Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study. / Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional.

BACKGROUND AND OBJECTIVES: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. METHODS: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. RESULTS: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. CONCLUSIONS: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso / Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain

OBJETIVOS: Desarrollar recomendaciones sobre el uso de la combinación paracetamol/tramadol (P/T) en pacientes con dolor moderado-intenso, basadas en la mejor evidencia y experiencia. MÉTODOS: Se siguió la metodología de grupos nominales y Delphi apoyados por una revisión sistemática de la literatura (RSL). Se seleccionó un panel multidisciplinar de 12 expertos en el manejo del dolor. En la primera reunión de grupo nominal se definió el objetivo, alcance, usuarios, apartados del documento de consenso, así como recomendaciones generales preliminares. Para la RSL se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda. Dos revisores seleccionaron y analizaron los artículos. Esta evidencia se discutió en una segunda reunión de grupo nominal y se generaron las recomendaciones definitivas. Para cada recomendación, el nivel de evidencia y el grado de recomendación se clasificaron según el modelo de Oxford, y el grado de acuerdo por técnica Delphi. Se definió acuerdo si al menos el 70% de los participantes contestaron ≥ 7 en cada recomendación (1 = total desacuerdo a 10 = total acuerdo). RESULTADOS: Se generaron 20 recomendaciones que cubren aspectos generales, como la evaluación del dolor, y específicos del manejo de P/T. Estos últimos abarcan la indicación de la combinación P/T (perfil de paciente, dosificación, pauta, formulaciones), gestión del riesgo (contraindicaciones, precauciones, interacciones, uso concomitante con otras medicaciones, seguimiento, situaciones especiales) y la educación del paciente. CONCLUSIONES: Estas recomendaciones pretenden resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones respecto al uso de la combinación P/T en pacientes con dolor moderado-intenso

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥ 7 for each recommendation (1 = total disagreement to 10 = total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain

[Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain]. / Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso.

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥7 for each recommendation (1=total disagreement to 10=total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain.

Manejo de las rinosinusitis en Atención Primaria / Management of Rhinosinusitis in Primary Care

La rinosinusitis aguda representa un importante problema de salud, y, aunque su frecuencia no está bien establecida en nuestro país, es motivo de una no desdeñable carga económica, alterando notablemente la calidad de vida de los pacientes que la padecen. Su diagnóstico es eminentemente clínico, debiendo reservar las exploraciones complementarias para el diagnóstico diferencial de las complicaciones y de procesos tumorales. Las causas más frecuentes son las infecciones, siendo los virus los agentes más comunmnte implicados. De entre las bacterias Streptococcus pneumoniae y Haemophilus influenzae son las más habitualmenta aisladas. Hoy las complicaciones no son frecuentes, pero sí pueden llegar a ser graves, de las cuales las más comunes son las orbitarias, seguidas de las endocráneales y las óseas. El tratamiento se basa en médidas sintomáticas, como los lavados con soluciones salinas y antibióticos para los casos de etiología bacteriana. Management of Rhinosinusitis in Primary Care

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin

[Management of Rhinosinusitis in Primary Care]. / Manejo de las rinosinusitis en Atención Primaria.

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin.

Inter- and intra-patient variability in breakthrough pain episodes of opioid-treated patients with underlying chronic pain. An observational, prospective and multicenter study / Variabilidad inter- e intra-individual en pacientes con dolor irruptor tratados con opioides. Estudio observacional, prospectivo y multicéntrico

Objective: Since, to date, there are few epidemiological data assessing the diversity in the characteristics of breakthrough pain episodes, the present study was performed to assess the intra-individual variability in the episodes of breakthrough pain in patients with underlying chronic pain controlled with opioids. Methods: An observational, prospective and multicenter study (CADI study) was conducted in the context of the routine clinical practice of Spanish pain specialists recruiting opioidtreated patients with underlying chronic pain. Data were recorded in three visits (baseline, at 7 and 28 days post-inclusion) and by the patient on a patient´s diary card, specifically designed to characterise the first 8 breakthrough pain episodes (type, intensity –using 100 mm Visual Analog Scale– and duration of pain), to assess the intra-individual and inter-individual variability in the intensity, duration and typology of episodes of breakthrough pain. Results: 50 opioid-treated patients were recruited (23 with oncologic pain and 27 with non oncologic pain, mean age of 61.1 years, 62 % females). For all three parameters, inter-patient variability was higher than intra-patient variability throughout the episodes. Nevertheless, we found intra-patient variability in maximum pain intensity, pain intensity at the end of the episode, pain relief and duration of the episode. Conclusions: This is the first study to quantify the intrapatient variability of breakthrough pain. The results show a great variability in terms of intensity and duration of the episode and its typology. Although inter-patient variability is higher, the intra-patient variability is important enough to be taken into account in optimizing the approach and treatment selection (AU)

Objetivos: Debido a los pocos datos epidemiológicos existentes que evalúen la diversidad de las características de los episodios de dolor irruptivo, se realizó el presente estudio, cuyo principal objetivo fue evaluar la variabilidad intraindividual de las crisis de dolor irruptivo en pacientes con dolor crónico controlado con opioides. Métodos: Este estudio observacional, prospectivo y multicéntrico (estudio CADI) se llevó a cabo en el contexto de la práctica clínica habitual, en Unidades del Dolor de España, con la participación de pacientes tratados con opioides para el dolor crónico. Los datos fueron registrados en tres visitas (basal, a los 7 y 28 días después de la inclusión) y por el propio paciente, en un Diario del Paciente, específicamente diseñado para caracterizar los primeros 8 episodios de dolor irruptivo (tipo, intensidad −utilizando la Escala Analógica Visual (EVA)− y duración del dolor) con el objetivo de evaluar la variabilidad intraindividual e interindividual en la intensidad, duración y tipología de los episodios de dolor irruptivo. Resultados: Se reclutaron 50 pacientes, 23 con dolor oncológico y 27 con el dolor no oncológico (edad media de 61,1 años; 62 % de mujeres). Aunque para los tres parámetros medidos, la variabilidad entre pacientes fue mayor que la variabilidad intrapaciente, la variabilidad intraindividual fue significativa en la evaluación de la máxima intensidad del dolor, la intensidad del dolor al final del episodio, el alivio del dolor y la duración del episodio de dolor irruptivo. Conclusiones: Este es el primer estudio que cuantifica la variabilidad intraindividual del dolor irruptivo. Los resultados muestran una gran variabilidad en cuanto a la intensidad y la duración del episodio y su tipología. Aunque la variabilidad entre pacientes es mayor, la variabilidad intrapaciente es lo suficientemente importante como para ser tenida en cuenta para la mejor aproximación y selección del tratamiento (AU)

