Asunto(s)
Lepra/tratamiento farmacológico , Metilprednisolona/administración & dosificación , Neuritis/tratamiento farmacológico , Quimioterapia por Pulso , Adolescente , Adulto , Antiinflamatorios/administración & dosificación , Niño , Femenino , Humanos , Lepra/complicaciones , Masculino , Persona de Mediana Edad , Neuritis/microbiología , Examen Neurológico , Nervios Periféricos/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía , Adulto JovenRESUMEN
SUMMARY: Sonographic identification of suprascapular nerve (SSN) is essential for diagnosis of suprascapular neuropathy and ultrasound-guided suprascapular nerve block. This study aims to demonstrate the accuracy of identification of SSN at supraclavicular region by ultrasonography in fresh cadavers. Ninety-three posterior cervical triangles were examined. With ultrasonography, SSN emerging from the upper trunk of brachial plexus was identified and followed until it passed underneath the inferior belly of omohyoid muscle. Sonographic visualization of SSN in supraclavicular fossa was recorded. Then, cadaveric dissection was performed to determine the presence or absence of SSN. An agreement between sonographic identification and direct visualization was specified and categorized the following three patterns: "correctly identified" (pattern I), "incorrectly identified" (pattern II), and "unidentified" (pattern III). The identification of SSN using sonography was correct in almost 90 %. The diameter of SSN with pattern I was the largest compared to those of other two patterns. In pattern I, SSN ran laterally from the upper trunk of brachial plexus and passed underneath the inferior belly of omohyoid muscle. Therefore, SSN was easily identified under ultrasonography. In pattern II, nerve identified by ultrasonography was literally the dorsal scapular nerve. In pattern III, SSN was unable to be identified because of its anatomical variation. The accuracy of ultrasonographic identification of SSN at supraclavicular fossa is high and the key sonoanatomical landmarks are the lateral margin of brachial plexus and the inferior belly of omohyoid muscle. The anatomical variants of SSN are reasons of incorrect or unable identification of SSN under ultrasonography.
RESUMEN: La identificación ecográfica del nervio supraescapular (NSE) es esencial para el diagnóstico de neuropatía supraescapular y bloqueo del nervio supraescapular mediante la ecografía. Este estudio tiene como objetivo demostrar la precisión de la identificación de NSE en la región supraclavicular por ecografía en cadáveres frescos. Se examinaron noventa y tres triángulos cervicales posteriores. Se identificó el NSE emergente de la parte superior del tronco del plexo braquial con la ecografía, y se siguió hasta su trayecto por debajo del vientre inferior del músculo omohioideo. Se registró la visualización ecográfica del NSE en la fosa supraclavicular. Luego, se realizó disección cadavérica para determinar la presencia o ausencia de NSE. Se especificó un acuerdo entre la identificación ecográfica y la visualización directa y se categorizaron los siguientes tres patrones: "identificado correctamente" (patrón I), "identificado incorrectamente" (patrón II) y "no identificado" (patrón III). La identificación de NSE mediante ecografía fue correcta en casi el 90 %. El diámetro del NSE con el patrón I fue el más grande en comparación con los de los otros dos patrones. En el patrón I, NSE corría lateralmente desde la parte superior del tronco del plexo braquial y pasaba por debajo del vientre inferior del músculo omohioideo. Por lo tanto, el NSE se identificó fácilmente mediante ecografía. En el patrón II, el nervio identificado por ecografía era literalmente el nervio escapular dorsal; en el patrón III, el NSE no pudo ser identificado debido a su variación anatómica. La precisión de la identificación ecográfica del NSE en la fosa supraclavicular es alta y los puntos de referencia sonoanatómicos clave son el borde lateral del plexo braquial y el vientre inferior del músculo omohioideo. Las variantes anatómicas de NSE son razones de identificación incorrecta o incapaz de NSE bajo ecografía.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Escápula/inervación , Escápula/diagnóstico por imagen , Clavícula/inervación , Clavícula/diagnóstico por imagen , Nervios Periféricos/anatomía & histología , Nervios Periféricos/diagnóstico por imagen , Cadáver , UltrasonografíaRESUMEN
INTRODUCTION: Hemophilia is a coagulation disorder; it is a recessive disease linked to the X chromosome. In patients with hemophilia (PWH), regional anesthetic blocks have been considered a contraindication. Safety has been increased by performing them guided by Ultrasound. The objective of our work is to show our experience in PWH and peripheral nerve blocks. MATERIAL AND METHOD: 41 PWH were operated under regional analgesia with Ultrasound-Guided Peripheral Nerve Blocks associated with general anesthesia in the period 2006-2019. All patients were Hemophilia A. Three patients had inhibitors. The mean age was 35 years. 40 lower limb blocks and 2 upper limb blocks were performed. The Sonosite® equipment model Micromaxx was used. RESULTS: All patients presented adequate peripheral nerve block for an average time of 12.5 hours (8-24). There were no complications. CONCLUSIÓN: The present study shows that Ultrasound-Guided Peripheral Nerve Blocks in PCH is a safe procedure, which reduces the requirements of opioids and the side effects of them, improving the postoperative period and the recovery of patients.
