Posthemithyroidectomy hypothyroidism. Prevalence and predictive markers. Comparison between patients with euthyroid and hyperthyroid nodular goitre.

BACKGROUND AND OBJECTIVE: Posthemithyroidectomy hypothyroidism (PHH) is a relatively common complication (22%-30%) for which we have no published information from our country. The objective of the study is to determine the prevalence of PHH and evaluate its predictive markers by comparing patients who had euthyroidism with those who had hyperthyroidism before hemithyroidectomy. PATIENTS AND METHOD: Retrospective observational cross-sectional study on 106 patients, 88 euthyroid before hemithyroidectomy and 18 hyperthyroid. RESULTS: Prevalence of PHH in euthyroid patients 42% (89.2% subclinical hypothyroidism; 10.8% manifest hypothyroidism) and in hyperthyroid patients 50% (77.8% subclinical hypothyroidism; 22.2% manifest hypothyroidism). Predictive markers in euthyroid patients: preoperative thyrotropin ≥ 2.2 mIU/L (OR: 4.278, 95% CI: 1.689-10.833; sensitivity: 54.1%, 95% CI: 38%-70.1%; specificity: 78.4%, 95% CI: 67.1%-89.7%), age ≥50 years (OR: 3.509, 95% CI: 1.438-8.563; sensitivity: 64.9%, 95% CI: 49.5%-80.3%; specificity: 64.7%, 95% CI: 51.6%-77.8%) and percentage of remainder lobe ≤ 19.6% (OR: 1.024, 95%: 1.002-1.046; sensitivity: 70.2%, 95% CI: 55.5%-84.9%; specificity: 48.6%, 95% CI: 34.9%-62.3%). Predictive marker in hyperthyroid patients: weight >70 kg (OR: 28, 95% CI: 2.067-379.247; sensitivity: 88.9%, 95% CI: 68.4%-100%; specificity: 88.9%, 95% CI: 68.4%-100%). CONCLUSIONS: This is the first study in our country that demonstrates a prevalence of PHH above the average in euthyroid patients, which is slightly higher and more intense in hyperthyroid patients, and that recognizes the classic predictive markers in euthyroid patients but highlights a novel predictive marker marker in hyperthyroid patients, useful to assess a different risk of PHH when indicating hemithyroidectomy and to establish closer control of postoperative hormonal evolution.

National survey on perioperative cognitive dysfunction.

BACKGROUND: Perioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population.The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity. MATERIAL AND METHODS: Prospective online survey conducted by the Neurosciences Section and distributed by SEDAR. RESULTS: 544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed. CONCLUSIONS: Among Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.

Strategy for the management of acute postoperative pain in day surgery centres in Spain. DUCMA 2.0. project.

INTRODUCTION: Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain. METHODS: A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country. RESULTS: We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs. CONCLUSIONS: The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery.

Crioterapia Intracanal para la Reducción Térmica de la Superficie Radicular Externa. Estudio in vitro

La aplicación de crioterapia en endodoncia consta de la irrigación con solución salina a temperaturas bajas con la finalidad de reducir el dolor post-operatorio en un tratamiento de conducto radicular. El objetivo de este estudio fue comparar la reducción térmica de la superficie radicular externa a través de la crioterapia intracanal según temperatura y tiempo. Materiales y métodos: Se realizó su limpieza y desinfección con hipoclorito de sodio (NaOCl) al 4 %, se procedió con apertura cameral, preparación biomecánica e irrigación final con hipoclorito de sodio (NaOCl) al 2,5 % y EDTA 17 % activándolo manualmente con un cono de gutapercha Nº 40 a 100 ciclos en 1 minuto. Se dividieron los treinta premolares monorradiculares en 3 intervenciones de irrigaciones diferentes usando solución salina a temperatura ambiente para el grupo control (GC), solución salina a temperatura 1.5 C° para el grupo 1 (G1), y solución salina a temperatura 4 C° para el grupo 2 (G2) con registro de temperatura a los 0, 1, 2 y 3 minutos post irrigación final. Resultados: Se encontró reducción térmica significativa en la superficie radicular externa de todos los grupos comparados en los diferentes tiempos y temperaturas criogénicas.