Radiofrecuencia pulsada (Rf) y ozono intradiscal en el alivio del dolor discogénico: experiencia en 51 casos / Intradiscal pulsed radiofrequency (Rf) and ozone in discogenic pain relief: Experience in 51 cases

Objetivo: aproximadamente el 40 % de los casos de dolor lumbosacro crónico tiene su origen en el disco intervertebral. La degeneración y deshidratación del núcleo pulposo pueden producir desgarros en el anillo fibroso que estimulan el crecimiento de vasos sanguíneos y nociceptores a este nivel que pueden dar lugar al dolor discogénico. La radiofrecuencia (Rf) intradiscal tiene un nivel de evidencia 2B± en el alivio del dolor discogénico. Nuestro objetivo fue comprobar si la radiofrecuencia pulsada (RfP) intradiscal combinada con ozono intradiscal podría mejorar los resultados. Material y métodos: estudio prospectivo, observacional de 51 pacientes diagnosticados de dolor discogénico de > 8 meses de evolución (lumbosacro irradiado a nalga, uni o bilateral, no radicular, sin respuesta a tratamiento farmacológico y/o intervencionista), severo EVA 7-9, con degeneración o zona de alta densidad discal en RM, y discografía con ozono 30 % (3-8 ml) sin fuga al espacio epidural, a través de aguja de Rf 15 cm, 20 mm, 20 G, con punta emplazada en núcleo pulposo. Los pacientes fueron clasificados aleatoriamente en 3 grupos: A - sólo ozono intradiscal; B - en los que posteriormente al ozono intradiscal se realizó RfP (2 Hz, 10 miliseg, 60 V) durante 15 min (Neurotherm); y C - Rf pulsada intradiscal (con los mismos parámetros). Los parámetros de lesión de Rf pulsada: temperatura, impedancia, voltaje y mA fueron registrados durante el procedimiento. Los pacientes fueron evaluados a los 3 y 12 meses de la técnica: eficacia analgésica (EVA); % mejoría (no efecto/EVA > 2/EVA > 50 %). Estadística con SPSS 16.0. t-Student para comparación de medias. p binomial simple para comparación de proporciones (p < 0,05). Resultados: mayor reducción del EVA a los 3 y 12 meses en el grupo B (8,1 ± 1,1/3,7 ± 1,9/4 ± 2,2) (p < 0,01). Todos los pacientes del B mejoraron de forma significativa a los 3 meses y en el 88,2 % esta mejoría continuó a los 12 meses (p < 0,05). Conclusiones: el ozono intradiscal mejoró los resultados de la RfP en el dolor discogénico en este estudio (AU)

Objective: About 40 % cases of lumbosacral pain has source in intervertebral disc. Degeneration and nucleus pulposus dehydration can produce tears in the annulus that stimulates growth irrigation and nocioceptors formation at this level and this could be the cause of discogenic pain. Intradiscal radiofrecuency (Rf) has 2B± evidence level for the discogenic pain relief. Our goal was to test if addition of intradiscal ozone to intradiscal Rf treatment could improve outcomes. Material and methods: Observational prospective study in which fifty-one patients with discogenic pain were treated. Inclusion criteria: a) Pain’s evolution higher than eight months; b) VAS higher than seven; c) non radicular pain characteristics; d) lumbosacral pain with uni- or bilateral buttock irradiation; e) without response to pharmacologic and interventional treatment; f) discal degeneration o presence of a high-intensity zone in RM; g) discography with 30 % ozone: Not evidence of fuga to epidural space with addition of 3-8 ml ozone in nucleus pulposus. Patients were randomized in three groups: A - Just intradiscal ozone (3-8 ml). B - Intradiscal ozone and next RfP (2 Hz, 10 miliseg, 60 V) for 15 minutes (Neurotherm). C - Intradiscal - Pulsed Rf (with same parameters). Pulsed Rf parameters were recorded during the procedure: impedance, temperature, voltage and mA. Patients were evaluated at three and twelve months of the technique. Parameters evaluated were: EVA, improve percentage (no effect/EVA > 2/EVA > 50 %). Chosen statistical program was SPSS 16.0, t-student for average comparison, p-simple binomial for percentage comparison (p < 0.05). Results: More EVA reduction at three and twelve months on the B group (8.1 ± 1.1/3.7 ± 1.9/4 ± 2.2) (p < 0.01). All patients from B group significantly improve at three months and 88.2 % of the patients’ improvement continuous for twelve months (p < 0.05). Conclusions: The association of intradiscal ozone with pulsed Rf can improve the results of the ozone’s application in discogenic pain (AU)

Contribución del bloqueo del plano transverso abdominal guiado por ultrasonidos a la analgesia postoperatoria tras la cesárea / Contribution to post-caesarean analgesia of ultrasound-guided transversus abdominis plane block