INTRODUCCIÓN: La hemofilia es un trastorno de la coagulación, es una enfermedad recesiva ligada al cromosoma X. En pacientes con hemofilia (PCH) los bloqueos regionales anestésicos se han considerado una contraindicación. Se ha aumentado la seguridad realizándolos guiados por Ecografía. El objetivo de nuestro trabajo es mostrar nuestra experiencia en PCH y bloqueos de nervios periféricos. MATERRIAL Y MÉTODO: 41 PCH fueron operados bajo analgesia regional con Bloqueos de Nervios Periféricos Guiados por Ecografía asociado a la anestesia general en el período 2006-2019. Todos los pacientes eran hemofilia A. Tres pacientes presentaban inhibidores. La edad media fue de 35 años. Se realizaron 40 bloqueos de miembros inferiores y 2 bloqueos miembros superiores. Se utilizó el equipo Sonosite® modelo Micromaxx. RESULTADOS: Todos los pacientes presentaron adecuado bloqueo de nervio periférico durante un tiempo promedio de 12,5 h (8-24). No se presentaron complicaciones. CONCLUSIÓN: El presente estudio muestra que los Bloqueos de Nervios Periféricos Guiados por Ecografía en PCH es un procedimiento seguro, que reduce los requisitos de los opioides y los efectos secundarios de ellos, mejorando el posoperatorio y la recuperación de los pacientes.
Asunto(s)
Humanos , Niño , Adolescente , Adulto , Persona de Mediana Edad , Nervios Periféricos/diagnóstico por imagen , Ultrasonografía Intervencional , Hemofilia A/complicaciones , Bloqueo Nervioso/métodos , Anestesia GeneralRESUMEN
As injeções anestésicas perineurais são frequentemente utilizadas para auxiliarem na identificação dos locais potencialmente causadores de dor e consequentemente claudicação nos equinos. Nesse sentido, o conhecimento anatômico detalhado das estruturas neurais é importante para realização correta e eficiente dos bloqueios perineurais nos membros locomotores de equinos, não gerando dúvidas em suas interpretações. Para tanto, a ultrassonografia torna-se uma ferramenta importante no processo de aprendizagem, além de apontar a melhor forma de realizar o procedimento. Esta revisão tem por objetivo apresentar os fatores que interferem na realização das injeções perineurais e como a ultrassonografia pode ser útil no processo de aprendizagem pode auxiliar na execução destes procedimentos.(AU)
Perineural anesthetic injections are often used to assist in the identification of potentially painful sites and, consequently, lameness in horses. In this sense, detailed anatomical knowledge of neural structures is important for the correct and efficient performance of perineural blocks in the limbs of horses, generating no doubts in their interpretations. For this, ultrasonography becomes an important tool in the learning process, in addition to pointing out the best way to perform the procedure. This review aims to present the factors that interfere with the performance of perineural injections and how ultrasound can be useful in the learning process can assist in the execution of these procedures.(AU)
Las inyecciones de anestesia perineural a menudo se usan para ayudar en la identificación de sitios potencialmente dolorosos y, en consecuencia, la cojera en los caballos. En este sentido, el conocimiento anatómico detallado de las estructuras neurales es importante para el funcionamiento correcto y eficiente de los bloqueos perineurales en las extremidades locomotoras de los caballos, sin generar dudas en sus interpretaciones. Para esto, la ecografía se convierte en una herramienta importante en el procesode aprendizaje, además de señalar la mejor manera de realizar el procedimiento. Esta revisión tiene como objetivo presentar los factores que interfieren con el rendimiento de las inyecciones perineurales y cómo la ecografía puede ser útil en el proceso deaprendizaje puede ayudar en la ejecución de estos procedimientos.(AU)
Asunto(s)
Animales , Nervios Periféricos/efectos de los fármacos , Nervios Periféricos/diagnóstico por imagen , Anestésicos/análisis , Caballos , Sistema Musculoesquelético/anatomía & histología , Ultrasonografía/veterinaria , Sistema Musculoesquelético/lesionesRESUMEN