The application of cryotherapy in endodontics consists of irrigation with saline solution at low temperatures with the aim of reducing post-operative pain in root canal treatment. The objective of this study was to compare the thermal reduction of the external root surface through intracanal cryotherapy according to temperature and time. Materials and methods: Cleaning and disinfection was carried out with 4 % sodium hypochlorite (NaOCl), proceeded with chamber opening, biomechanical preparation and final irrigation with 2.5 % sodium hypochlorite (NaOCl) and 17 % EDTA, activating it manually with a gutta-percha cone No. 40 to 100 cycles in 1 minute. The thirty single-root premolars were divided into 3 different irrigation interventions using saline solution at room temperature for the control group (CG), saline solution at a temperature of 1.5 C° for group 1 (G1), and saline solution at a temperature of 4 C° for group 2 (G2) with temperature recording at 0, 1, 2 and 3 minutes after final irrigation. Results: Significant thermal reduction was found in the external root surface of all groups compared at different cryogenic times and temperatures.

Use of cannabinoids for acute postoperative pain.

Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases.The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain. The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions.Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.

Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study.

INTRODUCTION: It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC). The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report. METHODS: Observational and prospective cohort study. The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI). RESULTS: The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively. The combination of sources improved CCI agreement by 8%-40% in the overall series and 39.1-89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %-67.5% in operations of greater complexity. The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively. CONCLUSIONS: The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.

Efectividad de la anestesia subaracnoidea con morfina como tratamiento del dolor postoperatorio en cesárea

Fundamento el dolor postoperatorio se considera un dolor con limitaciones de tiempo, a menudo mal controlado. Su manejo representa un gran desafío, ya que la analgesia postoperatoria debe brindar a la madre un control adecuado de este, y a su vez facilitar la atención del bebé. Objetivo evaluar la efectividad de la anestesia subaracnoidea con morfina como tratamiento del dolor postoperatorio en cesárea. Métodos estudio descriptivo y transversal, realizado en el Hospital General Docente Martín Chang Puga, del municipio de Nuevitas, provincia de Camagüey, entre enero de 2021 y diciembre de 2022. La muestra estuvo conformada por 36 pacientes a las cuales se aplicó anestesia subaracnoidea con lidocaína hiperbárica más morfina para la cesárea. Resultados predominó la edad comprendida entre 27-31 años. El 63,9 % de las cesareadas no refirió dolor postoperatorio. Casi la mitad de la población (47,2 %) estudiada presentó efectos secundarios con el uso de la morfina intratecal, principalmente el prurito. El 80,5 % expresó satisfacción con la analgesia postoperatoria. Conclusiones la mayoría de las pacientes encontraron satisfacción con el tratamiento analgésico, a pesar la presencia de efectos adversos, de modo que el uso de morfina intratecal es efectivo en el manejo del dolor poscesárea.

Foundation Postoperative pain is considered time-limited pain, often poorly controlled. Its management represents a great challenge, since postoperative analgesia must provide the mother with adequate control, and at the same time facilitate care for the baby. Objective to evaluate the effectiveness of subarachnoid anesthesia with morphine as a treatment for postoperative pain in cesarean section. Methods descriptive and cross-sectional study carried out at the Martín Chang Puga General Teaching Hospital, in the Nuevitas municipality, Camagüey province, between January 2021 and December 2022. 36 patients to whom subarachnoid anesthesia was applied with Hyperbaric lidocaine plus morphine for cesarean section were considered as the sample. Results the age between 27-31 years predominated. 63.9% of cesarean patients did not report postoperative pain. Almost half of the population (47.2%) studied presented side effects with the use of intrathecal morphine, mainly pruritus. 80.5% expressed satisfaction with postoperative analgesia. Conclusions the majority of patients were satisfied with the analgesic treatment, despite the presence of adverse effects, so that the use of intrathecal morphine is effective in the management of post-cesarean section pain.

Executive summary of the consensus document on the management of perioperative anemia in Spain.

Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 8 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from "strongly disagree [1]" to "strongly agree [5]". For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.

Chronic pain after breast surgery: incidence, risk factors and impact on quality of life.

INTRODUCTION AND OBJECTIVES: Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL). MATERIALS AND METHODS: Six-month observational prospective study conducted in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module. RESULTS: A total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, and almost all with potentially neuropathic pain. CPBS interfered with patients' daily life and reduced their QoL. Diabetes (p = 0.028), catastrophizing (p = 0.042), and acute postoperative pain severity (p < 0.001) were associated with CPBS. CONCLUSIONS: This study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information.