Objetivo. El objetivo principal de nuestro estudio fue valorar la contribución de la analgesia producida por el bloqueo del plano transverso abdominal (TAP), mediante punción ecoguiada, a la calidad analgésica obtenida con opioides intratecales, en cesáreas programadas. Material y métodos. Estudio prospectivo, aleatorizado en pacientes programadas para cesárea electiva con anestesia intradural con bupivacaína 0,5% hiperbara. Las pacientes se distribuyeron aleatoriamente en 3 grupos, según el fármaco complementario añadido para analgesia. En el grupo A 0,1mg de morfina, en el grupo B 10μg de fentanilo y en el grupo C 10μg de fentanilo y bloqueo TAP bilateral. El bloqueo TAP bilateral consistió en la inyección tras la cirugía de 20ml de levobupivacaína 0,5% a cada lado. En los grupos A y B, se inyectaron 20ml de suero salino. La analgesia postoperatoria se llevó a cabo con morfina iv en bolos, mediante un sistema de analgesia controlada por la paciente. Se estudió el dolor según una escala visual analógica a las 12 y 24h en reposo y movimiento, el tiempo en que se administró el primer bolo de analgesia y el número de bolos en 24h. También se valoraron los efectos adversos como: náuseas/vómitos, somnolencia y prurito. Se preguntó por el grado de satisfacción de la paciente. Resultados. Se incluyó a 90 pacientes. En reposo, el valor en la escala visual analógica 12/24h fue: grupo A, a las 12h 2,1±1,2, a las 24h 4,7±1,6; en el grupo B, a las 12h 4,3±2,9, a las 24h 4,8±2,0; y en el grupo C, a las 12h 1,9±1,1, y a las 24h 2,3±1,2 (p<0,05). En movimiento, la analgesia fue mejor en el grupo C (p≤0,02). El tiempo en solicitar el primer bolo fue inferior en el grupo B: en el grupo A 9,3±4,9 (p=0,02 respecto al grupo C); en el grupo B 2,0±1,8 (p<0,001 respecto al grupo C); y en el grupo C 13,2±2,1h. El número de bolos en 24h fue: en el grupo B de 38±5, en el grupo A de 10±2 (p<0,05) y en el grupo C de 5±2 (p<0,001). La incidencia de náuseas fue superior en el grupo B (36,6%) y la de prurito fue mayor en el grupo A (36,6%). Conclusiones. El bloqueo TAP mediante ultrasonidos (US), mejoró la eficacia de los opioides intratecales, reduciendo el dolor en las primeras 24h del postoperatorio, el consumo de opiáceos y los efectos secundarios(AU)

Objective. The aim of this study was to evaluate the contribution made by ultrasound-guided transversus abdominis plane block (TAP) to the quality of the analgesia with intrathecal opioids obtained in patients undergoing elective caesarean delivery. Material and methods. A prospective, randomized study in patients submitted to elective caesarean section with spinal anaesthesia with 0.5% hyperbaric bupivacaine. The patients were randomized into 3 groups according to the added complementary drug for analgesia: group A morphine 0.1mg; group B fentanyl 10μg; group C 10μg fentanyl+bilateral TAP block. The TAP block with 20ml of 0.5% levobupivacaine on each side, after surgery. Groups A and B, were injected with 20ml of saline. Postoperative analgesia was performed with morphine bolus through a system of patient-controlled analgesia (PCA). We studied the pain on a visual analogue scale at 12 and 24h at rest and movement, the time elapsed to require the first bolus, and morphine bolus in 24h. Secondary effects such as nausea, vomiting, pruritus, and drowsiness, were also evaluated. The level of patient satisfaction was also recorded. Results. A total of 90 patients were included. At rest the 12/24h VAS score was: group A, at 12h 2.1±1.2, at 24h 4.7±1.6; group B at 12h 4.3±2.9, at 24h 4.8±2; group C at 12h 1.9±1.09, at 24h 2.3±1.2 (P<.05). Walking improved analgesia more in group C (P≤.02). The time of asking for the first bolus was lower in group B: group A 9.3±4.9h (P=.02 compared to group C), in group B 2±1.8h (P<.001 compared to group C) and group C 13.2±2.1h. The number of bolus in 24h in group B was 38±5, in group A 10±2 (P<.05), group C 5±2 (P<.001). Delayed nausea was increased in group B (36.6%) and pruritus was greater in group A (36.6%). Conclusions. Ultrasound (US)-guided TAP block improves spinal opioid analgesia, with a decrease in VAS scores in the first 24h, and reduces opioid requirement and secondary effects after caesarean delivery(AU)

[Contribution to post-caesarean analgesia of ultrasound-guided transversus abdominis plane block]. / Contribución del bloqueo del plano transverso abdominal guiado por ultrasonidos a la analgesia postoperatoria tras la cesárea.

OBJECTIVE: The aim of this study was to evaluate the contribution made by ultrasound-guided transversus abdominis plane block (TAP) to the quality of the analgesia with intrathecal opioids obtained in patients undergoing elective caesarean delivery. MATERIAL AND METHODS: A prospective, randomized study in patients submitted to elective caesarean section with spinal anaesthesia with 0.5% hyperbaric bupivacaine. The patients were randomized into 3 groups according to the added complementary drug for analgesia: group A morphine 0.1mg; group B fentanyl 10 µg; group C 10 µg fentanyl+bilateral TAP block. The TAP block with 20 ml of 0.5% levobupivacaine on each side, after surgery. Groups A and B, were injected with 20 ml of saline. Postoperative analgesia was performed with morphine bolus through a system of patient-controlled analgesia (PCA). We studied the pain on a visual analogue scale at 12 and 24h at rest and movement, the time elapsed to require the first bolus, and morphine bolus in 24h. Secondary effects such as nausea, vomiting, pruritus, and drowsiness, were also evaluated. The level of patient satisfaction was also recorded. RESULTS: A total of 90 patients were included. At rest the 12/24h VAS score was: group A, at 12h 2.1 ± 1.2, at 24h 4.7 ± 1.6; group B at 12h 4.3 ± 2.9, at 24h 4.8 ± 2; group C at 12h 1.9 ± 1.09, at 24h 2.3 ± 1.2 (P<.05). Walking improved analgesia more in group C (P ≤.02). The time of asking for the first bolus was lower in group B: group A 9.3 ± 4.9h (P=.02 compared to group C), in group B 2 ± 1.8h (P<.001 compared to group C) and group C 13.2 ± 2.1h. The number of bolus in 24h in group B was 38 ± 5, in group A 10 ± 2 (P<.05), group C 5 ± 2 (P<.001). Delayed nausea was increased in group B (36.6%) and pruritus was greater in group A (36.6%). CONCLUSIONS: Ultrasound (US)-guided TAP block improves spinal opioid analgesia, with a decrease in VAS scores in the first 24h, and reduces opioid requirement and secondary effects after caesarean delivery.

