RESUMO

BACKGROUND: Data suggest that preprocedural ultrasound may improve the efficacy of central neuraxial puncture. However, it remains uncertain whether these findings can be extended to various clinical scenarios, including diverse patient populations and the application of real-time ultrasound guidance. Additionally, it is unclear whether ultrasound-guided techniques improve safety and patient-centered outcomes. METHODS: We searched six databases for randomized trials of adult patients undergoing neuraxial puncture, comparing real-time ultrasound, preprocedural ultrasound, and landmark palpation for efficacy, safety and patient-centered outcomes. Our primary outcome was a failed first-attempt neuraxial puncture. After two-person screening and data extraction, meta-analyses were conducted and the Grading of Recommendations Assessment, Development and Evaluation approach was applied to assess the certainty of evidence. RESULTS: Analysis of 71 studies involving 7153 patients, both real-time ultrasound (OR 0.30; 95% credible interval (CrI) 0.15 to 0.58; low certainty) and preprocedural ultrasound (OR 0.33; 95% CrI 0.24 to 0.44; moderate certainty) showed a significant reduction in the risk of a failed first neuraxial puncture. Real-time ultrasound had the best performance for preventing first-attempt failures (low certainty evidence). Although real-time ultrasound was also the leading method for reducing the risk of complete neuraxial puncture failure, the results did not show a statistically significant difference when compared with landmark palpation. Preprocedural ultrasound, however, significantly reduced the odds of complete puncture failure (OR 0.29; 95% CrI 0.11 to 0.61). These ultrasound-guided approaches also contributed to a reduction in certain complications and increased patient satisfaction without any other significant differences in additional outcomes. Trial sequential analysis confirmed that sufficient information was achieved for our primary outcome. CONCLUSIONS: Ultrasound-guided neuraxial puncture improves efficacy, reduces puncture attempts and needle redirections, reduces complication risks, and increases patient satisfaction, with low to moderate certainty of evidence. Despite real-time ultrasound's high ranking, a clear superiority over preprocedural ultrasound is not established. These results could prompt anesthesiologists and other clinicians to reassess their neuraxial puncture techniques.

RESUMO

Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients ( p < 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group ( p < 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.

RESUMO

Abstract Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients (p< 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group (p< 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.

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Resumo Objetivos Este estudo avaliou a intensidade da dor em idosos acometidos por fratura do quadril internados no setor de emergência e submetidos ao Pericapsular Nerve Group (PENG) block no pré-operatório. Ademais, o grau de flexão tolerável do quadril foi avaliado. Métodos Ensaio clínico, prospectivo, aleatorizado e controlado em grupos paralelos. O grupo controle consiste em idosos com fratura do quadril, submetidos à analgesia sistêmica endovenosa padronizada. O grupo intervenção consiste em idosos com fratura do quadril submetidos ao PENG block e analgesia sistêmica padronizada. Os grupos foram avaliados em repouso e durante o movimento pela escala de dor Pain Assessment in Advance Dementia (PAINAD). Aferiram-se intensidade da dor e redução álgica, assim como o grau de flexão tolerável do quadril fraturado. Todos os pacientes foram avaliados previamente à administração de medicação ou bloqueio e aos 45 minutos, 12, 24 e 36 horas pós-medicação ou bloqueio. Resultados No pré-operatório e 24 horas após o PENG block, idosos com fratura do quadril apresentaram redução significativa da dor em repouso ou movimento em comparação com o controle (p< 0,05), com 60% dos pacientes avaliados em repouso, demonstrando a redução álgica desejável de ≥ 50% e apenas 13,3% do grupo controle com redução álgica desejável. Durante o movimento, após o PENG block, 40% demonstraram redução álgica desejada e nenhum paciente do grupo controle apresentou a redução desejada. Verificou-se, também, no grupo intervenção a melhora significativa da flexão tolerável do quadril (p < 0,05). Conclusão O PENG block no pré-operatório de idosos com fratura do quadril, internados no setor de emergência, proporcionou redução significativa da dor em comparação ao grupo controle.