Relationships between sleep, quality of life and anxiety in patients undergoing cardiac surgeries / Relaciones entre sueño, calidad de vida y ansiedad en pacientes sometidos a cirugías cardíacas / Relações entre sono, qualidade de vida e ansiedade em pacientes sujeitos a cirurgias cardíacas

Objective: the objective of this study is to examine the relationships between sleep, quality of life and anxiety in patients undergoing cardiac surgeries during the preoperative period, at discharge, two weeks after discharge and three months after discharge. Method: this study had a prospective, descriptive and correlational design and was conducted in a single center. The sample consisted of 68 patients who had undergone cardiac surgeries. The data were collected using an Information Form, the State-Trait Anxiety Inventory, the Richard-Campbell Sleep Questionnaire and the Nottingham Health Profile. Results: the patients' sleep quality increased from moderate to good at each measurement moment after the surgeries, when compared to sleep quality measured at their first hospitalization. While the state anxiety scores decreased at discharge and 2 weeks after the initial hospitalization, they increased to a moderate level 3 months after discharge. There was no significant relationship between anxiety levels and sleep quality at any measurement moment. Additionally, the patients' quality of life was significantly improved 2 weeks and 3 months after discharge. Conclusion: The results of this study showed that the sleep quality of patients who had undergone cardiac surgeries was improved during the postoperative period, and that this improvement exerted a positive effect on their quality of life.

Objetivo: el objetivo de este estudio es examinar las relaciones entre el sueño, la calidad de vida y la ansiedad en pacientes sometidos a cirugías cardíacas durante el período preoperatorio, al momento del alta hospitalaria, y dos semanas y tres meses después del alta. Método: este estudio tuvo un diseño prospectivo, descriptivo y correlacional y se realizó en un único centro. La muestra estuvo compuesta por 68 pacientes que habían sido sometidos a cirugías cardíacas. Los datos se recolectaron por medio de un Formulario de Información y a través de los siguientes instrumentos: State-Trait Anxiety Inventory , Richard-Campbell Sleep Questionnaire y Nottingham Health Profile . Resultados: la calidad del sueño de los pacientes mejoró de moderada a buena en cada medición después de las cirugías, en comparación con la evaluada al momento de la primera internación. Si bien las puntuaciones de ansiedad rasgo disminuyeron al momento del alta hospitalaria y 2 semanas después de la internación inicial, aumentaron al nivel moderado 3 meses después del alta. No se registró ninguna relación significativa entre niveles de ansiedad y calidad del sueño en ninguna de las mediciones. Además, la calidad de vida de los pacientes mejoró significativamente 2 semanas y 3 meses después del alta hospitalaria. Conclusión: los resultados de este estudio demostraron que la calidad de sueño de los pacientes sometidos a cirugías cardíacas mejoró durante el período postoperatorio, además de que esta mejora ejerció un efecto positivo sobre su calidad de vida.

Objetivo: o objetivo deste estudo é examinar as relações entre sono, qualidade de vida e ansiedade em pacientes sujeitos a cirurgias cardíacas durante o período pré-operatório, na alta, duas semanas após a alta e três meses após a alta. Método: este estudo teve um projeto prospectivo, descritivo e correlacional e foi realizado em um único centro. A amostra foi composta por 68 pacientes sujeitos a cirurgias cardíacas. Os dados foram coletados por meio de um Formulário de Informações, do State-Trait Anxiety Inventory , do Richard-Campbell Sleep Questionnaire e do Nottingham Health Profile . Resultados: a qualidade de sono dos pacientes aumentou de moderada para boa em cada momento de medição após as cirurgias, quando comparada à qualidade de sono medida em sua primeira internação. Embora a pontuação de ansiedade-estado tenha diminuído na alta e duas semanas após a internação inicial, ela aumentou para um nível moderado três meses após a alta. Não houve relação significativa entre os níveis de ansiedade e a qualidade do sono em nenhum momento de medição. Além disso, a qualidade de vida dos pacientes melhorou significativamente duas semanas e três meses após a alta. Conclusão: os resultados desse estudo mostraram que a qualidade de sono dos pacientes sujeitos a cirurgias cardíacas melhorou durante o período pós-operatório, e que essa melhora exerceu um efeito positivo em sua qualidade de vida.