Ozonoterapia y síndrome de cirugía fallida de espalda / No disponible

No disponible

Discólisis percutánea con ozono: nuestra experiencia / Percutaneous ozone discolysis: our experience

Objetivo: Demostrar la eficacia y seguridad clínica de la discólisis percutánea con ozono en el tratamiento de la hernia discal lumbar sintomática. Material y métodos: Estudio observacional prospectivo en 41 pacientes diagnosticados de hernia discal lumbar sintomática, a los que se les realizó un total de 49 discólisis percutáneas con ozono durante el período comprendido entre febrero de 2004 y febrero de 2009.Todas las discólisis se realizaron en quirófano, bajo control radioscópico, con medidas de asepsia habitual, anestesia local y sedación. Se administró ozono intradiscal (5 a 7 ml), epidural (5 a 7 ml) y perirradicular (5 a 7 ml) a una concentración de 27 mg. En todos los casos se administró quimioprofilaxis con 1.500 mg de cefuroxima. La eficacia del tratamiento se basó en el control del dolor según la escala visual analógica basal (EVA 0), a los 30 días (EVA 1), a los 90 días (EVA 3) y a los 6 meses (EVA 6) de las discólisis y mediante el test de Lattinen evaluado antes del tratamiento (TLT 0) y al final del estudio (TLT 1). Todos los pacientes fueron preguntados acerca de posibles efectos secundarios y finalmente se registró el grado de satisfacción. Resultados: Se realizaron 49 discólisis percutáneas con ozono en 41 pacientes. La EVA media inicial fue de 7,37 ± 0,96 y la evolución al mes, a los 3 y a los 6 meses fue: 2,41 ±2,17, 1,80 ± 2,31 y 2,05 ± 2,45, respectivamente, con diferencia estadísticamente significativa en los 3 cortes. El índice de Lattinen medio inicial fue de 12,68 ± 2,32 y pasó a 6,07 ± 2,91 a los 6 meses, con una reducción también estadísticamente significativa. Solamente 5 pacientes (12,2%) presentaron efectos adversos que consistieron en 4 cefaleas transitorias leves y un neumoencéfalo bastante incapacitante que obligó al pacientea guardar reposo en cama durante 1 semana hasta su reabsorción espontánea...(AU)

Objective: To demonstrate the safety and effectiveness of percutaneous discolysis using ozone in the treatment of symptomatic lumbar hernia. Material and methods: We performed a prospective observational study in 41 patients diagnosed with symptomatic lumbar hernia, in whom we performed 49 percutaneous discolysis procedures introducing ozone in the lumbar region between February 2004 and February 2009.All the procedures were performed in the operating room under radiological guidance, with aseptic conditions, local anaesthesia and sedation. The ozone was introduced into the lumbar disc (5 to 7 ml), in the epidural (5 to 7 ml) and periradicular spaces (5 to 7ml) at a concentration of 27 Ìg. In all patients, 1500 mg of cefuroxime was administrated intravenously as a prophylactic measure. The effectiveness of the treatment was based on pain control according to the visual analogue scale before the procedure (VAS 0), at 30 days (VAS 1), at 90 days (VAS 3) and at 6 months (VAS 6), and by means of Lattinen’s test before treatment and at the end of the study. All the patients were asked about the possible adverse effects of the treatment and a survey was carried out on patient satisfaction with the technique. Results: We performed 49 percutaneous ozone discolysis procedures in 41 patients. The initial mean VAS was 7.37 ± 0.96 and subsequent values were 2.41 ± 2.17 at 1 month, 1.80± 2.31 at 3 months and 2.05 ± 2.45 at 6 months, with statically significant differences in the three measurements. The initial mean Latting en index was 12.68 ± 2.32 and was 6.07± 2.91 at 6 months, representing a statically significant reduction. Adverse effects occurred in only five patients (12.2%): four mild transient headaches and one symptomatic pneumoencephalos, requiring bed rest for 1 week until spontaneous reabsorption...(AU)

Ciática: tratamiento con ozono intradiscal y radiofrecuencia del ganglio de la raíz dorsal frente a cada una de estas dos técnicas / Sciatica: intradiscal ozone administration associated with pulsed radiofrequency of the dorsal root ganglia compared with the isolated use of each of these two techniques

Objetivo: Estudio prospectivo y comparativo que compara la eficacia de la administración intradiscal de ozono asociada a radiofrecuencia pulsada de la raíz lumbar comprometida con cada una de estas 2 técnicas, de forma aislada, en el tratamiento del dolor radicular secundario a hernia discal. Material y método: Se incluyó en el estudio a 30 pacientes con clínica de dolor lumbar severo, escala visual analógica (EVA) > 6, de más de 3 meses de duración, resistente al tratamiento conservador (medicación oral y fármacos epidurales), con signos de afectación radicular con o sin parestesia e hipoestesia y con distribución correspondiente al dermatoma afectado. Los criterios radiológicos de inclusión fueron: evidencia en la resonancia magnética (RM) de hernia discal contenida con o sin degeneración discal. Los pacientes se distribuyeron aleatoriamente en 3 grupos: grupo A (5-15 ml de ozono intradiscal a 27 mg/ml de concentración y radiofrecuencia pulsada del ganglio dela raíz dorsal correspondiente); grupo B (5-15 ml de ozono intradiscal a 27 mg/ml de concentración) y grupo C (radiofrecuencia pulsada del ganglio de la raíz dorsal al nivel comprometido). La eficacia analgésica se valoró a los 15 días, al mes, y a los 3 y 6 meses de la técnica, mediante EVA y se llevó a cabo una valoración radiológica con RM a los 3meses. El estudio estadístico se realizó mediante el programa SPSS 14.0 para Windows. Se consideró significativa una p < 0,05.Resultados: Los niveles afectados, por orden de frecuencia, fueron L4-L5 (16/53,3%),L5-S1 (10/33,3%) y L3-L4 (4/13,33%). El volumen medio de ozono administrado fue, en el grupo A, 8 ± 2,5 ml, y en el B, 6,5 ± 2,4 ml (...) (AU)

