level. In our experience, it is a safe option for complex cavity reconstructions. In this article the authors present the case of a patient in whom an orbit defect was reconstructed with a pre-laminated superficial temporal fascia flap

Asunto(s)

Trasplantes , Órbita , Fascia

RESUMEN

BACKGROUND: This randomized trial compared ultrasound-guided pericapsular nerve group block and suprainguinal fascia iliaca block in patients undergoing primary total hip arthroplasty. We selected the postoperative incidence of quadriceps motor block (defined as paresis or paralysis of knee extension) at 6 hours as the primary outcome. We hypothesized that, compared with suprainguinal fascia iliaca block, pericapsular nerve group block would decrease its occurrence from 70% to 20%. METHODS: Forty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=20) using 20 mL of adrenalized levobupivacaine 0.50%, or a suprainguinal fascia iliaca block (n=20) using 40 mL of adrenalized levobupivacaine 0.25%. After the performance of the block, a blinded observer recorded pain scores at 3, 6, 12, 18, 24, 36, and 48 hours; cumulative breakthrough morphine consumption at 24 and 48 hours; opioid-related side effects; ability to perform physiotherapy at 24 and 48 hours; as well as length of stay. Furthermore, the blinded observer also carried out sensory assessment (of the anterior, lateral, and medial aspects of the mid-thigh) and motor assessment (knee extension and hip adduction) at 3, 6, and 24 hours. RESULTS: Compared with suprainguinal fascia iliaca block, pericapsular nerve group block resulted in a lower incidence of quadriceps motor block at 3 hours (45% vs 90%; p<0.001) and 6 hours (25% vs 85%; p<0.001). Furthermore, pericapsular nerve group block also provided better preservation of hip adduction at 3 hours (p=0.023) as well as decreased sensory block of the anterior, lateral, and medial thighs at all measurement intervals (all p≤0.014). No clinically significant intergroup differences were found in terms of postoperative pain scores, cumulative opioid consumption at 24 and 48 hours, ability to perform physiotherapy, opioid-related side effects, and length of hospital stay. CONCLUSION: For primary total hip arthroplasty, pericapsular nerve group block results in better preservation of motor function than suprainguinal fascia iliaca block. Additional investigation is required to elucidate the optimal local anesthetic volume for motor-sparing pericapsular nerve group block and to compare the latter with alternate motor-sparing strategies such as periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER: NCT04402450.

Asunto(s)

Artroplastia de Reemplazo de Cadera , Bloqueo Nervioso , Artroplastia de Reemplazo de Cadera/efectos adversos , Fascia/diagnóstico por imagen , Nervio Femoral/diagnóstico por imagen , Humanos , Bloqueo Nervioso/efectos adversos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control