Medicines for managing lower pain in patients with failed back surgery syndrome treated with neuromodulation / Medicamentos para manejo da dor em pacientes com síndrome da falha da cirurgia na coluna tratados com neuromodulação / Medicamentos para el manejo del dolor en pacientes con síndrome de cirugía fallida de columna tratados con neuromodulación

ABSTRACT: Objective: To compare the use of drugs to control low back pain in the pre- and postoperative periods among patients with Failed Back Surgery Syndrome (FBSS) undergoing neuromodulation. Methods: Retrospective observational study analyzing the medical records of patients with FBSS who underwent neuromodulation, followed up in an outpatient clinic from 2018 to 2020. The characteristics of the patients were evaluated: the use of medications, quality of life through the results of the Short Form 36 Health Survey Questionnaire (SF-36), and functional capacity using the Oswestry Disability Index (ODI) in the pre-surgical and post-surgical periods (06 months, 01 year). The criterion for establishing statistical significance was p≤0.05. Results: 56 patients were evaluated. There was a reduction in the use of pain control drugs after the institution of neuromodulation, including in the opioid class (d=0.81). An improvement was also observed in the ODI scores (p<0.001) and all the SF-36 domains (p<0.02) in the postoperative periods investigated. Conclusion: The data suggest that neuromodulation positively impacted back pain by reducing medication use and improving functional capacity and quality of life. Level of Evidence IV; Retrospective, Observational Study.

RESUMO: Objetivo: Comparar o uso de medicamentos para o controle da dor lombar nos períodos pré e pós-operatórios entre pacientes com Síndrome da Falha da Cirurgia na Coluna (FBSS) submetidos à neuromodulação. Métodos: Estudo observacional retrospectivo de análise de prontuários dos pacientes com FBSS submetidos à neuromodulação, acompanhados ambulatorialmente no período de 2018 a 2020. Foram avaliadas as características dos pacientes; o uso de medicamentos; a qualidade de vida através dos resultados do Questionário Short Form 36 Health Survey Questionnaire (SF- 36) e a capacidade funcional utilizando o Oswestry Disability Index (ODI) nos períodos pré-cirúrgico e pós-cirúrgicos (06 meses, 01 ano). O critério para estabelecer significância estatística foi valores de p≤0,05. Resultados: Foram avaliados 56 pacientes. Verificou-se redução do uso de medicamentos para o controle da dor após a instituição da neuromodulação, inclusive na classe dos opioides (d=0,81). Observou-se ainda melhora nos escores do ODI (p<0,001) e de todos os domínios do SF-36 (p<0,02) nos períodos pós-operatórios investigados. Conclusão: Os dados sugerem que a neuromodulação teve impacto positivo na dor de coluna em termos de redução no uso de medicamentos, melhora da capacidade funcional e da qualidade de vida. Nível de Evidência IV; Estudo Retrospectivo, Observacional.

RESUMEN: Objetivo: Comparar el uso de fármacos para el control de la lumbalgia en el pre y posoperatorio en pacientes con Síndrome de Cirugía Fallida de Columna (FBSS) sometidos a neuromodulación. Métodos: Estudio observacional retrospectivo analizando las historias clínicas de pacientes con FBSS que se sometieron a neuromodulación, seguidos en consulta externa de 2018 a 2020. Se evaluaron las características de los pacientes; el uso de medicamentos; calidad de vida a través de los resultados del Cuestionario Short Form 36 Health Survey Questionnaire (SF-36) y la capacidad funcional mediante el Oswestry Disability Index (ODI) en los períodos prequirúrgico y posquirúrgico (06 meses, 01 año). El criterio para establecer la significación estadística fue p≤0,05. Resultados: se evaluaron 56 pacientes. Hubo una reducción en el uso de medicamentos para el control del dolor después de la institución de la neuromodulación, incluso en la clase de opioides (d = 0,81). También se observó una mejora en las puntuaciones del ODI (p<0,001) y en todos los dominios del SF-36 (p<0,02) en los períodos postoperatorios investigados. Conclusión: Los datos sugieren que la neuromodulación tuvo un impacto positivo en el dolor de espalda en términos de reducción del uso de medicamentos, mejorando la capacidad funcional y la calidad de vida. Nivel de Evidencia IV; Estudio Retrospectivo, Observacional.

A Structured Pre- and Post-Operative Voice Therapy Program for Benign Vocal Fold Lesions

Benign vocal fold lesions (BVFLs) are acquired structural anomalies of the vocal folds, and these are primarily a result of vocal abuse or phonotrauma. Phonotraumatic lesions are not generally regarded as recurrent, provided that appropriate behavioral changes are made after resolution or surgical removal. Voice therapy plays a crucial role in this aspect. The aim of this article is to propose a structured pre- and post-operative voice therapy program for patients undergoing surgical intervention for BVFLs. Voice therapy post-surgery has been proven to reduce the rate of recurrence in BVFLs. Having a standard treatment protocol is a useful tool for the therapist, particularly one without extensive voice training.