Objective: We performed a prospective, comparative study that evaluated the effectiveness of intradiscal ozone administration associated with pulsed radiofrequency of the compromised lumbar root versus the isolated use of each of these two techniques in the management of radicular pain secondary to a herniated disc. Materials and method: The study included 30 patients with severe back pain, visual analog scale (VAS) > 6 and onset more than 3 months previously, who were resistant to conservative treatment (oral medication and epidural drugs) and showed signs of radicular involvement with or without paresthesia and hypoesthesia in the region of the affected dermatomes. The radiological inclusion criteria were magnetic resonance imaging (MRI) evidence of acontained herniated disc with or without disc degeneration. The patients were randomly distributed into three groups: group A (5-15 ml intradiscal ozone concentration at 27 mg/ml and pulsed radiofrequency of the compromised dorsal root ganglia); group B (5-15 ml of intradiscal ozone concentration at 27mg/ml) and group C (pulsed radiofrequency of the dorsal root ganglia at the level of the hernia). Analgesic efficacy was assessed at 15 days,1 month, 3 months and 6 months of the technique, using the VAS. Radiological assessment with MRI was performed after 3 months. The statistical analysis was conducted using SPSS14.0 for Windows. Values of P < 0.05 were considered significant. Results: the levels affected, in order of frequency, were L4-L5 (16/53.3%), L5-S1(10/33.3%) and L3-L4 (4/13.33%). The mean amount of ozone administered was 8 ± 2.5ml in group A and 6.5 ± 2.4 ml in group B. In group A, 90% of the patients showed significant improvement (p < 0.05) in all follow-up evaluations. In 80% of the patients in group B, improvement occurred later, but was maintained at 6 months after the technique (...) (AU)

Radiofrecuencia pulsada en la neuralgia esencial del trigémino. ¿Es una alternativa válida a la radiofrecuencia convencional? / Pulsed radiofrequency in the tnanagetnent of trigetninal essential neuralgia. Is a valid alternative to the conventional radiofrequency?

Objetivos. Demostrar la eficacia y seguridad de la radiofrecuencia pulsada en el tratamiento de la neuralgia esencial del trigémino y compararla con la técnica convencional. Material y métodos. Estudio observacional prospectivo en 32 pacientes diagnosticados de neuralgia esencial del trigémino a los que se les realizó un total de 44 radiofrecuencias del ganglio de Gasser. Las radiofrecuencias fueron realizadas en quirófano, bajo control radioscópico con un generador Neurotherm, agujas SMK 22G, estimulación sensitiva a 50 Hz hasta notar parestesia con 0,3-0,5 V y motora a 2 Hz sin que haya contracción del músculo masetero excepto si se está estimulando la 3ª rama. Se realizaron 28 radiofrecuencias pulsadas (RFP) y 16 convencionales (RFC). La RFP se realizaba a una tª de 40º C durante 120 sg mientras que la RFC se realizaba a una tª de 80º C durante 60 sg. La eficacia del tratamiento se basó en control del dolor según la EVA a los 30, 90, y 180 días y mediante el test de Lattinen antes y al final del estudio. Todos los pacientes fueron preguntados acerca de posibles efectos secundarios. Resultados. Se realizaron un total de 44 procedimientos. El 60% de los pacientes fueron varones y el 40% mujeres. La edad media fue de 68.32 años. Ambos grupos fueron comparables en cuanto a patología previa y antecedentes personales. Entre las ramas afectas el 4.5% de los pacientes tenía afectada la primera rama, el 31.8% la segunda rama, el 36.4% la tercera rama, el 13.6% la primera y segunda rama, y el 13.6% la segunda y tercera rama. Los pacientes recibieron RFP en el 63,6% de los casos y RFC en el 36.4%. En el grupo de RFP la evolución del VAS fue: VAS 0: 8; VAS 1: 3 .4; VAS 3: 2.5 y VAS 6: 2. y del índice de Lattinen, L0: 16.9 y L6: 6. En el grupo de RFC, VAS 0: 7.9; VAS 1: 3.25; VAS 3: 2 y VAS 6: 2. El índice de Lattinen, L0: 16.125 y L6: 5. No hubo diferencias estadísticamente significativas en la reducción del VAS y del Lattinen. En el grupo de RFP se necesitó repetir la técnica en el 28,57 % de los casos y en el grupo de RFC en el 25% de los mismos. En ninguno de los dos grupos se observaron complicaciones derivadas de la técnica ni efectos secundarios. Conclusiones. La RFP del ganglio de Gasser se muestra como una alternativa eficaz y segura a la RFC en el tratamiento de la neuralgia esencial del trigémino (AU)