Assuntos

Humanos , Idoso , Idoso de 80 Anos ou mais , Dor , Fraturas do Quadril/cirurgia , Fraturas do Quadril/diagnóstico por imagem , Analgesia , Anestesia por Condução , Bloqueio Nervoso

RESUMO

Background: Comprehensive health care includes the evaluation of satisfaction in patient care and the quality of medical services. High-precision instruments have been used to assess the quality of recovery after anesthesia (QoR), such as the QoR-15 questionnaire, a validated and accurate assessment tool that considers aspects of emotionality, physical and psychological well-being, pain, and autonomy. Objective: To assess QoR in postoperative patients who underwent anesthesia. Material and methods: Observational, descriptive, cross-sectional study, carried out from March to August 2022. 80 patients from 18 to 70 years who underwent an anesthetic procedure and to which the anesthetic quality QoR-15 questionnaire was administered 24 hours after surgery were included. Descriptive statistics were performed according to the Shapiro-Wilk test. For quantitative variables it was used Mann-Whitney U, and for qualitative variables chi-squared; it was considered significant a value of p < 0.05. Results: The 80 patients obtained a QoR-15 score of 122.06 (52-147), and their QoR was considered good. Anesthetic recovery quality in patients undergoing regional anesthetic techniques was excellent in 42.5% and 10% had balanced general anesthesia, p = 0.011. Conclusions: QoR was higher with regional anesthetic techniques. Quality assessment through validated tools allows objective evaluation and monitoring of the care process in medical services.

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Introducción: la atención sanitaria integral incluye la satisfacción en la atención del paciente y la calidad de servicios médicos. Se han empleado instrumentos con alta precisión para evaluar la calidad de recuperación anestésica (CRA), como el cuestionario validado QoR-15, el cual considera aspectos sobre emocionalidad, bienestar físico y psicológico, dolor y autonomía física. Objetivo: evaluar la CRA en pacientes postoperados sometidos a anestesia. Material y métodos: estudio observacional, descriptivo, transversal, realizado de marzo a agosto de 2022. Se incluyeron 80 pacientes de 18 a 70 años sometidos a procedimiento anestésico y a quienes se les aplicó el cuestionario de calidad anestésica QoR-15 a las 24 horas de postoperados. Se empleó estadística descriptiva de acuerdo con la prueba de Shapiro-Wilk. Las variables cuantitativas se analizaron con U de Mann-Whitney y las cualitativas con chi cuadrada; se consideró significativo un valor de p < 0.05. Resultados: los 80 pacientes obtuvieron 122.06 (52-147) puntos en el cuestionario QoR-15 y su CRA se consideró como buena; en los pacientes sometidos a técnicas anestésicas regionales la CRA fue excelente en 42.5% y 10% tuvieron anestesia general balanceada, p = 0.011. Conclusión: la CRA fue mayor con las técnicas anestésicas regionales. La evaluación de la calidad mediante herramientas validadas permite su evaluación objetiva y hacer seguimiento del proceso de atención en los servicios médicos.

Assuntos

Anestesia , Anestésicos , Humanos , Estudos Transversais , Período de Recuperação da Anestesia , Inquéritos e Questionários

Assuntos

Artroplastia de Quadril , Bloqueio Nervoso , Humanos , Anestésicos Locais/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Nervo Femoral , Anestesia Local/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle

RESUMO

ABSTRACT Axillary dissection is a standard surgical procedure for stage III skin and soft tissue tumors and is usually performed under general anesthesia. This study aimed to investigate the feasibility of performing axillary dissection with Serratus muscle plane block plus intravenous sedation. Fifteen patients undergoing axillary dissection were prospectively recruited. The patients were evaluated during their pre-operative anesthetic appointment, during their procedure, and at post-operative days 1 and 30. The blockade was performed superficial to the Serratus muscle at the level of fourth rib. Sedation was performed using propofol, fentanyl, dexmedetomidine, and S-ketamine. None of the patients required conversion to general anesthesia. Surgeons showed a highly positive response when asked about the anesthetic technique, and most of them found the technique "indistinguishable" from general anesthesia. The median (interquartile range) pain scores at rest over all time frames was 0 (0-0). Furthermore, no patients developed nausea, hemodynamic instability, or any complications associated with the technique. The Serratus plane block associated with intravenous sedation proved feasible for axillary lymphadenectomy, however, further clinical trials should evaluate potential advantages compared to other techniques.

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RESUMO A linfadenectomia axilar é um procedimento cirúrgico padrão para tratamento de tumores de pele e partes moles no estádio III e usualmente é realizada sob anestesia geral. A presente serie de casos prospectiva tem por objetivo investigar a viabilidade da realização da linfadenectomia axilar com o uso do bloqueio do plano do músculo serrátil anterior associado a sedação endovenosa. Foram incluídos 15 pacientes no estudo. Os participantes foram recrutados e avaliados durante consulta pré-anestésica ambulatorial, acompanhados durante o dia da cirurgia, no primeiro e no trigésimo dias de pós-operatório. O bloqueio foi realizado anterior ao músculo serrátil anterior ao nível da quarta costela na linha axilar média. A sedação foi realizada com o uso de propofol, fentanil, dexmedetomidina e dextrocetamina. Não houve necessidade de conversão para anestesia geral em nenhum paciente. Os cirurgiões apresentaram resposta altamente positiva quando questionados sobre a técnica anestésica, considerando na maior parte dos casos "indistinguível" da anestesia geral. A mediana (intervalo interquartil) da dor em repouso em todos os momentos avaliados foi 0 (0-0). Além disso, nenhum paciente desenvolveu náuseas, vômitos, instabilidade hemodinâmica ou qualquer complicação relacionada à técnica empregada. O bloqueio do plano do músculo Serrátil anterior associado a sedação venosa se mostrou viável para execução de linfadenectomia axilar, entretanto ensaios clínicos adicionais são necessários para avaliar potenciais vantagens em comparação com outras técnicas.

RESUMO

BACKGROUND AND OBJECTIVES: Inguinal hernia repair is associated with significant postoperative pain. We assessed the analgesia efficacy of unilateral Erector Spinae Plane block (ESP) performed under ultrasound guidance in patients submitted to open unilateral inguinal hernia repair, comparing ESP to spinal anesthesia administered with or without opioid. METHODS: Forty-five patients with ages ranging from 27 to 83 years were randomly allocated into three groups: control group receiving spinal anesthesia (n = 14), ESP group receiving ESP block combined with spinal anesthesia (n = 16), and spinal morphine group receiving spinal anesthesia with morphine 1 mcg.kg-1 as adjuvant drug (n = 15). ESP was performed at the T8 level using 0.5% ropivacaine, 20 mL. We assessed the pain intensity in the initial 24 hours after surgery using the Visual Analogue Scale - VAS and rescue opioid requirement. RESULTS: The ESP group showed four times higher consumption of rescue opioids than the spinal morphine group, or 26.7% vs. 6.2%, respectively (RR = 4.01; 95% CI: 0.82 to 19.42; p = 0.048). The spinal morphine group showed higher incidence of adverse effects than the ESP group, 37.5% vs. 6.7%, respectively (p = 0.039). There were no statistically significant differences among groups for the mean values of VAS score at 24 hours after surgery (p = 0.304). CONCLUSION: At the doses used in this study, the ESP block was an ineffective technique for providing postoperative analgesia in unilateral open inguinal hernioplasty and was associated with higher consumption of rescue opioids when compared to spinal anesthesia with or without opioid.