Las lesiones benignas de los pliegues vocales (LBPV) son anomalías estructurales adquiridas de los pliegues vocales, y son principalmente el resultado de un abuso vocal o fonotrauma. Las lesiones fonotraumáticas generalmente no se consideran recurrentes, siempre que se realicen cambios apropiados en el comportamiento después de la resolución o la excisión quirúrgica. La terapia vocal juega un papel crucial en este aspecto. El objetivo de este artículo es proponer un programa estructurado de terapia de voz pre y postoperatorio para pacientes que son expuestos a una intervención quirúrgica para LBPV. Se ha demostrado que la terapia de voz después de la cirugía reduce la tasa de recurrencia en LBPV. Tener un protocolo de tratamiento estándar es una herramienta útil para el terapeuta, particularmente uno sin un entrenamiento extenso en patología de la voz.

Morfina/ketamina versus morfina en el control del dolor postoperatorio de cirugía renal electiva / Morphine/ketamine versus morphine in postoperative pain control for elective renal surgery

Resumen: Introducción: el dolor agudo postoperatorio demora la recuperación funcional del paciente. Objetivo: evaluar utilidad de la ketamina asociada a morfina administrados en bolos intravenosos en el control del dolor agudo postoperatorio de pacientes sometidos a cirugía renal electiva. Material y métodos: realizamos estudio doble ciego en pacientes con dolor postoperatorio moderado-severo sometidos a cirugía renal electiva. Se conformaron dos grupos: grupo MK administramos morfina 0.05 mg/kg más ketamina 0.2 mg/kg y grupo M morfina 0.05 mg/kg más solución salina a 0.9%. Pacientes con dolor de intensidad moderada-severa según escala analógica visual recibieron dosis de morfina cada 20 minutos hasta lograr dolor ligero, registrándose el consumo total de morfina por paciente. La tensión arterial, frecuencia cardíaca y respiratoria, saturación de oxígeno y efectos adversos fueron evaluados con la misma periodicidad. Resultados: el grupo MK mostró menor intensidad del dolor con disminución significativa del consumo de morfina. Ambos grupos resultaron ser similares en cuanto a cifras de tensión arterial, frecuencia cardíaca, frecuencia respiratoria y saturación de oxígeno. Las náuseas y vómitos fueron los efectos adversos de mayor prevalencia, siendo superiores en el grupo morfina. Conclusiones: la asociación morfina-ketamina resultó útil en el control del dolor moderado-severo en pacientes sometidos a cirugía renal electiva.

Abstract: Introduction: acute postoperative pain delays the patient's functional recovery. Objective: to evaluate the utility of ketamine associated with morphine administered in intravenous boluses in the control of acute postoperative pain in patients undergoing elective renal surgery. Material and methods: we conducted a double-blind study in patients with moderate-severe postoperative pain undergoing elective renal surgery. Two groups were formed: group MK administered 0.05 mg/kg morphine plus 0.2 mg/kg ketamine and group M 0.05 mg/kg morphine plus 0.9% saline solution. Patients with pain of moderate-severe intensity according to the visual analogue scale received doses of morphine every 20 minutes until achieving light pain, recording the total consumption of morphine per patient. Blood pressure, heart and respiratory rates, oxygen saturation, and adverse effects were evaluated with the same periodicity. Results: MK group showed lower pain intensity with a significant decrease in morphine consumption. Both groups turned out to be similar in terms of blood pressure, heart rate, respiratory rate and oxygen saturation Figures. Nausea and vomiting were the most prevalent adverse effects, being higher in the morphine group. Conclusions: the morphine-ketamine association was useful in the control of moderate-severe pain in patients undergoing elective renal surgery.

