Safenectomía corta versus larga en el tratamiento de las várices primarias de los miembros inferiores / Short versus long saphenectomy in the treatment primary inferior limb varices

Introducción. El limitar la longitud de la extirpación (stripping) de la vena safena mayor al segmento insuficiente con base en los hallazgos de la ecografía Doppler a color, permite disminuir la morbilidad. Materiales y métodos. Se llevó a cabo un estudio prospectivo y aleatorio de 155 pacientes intervenidos durante 24 meses, de los cuales 74 fueron sometidos a una safenectomía corta y 81 a una safenectomía larga. Las variables evaluadas durante el seguimiento fueron: tipo de anestesia, porcentaje de atención ambulatoria, morbilidad quirúrgica, días de incapacidad temporal y recidivas varicosas. Los síntomas de afectación neurológica ligados a la safenectomía se evaluaron de forma temprana y a largo plazo. Resultados. El 91,6 % de los enfermos fueron intervenidos de forma ambulatoria, con un período de incapacidad temporal menor de tres semanas y 18 % de recidivas. El costo unitario de las intervenciones concertadas con el Sistema Público de Salud fue inferior a USD$ 950. La safenectomía corta tuvo mejores resultados que la larga en casi todos los parámetros estudiados, con menos días de ausencia laboral (18,2 Vs. 22,6; p=0,013), morbilidad (14,9 % Vs. 33,3 %; p=0,036) y secuelas neurológicas a la finalización del estudio (2 % Vs. 11,9 %; p=0,043). Discusión. La safenectomía clásica es una técnica útil, con excelentes resultados clínicos y estéticos, escasas complicaciones y bajo costo. En ausencia de insuficiencia distal del eje safeno, la safenectomía corta es de elección por su menor morbilidad

Background: Limited stripping from the great saphenous vein to the insufficient segment based on the Doppler color echography findings reduces morbidity. Material and methods: A prospective randomized study was conducted on 155 patients who underwent surgery over a 24 months period, of which 74 were subjected to limited saphenectomy and 81 to total saphenectomy. The monitored variables during the followed up were: type of anesthesia, percentage as ambulatory surgery, surgical morbidity, temporary disability days, and recurrent varicose veins. Symptoms of neurological disturbances linked to saphenectomy were evaluated early and also at long term followup. Results: 91.6% were operated on as outpatients, exhibiting shorter period of temporary disability (3 weeks) and 18% recurrence rate. The cost of the actions agreed with the Public Health System interventions tariff, less than $950 USD. The limited saphenectomy procedure appeared better than the total saphenectomy in almost all parameters studied, with fewer days of sick leave (18,2 vs 22,6 p=0.013), morbidity rate (14.9% vs 33.3% p=0.036), and neurological sequelae at completion of the study (2% vs 11.9% p=0.043). Discussion: The classical saphenectomy is a useful technique, with excellent clinical and cosmetic results, few complications and low cost. In the absence of distal saphenous insufficiency axis, the limited saphenectomy appears as the preferred procedure in view of its lower morbidity

Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy: a randomized clinical trial.

BACKGROUND: There is no consensus on the efficacy of postoperative infusion of local anesthetics after radical mastectomy. METHODS: A randomized, double-blind, placebo-controlled, parallel-groups clinical trial was conducted in a tertiary hospital. Eighty consecutive women with operable breast cancer with indications for modified radical mastectomy without breast reconstruction were assigned randomly to receive infusion of levobupivacaine (0.5%) or saline at 2 ml/hour for 48 hours through a wound catheter. Seventy-three women finished the study (intervention group, n = 34; control group, n = 39). During surgery, all patients received 0.25% levobupivacaine (30 ml). RESULTS: The levobupivacaine group reported less pain (p < 0.001) than controls in the postanesthesia care unit (1.6 ± 1.3 versus 6.7 ± 1.8) and on the ward at 24 (0.8 ± 0.9 versus 4.2 ± 1.9) and 48 (0.4 ± 0.7 versus 3.3 ± 2.3) hours. In the postanesthesia care unit, the levobupivacaine group consumed less metamizole (0.4 ± 0.5 versus 0.8 ± 0.4; p < 0.001) and dexketoprofen (0.1 ± 0.3 versus 0.7 ± 0.4; p < 0.001), with differences in paracetamol use being insignificant (0.8 ± 0.4 versus 0.9 ± 0.3; p = 0.140). On the ward, the levobupivacaine group used significantly less paracetamol (0.5 ± 0.7 versus 2.0 ± 2.0; p < 0.001) and metamizole (0.2 ± 0.4 versus 1.2 ± 1.4; p < 0.001), but differences in dexketoprofen were not significant (0.03 ± 0.2 versus 0.2 ± 0.6; p = 0.074). In the postanesthesia care unit, the levobupivacaine and control groups consumed 0 ± 0 and 0.7 ± 1.2 doses of opioids (p = 0.001), respectively. The authors observed no differences in nausea and vomiting at any stage in the postanesthesia care unit (0.2 ± 0.4 versus 0.4 ± 0.5; p = 0.081) or on the ward (0.3 ± 0.5 versus 0.4 ± 0.5; p = 0.563). All participants reported high levels of satisfaction. CONCLUSION: Continuous infusion of local anesthetic reduces pain and analgesic consumption, with high satisfaction, but does not affect rates of nausea and vomiting.