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BACKGROUND: Pediatric regional anesthesia has been driven by the gradual rise in the adoption of opioid-sparing strategies and the growing concern over the possible adverse effects of general anesthetics on neurodevelopment. Nonetheless, performing regional anesthesia studies in a pediatric population is challenging and accounts for the scarce evidence. This study aimed to review the scientific foundation of studies in cadavers to assess regional anesthesia techniques in children. METHODS: We searched the following databases MEDLINE, EMBASE, and Web of Science. We included anatomical cadaver studies assessing peripheral nerve blocks in children. The core data collected from studies were included in tables and comprised block type, block evaluation, results, and conclusion. RESULTS: The search identified 2409 studies, of which, 16 were anatomical studies on the pediatric population. The techniques evaluated were the erector spinae plane block, ilioinguinal/iliohypogastric nerve block, sciatic nerve block, maxillary nerve block, paravertebral block, femoral nerve block, radial nerve block, greater occipital nerve block, infraclavicular brachial plexus block, and infraorbital nerve block. CONCLUSION: Regional anesthesia techniques are commonly performed in children, but the lack of anatomical studies may result in reservations regarding the dispersion and absorption of local anesthetics. Further anatomical research on pediatric regional anesthesia may guide the practice.
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This study assessed the analgesic and motor effects of the GIN-TONIC block, a combination of the greater ischiatic notch plane block and the caudal lateral quadratus lumborum block, in 24 dogs undergoing pelvic limb surgery. Dogs were randomly divided into two equal groups: GA received acepromazine [(20 µg kg-1 intravenously (IV)] as premedication, and GD received dexmedetomidine (2 µg kg-1 IV). General anesthesia was maintained with isoflurane, and both groups received a GIN-TONIC block using 2% lidocaine. Nociception during surgery and postoperative pain [assessed using the Glasgow Composite Measure Pain Score (GCMPS-SF)] were assessed. Fentanyl (2 µg kg-1 IV) was administered if nociception was noted and morphine (0.5 mg kg-1 IV) was administered during recovery if the pain scores exceeded the predefined threshold. Motor function was assessed during the recovery period using descriptors previously reported. All dogs received analgesics at the 4 h mark before being discharged. Three and two dogs in GD and GA required fentanyl once. Postoperative pain scores remained ≤4/20 for all dogs except one. Dogs achieved non-ataxic ambulation within 38.9 ± 10.3 and 35.1 ± 11.1 min after extubation in GD and GA, respectively. This study highlighted the potential of the GIN-TONIC block as a feasible regional anesthesia method for delivering perioperative analgesia in dogs undergoing pelvic limb orthopedic surgery.
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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.
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OBJECTIVE: The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. MATERIALS AND METHODS: This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. RESULTS: One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. CONCLUSION: ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.
OBJETIVO: Evaluar el efecto del bloqueo del plano erector espinal (ESPB) como terapia de rescate en la sala de recuperación. MÉTODO: Este estudio de cohortes histórico de un solo centro incluyó a pacientes que recibieron ESPB o meperidina intravenosa para el tratamiento del dolor en la sala de recuperación. Se evaluaron las puntuaciones de la escala de calificación numérica (NRS) de los pacientes y los consumos de opiáceos. RESULTADOS: En el análisis estadístico se incluyeron 108 pacientes. Recibieron ESPB 62 (57%) pacientes y los otros 46 (43%) fueron manejados solo con bolos de meperidina intravenosa. Las dosis acumuladas de meperidina administradas fueron 0 (0-40) y 30 (10-80) mg para los grupos de ESPB y de meperidina sola, respectivamente (p < 0.001). Las puntuaciones de dolor del grupo ESPB fueron significativamente más bajas que las del grupo de meperidina sola en T30 y T60. CONCLUSIONES: El ESPB reduce la frecuencia de administración de opiáceos y la cantidad de estos administrada en el posoperatorio temprano. Cuando se requiera terapia de rescate posoperatoria, se debe considerar antes que los opiáceos.