Lidocaína en infusión transoperatoria para control de dolor: un estudio aleatorizado / Intraoperative intravenous lidocaine pain control: a randomized study

Resumen: Introducción: contar con una analgesia efectiva en el postoperatorio es fundamental para evitar complicaciones asociadas a dolor, en pacientes sometidos a colecistectomía laparoscópica. Objetivos: evaluar la efectividad de la lidocaína en infusión transoperatoria para el control de dolor postoperatorio en pacientes sometidos a colecistectomía laparoscópica. Material y métodos: se realizó un estudio experimental, aleatorizado, ciego simple, en pacientes sometidos a colecistectomía laparoscópica en el Hospital General Regional No. 1 en Obregón. Se dividieron en dos grupos de forma aleatoria, al grupo L se le aplicó lidocaína 1.5 mg/k en infusión, al grupo P se le aplicó placebo. Se realizó un análisis estadístico en SPSS v. 22 y se consideró significativa una p < 0.05. Resultados: se observó un adecuado manejo del dolor en los pacientes del grupo L a su ingreso a la Unidad de Recuperación Postanestésica (URPA) (p = 0.002), menor consumo de fentanyl transoperatorio sin diferencia estadística contra placebo (p = 0.086), menor uso de analgesia de rescate postquirúrgica (p = 0.045). Conclusiones: la infusión de lidocaína es efectiva para el manejo del dolor postquirúrgico inmediato, así como disminución de consumo de opioides y dosis de rescate analgésico, con una baja incidencia de náuseas y vómito, pero se asoció a hipotensión transoperatoria.

Abstract: Introduction: having an effective analgesia in the postoperative period is essential to avoid complications associated with pain in patients undergoing laparoscopic cholecystectomy. Objectives: test the effectiveness of intravenous lidocaine for postoperative pain in cholecystectomized patients by laparoscopy. Material and methods: an experimental, randomized, single-blind study was carried out in patients who underwent laparoscopic cholecystectomy at the No. 1 Regional General Hospital in Obregon, Sonora. They were divided into two groups randomly: group L to whom we applied lidocaine 1.5 mg/k in infusion and group P to whom placebo was applied. A statistical analysis was performed in SPSS v. 22 and a p < 0.05 was considered significant. Results: adequate pain management was observed in patients of group L upon admission to PACU (p = 0.002), lower consumption of transoperative fentanyl without statistical difference against placebo (p = 0.086), lower use of post-surgical rescue analgesia (p = 0.045), but higher incidence of adverse effects such as hypotension and bradycardia (p = 0.024). Conclusions: the infusion of lidocaine is effective for the management of immediate postsurgical pain; as well it decreases opioid consumption and analgesic rescue dose, with a low incidence of nausea and vomiting, but associated with hypotension after surgery.

Bloqueo del músculo erector de la espina como rescate analgésico para control de dolor agudo postoperatorio en fractura de escápula: reporte de caso / Erector spinae plane block as an analgesic rescue to acute control postoperative pain in scapula fracture: case report

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.

The effect of pre-operative sleep quality on post-operative pain and emergence agitation: prospective and cohort study.

OBJECTIVE: Our study aimed to investigate the effect of pre-operative sleep quality on post-operative pain and emergence agitation. MATERIALS AND METHODS: Our study was performed 80 patients with American Society of Anesthesiologists I-II and 18-65 years of age. The patients were divided into poor (Group A, n = 40) and good sleep quality (Group B, n = 40). All patients were operated on under standard general anesthesia. The emergence agitation and pain status of all groups were evaluated in the recovery room and post-operative period. RESULTS: There was no significant difference between the groups regarding demographic data. Post-operative numeric rating scale scores and analgesic consumption were significantly higher in Group A than in Group B (p < 0.05). There was no significant difference between the groups regarding post-operative emergence agitation and extubation quality (p > 0.05). CONCLUSION: In our study, poor pre-operative sleep quality increases post-operative pain and analgesic consumption; however, emergence agitation is not associated with sleep quality in the pre-operative period.

OBJETIVO: Nuestro estudio tuvo como objetivo investigar el efecto de la calidad del sueño preoperatorio sobre el dolor posoperatorio y la agitación de emergencia. MATERIALES Y MÉTODOS: Nuestro estudio se realizó en 80 pacientes con ASA I-II y de 18 a 65 años de edad. Los pacientes se dividieron en mala (grupo A, n = 40) y buena calidad del sueño (grupo B, n = 40). Todos los pacientes fueron operados bajo anestesia general estándar. La agitación de emergencia y el estado del dolor de todos los grupos se evaluaron en la sala de recuperación y en el período postoperatorio. RESULTADOS: No hubo diferencia significativa entre los grupos con respecto a los datos demográficos. Las puntuaciones NRS postoperatorias y el consumo de analgésicos fueron significativamente más altos en el Grupo A que en el Grupo B (p < 0.05). No hubo diferencia significativa entre los grupos con respecto a la agitación de emergencia postoperatoria y la calidad de la extubación (p > 0.05). CONCLUSIÓN: En nuestro estudio, la mala calidad del sueño preoperatorio aumenta el dolor posoperatorio y el consumo de analgésicos; sin embargo, la agitación de emergencia no se asocia con la calidad del sueño en el período preoperatorio.