As injeções anestésicas perineurais são frequentemente utilizadas para auxiliarem na identificação dos locais potencialmente causadores de dor e consequentemente claudicação nos equinos. Nesse sentido, o conhecimento anatômico detalhado das estruturas neurais é importante para realização correta e eficiente dos bloqueios perineurais nos membros locomotores de equinos, não gerando dúvidas em suas interpretações. Para tanto, a ultrassonografia torna-se uma ferramenta importante no processo de aprendizagem, além de apontar a melhor forma de realizar o procedimento. Esta revisão tem por objetivo apresentar os fatores que interferem na realização das injeções perineurais e como a ultrassonografia pode ser útil no processo de aprendizagem pode auxiliar na execução destes procedimentos.
Perineural anesthetic injections are often used to assist in the identification of potentially painful sites and, consequently, lameness in horses. In this sense, detailed anatomical knowledge of neural structures is important for the correct and efficient performance of perineural blocks in the limbs of horses, generating no doubts in their interpretations. For this, ultrasonography becomes an important tool in the learning process, in addition to pointing out the best way to perform the procedure. This review aims to present the factors that interfere with the performance of perineural injections and how ultrasound can be useful in the learning process can assist in the execution of these procedures.
Las inyecciones de anestesia perineural a menudo se usan para ayudar en la identificación de sitios potencialmente dolorosos y, en consecuencia, la cojera en los caballos. En este sentido, el conocimiento anatómico detallado de las estructuras neurales es importante para el funcionamiento correcto y eficiente de los bloqueos perineurales en las extremidades locomotoras de los caballos, sin generar dudas en sus interpretaciones. Para esto, la ecografía se convierte en una herramienta importante en el procesode aprendizaje, además de señalar la mejor manera de realizar el procedimiento. Esta revisión tiene como objetivo presentar los factores que interfieren con el rendimiento de las inyecciones perineurales y cómo la ecografía puede ser útil en el proceso deaprendizaje puede ayudar en la ejecución de estos procedimientos.
Asunto(s)
Animales , Anestésicos/análisis , Caballos , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/efectos de los fármacos , Sistema Musculoesquelético/anatomía & histología , Sistema Musculoesquelético/lesiones , Ultrasonografía/veterinariaRESUMEN
BACKGROUND AND OBJECTIVES: This multicenter, randomized trial compared 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular brachial plexus block. Our research hypothesis was that all three doses of dexamethasone would result in equivalent durations of motor block (equivalence margin=3.0 hours). METHODS: Three hundred and sixty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block were randomly allocated to receive 2, 5, or 8 mg of preservative-free perineural dexamethasone. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) was identical in all subjects. Patients and operators were blinded to the dose of dexamethasone. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. The main outcome variable was the duration of motor block. RESULTS: No intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain complications), onset time, success rate, and surgical anesthesia. Furthermore, all three doses of dexamethasone provided similar durations of motor block (14.9-16.1 hours) and sensory block. Although 5 mg provided a longer analgesic duration than 2 mg, the difference (2.7 hours) fell within our pre-established equivalence margin (3.0 hours). CONCLUSIONS: 2, 5, and 8 mg of dexamethasone provide clinically equivalent sensorimotor and analgesic durations for ultrasound-guided infraclavicular block. Further trials are required to compare low (ie, 2 mg) and ultra-low (eg, 0.5-1 mg) doses of perineural dexamethasone for brachial plexus blocks. TRIAL REGISTRATION NUMBER: TCTR20150624001.