Assuntos

Hérnia Inguinal , Bloqueio Nervoso , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides , Hérnia Inguinal/cirurgia , Humanos , Pessoa de Meia-Idade , Morfina , Bloqueio Nervoso/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção/métodos

RESUMO

INTRODUCTION: Cervical erector spinae plane block (ESPB) provides postoperative pain relief when administered at the level of first thoracic costotransverse junction (CTJ) for surgeries on the proximal shoulder and cervical spine. We propose to describe the spread of 20 ml radiocontrast - dye solution administered at this level from caudad to cephalad direction in a fresh frozen cadaveric model through imaging and cross-sections. METHODS: An observational study with four thoracic to cervical ESP blocks at the level of first thoracic CTJ level on two fresh cadavers (total 4 specimens) was conducted using 20 ml of radiocontrast- methylene blue combination (10 ml through the needle and 10 ml through the catheter). Both cadavers were subjected to computed tomography (CT) scan. An anatomist and radiologist, respectively, analyzed cross-sections of cadavers and CT contrasted images. RESULTS: The spread was assessed in axial, sagittal, and coronal at the levels of C4, C5, C6, C7and T1. The medial limit was articular processes in both cadavers. The lateral limits were the outer border of the middle scalene muscle in cadaver 1 and posterior to the sternocleidomastoid muscle in cadaver 2. Contrast spread was visualized on the superior and anterior aspect of anterior scalene muscle in cadaver 2. An epidural spread was observed at the level of C5-6 and C6-7 in axial and coronal planes in cadaver 1. CONCLUSIONS: The cervical ESPB administered at the first thoracic CTJ with injections directed cephalad has a consistent action on the dorsal spinal nerves of thoracic and cervical area, and spreads in the paravertebral space dorsal to the ventral cervical roots.

RESUMO

ABSTRACT BACKGROUND AND OBJECTIVES: Total hip replacement surgeries may result in intense postoperative pain. There are many analgesia techniques available in clinical practice and lumbar erector spine plane (LESP) block may be an option of an effective technique with milder adverse effects and easier execution. CASE REPORT: Female patient, 23-year-old, allergic to morphine and tramadol, underwent a total left hip arthroplasty under mild sedation, no opioid spinal anesthesia and ultrasound guided LESP. After the surgery the patient's pain was under control, and methadone rescue analgesia was not used. CONCLUSION: LESP block is easy to perform and may be effective for postoperative analgesia in hip surgeries, with fewer adverse effects than other techniques.

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RESUMO JUSTIFICATIVA E OBJETIVOS: Artroplastia total de quadril pode evoluir com dor pós-operatória intensa. Há várias técnicas disponíveis na prática clínica para analgesia. O bloqueio do plano eretor da espinha lombar (LESP block) pode ser uma opção efetiva, de fácil execução e efeitos adversos mais leves. RELATO DO CASO: Paciente do sexo feminino, 23 anos, alérgica a morfina e tramadol, submetida à artroplastia total de quadril sob sedação leve, anestesia subaracnóidea sem opioides e LESP block guiado por ultrassonografia. Evoluiu com controle de dor efetivo, sem uso de metadona de resgate. CONCLUSÃO: LESP block é fácil de ser executado, pode ser efetivo para analgesia pós-operatória de cirurgias de quadril e apresenta menos efeitos adversos que outras técnicas.