Objectives. To demónstrate the effectiveness and safety of pulsed radiofrequency in the treatment of the essential trigeminal neuralgia and to compare it with the conventional technique. Matherial and Methods. This is a prospective observational study of 32 patients diagnosed of essential trigeminal neuralgia in which a total of 44 radiofrequencies were applied to the Gasserian ganglion. The radiophrequencies were performed in operating room under X-ray control with a Neurotherm generator, a 22G SMK needles, a sensitive stimulation to 50 Hz up to noticing parestesia with 0,3-0,5 V and motor to 2 Hz without contraction of the masseter muscle finds except if third branch was stimulated. 28 pulsed radiophrequencies (RFP) and 16 conventional (RFC) were carried out. The RFP were carried out at a temperature 40 ºC during 120 seconds whereas the RFC were performed at 80 ºC during 60 seconds. The efficiency of the treatment was based on control of the pain according to the EVA scale at 30, 90, and 180 days and by means of Lattinen's test before and at the end of the study. All the patients were asked regarding the possible side effects of the treatment. Results. 44 procedures were realized. 60% of the patients were males and 40% women. The mean age was 68.32 years. Both groups were comparable as for previous pathology and personal precedents. In 4.5% of the patients, the first branch was affected, in 31.8% the second branch, in 36.4% the third branch, in 13.6% the first and second branch, and finally in 13.6% the second and third branch. The patients received RFP in 63,6% of the cases and RFC in 36.4 %. In the RFP group the evolution of the VAS was as followed: VAS 0: 8; VAS 1: 3.4; VAS 3: 2.5 and VAS 6: 2. and the Lattinen Índex, LO: 16.9 and L6: 6. In the RFC group: VAS 0: 7.9; VAS 1: 3.25; VAS 3: 2 and VAS 6: 2. Lattinen índex: LO: 16.125 and L6: 5. There were no statistically significant differences in the reduction of VAS and Lattinen. In the group of RFP it was necessary repeat the technique in 28,57% of the cases and in the group of RFC in 25% of the same ones. In none of two groups were observed neither complications derived from the technique ñor side effects. Conclusions. The RFP of the Gasser's ganglion appears as an effective and safe alternative treatment to the RFC in the management of the essential trigeminal neuralgia (AU)

[Spectral analysis of the electroencephalogram in subjects with mild cognitive impairment]. / Análisis espectral del electroencefalogramaen sujetos con deterioro cognitivo leve.

INTRODUCTION: Mild cognitive impairment (MCI) is defined as a state of the ageing brain midway between normal cognition and dementia. Special attention has been paid to the electrophysiological substrate underlying Alzheimer's disease and MCI in order to identify as early as possible which subjects with MCI progress towards Alzheimer, which could be crucial for starting rehabilitation or pharmacological therapies. AIM: To perform a spectral characterisation of the electroencephalogram in subjects with MCI. PATIENTS AND METHODS: An electroencephalogram was carried out on 41 subjects with MCI in order to analyse the spectral measurements; apolipoprotein E genotype was also performed. RESULTS: In all, 94.8% of the sample displayed a significant increase in energy, and in 66.6% of them this was observed in the theta and delta bands, or both. Significant differences were found in the spectral measurements between carriers and non-carriers of the apolipoprotein E epsilon4 allele in the theta and alpha bands; there was also a statistically significant association between the years of schooling and being a carrier of this allele or not. An increase in the theta-alpha bands was observed in the left temporal region in subjects with a below-average number of years of schooling and carriers of the epsilon4 allele. CONCLUSIONS: In subjects with MCI and carriers of the epsilon4 allele, the alpha and theta cortical rhythms can be affected by similar pathological mechanisms and may be expressed earlier in subjects who have a lower level of schooling.

Análisis espectral del electroencefalogramaen sujetos con deterioro cognitivo leve / Spectral analysis of the electroencephalogram in subjects with mild cognitive impairment

Introducción. El deterioro cognitivo leve (DCL) se define como un estado del cerebro envejecido intermedio entrela cognición normal y la demencia; se ha prestado una especial atención al sustrato electrofisiológico de la enfermedad de Alzheimer y el DCL con la finalidad de identificar lo antes posible qué sujetos con DCL progresan a Alzheimer, lo cual podría ser crucial para el inicio de terapias de rehabilitación o farmacológicas. Objetivo. Caracterización espectral del electroencefalograma en sujetos con DCL. Pacientes y métodos. Se estudió a 41 sujetos con DCL a los cuales se les realizó electroencefalograma para el análisis de las medidas espectrales; además se realizó genotipo de apolipoproteína E. Resultados. El94,8por ciento de la muestra reveló un incremento significativo de energía; en el 66,6 por ciento de ellos se observó en las bandas theta y delta,o ambas. Se encontraron diferencias significativas en las medidas espectrales entre portadores y no portadores del alelo epsilon4 de la apolipoproteína E en las bandas theta y alfa, y además existió una asociación estadísticamente significativa entrelos años de escolaridad y ser portador o no de dicho alelo. Se observó un incremento en las bandas theta-alfa en la región temporal izquierda en los sujetos por debajo de la media de años de escolaridad y portadores del alelo epsilon4. Conclusiones. En los sujetos con DCL y portadores del alelo epsilon4, los ritmos corticales alfa y theta pueden verse afectados por mecanismospatológicos similares, y puede expresarse de forma más precoz en los sujetos que presentan un nivel de escolaridad bajo(AU)

INTRODUCTION: Mild cognitive impairment (MCI) is defined as a state of the ageing brain midway between normal cognition and dementia. Special attention has been paid to the electrophysiological substrate underlying Alzheimer's disease and MCI in order to identify as early as possible which subjects with MCI progress towards Alzheimer, which could be crucial for starting rehabilitation or pharmacological therapies. AIM: To perform a spectral characterisation of the electroencephalogram in subjects with MCI. PATIENTS AND METHODS: An electroencephalogram was carried out on 41 subjects with MCI in order to analyse the spectral measurements; apolipoprotein E genotype was also performed. RESULTS: In all, 94.8percent of the sample displayed a significant increase in energy, and in 66.6 percent of them this was observed in the theta and delta bands, or both. Significant differences were found in the spectral measurements between carriers and non-carriers of the apolipoprotein E epsilon4 allele in the theta and alpha bands; there was also a statistically significant association between the years of schooling and being a carrier of this allele or not. An increase in the theta-alpha bands was observed in the left temporal region in subjects with a below-average number of years of schooling and carriers of the epsilon4 allele. CONCLUSIONS: In subjects with MCI and carriers of the epsilon4 allele, the alpha and theta cortical rhythms can be affected by similar pathological mechanisms and may be expressed earlier in subjects who have a lower level of schooling(AU)

Análisis espectral del electroencefalograma en sujetos con deterioro cognitivo leve / Spectral analysis of the electroencephalogram in subjects with mild cognitive impairment