Asunto(s)
Bloqueo del Plexo Braquial/métodos , Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional/métodos , Adulto , Clavícula/diagnóstico por imagen , Clavícula/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico por imagen , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/efectos de los fármacosRESUMEN
O estudo dos dados anatômicos é fundamental para possibilitar ao médico veterinário o reconhecimento de pequenas estruturas, como os nervos nos animais, oferecendo subsídio para construção do conhecimento do profissional principalmente em técnicas anestésicas e cirúrgicas. Para investigar e mapear os nervos do plexo braquial (nervo radial, nervo musculocutâneo, nervo ulnar, nervo mediano), nervo isquiático, nervo tibial, nervo femoral e os nervos para bloqueio paravertebral, foram utilizados um cadáver canino adulto, de peso aproximado de 8kg, e um cadáver de bezerro Holandês, de peso aproximado de 40kg. O mapeamento dos nervos é de grande importância, já que conhecer bem essas estruturas permite ao veterinário um bom desenvolvimento de suas atividades profissionais a fim de exercer funções mais complexas durante a anestesia e cirurgia veterinária, uma vez que, identificados os pontos de referência anatômicos, é possível trabalhar com mais clareza nas técnicas de bloqueios dos nervos periféricos.(AU)
Knowledge of animal anatomy is essential for the veterinarian to identify small structures such as nerves, thus providing a solid background for the professional especially for surgical and anesthetic techniques. To investigate and map the nerves of the brachial plexus (radial, musculocutaneous, ulnar, median), sciatic, tibial, femoral and the nerves for paravertebral blocking in bovine, embalmed specimens were used. One adult male dog weighing approximately 8kg and one 40kg male calf were used. Nerve mapping is fundamental due to its interdisciplinary nature, thus providing the veterinarian with a major improvement in his/her professional activities which permits allows one to perform complex tasks in anesthesia and veterinary surgery. Knowledge ofanatomical reference points increases clarity and precision in techniques involving peripheral nerve blocks.(AU)
Asunto(s)
Animales , Bovinos , Perros , Bovinos/anatomía & histología , Perros/anatomía & histología , Nervios Periféricos/diagnóstico por imagen , Anestesia Local/veterinariaRESUMEN
O estudo dos dados anatômicos é fundamental para possibilitar ao médico veterinário o reconhecimento de pequenas estruturas, como os nervos nos animais, oferecendo subsídio para construção do conhecimento do profissional principalmente em técnicas anestésicas e cirúrgicas. Para investigar e mapear os nervos do plexo braquial (nervo radial, nervo musculocutâneo, nervo ulnar, nervo mediano), nervo isquiático, nervo tibial, nervo femoral e os nervos para bloqueio paravertebral, foram utilizados um cadáver canino adulto, de peso aproximado de 8kg, e um cadáver de bezerro Holandês, de peso aproximado de 40kg. O mapeamento dos nervos é de grande importância, já que conhecer bem essas estruturas permite ao veterinário um bom desenvolvimento de suas atividades profissionais a fim de exercer funções mais complexas durante a anestesia e cirurgia veterinária, uma vez que, identificados os pontos de referência anatômicos, é possível trabalhar com mais clareza nas técnicas de bloqueios dos nervos periféricos.(AU)