RESUMO

Introduction Cervical erector spinae plane block (ESPB) provides postoperative pain relief when administered at the level of first thoracic costotransverse junction (CTJ) for surgeries on the proximal shoulder and cervical spine. We propose to describe the spread of 20 ml radiocontrast - dye solution administered at this level from caudad to cephalad direction in a fresh frozen cadaveric model through imaging and cross-sections. Methods An observational study with four thoracic to cervical ESP blocks at the level of first thoracic CTJ level on two fresh cadavers (total 4 specimens) was conducted using 20 ml of radiocontrast- methylene blue combination (10 ml through the needle and 10 ml through the catheter). Both cadavers were subjected to computed tomography (CT) scan. An anatomist and radiologist, respectively, analyzed cross-sections of cadavers and CT contrasted images. Results The spread was assessed in axial, sagittal, and coronal at the levels of C4, C5, C6, C7and T1. The medial limit was articular processes in both cadavers. The lateral limits were the outer border of the middle scalene muscle in cadaver 1 and posterior to the sternocleidomastoid muscle in cadaver 2. Contrast spread was visualized on the superior and anterior aspect of anterior scalene muscle in cadaver 2. An epidural spread was observed at the level of C5-6 and C6-7 in axial and coronal planes in cadaver 1. Conclusions The cervical ESPB administered at the first thoracic CTJ with injections directed cephalad has a consistent action on the dorsal spinal nerves of thoracic and cervical area, and spreads in the paravertebral space dorsal to the ventral cervical roots.

Assuntos

Humanos , Anestesia por Condução/métodos , Bloqueio Nervoso , Cadáver , Ultrassonografia , Dissecação

RESUMO

Abstract Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. Conclusion: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

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Resumo Justificativa e objetivos: Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial. Métodos: Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA). Resultados: Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p< 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72vs. 0,02 ± 0,17; p< 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4%vs.0%; p< 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante. Conclusão: A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.

Assuntos

Humanos , Masculino , Feminino , Artroscopia/métodos , Articulação do Ombro/cirurgia , Dexametasona/administração & dosagem , Ultrassonografia de Intervenção/métodos , Bloqueio do Plexo Braquial/métodos , Anti-Inflamatórios/administração & dosagem , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Artroscopia/efeitos adversos , Fatores de Tempo , Vasoconstritores/administração & dosagem , Medição da Dor , Método Duplo-Cego , Estudos Prospectivos , Análise de Variância , Náusea e Vômito Pós-Operatórios/epidemiologia , Solução Salina/administração & dosagem , Levobupivacaína , Analgesia , Anestésicos Locais , Pessoa de Meia-Idade

RESUMO

BACKGROUND AND OBJECTIVES: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. METHODS: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). RESULTS: Seventy-four patients were recruited and 71 completed the study (Group C, n=37; Group D, n=34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440±0 min vs. 1267±164 min, p<0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08±1.72 vs. 0.02±0.17, p <0.001) and a greater number of patients (68.4% vs. 0%, p <0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. CONCLUSION: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

Assuntos

Anti-Inflamatórios/administração & dosagem , Artroscopia/métodos , Bloqueio do Plexo Braquial/métodos , Dexametasona/administração & dosagem , Articulação do Ombro/cirurgia , Ultrassonografia de Intervenção/métodos , Analgesia , Análise de Variância , Anestésicos Locais , Artroscopia/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Levobupivacaína , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Solução Salina/administração & dosagem , Fatores de Tempo , Vasoconstritores/administração & dosagem

RESUMO

Abstract The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology 2014 guideline, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have presented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narrative review, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrombotic drugs, such as: possible technique-associated complications; spinal hematoma-associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.

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Resumo Os padrões evolutivos para a prevenção do tromboembolismo venoso perioperatório e a introdução de medicações antitrombóticas cada vez mais potentes resultaram em preocupações com o aumento do risco de sangramento neuroaxial. Após o consenso da Sociedade Brasileira de Anestesiologia em 2014, novos medicamentos anticoagulantes orais foram aprovados pelas instituições reguladoras internacionais, assim como pela ANVISA. As sociedades que buscam abordar o manejo perioperatório desses fármacos apresentam recomendações conflitantes. Em resposta a essas questões e à necessidade de uma abordagem mais racional, as condutas foram atualizadas nesta revisão narrativa e feitas declarações de consenso. Elas foram projetadas para encorajar a assistência ao paciente de forma segura e de qualidade, mas não podem garantir um resultado específico. Tal como acontece com qualquer recomendação de orientação clínica, estas estão sujeitas a revisão com o conhecimento de avanços específicos de complicações. O objetivo foi avaliar aspectos da segurança em anestesia e analgesia regional em pacientes em uso de medicações antitrombóticas, tais como: possíveis complicações decorrentes da técnica; fatores de risco associados ao hematoma espinhal, estratégias de prevenção, diagnóstico e tratamento; intervalo seguro para suspensão e reinício da medicação após o bloqueio regional.