Normocalcemic hyperparathyroidism after successful parathyroidectomy for single parathyroid adenoma: Prevalence, etiological factors, predictive markers, treatment and evolution.

BACKGROUND AND OBJECTIVE: Postparathyroidectomy normocalcemic hyperparathyroidism (PPNCHPPT) is a frequent situation for which we have no information in our country. The objective is to know our prevalence of PPNCHPPT, the associated etiological factors, the predictive markers, the treatment administered and the evolution. PATIENTS AND METHOD: Retrospective observational cross-sectional study on 42 patients. Twelve patients with PPNCHPPT and 30 without PPNCHPPT are compared. RESULTS: HPPTNCPP prevalence: 28.6%. Etiological factors: vitamin D deficiency: 75%; bone remineralization: 16.7%; renal failure: 16.7%; hypercalciruria: 8.3%. No change in the set point of calcium-mediated parathormone (PTH) secretion was observed, but an increase in the preoperative PTH/albumin-corrected calcium (ACC) ratio was observed. Predictive markers: PTH/ACC ratio (AUC 0.947; sensitivity 100%, specificity 78.9%) and PTH (AUC 0.914; sensitivity 100%, specificity 73.7%) one week postparathyroidectomy. EVOLUTION: follow-up 30 ±â€¯16.3 months: 50% normalized PTH and 8.3% had recurrence of hyperparathyroidism. Patients with PPNCHPPT less frequently received preoperative treatment with bisphosphonates and postoperative treatment with calcium salts. CONCLUSIONS: This is the first study in our country that demonstrates a mean prevalence of PPNCHPPT, mainly related to a vitamin D deficiency and a probable resistance to the action of PTH, which can be predicted by the PTH/ACC ratio and PTH a week post-intervention and often evolves normalizing the PTH. We disagree with the etiological effect of hypercalciuria and the change in the PTH/calcemia regulation set point, and we acknowledge the scant treatment administered with calcium salts in the postoperative period.

Preemptive caudal anesthesia on back pain after lumbar discectomy: a randomized and controlled study.

OBJECTIVE: In this randomized and prospective research, we aimed to relieve surgical and muscle-related pain early after lumbar disc operations with caudal preemptive analgesia. MATERIALS AND METHODS: A total of 120 patients with single-level lumbar disc herniation were included in this study. The caudal epidural injection was performed for all patients 20 min before surgery. The patients were divided into three groups. Non-steroidal anti-inflammatory drugs or tramadol use were recorded. Pre-operative and post-operative pain was interpreted through a visual analog scale. RESULTS: There was a difference between the groups in all post-operative measurements (p < 0.05), between Group 1 and Group 3, and between Group 2 and Group 3. A statistical significance has been achieved between the groups at the 1st h, 2nd h, 4th h, and 24th h (p < 0.05). The difference between the pain intensities of the patients at the 24th h and the 1st week was statistically significant in Groups 1 and 2 (p < 0.05). Evaluation of the effects of medical treatments reduced the severity of back pain and foot pain. CONCLUSION: The preemptive bupivacaine or in combination with methylprednisolone caudal injection is an effective and safe method to reduce post-operative pain and ameliorate functional capacity for the treatment of lumbar disc herniation.

OBJETIVO: En esta investigación prospectiva aleatorizada, nuestro objetivo fue aliviar el dolor quirúrgico y muscular temprano después de las operaciones de disco lumbar con analgesia preventiva caudal. MATERIALES Y MÉTODOS: en este estudio se incluyeron un total de 120 pacientes con hernia de disco lumbar de un solo nivel. La inyección epidural caudal se realizó para todos los pacientes 20 minutos antes de la cirugía. Los pacientes fueron divididos en tres grupos. Se registró el uso de AINE o tramadol. El dolor preoperatorio y postoperatorio se interpretó a través de una escala analógica visual. RESULTADOS: Hubo diferencia entre los grupos en todas las medidas postoperatorias (p < 0.05), entre el grupo 1 y el grupo 3, y entre el grupo 2 y el grupo 3. Se ha logrado una significación estadística entre los grupos a la 1a hora, 2a hora, 4 y 24 horas (p < 0.05). La diferencia entre las intensidades de dolor de los pacientes a la hora 24 y la primera semana fue estadísticamente significativa en los Grupos 1 y 2 (p < 0.05). La evaluación de los efectos de los tratamientos médicos redujo la gravedad del dolor de espalda y de pie. CONCLUSIÓN: La bupivacaína preventiva, o en combinación con la inyección caudal de metilprednisolona, es un método eficaz y seguro para reducir el dolor posoperatorio y mejorar la capacidad funcional para el tratamiento de la hernia de disco lumbar.

