Comparison of the Analgesic Efficacy between Levobupivacaine 0.25% and Ropivacaine 0.375% for PENG (Pericapsular Nerve Group) Block in the Context of Hip Fracture Surgery of Elderly Patients: A Single-Center, Randomized, and Controlled Clinical Trial.

Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed. Patients were randomized to receive ultrasound-guided PENG blocks using 20 mL of either 0.25% levobupivacaine or 0.375% ropivacaine (both of which are equipotent concentrations). The primary endpoint was to compare the analgesic duration (time to first rescue) and analgesic quality (pain scores using the VAS, PAINAD, and AlgoPlus scales) between the groups. Secondary endpoints included comparing the onset time, describing the need for and type of rescue analgesics, and possible associated adverse effects. There were no statistically significant differences in analgesic duration between levobupivacaine (median 861.0, IQR 960) and ropivacaine (median 1205.0, IQR 1379; p = 0.069). Likewise, the quality of analgesia and onset time were comparable among the groups. A small number of patients required opioids as rescue analgesics (4.6%). The possible associated adverse effects included postoperative infection (11.1%) and delirium (2.8%).

Plasmocitoma de laringe / Plasmocytoma of the Larynx

Los plasmocitomas solitarios, son una rara forma de presentación de las neoplasias de células plasmáticas, ya que sólo 1 por ciento de estas neoplasias se presenta fuera de la médula ósea. Aunque la afección ósea es la más frecuente, algunos casos se pueden ver afectados por lesiones en tejidos blandos. En ambas condiciones la radioterapia continúa siendo el tratamiento de elección. Se presenta en el caso de un paciente con plasmocitoma primario de laringe, el cual se encuentra vivo y en remisión después de tratamiento con radioterapia. Se hacen consideraciones sobre el diagnóstico diferencial y una revisión de la literatura.