Assuntos

Humanos , Guias de Prática Clínica como Assunto , Anestesia por Condução/métodos , Anticoagulantes/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Brasil , Fatores de Risco , Assistência Perioperatória/métodos , Tromboembolia Venosa/prevenção & controle , Hemorragia/induzido quimicamente , Anticoagulantes/efeitos adversos

RESUMO

The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology (SBA) 2014 guideline, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have presented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narrative revision, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrombotic drugs, such as: possible technique-associated complications; spinal hematoma-associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.

Assuntos

Anestesia por Condução/métodos , Anticoagulantes/administração & dosagem , Guias de Prática Clínica como Assunto , Anticoagulantes/efeitos adversos , Brasil , Hemorragia/induzido quimicamente , Humanos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Tromboembolia Venosa/prevenção & controle

RESUMO

Resumen Objetivo: Mostrar los resultados y satisfacción en pacientes operados de cirugía de mano con esta técnica. Materiales y métodos: Se trata de una cohorte prospectiva y observacional de pacientes a los cuales se les practicó cirugía de mano. Se usó la combinación de inducción intravenosa con remifentaníl + Propofol, y bloqueo regional con bupivacaina al 0.5 % y lidocaína al 1 %. Se usó la escala de Fast-track y escala de calidad de recuperación posanestésica (CdR) para evaluar la satisfacción del paciente; adicionalmente se evaluó el dolor con EVA a las 6 horas posoperatorias. Resultados: El promedio de tiempo quirúrgico fue de 11.5 minutos y el tiempo de recuperación 14 minutos desde el inicio de la anestesia. Ningún paciente presentó náuseas o vómito, todos cumplieron criterios de Fast track, con buen patrón respiratorio y saturación parcial de oxígeno mayor a 90 % sin oxígeno suplementario. El 95.8 % estuvieron satisfechos con la cirugía y la técnica anestésica. Conclusión: Esta técnica da excelentes resultados en cirugía de mano ambulatoria. La combinación de anestesia endovenosa y de anestesia local permite ir directamente a la sala de cuidados ambulatorios. Desde que iniciamos el uso de esta técnica, hemos tenido una buena satisfacción y de menor dolor e inconformidad de los pacientes. Es una técnica segura y suficiente en pacientes para cirugía de mano ambulatoria.

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Abstract Objective: To show the results and satisfaction in patients undergoing hand surgery with this technique. Materials and methods: This is a prospective and observational cohort of patients who underwent hand surgery. The combination of intravenous induction with remifentaníl + propofol, and regional block with 0.5% bupivacaine and lidocaine 1 % was used. Scale Fast-track and scale for measuring the quality of post-anaesthetic (CdR) for measuring patient satisfaction were used and the pain with EVA at postoperative six hours was evaluated. Results: The average time of surgery was 11.5 minutes, and the time from the onset of anesthesia for recovery was 14 minutes. No patient had nausea or vomiting. All patients had Fast-track critera with good breathing patterns and oxygen partial saturation greater than 90 % without supplemental oxygen. 95.8 % were satisfied with the surgery and anesthetic technique. Conclusions: This technique gives excellent results in outpatient hand surgery. The combination of intravenous anesthesia and local anesthesia can go directly to the ambulatory care unit. Since we started using this technique, we have had high satisfaction and less pain and discomfort for patients. It is a safe and adequate technique for patients who undergo outpatient hand surgery.