El deterioro cognitivo leve (DCL) se define como un estado del cerebro envejecido intermedio entrela cognición normal y la demencia; se ha prestado una especial atención al sustrato electrofisiológico de la enfermedad de Alzheimer y el DCL con la finalidad de identificar lo antes posible qué sujetos con DCL progresan a Alzheimer, lo cual podríaser crucial para el inicio de terapias de rehabilitación o farmacológicas. Objetivo. Caracterización espectral del electroencefalograma en sujetos con DCL. Pacientes y métodos. Se estudió a 41 sujetos con DCL a los cuales se les realizó electroencefalograma para el análisis de las medidas espectrales; además se realizó genotipo de apolipoproteína E. Resultados. El 94,8% de la muestra reveló un incremento significativo de energía; en el 66,6% de ellos se observó en las bandas theta y delta,o ambas. Se encontraron diferencias significativas en las medidas espectrales entre portadores y no portadores del alelo epsilon4 de la apolipoproteína E en las bandas theta y alfa, y además existió una asociación estadísticamente significativa entre los años de escolaridad y ser portador o no de dicho alelo. Se observó un incremento en las bandas theta-alfa en la región temporal izquierda en los sujetos por debajo de la media de años de escolaridad y portadores del alelo epsilon4. Conclusiones. En los sujetos con DCL y portadores del alelo epsilon4, los ritmos corticales alfa y theta pueden verse afectados por mecanismospatológicos similares, y puede expresarse de forma más precoz en los sujetos que presentan un nivel de escolaridad bajo

Mild cognitive impairment (MCI) is defined as a state of the ageing brain midway between normalcognition and dementia. Special attention has been paid to the electrophysiological substrate underlying Alzheimer’s disease and MCI in order to identify as early as possible which subjects with MCI progress towards Alzheimer, which could be crucial forstarting rehabilitation or pharmacological therapies. Aim. To perform a spectral characterisation of the electroencephalogram in subjects with MCI. Patients and methods. An electroencephalogram was carried out on 41 subjects with MCI in order to analyse the spectral measurements; apolipoprotein E genotype was also performed. Results. In all, 94.8% of the sampledisplayed a significant increase in energy, and in 66.6% of them this was observed in the theta and delta bands, or both. Significant differences were found in the spectral measurements between carriers and non-carriers of the apolipoprotein E epsilon4 allele in the theta and alpha bands; there was also a statistically significant association between the years of schoolingand being a carrier of this allele or not. An increase in the theta-alpha bands was observed in the left temporal region in subjects with a below-average number of years of schooling and carriers of the epsilon4 allele. Conclusions. In subjects withMCI and carriers of the epsilon4 allele, the alpha and theta cortical rhythms can be affected by similar pathological mechanisms and may be expressed earlier in subjects who have a lower level of schooling

Efectos de duloxetina y amitriptilina en el dolor neuropático: estudio en 180 casos / Effects of duloxetin and amitriptilin in neurophatic pain: study in 180 patients

Objetivo. Valoración de la eficacia analgésica y la tolerancia de duloxetinafrente a amitriptilina en el tratamiento del dolor neuropático. Material y Método. Estudio prospectivo en 180 pacientes durante un periodo de 3 meses. Se excluyeron del estudio los pacientes con depresión y ansiedad. Se dividieron, aleatoriamente, en 3 grupos: Grupo A (recibieron 30 mg de duloxetina con la cena, con incremento a los 3 días a 60 mg, y posteriores incrementos semanales de 30 mg hasta alivio del dolor); Grupo B (recibieron 60 mg de duloxetina con la cena, con incrementos semanales de 30 mg hasta alivio del dolor); Grupo C (recibieron10 mg de amitriptilina los >60 años y 25 mg los menores, con la cena, con incrementos semanales de 25 mg hasta alivio del dolor). Se valoraron: 1. Edad; 2. Diagnóstico; 3. Duración e intensidad del dolor (EVA); 4. Eficacia analgésica (EVA); 5. Tiempo de alivio del dolor; 6. Dosis media analgésica; 7. Efectos indeseable: incidencia, duración e intensidad; 8. Satisfacción del paciente. Los pacientes fueron evaluados a la semana, 15 días, mes y 3 meses de comenzarel tratamiento. Se utilizaron la t de Student para la comparación de medias y una prueba binomial simple para la comparación de proporciones. Resultados. La edad de los pacientes se encontraba, en un intervalo, entre 42-86 años. Los cuadros dolorosos estudiados fueron: Radiculopatía lumbar (45%), radiculopatía cervical (23%), neuralgia postherpética (11.5%), neuralgia del trigémino (10%), síndrome de dolor regional complejo tipo I (5 %), y dolor neuropático postcirugía (5.5%). El tiempo de alivio del dolor fue: A 5±2 días, B 6±1 días, C 14±6 días; las dosis medias analgésicas fueron: A 65±24 mg, B 67±22 mg, C 35±32 mg. La incidencia de efectos indeseables fue significativamente superioren el grupo amitriptilina (sequedad de boca, estreñimientoe hipotensión ortostática) frente a duloxetina (náuseas,somnolencia). En los pacientes del Grupo A, los efectos indeseables fueron de intensidad leve. La satisfacción personal fue excelente/buena en el 95.6% de las pacientes de los grupos A y B y en el 78,7% de las pacientes del grupo C. Conclusiones. Ambos fármacos son eficaces en el tratamiento del dolor neuropático. Duloxetina tiene como ventajas, un menor tiempo de inicio del efecto analgésico y una menor incidencia de efectos indeseables. Los efectos indeseables de duloxetina se minimizan significativamente comenzando con la dosis de 30mg

