Eficacia y seguridad del bloqueo femoral continuo guiado con ecografía frente a la analgesia epidural en el postoperatorio de artroplastia total de rodilla / Effectiveness and safety of continuous ultrasound-guided femoral nerve block versus epidural analgesia after total knee arthroplasty

Objetivos. La artroplastia total de rodilla es una intervención asociada a dolor postoperatorio de severa intensidad. El objetivo de este estudio fue comparar el bloqueo continuo del nervio femoral ecoguiado con la analgesia epidural continua, ambos con bajas concentraciones de anestésico local en el postoperatorio inmediato de este proceso. Material y métodos. Estudio prospectivo aleatorizado no enmascarado de 60 pacientes intervenidos de prótesis total de rodilla aleatorizados en 2 grupos. Treinta pacientes recibieron un bloqueo epidural continuo mientras que los otros 30 recibieron un bloqueo continuo del nervio femoral ecoguiado, utilizando para la infusión levobupivacaína 0,125% en ambos grupos. Se valoró la existencia de diferencias en cuanto al control del dolor, la aparición de efectos colaterales y complicaciones entre ambas técnicas, así como la necesidad de opiáceos de rescate y el grado de satisfacción con el tratamiento recibido durante las primeras 48h de postoperatorio. Resultados. La calidad de la analgesia fue similar en ambos grupos, aunque en las primeras 6h de postoperatorio los pacientes del grupo epidural presentaron menor dolor tanto en reposo como en movimiento (p=0,007 y p=0,011). Esta diferencia no se observó a las 24h (p=0,084 y p=0,942). A las 48h el control del dolor en reposo en el grupo bloqueo femoral fue mejor que en el epidural (p=0,009). El consumo medio de morfina y el grado de satisfacción fueron similares. La analgesia epidural presentó el mayor índice de efectos colaterales (p=0,003). Conclusiones. El bloqueo continuo del nervio femoral ecoguiado proporciona una analgesia y un consumo de morfina similares a la analgesia epidural, con un mismo grado de satisfacción pero con menor índice de efectos colaterales en el postoperatorio de artroplastia total de rodilla (AU)

Objectives. Total knee arthroplasty is associated with severe postoperative pain. The aim of this study was to compare continuous ultrasound-guided femoral nerve block with continuous epidural analgesia, both with low concentrations of local anaesthetic after total knee arthroplasty. Material and methods. A prospective, randomised, unblinded study of 60 patients undergoing total knee replacement, randomised into two groups. A total of 30 patients received continuous epidural block, while the other 30 received continuous ultrasound-guided femoral nerve block, as well as using 0.125% levobupivacaine infusion in both groups. Differences in pain control, undesirable effects, and complications between the two techniques were assessed, as well as the need for opioid rescue and the level of satisfaction with the treatment received during the first 48hours after surgery. Results. No differences were found in demographic and surgical variables. The quality of analgesia was similar in both groups, although in the first six hours after surgery, patients in the epidural group had less pain both at rest and with movement (P=.007 and P=.011). This difference was not observed at 24hours (P=.084 and P=.942). Pain control at rest in the femoral block group was better at 48hours after surgery than in the epidural group (P=.009). The mean consumption of morphine and level of satisfaction were similar. Epidural analgesia showed the highest rate of side effects (P=.003). Conclusions. Continuous ultrasound-guided femoral nerve block provides analgesia and morphine consumption similar to epidural analgesia, with the same level of satisfaction, but with a lower rate of side effects after total knee arthroplasty (AU)

Effectiveness and safety of continuous ultrasound-guided femoral nerve block versus epidural analgesia after total knee arthroplasty. / Eficacia y seguridad del bloqueo femoral continuo guiado con ecografía frente a la analgesia epidural en el postoperatorio de artroplastia total de rodilla.

