RESUMO
OBJECTIVES: To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. MATERIAL AND METHODS: Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. RESULTS: The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. CONCLUSION: Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist.
Assuntos
Anestesiologistas , Hérnia Inguinal/cirurgia , Herniorrafia , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios , Analgesia/métodos , Anestesia Geral/estatística & dados numéricos , Raquianestesia/estatística & dados numéricos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Pesquisas sobre Atenção à Saúde , Humanos , Injeções a Jato , Ambulatório Hospitalar/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , EspanhaRESUMO
Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS.
Assuntos
Androstanóis/administração & dosagem , Eletroconvulsoterapia , Síndrome Maligna Neuroléptica/terapia , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Esquizofrenia Paranoide/terapia , gama-Ciclodextrinas/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacologia , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Maligna Neuroléptica/etiologia , Monitoração Neuromuscular , Propofol/administração & dosagem , Propofol/farmacologia , Rocurônio , Esquizofrenia Paranoide/tratamento farmacológico , SugammadexRESUMO
INTRODUCTION: Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. MATERIAL AND METHODS: A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. RESULTS: The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. CONCLUSIONS: Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks.
Assuntos
Axila/cirurgia , Mama/cirurgia , Nervos Intercostais/efeitos dos fármacos , Excisão de Linfonodo/métodos , Mastectomia/métodos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção , Ultrassonografia Mamária/métodos , Adolescente , Adulto , Idoso , Analgesia/métodos , Axila/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Corantes , Feminino , Humanos , Nervos Intercostais/diagnóstico por imagem , Metástase Linfática , Azul de Metileno , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. MATERIALS AND METHODS: Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30 min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. RESULTS: The antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. CONCLUSIONS: A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção , Braço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: Postoperative pain is one of the most frequent complications of outpatient orthopedic surgery. We therefore studied the efficacy, feasibility, and safety of the continuous femoral nerve block as an analgesic technique for outpatient anterior cruciate ligament reconstruction. MATERIAL AND METHODS: We carried out a single-blind prospective study of ASA 1-2 patients who received a continuous femoral nerve block with 0.125% bupivacaine through an elastomeric pump to treat postoperative pain as part of a multimodal approach. Postoperative pain was assessed on a verbal numerical scale from the immediate postoperative period until 48 hours after the operation. Side effects and patient satisfaction were also assessed. RESULTS: Sixty-three patients were enrolled. The continuous femoral nerve block was effective: in the first 24 hours following surgery 90% of patients had mild or no pain, and 92% required no rescue medication. It also proved safe, as there were no significant side effects. CONCLUSION: The continuous femoral nerve block with 0.125% bupivacaine is a safe, effective option for the management of postoperative pain in outpatient anterior cruciate ligament reconstruction.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Ligamento Cruzado Anterior/cirurgia , Bloqueio Nervoso Autônomo/métodos , Bombas de Infusão , Dor Pós-Operatória/tratamento farmacológico , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Bloqueio Nervoso Autônomo/instrumentação , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Quimioterapia Combinada , Elastômeros , Assistência Domiciliar , Humanos , Infusões Intravenosas , Entorpecentes/administração & dosagem , Entorpecentes/uso terapêutico , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Método Simples-Cego , Tramadol/administração & dosagem , Tramadol/uso terapêuticoRESUMO
Peripheral nerve blocks have aroused increasing interest in recent years, leading to a rise in the rate of complications. At the same time noteworthy technical advances have been made in areas such as nerve stimulation and ultrasound imaging, and local anesthetics have become safer. Nevertheless, the risk of anesthetic-related systemic toxicity, which manifests with neurological symptoms that tend to be forerunners of cardiovascular ones, can not be ignored. We report 2 cases of systemic toxicity due to the use of a mixture of local anesthetics during nerve blocks for outpatient surgery.