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Analgésicos Opioides , Meperidina , Bloqueio Nervoso , Dor Pós-Operatória , Músculos Paraespinais , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Bloqueio Nervoso/métodos , Músculos Paraespinais/inervação , Adulto , Meperidina/administração & dosagem , Meperidina/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Medição da Dor , Idoso , Colecistectomia , Anestésicos Locais/administração & dosagem , Estudos RetrospectivosRESUMO
INTRODUCTION: In an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of this practice are compared with bupivacaine alone. We hypothesized that bupivacaine alone increases the duration of motor block, sensory block, and postoperative analgesia while resulting in a slower onset time compared with a bupivacaine and lidocaine mixture. METHODS: 40 patients receiving ultrasound-guided infraclavicular brachial plexus block were randomly assigned to receive either 35 mL of 0.25% bupivacaine and 1% lidocaine or 0.5% bupivacaine, both associated with perineural adjuvants (epinephrine 5 µg/mL and dexamethasone 4 mg). After the block was performed, a blinded observer evaluated the success of the block, the onset time, and the incidence of surgical anesthesia. Postoperatively, a blinded observer contacted patients who had successful blocks to inquire about the duration of motor block, sensory block, postoperative analgesia, and the presence of rebound pain. RESULTS: When comparing patients having bupivacaine alone versus bupivacaine and lidocaine, the mean (SD) motor block duration was 28.4 (5.2) vs 18.9 (3.1) hours, respectively; the mean difference 9.5 hours (95% CI 6.5 to 12.4; p<0.001); the mean (SD) sensory block duration was 29.3 (5.8) vs 18.7 (4.0) hours, respectively; the mean difference 10.6 hours (95% CI 7.1 to 14.0; p<0.001); the mean (SD) postoperative analgesia duration was 38.3 (7.4) vs 24.3 (6.6) hours, respectively; the mean difference 14 hours (95% CI 9.2 to 18.8; p<0.001); and the median (IQR) onset time was 35 (15) vs 20 (10) min, respectively; p<0.001. No other significant differences were detected. CONCLUSIONS: Compared with mixed bupivacaine-lidocaine, 0.5% bupivacaine significantly prolongs sensorimotor block and postoperative analgesia at the expense of a delayed onset time. TRIAL REGISTRATION NUMBER: NCT05834023.
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Abstract Introduction: Bone cancer metastasis may produce severe and refractory pain. It is often difficult to manage with systemic analgesics. Chemical neurolysis may be an effective alternative in terminally ill patients. Case report: Female terminally ill patient with hip metastasis of gastric cancer in severe pain. Neurolytic ultrasound-guided blocks of the pericapsular nerve group and obturator nerve were performed with 5% phenol. This led to satisfactory pain relief for 10 days, until the patient's death. Discussion: This approach may be effective and safe as an analgesic option for refractory hip pain due to metastasis or pathologic fracture in terminally ill patients.
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Abstract Introduction: Bone cancer metastasis may produce severe and refractory pain. It is often difficult to manage with systemic analgesics. Chemical neurolysis may be an effective alternative in terminally ill patients. Case report: Female terminally ill patient with hip metastasis of gastric cancer in severe pain. Neurolytic ultrasound-guided blocks of the pericapsular nerve group and obturator nerve were performed with 5% phenol. This led to satisfactory pain relief for 10 days, until the patient's death. Discussion: This approach may be effective and safe as an analgesic option for refractory hip pain due to metastasis or pathologic fracture in terminally ill patients.
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Humanos , Feminino , Dor Intratável/etiologia , Dor Intratável/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Neoplasias , Fenóis/farmacologia , Ultrassonografia de Intervenção , Artralgia , Fenol , Nervo Femoral , Analgésicos , Pacientes Internados , Nervo ObturadorRESUMO
Resumen: Introducción: el bloqueo en el plano del músculo erector de la espina (ESPB, por sus siglas en inglés) es un procedimiento seguro, en teoría menos exigente que las técnicas convencionales de anestesia regional torácica. Se utiliza para el tratamiento del dolor agudo y crónico. En la revisión de la literatura, no se encontraron informes de su uso como una técnica única en el dolor agudo de fractura de escápula. Presentación de caso: se reporta un caso clínico de ESPB como técnica experimental para el control del dolor postoperatorio agudo en fracturas de la escápula con aplicación a nivel T2. Se llevó a cabo postoperatorio con disminución de dolor después de 10 minutos de realizado, con una calificación de cero en la escala análoga del dolor. En este caso el ESPB fue realizado en el postoperatorio inmediato, con lo que se logró una disminución total del dolor a los 10 minutos, con posterior control de dolor a las 36 horas. Conclusión: este caso muestra la efectividad de ESPB como técnica experimental para control de dolor postoperatorio en fractura de escápula.