OBJECTIVES: Total knee arthroplasty is associated with severe postoperative pain. The aim of this study was to compare continuous ultrasound-guided femoral nerve block with continuous epidural analgesia, both with low concentrations of local anaesthetic after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomised, unblinded study of 60 patients undergoing total knee replacement, randomised into two groups. A total of 30 patients received continuous epidural block, while the other 30 received continuous ultrasound-guided femoral nerve block, as well as using 0.125% levobupivacaine infusion in both groups. Differences in pain control, undesirable effects, and complications between the two techniques were assessed, as well as the need for opioid rescue and the level of satisfaction with the treatment received during the first 48hours after surgery. RESULTS: No differences were found in demographic and surgical variables. The quality of analgesia was similar in both groups, although in the first six hours after surgery, patients in the epidural group had less pain both at rest and with movement (P=.007 and P=.011). This difference was not observed at 24hours (P=.084 and P=.942). Pain control at rest in the femoral block group was better at 48hours after surgery than in the epidural group (P=.009). The mean consumption of morphine and level of satisfaction were similar. Epidural analgesia showed the highest rate of side effects (P=.003). CONCLUSIONS: Continuous ultrasound-guided femoral nerve block provides analgesia and morphine consumption similar to epidural analgesia, with the same level of satisfaction, but with a lower rate of side effects after total knee arthroplasty.

Eficacia de la radiofrecuencia convencional de geniculados para el tratamiento del dolor en gonartrosis moderada-severa / Effectiveness of genicular nerve radiofrequency treatment in knee osteoarthritis chronic pain

Introducción: la artrosis de rodilla o gonartrosis es una de las patologías articulares más comunes y extendidas en la edad avanzada, que se caracteriza, entre otros, por ocasionar dolor, rigidez e incapacidad funcional en un gran número de casos dificultando las actividades de la vida diaria. Objetivo: nuestro objetivo consistió en evaluar la eficacia del tratamiento con radiofrecuencia convencional de nervios geniculados en pacientes con gonartrosis rebelde a medidas conservadoras, en relación al dolor y mejoría de la rigidez y mejorar la funcionalidad, así como registrar los efectos adversos de la técnica en la gonartrosis. Como objetivo secundario nos planteamos valorar la reducción en el consumo de fármacos antiálgicos, así como la satisfacción de los pacientes tras esta nueva posibilidad terapéutica. Material y métodos: estudio prospectivo no controlado a una serie de pacientes con dolor moderado a severo por artrosis de rodilla a los que se realizó radiofrecuencia convencional de nervios geniculados de la rodilla. La medición del dolor se realizó mediante escala visual analógica (EVA) basal, al mes, a los 3 y a los 6 meses, y para la evaluación de la función se aplicó el cuestionario de Ontario McMaster Universidades Western (WOMAC) a los 3 y 6 meses tras el tratamiento. La respuesta al tratamiento se definió como ≥ 50 % de disminución de la EVA del dolor. Así mismo se registró el grado de satisfacción de los pacientes con la técnica. Resultados: se incluyeron 16 pacientes remitidos a nuestra Unidad con el diagnóstico de gonartrosis con dolor de más 3 meses de evolución, una intensidad del dolor medida mediante la escala VAS ≥ 5 y escala radiológica de severidad de Kellgren- Lawrence 3-4, en los que habían fracasado tratamientos anteriores. Se encontraron diferencias estadísticamente significativas en el valor del EVA inicial 7 (6-8) y el valor al mes 3,5 (1-6), tres 3,3 (1-7) y seis meses 3,37 (1-8) (p = 0,009). El 75 % de los pacientes presentó una reducción del EVA ≥ 50 % en el primer mes, el 68,7 % a los 3 meses, y el 65 % a los 6 meses de tratamiento. Con respecto a la mejoría del dolor y capacidad funcional medida mediante la escala WOMAC, se obtuvo una media inicial de 65,8 (54-79), de 54,7 (41-67) a los tres meses y 50,3 (37-69) a los seis meses, siendo estas diferencias estadísticamente significativas. En ningún caso hubo un empeoramiento de la sintomatología de los pacientes. No se objetivaron complicaciones serias derivadas de la técnica. Conclusiones: en conclusión, la RF convencional parece reducir de manera significativa la intensidad del dolor en un periodo de 6 meses en más del 50 % de los pacientes, al igual que mejora la capacidad funcional en pacientes diagnosticados de artrosis de rodilla. Son necesarios estudios más amplios, comparativos y prospectivos para poder realizar la evaluación de la eficacia de esta técnica (AU)

