Manejo del dolor irruptivo asociado a la cura de úlceras cutáneas / Management of breakthrough pain associated with the cure of skin ulcers

OBJETIVOS: Valorar el manejo profiláctico del dolor irruptivo asociado a la cura de úlceras cutáneas, teniendo en cuenta los diferentes tratamientos que se usan en la práctica clínica para la prevención y la reducción del dolor. MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional y transversal. El estudio se llevó a cabo en 11 hospitales en España. Se recopilaron datos sobre las características de las úlceras, además de variables demográficas y clínicas de los pacientes. La valoración del dolor, la ansiedad y la satisfacción del paciente se midieron mediante el cuestionario del dolor de McGill, la escala de ansiedad de Hamilton y escalas visuales analógicas. RESULTADOS: La mayoría de los pacientes presentaba niveles bajos de ansiedad (74,2 %, ninguna o leve), mientras que la satisfacción de los pacientes y los profesionales sanitarios era alta (8,3 y 7,7, respectivamente). Se administraron medicamentos opioides al 73,8 % de los pacientes, que experimentaron significativamente (p < 0,0001) menos dolor que aquellos que no recibieron tratamiento o que recibieron medicamentos no opioides. El tipo de tratamiento se relacionó con la edad del paciente, la percepción del dolor durante la cura, los años de experiencia del profesional, el uso de guías clínicas y el servicio o unidad en el que se llevó a cabo la cura. El uso de profilaxis se relacionó significativamente con el tratamiento del dolor irruptivo, con úlceras más graves y con el tratamiento realizado por un profesional con menos de 20 años de experiencia, que siguió las guías clínicas. Otros factores relacionados con el uso de opioides fueron la presencia de ansiedad, la unidad donde se realizaron los cuidados y los años de experiencia del profesional de la salud. CONCLUSIONES: Las diferencias en el manejo del paciente dependieron de numerosos factores. La profilaxis con opioides se asoció con una menor percepción del dolor para el paciente

OBJECTIVE: to assess the prophylactic management of breakthrough pain associated with skin ulcers care procedures, considering the different treatments used in clinical practice for the prevention and minimization of pain. MATERIAL AND METHODS: A multicenter, cross-sectional, observational study. The study was conducted in 11 hospitals distributed throughout Spain. Ulcer features, patient demographics and clinical characteristics were recorded. Pain assessment, and patients' anxiety and satisfaction were measured using McGill Pain Questionnaire, Hamilton Anxiety Rating Scale and visual analogue scales (VAS). RESULT: Low levels of anxiety were registered (74.2%, none or mild) and patient and healthcare professional satisfaction was high (8.3 and 7.7, respectively). Opioid drugs were administered to 73.8% of patients, who experienced significantly less pain than those who did not receive treatment or who received non-opioid drugs (p < 0.0001). Type of management was related to patient age, ulcer characteristics, treatment for background pain, patient anxiety levels, perception of pain during the procedure, years of experience of the healthcare professional, the use of clinical guidelines, and the unit in which it was performed. Factors significantly related to the use of prophylaxis were treatment for background pain, more severe ulcers, and treatment by a professional with <20 years of experience who followed clinical guidelines. Significant factors related to the use of opioids were anxiety, the care unit, and the years of experience of the healthcare professional. CONCLUSIÓN: Differences in patient management depended on numerous factors. Prophylaxis with opioids, mainly fentanyl, resulted in less pain for the patient

Ultrasound guidance for lateral midfemoral sciatic nerve block: a prospective, comparative, randomized study.

Block of the sciatic nerve at the midfemoral level is usually performed using nerve stimulation techniques. We investigated the efficacy of ultrasound, combined with nerve stimulation, to locate and block the sciatic nerve at the lateral midfemoral level compared to nerve stimulation alone. Sixty-one patients scheduled for foot and ankle surgery were enrolled in this prospective, randomized study. Thirty patients underwent a lateral block of the sciatic nerve at the midfemoral level guided by ultrasound (group US) and 31 patients received the block without ultrasound (group ES). Once an adequate motor response was obtained using nerve stimulation, 35 mL of ropivacaine 0.5% was administered. The main end-points of the study were: number of attempts to obtain an adequate motor response, success rate of nerve location at the first attempt, quality and duration of both sensory and motor blocks, and anesthetic distribution. The success of sciatic nerve location at the first attempt was significantly more frequent in the US group than in the ES group (76.6% versus 41.9%; P < 0.001). The quality of the sensory block and the tolerance to the pneumatic tourniquet were also significantly better in the US group (P < 0.01). We conclude that ultrasound combined with nerve stimulation improved the quality of the sensory block and the tolerance to the pneumatic tourniquet, reducing the number of attempts to perform sciatic nerve block at the midfemoral level.