Abstract: Introduction: the erector spine plane block (ESPB) is a safe procedure, technically is less demanding than conventional thoracic regional anesthesia techniques. It is used for the treatment of acute and chronic pain. In the literature review, no reports of its use as a single technique in the acute pain of scapula fracture were found. Case presentation: ESPB is reported in a case as an experimental technique for controlling acute postoperative pain in scapula fractures with an application at the T2 level. It was performed postoperatively with a decrease in pain after 10 minutes and a score of zero on the analog pain scale. In this case, the ESPB was performed in the immediate postoperative period, achieving a total decrease in pain at 10 minutes, with subsequent pain control at 36 hours. Conclusion: this case shows the effectiveness of ESPB as an experimental technique for postoperative pain control in scapula fractures.
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Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.
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Bloqueio Nervoso , Cadáver , Ultrassonografia de Intervenção , AgulhasRESUMO
Abstract An elderly patient was admitted to the hospital due to an enterovesical fistula and a terminal colostomy was proposed. The patient had a high anesthetic risk and thus a quadratus lumborum block was chosen as the sole anesthetic technique. This block has been described to provide both somatic and visceral analgesia to the abdomen. In fact, it yielded good anesthetic conditions to perform the procedure and allowed the patient to be hemodynamically stable and comfortable throughout the case. The postoperative period was uneventful.
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Humanos , Idoso , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Bloqueio Nervoso/métodos , Colostomia/efeitos adversos , Músculos Abdominais , Anestésicos LocaisRESUMO
Introduction: Transversus abdominis plane (TAP) block provides somatic analgesia postoperatively in cesarean sections, however erector spinae plane (ESP) block has shown to provide both somatic and visceral analgesia. Objective: To compare the efficacy of TAP and ESP blocks for pain control after cesarean section under spinal anesthesia. Methods: In a double-blind superiority trial, pregnant patients undergoing cesarean section were randomized into either bilateral TAP or ESP block groups. Primary outcome was total consumption of patient-controlled analgesia (PCA) tramadol in the first 24 hours. Secondary outcomes included time required for first rescue analgesia, post-surgery visual analog score (VAS) for pain, patient satisfaction, and adverse effects. Results: 50 pregnant patients were randomized into TAP and ESP blocks. There was no difference in the amount of PCA tramadol within the first 24 hours between both groups [100mg (63-125) in TAP group vs 75mg (38-100) ESP group]. Pain score at rest and on movement and patient satisfaction were comparable in both groups, with no difference in adverse effects. There was a slight difference in the median time for first rescue analgesia [210min (135-315) in TAP group and 270min (225-405) ESP group] (p=0.03). Conclusions: TAP and ESP blocks provide similar analgesia with comparable consumption of tramadol in the first 24 hours post-cesarean section and no difference in pain scores at rest/on movement.