Introduction: Knee osteoarthritis is a common joint disease in the elderly characterized by pain, stiffness and functional limitation, and daily life disability. Objective: The purpose of this study was to assess the outcome in terms of pain, functional recovery, and side effects during six month of radiofrequency treatment applied to the articular nerve branches (genicular nerves) in patients with chronic knee pain. As secondary outcome we investigated pharmacological therapy reduction and patient’s satisfaction after treatment. Material and methods: This prospective, uncontrolled study involved 16 elderly patients with severe knee osteoarthritis pain after genicular nerve radiofrequency treatment. Visual analogic scale (VAS) was measured at baseline (before treatment), at one, three and six months post-procedure. For measurement of functional limitation we used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before treatment, and three and six months after procedure. Treatment response was defined as at least 50 % of VAS reduction. We also registered patient’s satisfaction after treatment. Results: We included 16 patients with severe knee osteoarthritis pain lasting more than three months, VAS score higher than 5, severe osteoarthritis in Kellgren-Lawrence classification (3-4) and pain resistant to conventional care. We found significant differences in the mean VAS value before radiofrequency 7 (6-8) and after one 3,5 (1-6), three 3,3 (1-7) and six months 3,37 (1-8) after treatment. 75 % of patients had 50 % of VAS score reduction after one month, 68,75 % of patients after three months and 65 % of patients after six months (p = 0,009). Moreover, we also found significant differences in WOMAC score mean values before treatment 65,8 (54-79) and after three 54,7 (41-67) and six 50,3 (37-69) months after radiofrequency. No patient reported a post-procedure adverse event during de follow-up period. Conclusions: RF application to genicular nerves showed significant benefit in terms of pain reduction and functional improvement in a 6 month follow-up in patients with chronic knee osteoarthritis and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are needed (AU)

Bloqueo axilar ecoguiado frente a bloqueo infraclavicular ecoguiado para la cirugía de miembro superior / Ultrasound-guided axillary block versus ultrasound-guided infraclavicular block for upper extremity surgery

Introducción. Con la incorporación de la ecografía en la práctica habitual de la anestesia regional, el bloqueo infraclavicular ha ido ganando popularidad. La mayoría de los abordajes de anestesia regional del miembro superior tienen una alta tasa de éxito, y las diferencias en la eficacia y en la calidad del bloqueo deberían favorecer la elección de una técnica frente a otra. Nuestro objetivo fue evaluar si el bloqueo infraclavicular del plexo braquial presentaba ventajas respecto al axilar en relación con los tiempos de instauración y efectividad clínica. Métodos. Estudio comparativo, prospectivo, aleatorizado entre el bloqueo infraclavicular ecoguiado y el bloqueo axilar ecoguiado en la cirugía de miembro superior. Se evaluó el tiempo anestésico total (definido como la suma del tiempo de realización del bloqueo y el tiempo de instauración). Se registró la tasa de éxito (anestesia quirúrgica), la duración de la analgesia, el dolor postoperatorio mediante escala visual analógica y la incidencia de complicaciones durante y tras la técnica (hasta 24 h después). Resultados. Se incluyeron 82 pacientes, que se dividieron en 2 grupos: bloqueo infraclavicular (BI) (n = 42) y bloqueo axilar (BA) (n = 40). No se observaron diferencias entre los 2 grupos en cuanto a tiempo de realización del bloqueo, tasa de éxito (90-95%) y dolor postoperatorio. Comparado con el abordaje infraclavicular, el grupo BA requirió un mayor tiempo de instauración, 10,2 min (DE ± 1,4) frente a 6,35 min (DE ± 2), siendo esta diferencia estadísticamente significativa (p < 0,05). Además, hubo una mayor duración de la analgesia en el grupo BI que en el grupo BA, 20 h (DE ± 1,36) frente a 13,70 h (DE ± 2,16), respectivamente. Las únicas complicaciones registradas fueron punciones vasculares, que no tuvieron incidencias. Conclusiones. El BI proporciona una eficacia similar, con un menor tiempo de instauración del bloqueo y una analgesia más duradera que el BA(AU)

