Association between CACNG2 polymorphisms (rs4820242, rs2284015 and rs2284017) and chronic peripheral neuropathic pain risk in a Mexican population.

OBJECTIVE: In animal models and humans, mutations in voltage-dependent calcium channel gamma-2 subunit gene (CACNG2) have been associated with neuronal hyperexcitability, including neuropathic pain. The objective of this study was to determine the allelic and genotypic frequencies of CACNG2 polymorphisms (rs4820242, rs2284015 and rs2284017) and their association with the risk of chronic peripheral neuropathic pain (CPNP) in the Mexican population. PATIENTS AND METHODS: Single nucleotide polymorphisms (SNPs) were determined by real-time PCR, and allelic and genotypic frequencies were compared between healthy Mexican subjects and CPNP patients. The risk of association of CACNG2 SNPs with the presence of CPNP and its characteristics was evaluated. RESULTS: The allele G (OR 2.08, p = 0.01) of rs2284015 was observed as a risk factor for developing CPNP. The allele A of rs4820442 showed a risk of association with a history of surgery (OR 3.92, p = 0.04), radiculopathy (OR 4.29, p = 0.0001), bilateral presentation of pain (OR 3.15, p = 0.003), and neuropraxia (OR 0.36, p = 0.01). The allele C of rs2284015 was associated with an increased risk of burning and allodynia. In the analysis of the association of genotype frequencies and inheritance patterns, as well as in the analysis of interaction with sex, a modification of risk was observed. CONCLUSIONS: The allele G of rs2284015 and the AGC haplotype of CACNG2 rs4820242, rs2284015 and rs2284017, regardless of sex and etiology could contribute to the risk of CPNP. Certain alleles and genotypes could constitute severity markers in CPNP with sex-biased effects; however, further studies are required to confirm these observations.

[Diagnostic concordance of Magnetic Resonance Imaging of Adhesive Capsulitis, between Imaging Centers and a Shoulder Clinic, with surgical correlation]. / Concordancia diagnóstica de capsulitis adhesiva por resonancia magnética entre centros de imagenología y una clínica de reconstrucción articular con correlación quirúrgica.

INTRODUCTION: Despite the MRI findings present an adequate sensitivity and specificity for the diagnosis of adhesive capsulitis, there is a poor correlation between the imaging results in imaging centers and the diagnosis of a shoulder surgeon and the surgical findings. OBJECTIVE: To evaluate the correlation of the diagnosis of adhesive capsulitis by MRI between imaging centers and the shoulder and elbow surgery service, with subsequent surgical verification. MATERIAL AND METHODS: Retrospective, observational and comparative study in 41 patients with adhesive capsulitis diagnosis, the concordance among the MRI reports of different radiology cabinets and the Joint reconstruction clinic was calculated, in 10 cases the diagnosis was corroborated by surgery. The index was determinated between both interpretations and the surgical findings. RESULTS: The concordance among the reports analyzed by the shoulder surgeon of the Joint reconstruction clinic and the cabinets was low, with a index of 0.12, in all the surgical cases the presence of adhesive capsulitis was proved with a index of 0.10 with respect to the cabinets reports. CONCLUSION: The imaging findings described in the literature are reliable for the diagnosis of adhesive capsulitis. The low concordance with the imaging cabinets leads us to think that it is an underdiagnosed entity.

INTRODUCCIÓN: Los hallazgos en resonancia magnética (IRM) presentan una adecuada sensibilidad y especificidad para el diagnóstico de capsulitis adhesiva; sin embargo, existe una baja correlación diagnóstica entre la interpretación realizada en los centros de imagenología y la de la clínica de reconstrucción articular y los hallazgos quirúrgicos. OBJETIVO: Conocer la correlación del diagnóstico de capsulitis adhesiva por IRM entre centros de imagenología y la clínica de reconstrucción articular con posterior comprobación quirúrgica. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional y comparativo en un grupo de 41 pacientes con diagnóstico de capsulitis adhesiva, comparando la concordancia de los reportes de IRM de distintos centros de imagenología y la clínica de reconstrucción articular, se corroboró quirúrgicamente en 10 casos. Se determinó el índice entre ambas interpretaciones y los hallazgos quirúrgicos. RESULTADOS: La concordancia de los reportes analizados por el cirujano de hombro de la clínica de reconstrucción articular y los reportes de los centros de imagenología fue baja con un índice de 0.12, en todos los casos quirúrgicos se corroboró la presencia de capsulitis adhesiva, el índice con los reportes de los centros de imagenología fue de 0.10. CONCLUSIÓN: Los hallazgos en la IRM descritos en la literatura son confiables para el diagnóstico capsulitis adhesiva. La baja concordancia con los centros de imagenología nos orienta a pensar que es una entidad subdiagnosticada por esas instituciones.

[Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico]. / Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México.

INTRODUCTION: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. CLINICAL CASE: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. DISCUSSION: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

INTRODUCCIÓN: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. CASO CLÍNICO: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). DISCUSIÓN: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Postoperative analgesia with dexmedetomidine in interscalene block. Comparative study. / Analgesia postoperatoria con dexmedetomidina en bloqueo interescalénico. Estudio comparativo.

INTRODUCTION: Dexmedetomidine prolongs sensory block of ropivacaine. Our objective was to study whether this extension would produce better postoperative pain control compared to that produced by clonidine in patients undergoing arthroscopic shoulder. MATERIALS AND METHODS: Study comparative, longitudinal, controlled, randomized into 3 groups. Control group I: ropivacaine 0.75% clonidine group II: 0.75% ropivacaine plus clonidine 1mg/kg group iiidexmedetomidine: 0.75% ropivacaine more dexmedetomidine 1mg/kg. Interscalene block single dose ultrasound-guided. Sensory and motor blockade, pain intensity, sedation level, heart rate, respiratory rate, blood pressure at 6, 12 and 24hours was measured. RESULTS: Pain intensity at 6hours in groups I and II moderate to severe pain, mild pain group iii. At 12hours the groups IIand II showed moderate to severe pain by more than 60% of patients, and in group iiionly 10%. At 24hours I and II group 20% of patients they continued to moderate pain. CONCLUSION: The prolonged interscalene block produced by dexmedetomidine provided better postoperative pain control during the first 24hours.

[Postoperative analgesia in joint replacement surgery]. / Analgesia postoperatoria en cirugía de reemplazo articular.

Patients undergoing joint replacement surgery may experience intense and sustained postoperative pain due to inappropriate analgesia that delays recovery and hospital discharge. Traditionally, postoperative analgesia following arthroplasty is achieved with scheduled analgesia, either patient-controlled or with epidural spinal blocks. The former techniques have advantages and disadvantages. Recently, peripheral nerve block has emerged as an appropriate alternative for postoperative pain. Numerous trials report that the use of multimodal analgesia based on peripheral nerve blocks may control pain and offer functional results similar to those obtained with continuous epidural blocks or systemic opioids, but without their unwanted systemic effects. This review discusses the indications, benefits and adverse effects associated with standard and new analgesic techniques.

[Total shoulder arthroplasty with interscalene block. Feasibility study]. / Artroplastía total de hombro con bloqueo interescalénico. Estudio de factibilidad.

INTRODUCTION: General anesthesia is considered as the technique of choice for shoulder surgery, either alone or combined. We propose to show the feasibility of using guided interscalene block as the single anesthetic technique for total shoulder arthroplasty. MATERIAL AND METHODS: Neurostimulation-guided interscalene block plus sedation with dexmedetomidine were used. The following were measured intraoperatively: latency time, intraoperative analgesia, motor block according to Monzo's scale, success rate, adverse events and complications. The following were measured postoperatively: duration of postoperative analgesia and pain intensity with a visual analogue scale at 6, 12 and 24 hours. Patient satisfaction was also measured. RESULTS: Intraoperative analgesia was appropriate in 100% of patients. Motor block was grade 0 in 76.4% and grade 1 in 23.6%, which is appropriate for surgery. The success rate was 100%. Mean postoperative pain at 6 hours was 0.13 +/- 0.54 points in the visual analogue scale; 1.67 +/- 1.15 at 12 hours, and 3.15 +/- 1.66 points at 24 hours. 54.5% of patients were very satisfied and 45.5% were satisfied. Complications occurred in 8.18%. CONCLUSION: This type of surgery is feasible with interscalene block plus sedation; it is a safe and efficacious technique.