RESUMO

The decision to administer general anesthesia is childhood age remains controversial. East the issue has not only generated a high degree of concern in health professionals for Neonates and infants, but also, by the school age, being susceptible to alterations. during the consolidation process of earning and memory, where anesthetics They alter brain functioning, causing alterations in synaptogenesis and neurodegeneration in different areas such as. primary visual cortex, temporal cortices / sensory, the frontal cortex and the hippocampus. This is associated with some factors. of risk as the drugs and / or doses used for the procedure, exposure time, or own conditions of the patient.

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La decisión de administrar anestesia general en la edad infantil sigue siendo controversial. Este tema no solo ha generado un alto grado de preocupación en los profesionales de la salud por los neonatos y lactantes, sino también, por la edad escolar, siendo susceptibles a alteraciones durante el proceso de consolidación del aprendizaje y memoria, donde los anestésicos alteran el funcionamiento cerebral, provocando alteraciónes en la sinaptogénesis y neurodegeneración en diferentes áreas como la corteza visual primaria, cortezas temporales / somato sensoriales, la corteza frontal y el hipocampo . Esto asociado a algunos factores de riesgo como los fármacos y/o dosis utilizadas para el procedimiento, tiempo de exposición, o condiciones propias del paciente.

Assuntos

Anestesia Geral/efeitos adversos , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/prevenção & controle , Anestesia Geral/métodos , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Fatores de Risco

RESUMO

ABSTRACT Introduction: Spinal anesthesia involves the administration of a dose of local anesthesia into the intrathecal space of the lumbar spine, using spinal needles with varying characteristics and design. When completing the administration of spinal anesthesia, you may check the volume of fluid remaining inside the spinal needle. Objective: To measure and compare the volume of residual fluid following the administration of spinal anesthesia using three different brands of 27 gauge spinal needles. Methods: This is an observational analytical cross-section trial for which tree types of 27 gauge commercial needles were selected: BD Whitacre pencil point, Spinocan Quincke sharp point, and Disposable spinal needle. Following the administration of spinal anesthesia, the same operator, without detaching the syringe from the needle, deposited the residual vol ume into a collection tube so that a second operator quantifies the volume using a precision micropipette. Results: The residual volume obtained fromthe27Gspinalneedlesshowed astatistically significant difference in favor of the BD Whitacre needles (P < 0.01), compared against Spinocan Quincke and Disposable spinal needle. Conclusions: The BD Whitacre pencil point proved to lodge less residual volume following spinal anesthesia. No clinical implications can be made from this finding and new studies are required to ratify these results.

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R E S U M E N Introducción: La anestesia raquídea consiste en la aplicación de una dosis de anestésico local en el espacio intratecal de la columna lumbar, por medio de agujas espinales cuyas características varían tanto en calibre como en diseño. Al terminar la aplicación de una anestesia raquídea se puede comprobar un volumen remanente de líquido en el interior de la aguja espinal. Objetivo: Medir y comparar el volumen remanente de líquido posterior a la aplicación de anestesia raquídea en 3 marcas comerciales de agujas espinales de calibre 27. Métodos: Este es un estudio observacional analítico de corte transversal; se escogieron 3 tipos comerciales de agujas de calibre 27: BD Whitacre punta de lápiz, Spinocan Quincke punta cortante y Disposable spinal needle. Tras la aplicación de una anestesia raquídea, el mismo operador, sin desconectar la jeringa de la aguja, depositó el volumen residual en un tubo de recolección, para que un segundo operador cuantificara el volumen con una micropipeta de precisión. Resultados: El volumen residual obtenido de las agujas espinales 27G mostró una diferencia estadísticamente significativa a favor de las agujas BD Whitacre (p<0,01), comparadas con las agujas Spinocan Quincke y Disposable spinal needle. Conclusiones: Se comprobó que las agujas BD Whitacre pencil point alojan un menor volumen residual después de una anestesia espinal. No se puede afirmar que este hallazgo tenga implicaciones clínicas. Son necesarios nuevos estudios para corroborar estos resultados.

