Estudio comparativo entre la ecografía y la neuroestimulación en el aprendizaje del bloqueo ciático poplíteo posterior / No disponible

Introducción: La anestesia regional guiada mediante ecografía es un campo en rápido crecimiento y su docencia está siendo objeto de estudio. Este trabajo compara la realización del bloqueociático-poplíteo posterior mediante ecografía (ECO) o neuroestimulación (NE) por médicos especialistas en formación. Material y método: Se realizó un estudio prospectivo aleatorizado, con los pacientes distribuidos en dos grupos: el grupo ECO mediante técnica guiada con ecografía; el grupo NE empleó referencias de anatomía de superficie más neuroestimulación, considerando válida una respuesta muscular entre 0.2-0.5 mA. Las variables registradas fueron: tiempo de ejecución, número de intentos, número de punciones vasculares y de parestesias, así como éxito del bloqueo. Las técnicas fueron realizadas por un único especialista en formación, sin experiencia previa en anestesia regional ni ecografía, bajo la supervisión de un anestesiólogo experto. Resultados: Se obtuvieron 19 casos (ECO: 10; NE: 9). El grupo ECO requirió menos tiempo que el NE (108,5-338,6 sg, IC95%; p < 0,005) y menor número de intentos, 1,6 ± 0,7 para ECO, frente 9,5 ± 3,8 para NE (media ± ds; p < 0,05), obteniendo éxito en primera punción en un 80% para ECO frente a al11,1% para NE (p < 0,05). El grupo ECO asoció una menor incidencia de punciones vasculares y de parestesias. La tasa de éxito de la técnica fue del 100% en el grupo ECO, frente al 67,7% en NE. Conclusiones: Estos resultados sugieren que el empleo de ecografía en el aprendizaje del bloqueo poplíteo posterior por especialistas en formación, pudiera facilitar la ejecución de la técnica, asociar menor morbilidad y proporcionar mayor éxito del bloqueo nervioso periférico (AU)

Background: The ultrasound-guided regional anesthesia is a rapidly growing field and its teaching is being studied. This paper compares the performance of the posterior popliteal sciatic blockadeby ultrasound (ECO) with that of neurostimulation (NS) carried out by specialist doctors in training. Material and method: A prospective randomized trial was conducted with patients divided into two groups: group ECO treated with ultrasound-guided technique, and group NE in which surface anatomy and neurostimulation references were used, considering valid a muscle response between 0.2 and 0.5 mA. The variables recorded were run time, number of attempts, number of vascular punctures and paresthesias, and success of the blockade. The techniques were performed by a single training specialist without prior experience in regional anesthesia and ultrasound, under the supervision of an expert anaesthesiologist. Results: 19 cases were obteined (ECO: 10, NE 9), the ECO required less time than NE (108,5-338,6 sg, 95%, p < 0.005)and fewer attempts, 1.6 ± 0.7 for ECO, versus 9.5 ± 3.8 for NE(mean ± sd, p < 0.05), and success was achieved on first puncture on 80% of attempts in ECO group, versus 11.1% in NE group (p< 0.05). The ECO group associated a lower incidence of vascular puncture and paresthesia. The success rate of the technique was 100% in the ECO group, versus 67,7% in NE group. Conclusions: These results suggest that the use of ultrasound in the posterior popliteal block learning by training specialists could facilitate the implementation of the technique, and provideless morbidity associated with more successful peripheral nerveblock (AU)

[Continuous popliteal block with ropivacaine via a stimulant catheter for postoperative analgesia after foot surgery]. / Bloqueo poplíteo continuo con ropivacaína mediante catéter estimulante para analgesia postoperatoria tras cirugía del pie.

Three patients underwent foot surgery to correct hallux valgus and other toe deformities. Postoperative analgesia was provided by a sciatic nerve block in the popliteal fossa through a 21-gauge 64 mm needle and a 50 cm catheter connected to a nerve stimulator. Ropivacaine 0.125% was perfused continuously at a rate of 7 mL/h for 48 h. All 3 patients were very satisfied with the level of analgesia, given that the intensity of pain upon movement was never more than slight. Hallux valgus surgery causes intense postoperative pain that can be prevented by a peripheral nerve block. A continuous popliteal block through a catheter equipped with a nerve stimulator is an easy technique that provides very good pain management after this type of surgery, with few undesirable side effects.

Bloqueo poplíteo continuo con ropivacaína mediante catéter estimulante para analgesia postoperatoria tras cirugía del pie / Continuous popliteal block with ropivacaine through a stimulation catheter for postoperative anesthesia after foot surgery

Tres pacientes fueron intervenidas de hallux valgus y de dedos de los pies. La analgesia postoperatoria se consiguió mediante bloqueo del nervio ciático en la fosa poplítea realizado con una aguja 21G x 64 mm y un catéter de 50 cm conectados a un neuroestimulador. Por el catéter se administró ropivacaína 0,125 por ciento, en perfusión continua a 7 ml/h durante 48 h. Las tres pacientes valoraron muy satisfactoriamente la analgesia recibida dado que la intensidad del dolor no pasó en ningún momento de ser ligera con el movimiento .La cirugía del hallux valgus produce un intenso dolor postoperatorio que puede evitarse realizando técnicas de bloqueo nervioso periférico. El bloqueo poplíteo continuo con catéter estimulante es una técnica fácil que proporciona muy buena calidad analgésica en el tratamiento del dolor postoperatorio de esta cirugía con pocos efectos indeseables (AU)

[Satisfaction with locoregional anesthesia in women who had undergone cesarean section]. / Satisfacción con la anestesia locorregional en mujeres intervenidas de cesárea.

OBJECTIVES: To compare satisfaction with local-regional and general anesthesia in women undergoing cesarean, the possible influence of time of evaluation and recall of the anesthesiologist. PATIENTS AND METHODS: Retrospective study performed in all women who delivered by cesarean in the 6 first months of 1997. The women were assigned to two groups according to type of anesthesia, local-regional or general. Their satisfaction with anesthesia was evaluated by questionnaire 48 to 72 hours after surgery and two weeks after release. Most items required discrete-point answers, including a satisfaction of a scale of 0 to 10. During the second interview we also evaluated satisfaction with the procedure and hospital in general, as well as recall of the anesthesiologist. Group homogeneity was based on demographic, sociocultural, obstetric and surgical variables. RESULTS: In a context of high satisfaction with anesthesia, 189 (76%) of the 247 women receiving local-regional anesthesia gave high evaluations to the anesthesia (8.90 +/- 1.5; mean: 10), compared with 58 (24%) of those receiving general anesthesia (8 +/- 2; mean 8.5) (p = 0.001). Both groups were homogeneous except for the distribution of emergencies, which occurred more often in those receiving general anesthesia (p < 0.001). Women who had received local-regional anesthesia expressed greater willingness to repeat or recommend the technique (p < 0.001). The highest score in this group was from women receiving intradural anesthesia along with fentanyl for local anesthesia, with significant differences only in comparison to epidural anesthesia. The differences in responses between the first and second interview were scarce. The hospital received a lower evaluation than did either anesthesia or surgery (p < 0.001). The anesthesiologist, who was less well recognized than the obstetrician was remembered better among women receiving local-regional anesthesia (p = 0.008). CONCLUSIONS: Local-regional anesthesia can improve levels of satisfaction over that of general anesthesia among women undergoing cesarean surgery, and contributes to maintaining recall of the anesthesiologist. These results may be related to the fact of being conscious during the birth of a child.