Knowledge of animal anatomy is essential for the veterinarian to identify small structures such as nerves, thus providing a solid background for the professional especially for surgical and anesthetic techniques. To investigate and map the nerves of the brachial plexus (radial, musculocutaneous, ulnar, median), sciatic, tibial, femoral and the nerves for paravertebral blocking in bovine, embalmed specimens were used. One adult male dog weighing approximately 8kg and one 40kg male calf were used. Nerve mapping is fundamental due to its interdisciplinary nature, thus providing the veterinarian with a major improvement in his/her professional activities which permits allows one to perform complex tasks in anesthesia and veterinary surgery. Knowledge ofanatomical reference points increases clarity and precision in techniques involving peripheral nerve blocks.(AU)
Asunto(s)
Animales , Bovinos , Perros , Bovinos/anatomía & histología , Perros/anatomía & histología , Nervios Periféricos/diagnóstico por imagen , Anestesia Local/veterinariaRESUMEN
OBJECTIVES: Update our experience using radiotherapy (RT) for head-and-neck squamous or basal cell carcinoma with clinical perineural invasion (PNI) and correlate radiographic findings with outcomes. MATERIALS AND METHODS: We treated 65 patients with cT4N0 head-and-neck skin cancers with clinical PNI from 1965 to 2009 (N0 disease, 59; N1 disease, 6). Treatment included RT alone (N=18), RT with concurrent chemotherapy (N=14), surgery and postoperative RT (N=26), or postoperative RT with concurrent chemotherapy (N=5), and preoperative RT and surgery (N=2). Patients were stratified by imaging-negative disease (N=11), minimal or moderate peripheral disease (N=18), and macroscopic and/or central disease (N=36). Median RT dose was 72.6 Gy (50.4 to 79.2 Gy). Median follow-up overall and for living patients was 5.4 and 11.6 years, respectively. RESULTS: Five-year outcomes for imaging-negative disease versus minimal/moderate peripheral disease versus macroscopic/central disease were: local control, 81% versus 60% versus 47% (P=0.23); local-regional control, 80% versus 54% versus 47% (P=0.22); neck control, 100% versus 89% versus 93% (P=0.45); and distant metastasis-free survival, 89% versus 100% versus 93% (P=0.57), respectively. Five-year survival rates for imaging-negative disease versus minimal/moderate peripheral disease versus macroscopic/central disease were: overall survival, 82% versus 50% versus 52% (P=0.26), and cause-specific survival, 100% versus 58% versus 65% (P=0.08). Twenty-two (34%) patients had 1 or more severe (grade ≥3) late complications. CONCLUSIONS: There is a nonsignificant trend towards improved local control for imaging-negative patients and patients with minimal/moderate peripheral disease compared with macroscopic/central disease. Although survival appears better for imaging-negative patients, extent of imaging-positive PNI did not impact overall or cause-specific survival.
Asunto(s)
Carcinoma Basocelular/diagnóstico por imagen , Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Nervios Periféricos/patología , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Terapia Combinada/efectos adversos , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Nervios Periféricos/diagnóstico por imagen , Pronóstico , Dosificación Radioterapéutica , Neoplasias Cutáneas/terapia , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
Fibrolipomatous hamartoma is a benign tumor mainly affecting peripheral nerves. It is characterized by abnormal growth of fibroadipose tissue within the nerve, leading to progressive compressive neuropathies. Carpal tunnel syndrome is the most frequent among them. Although it is considered an infrequent tumor, magnetic resonance imaging use has led to an increase in case reports. We present 3 clinical cases of fibrolipomatous hamartoma consulting due to soft tissue mass, which were diagnosed by ultrasound.