Assuntos

Humanos

RESUMO

Abstract Background Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. Methods After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Results Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. Conclusions These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block.

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Resumo Justificativa Os analgésicos orais à base de opioides têm sido usados para o manejo da analgesia nos períodos peri e pós-operatório de pacientes submetidos à linfadenectomia axilar. A região axilar é uma zona difícil de bloquear e não há registro de uma técnica de anestesia regional específica que ofereça o seu bloqueio adequado. Métodos Após a aprovação do Conselho de Ética institucional, estudos anatômicos e radiológicos foram feitos para determinar a deposição e disseminação de azul de metileno e anestésico local, respectivamente injetados na axila via plano interfascial torácico. Exames de ressonância magnética foram então feitos em 15 de 34 pacientes programados para cirurgia de mama unilateral que envolveria qualquer um dos seguintes procedimentos: esvaziamento axilar, biópsia de linfonodo sentinela, biópsia de linfonodo axilar ou mamas supranumerárias, para verificar a deposição e o tempo de propagação da solução dentro do plano interfascial torácico in vivo. Resultados Estudos radiológicos e em cadáveres mostraram que a injeção de anestésico local e azul de metileno via plano interfascial torácico com a técnica guiada por ultrassom resulta em deposição confiável na axila. Nos pacientes, a injeção de anestésico local produziu um bloqueio sensitivo axilar confiável. Esse achado foi corroborado por estudos de ressonância magnética que mostraram sinais hiperintensos na região axilar. Conclusões Esses achados definem as características anatômicas do bloqueio da região axilar e destacam o potencial clínico desses novos bloqueios.

Assuntos

Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacocinética , Bloqueio Nervoso/métodos , Axila , Cadáver , Músculos Intercostais/diagnóstico por imagem , Ultrassonografia , Nervos Intercostais/diagnóstico por imagem , Pessoa de Meia-Idade

RESUMO

BACKGROUND: Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. METHODS: After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. RESULTS: Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. CONCLUSIONS: These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block.

Assuntos

Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacocinética , Bloqueio Nervoso/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Cadáver , Feminino , Humanos , Músculos Intercostais/diagnóstico por imagem , Nervos Intercostais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Adulto Jovem

RESUMO

Introduction: There are significant developmental differences in physiology and pharmacology in neonates that make the conduct of a safe anesthetic much more challenging in a neonate. Objectives: Complete a focused review of the current knowledge of the physiological and pharmacologic differences seen in newborns that impact the safe administration of anesthesia. Methods: A selective review of literature in developmental changes in physiology and pharmacology was completed. Results: This knowledge acquired in the review was used to establish common principles for the safe administration of anesthesia to newborn patients. Conclusion: In spite of the persistence of large gaps in our knowledge in this physiology and pharmacology, common modern anesthetic management principles for neonatal surgery have significantly improved clinical outcomes.

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Introducción: Existen diferencias significativas de desarrollo en la fisiología y la farmacología de los neonatos que hacen que sea mucho más difícil llevar a cabo una anestesia segura. Objetivos: Completar una revisión focalizada del conocimiento actual sobre las diferencias fisiológicas y farmacológicas observadas en recién nacidos que tienen un impacto en la administración segura de la anestesia. Métodos: Se llevó a cabo una revisión selectiva de la literatura sobre cambios en el desarrollo fisiológico y farmacológico. Resultados: El conocimiento adquirido en esta revisión fue usado para establecer principios comunes para la administración segura de la anestesia en pacientes recién nacidos. Conclusión: A pesar de la persistencia de grandes lagunas en nuestro conocimiento en esta fisiología y la farmacología, los principios modernos y comunes del manejo de la anestesia en cirugía neonatal han mejorado significativamente los resultados clínicos.

Assuntos

Humanos