Background. Most upper limb regional anaesthesia techniques are successful, and differences in efficacy should dictate the choice of technique. Methods. This prospective, randomised study compares ultrasound-guided infraclavicular (IB) and ultrasound-guided axillary brachial plexus blocks (AB) for upper limb surgery. Anaesthesia time (performance time and onset time) was the primary outcome measure. The success rate (surgical anaesthesia), analgesia duration, postoperative pain scores, and the incidence of complications over the following 24 h were recorded. Results. A total of 82 patients were included in the study, and received either IB (n = 42) or AB (n = 40). No differences were observed between the 2 groups in terms of total anaesthesia-related time, performance time, success rate (90-95%), or postoperative pain scores. Compared with the infraclavicular approach, ultrasound-guided AB group required a longer onset time, 10.2 min (SD ± 1.4), than IB group, 6.35 min (SD ± 2). IB was also associated with a longer analgesia duration than that of AB; 20 h (SD ± 1.36) versus 13.70 h (SD ± 2.16), respectively. The only complications we observed were uneventful vascular punctures. Conclusions. We can conclude that compared to ultrasound-guided AB, ultrasound-guided IB provides a similar efficacy, a shorter onset time and longer lasting analgesia(AU)

[Ultrasound-guided axillary block versus ultrasound-guided infraclavicular block for upper extremity surgery]. / Bloqueo axilar ecoguiado frente a bloqueo infraclavicular ecoguiado para la cirugía de miembro superior.

BACKGROUND: Most upper limb regional anaesthesia techniques are successful, and differences in efficacy should dictate the choice of technique. METHODS: This prospective, randomised study compares ultrasound-guided infraclavicular (IB) and ultrasound-guided axillary brachial plexus blocks (AB) for upper limb surgery. Anaesthesia time (performance time and onset time) was the primary outcome measure. The success rate (surgical anaesthesia), analgesia duration, postoperative pain scores, and the incidence of complications over the following 24h were recorded. RESULTS: A total of 82 patients were included in the study, and received either IB (n=42) or AB (n=40). No differences were observed between the 2 groups in terms of total anaesthesia-related time, performance time, success rate (90-95%), or postoperative pain scores. Compared with the infraclavicular approach, ultrasound-guided AB group required a longer onset time, 10.2min (SD±1.4), than IB group, 6.35min (SD±2). IB was also associated with a longer analgesia duration than that of AB; 20h (SD±1.36) versus 13.70h (SD±2.16), respectively. The only complications we observed were uneventful vascular punctures. CONCLUSIONS: We can conclude that compared to ultrasound-guided AB, ultrasound-guided IB provides a similar efficacy, a shorter onset time and longer lasting analgesia.

Gastrostomía percutánea endoscópica y posterior traqueostomía en un paciente con esclerosis lateral amiotrófica / No disponible

No disponible

ELISA test for the detection of influenza H7 antibodies in avian sera.

Using a monoclonal antibody (MAb) specific for the H7 influenza surface glycoproteins, a serological enzyme-linked immunosorbent assay (ELISA) test has been developed. This MAb was made using the low-pathogenicity (LP) avian influenza (AI) strain (BS2676/99) isolated in Italy during a recent outbreak. The test is able to detect H7 antibodies in avian sera. The H7 ELISA has a 99% concordance of results with the classical hemagglutination inhibition (HI) test.

Avian infectious bronchitis: characterization of new isolates from Italy.

The isolation of four new variants or serotypes of avian infectious bronchitis virus in Italy is reported. The antigenic characteristics of these strains were investigated by cross-neutralization tests with the new isolates, Fa 6881/97, AZ 27/98, AZ 20/97, and BS 216/01; two of the most common European serotypes, AZ 23/74 and CR 88121 (793B); and the classic Massachusetts M41 serotype in association with a panel of 17 specific antisera. On the basis of the results obtained, the new isolates show relevant serologic differences. In fact, the four isolates were not neutralized by antisera against the most common European and American serotypes; the AZ 20/97 isolate was partially neutralized by FA 6881/97 antiserum but not reciprocally. The closely related Fa 6881/97 and AZ 27/98 isolates can be considered rather diffused in our country because they have been isolated over 20 times in the last 3 yr in different parts of Italy. On the contrary, the AZ 20/97 and BS 216/01 isolates were reported only once so far. The reverse transcription-polymerase chain reaction showed that Fa 6881/97 isolate is related to 793B isolate, whereas AZ 27/98 and BS 216/01 isolates appeared not to be related to the most common European and Massachusetts serotypes.