ABSTRACT
La cirugía de corrección de la columna es un procedimiento quirúrgico invasivo que origina daño postoperatorio severo. Reportamos 6 casos de bloqueo en el plano del músculo erector de la columna para cirugía de escoliosis. Nuestro objetivo fue aportar tratamiento efectivo para el dolor perioperatorio, y lograr estabilidad hemodinámica intraoperatoria, sin interferir en la neuromonitorización. También se destacan los retos técnicos. El escáner ecoguiado es necesario para identificar las prominencias óseas y determinar los posibles puntos de inyección múltiples. El bloqueo en el plano del músculo erector de la columna en cirugía de escoliosis es una técnica más fácil y segura, en comparación con la anestesia epidural, pudiendo utilizar cirugía de columna compleja instrumentada. Este bloqueo parece desempeñar un papel en la vía del dolor perioperatorio, complementando el régimen anestésico multimodal y no interfiriendo en los potenciales evocados en adultos. Sin embargo, el mecanismo de difusión de este bloqueo es poco conocido aún y, por tanto, debemos ser conscientes de la toxicidad del anestésico local
Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. The technical challenges are also highlighted. An ultrasound guided scout scan is necessarry to identify the bony prominences and determine the possible multiple injection points. Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity
Subject(s)
Humans , Male , Female , Child , Adolescent , Neuromuscular Blockade/methods , Anesthetics, Local/administration & dosage , Ropivacaine/administration & dosage , Scoliosis/surgery , Treatment OutcomeABSTRACT
Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. The technical challenges are also highlighted. An ultrasound guided scout scan is necessarry to identify the bony prominences and determine the possible multiple injection points. Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity.
Subject(s)
Nerve Block/methods , Pain, Postoperative/therapy , Paraspinal Muscles , Scoliosis/surgery , Adolescent , Anesthetics, Intravenous/administration & dosage , Anesthetics, Local/administration & dosage , Child , Dexmedetomidine/administration & dosage , Female , Humans , Hypnotics and Sedatives/administration & dosage , Male , Propofol/administration & dosage , Ropivacaine/administration & dosageABSTRACT
The current study aimed to explore the anatomy of the dorsal radio-carpal ligament (DRC ligament) and to investigate the presence and histological structure of ulnar part of the DRC ligament. Twenty cadaveric wrist joints were dissected and attachments of the DRC ligament and the newly described ulnar part of the DRC ligament were identified and noted. Samples of both ligaments were sent for histological examination. The DRC ligament was identified in all 20 specimens with type I Mizuseki arrangement of fibres seen in 60% of wrists. The ulnar part of the DRC ligament was successfully identified in 18 of the 20 wrists. The histological observation of the ulnar part of the DRC ligament showed the highly uniform arrangement of collagen bundles typical of ligaments. This study explores the anatomy of the DRC ligament and confirms the presence of the ulnar part of DRC ligament through histological analysis not undertaken in previous studies.
Subject(s)
Carpal Bones/anatomy & histology , Joint Capsule/anatomy & histology , Ligaments, Articular/anatomy & histology , Wrist Joint/anatomy & histology , Aged , Aged, 80 and over , Cadaver , Female , Humans , MaleABSTRACT
Rapidly-progressive spontaneous progression of the osteolysis following internal fixation of pathological fracture in patients with Paget's disease has not been previously reported. We describe two patients, aged 59 and 65 years, respectively, who had pathological subtrochanteric fractures in Pagetic femora fixed internally using an interlocked intramedullary nail, and who developed spontaneous rapid osteolysis. Both patients responded favourably to long-term treatment with alendronate, with resultant fracture union and resolution of osteolysis.
