[Pain-free hospital audit: a pre-post assessment]. / Evaluación antes-después del "hospital sin dolor".

OBJECTIVE: To evaluate improvement after implementation of care through a nurse-managed acute pain unit in a district hospital, using statistical process control (SPC) methods. MATERIAL AND METHODS: Each month we measured 3 acute pain unit quality indicators: pain prevalence, pain relief, and satisfaction with pain management. The indicators were monitored on P-charts according to SPC procedures that determine their distribution within control limits and track variability. RESULTS: The hospital prevalence of acute pain stabilized at 30% after a year. Eight-five percent of patients achieved adequate pain relief and 90% were satisfied with pain management. CONCLUSIONS: A nurse-managed acute pain unit designed and managed with tools for monitoring quality assurance produces significant absolute and relative improvements in the prevalence of pain, pain relief, and patient satisfaction (P < .001), leading to a savings of 15 000 days of unnecessary suffering per year.

[Cerebellar hemorrhage after spinal anesthesia]. / Hemorragia cerebelosa tras anestesia subaracnoidea.

Cerebellar hemorrhage is a rare complication of spinal anesthesia. We report a case in a 51-year-old woman with a history of hypertension who underwent uterine dilatation and curettage with spinal anesthesia. During recovery she vomited and complained of headache. Postdural puncture headache was diagnosed. When there was no response to conventional treatment, computed tomography and magnetic resonance scans of the head were performed. The scans confirmed cerebellar hemorrhage due to rupture of a cavernous angioma. The patient recovered fully without surgical decompression. We review the pathogenesis of headache and cerebral hemorrhage after spinal anesthesia and propose differential diagnosis between spontaneous rupture related to hypertension and cerebrospinal fluid hypotension syndrome caused by trauma from lumbar spinal puncture. Patients with prolonged severe headache after spinal anesthesia require neurologic and radiologic monitoring to rule out the possibility of intracranial complications.

[Peripartum cardiomyopathy and preeclampsia: an association with fatal outcome]. / Cardiomiopatía periparto y preeclampsia: una asociación de fatal desenlace.

A 33-year-old obese gypsy woman was admitted in labor with signs of preeclampsia followed by sudden pulmonary edema and cardiac arrest. Cesarean delivery was performed during resuscitation maneuvers, but both mother and fetus died. The diagnosis of peripartum cardiomyopathy was confirmed by pathology. The association of latent peripartum cardiomyopathy and episodes of hypertension greatly increases the risk of maternal and fetal death. Careful management of anesthesia and rigorous measures are necessary with a view to possible litigation.

[Hyperbaric subarachnoid ropivacaine in ambulatory surgery: comparative study with hyperbaric bupivacaine]. / Ropivacaína hiperbárica subaracnoidea en cirugía ambulatoria: estudio comparativo con bupivacaína hiperbárica.

OBJECTIVES: To compare the clinical efficacy of hyperbaric 0.5% ropivacaine and 0.5% bupivacaine in subarachnoid blockade for ambulatory surgery. MATERIAL AND METHOD: Randomized double-blind study of 90 patients undergoing lower abdominal surgery. Subarachnoid blockade was achieved with 0.5% ropivacaine (12.5 mg) or 0.5% bupivacaine (12.5 mg) in 10% glucose. We recorded age, sex, weight, latency, extension of motor and sensory blocks, duration of surgery, side effects and quality as perceived by the surgeon and the patient. RESULTS: The two groups were similar with respect to latency time and extension of sensory block. Durations of motor (68.9 +/- 22.9 min) and sensory (127.0 +/- 24.3 min) blocks were significantly shorter with ropivacaine than with bupivacaine (133.3 +/- 29.4 and 174.9 +/- 25.5 min, respectively). Patients in the ropivacaine group also experienced a less intense motor block (Bromage 1, 11.1% vs. 93.3%) and fewer episodes of hypotension 0% vs. 17.7%) or bradycardia (4.4% vs. 8.8%) than those in the bupivacaine group. No neurotoxic effects or instances of postdural puncture headache were recorded. CONCLUSIONS: Hyperbaric 0.5% ropivacaine offers certain advantages over hyperbaric 0.5% bupivacaine for subarachnoid block in outpatient surgery. Duration and intensity of the sensory-motor blockade is less with ropivacaine and fewer cardiovascular side effects develop.

[Cauda equina hemisyndrome after intradural anesthesia with bupivacaine for hip surgery]. / Hemisíndrome de cauda equina tras anestesia intradural con bupivacaína para cirugía de la cadera.

A 68-year-old man underwent hip surgery under subarachnoid anesthesia with bupivacaine and fentanyl to replace an acetabular component. Two days after surgery the patient developed unilateral cauda equina syndrome, affecting five nerve roots (L4 to S3), with no sphincter involvement. Two and a half years later, the lesion had become permanent. We discuss the possible origin of the condition, suggesting differential diagnoses such as mechanical problems (position-mobilization) and anesthetic toxicity.