Asunto(s)
Hamartoma/diagnóstico por imagen , Lipomatosis/diagnóstico por imagen , Nervios Periféricos/diagnóstico por imagen , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen , Ultrasonografía/métodos , Adolescente , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Obese patients can pose a unique perioperative anesthetic challenge, making regional anesthetic techniques an intriguing means of providing analgesia for this population. Ultrasound guidance has been touted recently as being beneficial for this population in which surface landmarks can become obscured. In this study, the effect of increased Body Mass Index (BMI) on ultrasound guided interscalene peripheral nerve blockade is investigated. MATERIAL AND METHODS: This study is a retrospective review of 528 consecutive patients who received preoperative ultrasound-guided interscalene nerve blocks at the University of Wisconsin Hospital and Clinics. We examined the association between BMI and the following parameters: time required for block placement; presence of Postoperative Nausea and Vomiting (PONV); postoperative Post Anesthesia Care Unit (PACU) pain scores; volume of local anesthetic injected; acute complications; and opioid administration preoperatively, intraoperatively, and postoperatively. Univariate and multivariate least squares and logistic regression models were used. RESULTS: An elevated BMI was associated with an increased: time required for block placement (p-value=0.025), intraoperative fentanyl administration (p-value<0.001), peak PACU pain scores (p-value<0.001), PACU opioid administration (p-value<0.001), PACU oral opioid administration (p-value<0.001), total PACU opioid administration (p-value<0.001) and incidence of PACU nausea (p-value=0.025) CONCLUSIONS: Ultrasound guided interscalene nerve blocks for perioperative analgesia can be safely and effectively performed in the obese patient but they may be more difficult to perform and analgesia may not be as complete.
Asunto(s)
Índice de Masa Corporal , Bloqueo Nervioso/métodos , Obesidad , Dolor Postoperatorio/prevención & control , Nervios Periféricos/diagnóstico por imagen , Ultrasonografía Intervencional , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos del Cuello , Estudios RetrospectivosRESUMEN
Neuropathic arthropathy (Charcot's arthropathy) is a progressive articular disease associated with a reduced sensorial and protector proprioceptive reflex. Its etiology includes many different conditions such as syringomyelia, traumatic lesion causing medullary deformity, spina bifida, diabetic neuropathy, leprosy neuropathy, neurofibromatosis, amyloid neuropathy, alcohol, and repetitive injection of hydrocortisone into joints, among others. However, the relationship between Charcot's arthropathy and herpetic encephalitis has not yet been described. Herpes encephalitis causes acute and chronic diseases of the peripheral or central nervous system. It can manifest as subacute encephalitis, recurrent meningitis, or myelitis. It can also resemble psychiatric syndromes, diplopia, sensory changes in the face and limbs, personality changes, frontal dysexecutive syndrome, stiff neck, subclinical alterations of the vestibular function, intracranial hypertension, convulsion, hemiparesis, and generally includes motor components, among others. On the other hand, pure peripheral sensory disturbance has not been described. In this article, we report the clinical case of a patient with Charcot's arthropathy secondary to pure peripheral sensory polyneuropathy as a consequence of progressive herpetic encephalitis sequelae. In this article, the authors report the first case of Charcot's arthropathy secondary to herpetic encephalitis.
Asunto(s)
Artropatía Neurógena/inmunología , Encefalitis por Herpes Simple/complicaciones , Enfermedades del Sistema Nervioso Periférico/inmunología , Enfermedades del Sistema Nervioso Periférico/virología , Vías Aferentes/inmunología , Vías Aferentes/patología , Vías Aferentes/virología , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/inervación , Articulación del Tobillo/patología , Artropatía Neurógena/diagnóstico por imagen , Artropatía Neurógena/patología , Progresión de la Enfermedad , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/inervación , Articulación del Codo/patología , Humanos , Masculino , Persona de Mediana Edad , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/inmunología , Nervios Periféricos/patología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Radiografía , Células Receptoras Sensoriales/inmunología , Células Receptoras Sensoriales/patología , Células Receptoras Sensoriales/virologíaRESUMEN
Continuous peripheral nerve blocks (CPNB) are effective for postoperative pain management in children in the hospital and at home. CPNB techniques are particularly advantageous when compared with systemic or oral opioids on medical missions to unfamiliar environments with minimal monitoring capacity. In addition, ultrasound-guidance facilitates the placement of perineural catheters in anesthetized children even in the absence of commercially packaged regional anesthesia equipment. We present a series of successful cases employing ultrasound-guided CPNB for postoperative analgesia on medical missions and discuss the impact of this technology on present and future patients in underserved countries.