Introducción: El bloqueo del plano transverso abdominal (TAP - por sus siglas en inglés), ofrece analgesia somática postoperatoria en cesárea; sin embargo, el bloqueo del plano erector de la espina (ESP - por sus siglas en inglés) ha demostrado proporcionar analgesia tanto somática, como visceral. Objetivo: Comparar la eficacia de los bloqueos TAP y ESP para el control del dolor posterior a la cesárea, bajo anestesia raquídea. Métodos: En un estudio de superioridad doble ciego, las pacientes embarazadas sometidas a cesárea se aleatorizaron bien sea al grupo de bloqueo bilateral TAP o ESP? El desenlace principal fue el consumo total de analgesia controlada por la paciente (PCA - por sus siglas en inglés) con tramadol en las primeras 24 horas. Los desenlaces secundarios incluyeron el tiempo transcurrido para la primera analgesia de rescate, el puntaje en la escala visual analógica (EVA) para dolor, la satisfacción del paciente y los efectos adversos. Resultados: 50 pacientes embarazadas se aleatorizaron entre bloqueo TAP y bloqueo ESP. No hubo diferencia en la cantidad de tramadol de la PCA dentro de las primeras 24 horas entre los dos grupos [100mg (63-125) en el grupo TAP vs 75mg (38-100) en el grupo ESP]. El puntaje de dolor en reposo y en movimiento y la satisfacción de la paciente fueron comparables en ambos grupos, sin diferencia en los efectos adversos. Hubo una ligera diferencia en la media de tiempo hasta la primera analgesia de rescate [210 min (135-315) en el grupo de TAP y 270 min (225-405) en el grupo ESP] (p=0,03). Conclusiones: Los bloqueos TAP y ESP ofrecen una analgesia similar, con un consumo comparable de tramadol en las primeras 24 horas posteriores a la cesárea y no hay diferencia en los puntajes de dolor en reposo, o en movimiento.
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PURPOSE: Postoperative complications after major surgery, especially vascular procedures, are associated with a significant increase in costs and mortality. Previous studies evaluating general anesthesia versus regional or neuraxial anesthesia for infrainguinal bypass have produced conflicting results. The main aim of the present study is to review current evidence on the application of regional or general anesthesia in patients undergoing infrainguinal bypass surgery and its potential favorable effects on postoperative outcomes. CONTENTS: Patients undergoing vascular surgery often have multiple comorbidities, and it is important to outline both benefits and risks of regional anesthesia techniques. Neuraxial anesthesia in vascular surgery allows overall avoidance of general anesthesia and does provide short-term benefits beyond analgesia. Previous observational studies suggest that neuraxial anesthesia for lower limb revascularization may reduce morbidity and length of stay. However, evidence of long-term benefits is lacking in most procedures and further work is still warranted. CONCLUSIONS: Neuraxial anesthesia is usually an effective anesthesia technique for infrainguinal bypass surgery. Elderly patients and those with underlying respiratory problems may display some benefit from neuraxial anesthesia. Further evaluation within institutions should be performed to identify which patients would most benefit from regional techniques. Notably, systemic antithrombotic and anticoagulation therapy is common among this population and may affect anesthetic choices.
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BACKGROUND: Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. METHODS: ASA I-III, aged 6 months -to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg-1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. RESULTS: A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). CONCLUSION: Lateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. CLINICAL TRIALS REGISTRY: NCT03969316.
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Resumen: La estenosis carotídea (EC) ocurre en 13% de los pacientes con estenosis valvular aórtica (EVA). El riesgo de evento vascular cerebral (EVC), en los pacientes con EC significativa sometidos a cirugía valvular cardíaca, puede aumentar hasta 11%. Someter a un paciente con EVA crítica y fracción de eyección del ventrículo izquierdo (FEVI) disminuida a endarterectomía carotídea es todo un reto anestésico, cuyo principal objetivo es evitar la hipotensión y el bajo gasto cardíaco. La anestesia regional es una opción para estos pacientes. Presentamos el caso de un hombre de 70 años con diagnóstico de EC significativa y EVA crítica con disfunción ventricular izquierda, al que se realizó endarterectomía carotídea con bloqueo del plexo cervical superficial por alto riesgo de colapso circulatorio. Dicha estrategia anestésica permitió mantener al paciente despierto durante la cirugía, al valorar continuamente su estado neurológico. Asimismo, se documentaron los cambios transoperatorios en el NIRS (Near-infrared spectroscopy) cerebral y Doppler transcraneal (DTC), los cuales se correlacionaron con el estado clínico del paciente. En un segundo tiempo se hizo cambio valvular aórtico sin complicaciones. En este caso destaca la importancia de la anestesia regional y el monitoreo neurológico con Doppler transcraneal, en pacientes sometidos a endarterectomía carotídea con alto riesgo quirúrgico por EVA crítica.