Objective. Evaluation of analgesia efficacy and tolerability of duloxetine versus amitriptyline in neuropathic pain. Methods. Prospective study in 180 patients during three months. We excluded patients with anxiety or depression. The patients were distributed in three groups: A (30 mg duloxetine at dinner, in the third day 60 mg, increasing 30 mg a week until relief pain); B (60 mg duloxetine at dinner, increasing 30 mg a week until relief pain); C (>60 years: 10 mg amitriptyline and <60 years 25 mg amitriptyline at dinner, increasing 25 mg a week until relief pain). We study: Age,diagnose, duration and severity pain (VAS), analgesia efficacy, time until relief pain, analgesic dose, adverse events (frequency, duration and severity), satisfaction of patient. The patients were evaluated a week, fifteen days, a month and three months. The student t test and binomial model was used for statistical comparison. Results. We studied: lumbar radiculopathy (45%), cervical radiculopathy (23%), postherpetic neuralgia (11.5%), trigeminal neuralgia (10%), Complex Regional Pain syndrome I (5%), postsurgical neuropathic pain (5.5%). In A and B groups the pain relief in a week of treatment, in C group after 15 days of treatment. The time until relief pain were: A 5±2, B 6±1,C 14±6 days; the analgesic doses were: A 65±24 mg, B67±22 mg, C 35±32 mg. The frequency of adverse events was more significant in the group amitriptyline (dry mouth,constipation, orthostatic hypotension) versus duloxetine(nausea, somnolence). Adverse events in the patients of the group A were weight. The personal satisfaction was excellent/good in 95.6% patients included in groups A and B,and 78.7% in groups C. Conclusions: Duloxetine andamitriptyline are effective in neuropathic pain. Less time until relief pain and less adverse events with duloxetine. The beginning of treatment with 30 mg duloxetine decrease events adverse

Eficacia analgésica de citrato de fentalino transmucosa oral (CFOT) en histeroscopias / Analgesic efficacy of transmucosal fentanyl for hysteroscopies

ObjetivoEl objetivo de este estudio fue valorar la eficacia del fentanilotransmucosa oral como analgésico, sedante y ansiolítico en pacientes sometidas a histeroscopia diagnóstica y terapéutica.MétodosSe estudiaron 40 pacientes programadas para histeroscopiadiagnóstica y/o terapéutica. Los criterios de inclusión fueron:pacientes ASA I y II, con 8 h. de ayuno. Los criterios deexclusión fueron: embarazo y ASA >=3. Ninguna de las pacientesestaba en tratamiento con antidepresivos y/o ansiolíticos.Se dividieron en 2 grupos: Grupo A (n=20), pacientesprogramas para histeroscopia diagnóstica, que recibieron 200 mg de CFOT 20 min. antes del procedimiento. A aquellas pacientesen las que el procedimiento diagnóstico se convertíaen terapéutico, o la dosis era insuficiente, se les administrabaotra dosis de 200 mg. Grupo B (n=20), pacientes programadaspara histeroscopia terapéutica, que recibieron 400 mg.A aquellas pacientes en las que se consideraba que la dosisinicial era insuficiente, se les administraba otra dosis de 200 mg. Se estudiaron: 1. Presión arterial (PA), Frecuencia Cardiaca(FC) y Saturación de O2 (Sat O2), cada 10 min. 2. Nivelde analgesia, sedación y grado de ansiedad, durante todoel proceso. Tiempo transcurrido desde la premedicación hastael alta. Efectos indeseables. Satisfacción del paciente. Parala valoración del dolor se utilizó una escala de 1 a 5. Parael nivel de sedación, se utilizó la escala de Ramsay de 1 a 6.Para el grado de ansiedad se utilizó Spielberger State-TraitAnxiety Inventory Short Form. Resultados: La PA, FC y SatO2, se mantuvo estable en todas las pacientes desde la premedicaciónhasta el alta. El nivel medio de analgesia, el gradode sedación y de ansiedad fue satisfactorio durante todo elestudio. La dosis de CFOT consumido A: 210 mg y B 434.78mg y los tiempos premedicación - alta fueron: A 1.8 ± 0.7 h.y B 2.6 ± 1 1 h.La satisfacción fue buena/excelente en el 99.3% de loscasos. Conclusiones: este estudio demostró que el CFOT esun buen analgésico, ansiolítico y sedante en histeroscopias (AU)

Background: The aim of this study was to evaluate the effectiveness of the OTFC as analgesic, sedative and anxiolytic in patients who undergo diagnostic and therapeutic hysteroscopy. Methods: We carried out a prospective study in 40 patients who were programmed for diagnostic and therapeutic hysteroscopy. The inclusion’s criteria were: Patients with ASA I y II and who were nil by mouth for 8 hours. The exclusion’s criteria were: pregnancy and ASA > 3. None of the patients consumed antidepressants and/or anxiolytics. The patients were divided en 2 groups. Group A (n =20), patients planned for undergo diagnostic hysteroscopy received OTFC 20 minutes before surgery. The doses administrated were 200 μg. In those patients in which the diagnostic procedure was converted to the therapeutic, and the doses were insufficient an other dose of 200 μg was given 30 minutes after the first one. Group B (n = 20), patients planned for therapeutic hysteroscopy received 400 μg, 20 minutes before the procedure. In those patients in which we consider that the initial dose was insufficient, we given them a second dose of 200 μg 30 minutes after the first one. It was studied: 1. Blood pressure, heart rate and oxygen saturation, every 10 minutes from the premedication up to the discharge. 2. Level of analgesia, sedation and anxiety from the premedication up to the discharge. 3. Times between premedication up to the discharge. 4. Side effects. 5. Satisfaction of the patients: bad, regular, good and excellent. To evaluate the pain, we used a scale from 1 to 5. To evaluate the level of sedation, we used the scale of Ramsay from 1 to 6. To evaluate the grade of anxiety we used the Spilberger State-Trait Inventory sort form. Results: The blood pressure, heart rate and pulse oxymetry were constant in both groups from from the premedication up to the discharge. The level of analgesia, the grade of sedation and anxiety in both groups were satisfactory. The average of OTFC used was 210 μg and 434.78 μg in the group A and B respectively. Times between the premedication up to the discharge were: A 1.8 ± 0.7 h. y B 2.6 ± 1 1 h. 99.3% of the patients found OTFC excellent. Conclusions: This study demonstrates that the OTFC is an effective anxiolytic in patients who undergo diagnostic and therapeutic hysteroscopy