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Abstract Introduction: Spinal anesthesia (SA) and sciatic-femoral nerve block are the most widely used anesthesia techniques for knee arthroscopy; however, there is still some controversy with regard to which anesthetic procedure offers improved safety, better pain control, and higher patient satisfaction. Objective: To assess the effectiveness of exclusive SA with bupivacaine versus sciatic-femoral nerve block, regardless of the drug, during the postoperative period of patients having undergone knee arthroscopy, through a systematic review of the scientific literature. Methods: A search of Randomized Clinical Trials was conducted in a number of databases including Ovid, Cochrane, Embase, Lilacs, Open Grey, ClinicalTrials.gov, and academic Google. The snowball technique was also used to identify additional trials. The design of the search strategy included Boolean operators and considered studies in English, Spanish, and Portuguese, with no date restrictions. The information is presented in narrative form. Results: The search identified 478 studies, of which 3 met the eligibility criteria. The effectiveness was evaluated based on total anesthesia time and rescue analgesia. Safety was evaluated with heart rate monitoring and time to first micturition. Patient satisfaction was identified through surveys to measure the acceptance of the anesthetic technique. Conclusion: SA is effective as assessed based on the motor-sensory blockade effect and pain control, but its adverse events shall be taken into consideration when making a decision. The anesthetic techniques of the peripheral sciatic-femoral nerve block present less undesirable side effects than spinal analgesia and provide better postoperative pain control.

Resumen Introducción: La anestesia espinal y el bloqueo de nervios ciático-femoral son las técnicas de anestesia regional más utilizadas para la artroscopia de rodilla, sin embargo, existe controversia en relación a qué procedimiento anestésico ofrece mayor seguridad, mejor control del dolor y satisfacción del paciente. Objetivo: Evaluar la efectividad de la anestesia espinal exclusiva con bupivacaína vs el bloqueo de nervio ciático -femoral sin distinción de fármaco en el postoperatorio de pacientes intervenidos con artroscopia de rodilla, a través de una revisión sistemática de la literatura científica. Métodos: se realizó una búsqueda de Ensayos Clínicos Aleatorizados en las bases de datos Ovid, Cochrane, Embase, Lilacs, al igual que en Open Grey, ClinicalTrials.gov y Google académico, también se utilizó la técnica bola de nieve para encontrar estudios adicionales. El diseño de la estrategia de búsqueda incluyó operadores boleanos y consideró estudios en inglés, español y portugués, sin restricción de fecha. La información se presenta de forma narrativa. Resultados: la búsqueda identificó 478 estudios de los cuales tres cumplieron los criterios de elegibilidad. La efectividad fue valorada con el tiempo total de anestesia y analgesia de rescate. La seguridad fue evaluada con monitoreo de frecuencia cardiaca y tiempo de primera micción. La satisfacción del paciente se indagó a través de encuestas de aceptación de la técnica anestésica. Conclusiones: la anestesia espinal resulta efectiva valorada por el efecto de bloqueo motor-sensitivo y control del dolor, pero sus eventos adversos deben ser considerados en la selección. Las técnicas anestésicas de bloqueo periférico del nervio ciático-femoral presentan menos efectos indeseables que la analgesia espinal y ofrecen un mejor control del dolor postoperatorio.

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BACKGROUND: Surveys of cardiac pacing and implantable cardiovertor defibrillators (ICD) have been reported since 1969 and 1993 respectively. Increasing costs of medical technology, budget constraints and emergent new clinical indications prompted our committee to conduct the first survey of cardiac rhythm management and device implant patterns in Puerto Rico. METHOD: Clinical and demographic data were obtained for all cardiac devices sold and implanted from 2000 to 2006, through a joint agreement with official representatives of the 2 largest manufacturers and distributors of cardiac pacemakers and ICD in Puerto Rico. RESULTS: 13,854 cardiac devices were implanted from 2000 to 2006. The number of permanent pacemakers (PP) implanted per million population has varied from 430 in the year 2000 to 482 in the year 2006. A significant greater number of males received PP than females (P < .05). Yearly increases in implant rates for cardiac resynchronization therapy (CRT) and ICD were observed, mainly due to new emergent clinical indications, appropriate insurance coverage and availability of implanting electrophysiologists. CONCLUSIONS: Sales figures from PP and ICD manufacturers are a reliable system to calculate and analyze changes in cardiac device implant patterns. The rate of 482 PP per million population positions Puerto Rico as the third largest implant market in North and South America. This finding should be useful to insurance health providers since 76% of the implants are performed in patients over 65 years old. In the year 2006, Puerto Rico was the 10th largest implant market in the world with 67 CRT implanted per million population. A significant greater number of CRT and ICD were implanted in males than females. This gender difference has increased in spite of strict requirements to include more females in clinical trials and intensive, educational and awareness efforts conducted among physicians and patients. A summary of the current guidelines and clinical indications is provided to assist the physician in the selection of patients referred for cardiac rhythm management and implant procedures.

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