Abstract: Carotid stenosis occurs in 13% of patients with aortic valve stenosis. The risk of stroke in patients with significant carotid stenosis undergoing heart valve surgery may increase to 11%. Proposing a patient with critical aortic valve stenosis and left ventricular dysfunction to carotid endarterectomy is an anesthetic challenge, where the objective is to avoid hypotension and low cardiac output. Regional anesthesia is an option for these patients. Due to the high incidence of intraoperative stroke during carotid endarterectomy, continuous neurological monitoring is of relevance. We present the case of a 70-year-old man diagnosed with significant carotid stenosis and critical aortic valve stenosis and left ventricular dysfunction who underwent carotid endarterectomy with superficial cervical plexus block due to a high risk of circulatory collapse. In addition, this anesthetic strategy made it possible to keep the patient awake during surgery, and to continuously assess their neurological status. Likewise, transoperative changes in brain NIRS and transcranial Doppler were documented, which correlated with the patient's clinical status. In a second time, aortic valve replacement was performed without complications. This case highlights the importance of regional anesthesia and neurological monitoring in patients undergoing carotid endarterectomy with high surgical risk due to critical aortic valve stenosis.
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In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.
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Analgesia , Bloqueio do Plexo Braquial , Humanos , Ropivacaina , Anestésicos Locais , Ombro/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Bloqueio do Plexo Braquial/métodos , Catéteres , Ultrassonografia de Intervenção/métodosRESUMO
BACKGROUND: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach â TAPP). METHODS: Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. RESULTS: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). CONCLUSION: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. REGISTER NUMBER: NCT05199922.
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Hérnia Inguinal , Laparoscopia , Bloqueio Nervoso , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Hérnia Inguinal/cirurgia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , BupivacaínaRESUMO
Introduction: The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. Methods: Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. Results: 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. Conclusion: In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.
Introducción: La aplicación de la recuperación acelerada en cirugía de hombro no ha tenido una aceptación tan favorable. Por ello, el objetivo de este estudio fue presentar y describir el uso de bloqueo interescalénico para favorecer la recuperación acelerada en una serie de pacientes sometidos a cirugía artroscopica de hombro. Métodos: Se incluyeron 35 pacientes sometidos a cirugía artroscópica de hombro, en quienes se administró bloqueo interescalénico y sedación. Posteriormente se evaluó la intensidad del dolor, náuseas, vómito, disnea, presencia de síndrome de Horner, visión borrosa, ronquera, tiempo transcurrido hasta el alta, reingresos no planeados, satisfacción del paciente y cumplimiento de los criterios de alta hospitalaria en las primeras 12 horas siguiendo los criterios de una recuperación acelerada. Resultados: En total, 27 pacientes (77,1%) tuvieron clasificación de la (ASA) I y 8 pacientes (22,9%) ASA II. Además, 97,1% fueron reparaciones de manguito rotador. Previo al alta, dos pacientes (5,7%) presentaron náuseas. Al momento del alta ningún paciente presentó disnea o visión borrosa, dos pacientes (5,7%) presentaron ronquera y la mediana de intensidad del dolor fue de 1,0 (0,0 a 7,0). Entre las 24 y 48 horas solo un (2,8%) paciente presentó náuseas y la mediana de intensidad del dolor fue de 1,0 (0,0 a 8,0). Todos los pacientes se mostraron satisfechos con disposición a repetir la experiencia. El 100% de pacientes cumplió los criterios médicos de alta a las 12 horas y 30 pacientes (85,7%) se dieron de alta el mismo día. La estancia fue de 12 (11,5 a 12,5) horas y ningún paciente reingresó. Conclusión: En pacientes seleccionados, con un equipo quirúrgico-anestésico comprometido, capacitado y con experiencia, hay una alta posibilidad de que el bloqueo interescalénico favorezca la realización de programas de recuperación acelerada en cirugía artroscópica de hombro.
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Bloqueio do Plexo Braquial , Ombro , Humanos , Ombro/cirurgia , Rouquidão , Dor Pós-Operatória , NáuseaRESUMO
Abstract Background and objectives: Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: (‟regional anesthesia" OR ‟nerve block") AND (‟complications" OR ‟nerve lesion" OR ‟nerve damage" OR ‟nerve injury"). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed. Results: Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000. Conclusion: Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.
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Humanos , Anestesia por Condução/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Estados Unidos , Estresse FinanceiroRESUMO
Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.