Prescripción del ejercicio en paciente post operatorio de cirugía bariátrica 2010-2020: Revisión exploratoria

El ejercicio sigue siendo una intervención necesaria para la pérdida y mantenimiento del peso en pacientes postquirúrgicos de cirugía bariátrica. Sin embargo, los principios básicos de su prescripción luego de este tipo de intervenciones son aún controversiales en la literatura. En este contexto, el objetivo de este estudio fue describir los principales componentes de la prescripción del ejercicio en pacientes postquirúrgicos de cirugía bariátrica y sus beneficios asociados. Se realizó una revisión exploratoria usando las bases de datos Pubmed, PEDro, Springer, Science Direct, y Scielo. Se utilizó un algoritmo de búsqueda con los términos clave "cirugía bariátrica", "obesidad", "ejercicio", "post-quirúrgico", "prescripción del ejercicio" y "actividad física", en inglés y español. Fueron incluidos ensayos clínicos y estudios observacionales publicados entre 2010-2020, donde hubo prescripción del ejercicio posterior a cirugía bariátrica. Un total de 13 estudios fueron analizados. Los parámetros recomendados incluyeron la frecuencia de 3 a 5 veces por semana, intensidad aeróbica entre el 60-85% de la FCmáx o 60-70% de VO2máx, intensidad anaeróbica entre el 60-85% de 1 repetición máxima (1RM), y duración entre 12 y 18 semanas. El ejercicio es una herramienta importante para mantener y reducir el peso, atenuar el sedentarismo y mejorar la calidad de vida en paciente postquirúrgicos de cirugía bariátrica con resultados seguros y eficaces siempre y cuando se garanticen los niveles de intensidad, frecuencia, duración, tipo y progresión sugeridos.

Exercise remains a necessary intervention for weight loss and weight maintenance in post-bariatric surgery patients. However, the basic principles of its prescription after this type of interventions are still controversial in the literature. In this context, our objective was to describe the main components of exercise prescription in post-bariatric surgery patients and its associated benefits. A scoping review was carried out using the Pubmed, PEDro, Springer, Science Direct, and Scielo databases. A search algorithm was used with the terms "bariatric surgery", "obesity", "exercise", "post-surgical", "exercise prescription" and "physical activity", in English and Spanish. Clinical trials and observational studies published between 2010-2020, where there was exercise prescription after bariatric surgery, were included. A total of13 studies were analyzed. The recommended parameters included frequency 3 to 5 times per week, aerobic intensity between 60-85% of HRmax or 60-70% of VO2max, anaerobic intensity between 60-85% of 1 repetition maximum (1RM), and duration period between 12 and 18 weeks. Exercise is an important tool to maintain and reduce weight, attenuate sedentary lifestyle and improve quality of life in post-bariatric surgery patients with safe and effective results as long as the suggested levels of intensity, frequency, duration, type and progression are guaranteed.

Management of acute postoperative pain: Conditions to guarantee the safety and effectiveness of analgesic treatments.

The evidence on postoperative pain management is of low or insufficient quality. The SEDAR Acute Pain Working Group has prepared this guideline-document to apply the best available scientific evidence to clinical practice, individualizing it based on factors specific to the patient and the procedure, and encompassing different organizational options, attempting to individualize it based on specific factors of the patient and the procedure, and encompassing the different organizational options for pain control. The document updates concepts and minimum requirements necessary for optimal postoperative analgesia, a multidisciplinary approach and the management of Acute Postoperative Pain. Strategic lines and different management models are defined. A general perioperative action plan is established based on collaboration with the surgical departments involved, on the joint review of the evidence and on preparation of protocols by the procedure. Finally, a follow-up plan and a series of minimum indicators necessary for quality control of postoperative pain are presented.