Correlation between plasma fibrinogen and FIBTEM thromboelastometry during liver transplantation: a comprehensive assessment.

BACKGROUND: Thromboelastometry may reduce red blood cell (RBC) transfusion in liver transplantation (LT). Fibrinogen concentration is a primary determinant of FIBTEM maximum clot firmness (MCF), but several factors could affect the correlation between FIBTEM MCF and fibrinogen values. We aimed to investigate (1) the concordance between fibrinogen level and FIBTEM MCF and (2) the association of fibrinogen level and FIBTEM MCF with RBC transfusion during LT. METHODS: A post hoc analysis of data from a randomized, multicentre, double-blind, saline/fibrinogen trial was used (NCT01539057). A total of 86 adult patients were included. RESULTS: The Lin concordance coefficient (LCC) between FIBTEM MCF and fibrinogen levels with the model formula 1·3679 + 0·05414* FIBTEM MCF was poor overall (LLC [95% CI]: 0·387 [0·340 to 0·432]) and moderate for the preperfusion period (LLC [95% CI]: 0·789 [0·747 to 0·824]), but very poor for the postreperfusion period (LLC [95% CI] 0·170 [0·105 to 0·233]). The model assessed for RBC transfusion for FIBTEM MCF showed an area under the curve of 0·788 [0·745-0·832]. Patients with FIBTEM MCF values <8 mm had a significantly higher likelihood of receiving RBC than patients with higher values. (OR [95% CI]: 2·08 [1·30-3·33], P = 0·002). FIBTEM MCF values over 10 mm do not appear to reduce the likelihood of RBC transfusion. CONCLUSION: FIBTEM MCF is not a good indicator of plasma fibrinogen values after graft reperfusion. FIBTEM MCF >8 mm during the LT procedure is associated with less RBC transfusion. FIBTEM MCF values over 10 mm could lead to unnecessary fibrinogen administration.

Uso del parche de lidocaína al 5% para el tratamiento del dolor postquirúrgico en cirugía de torax / The use of a 5% lidocaine patch for the treatment of postoperative pain in thoracic surgery

Una analgesia inadecuada en cirugia toracica facilita las complicaciones respiratorias potencialmente graves y se asocia al sindrome de dolor cronico post-toracotomia. El cateter epidural y el cateter paravertebral son los tratamientos que resultan mas efectivos, dentro de una estrategia multimodal. El parche de lidocaina 5 % esta indicado para el dolor en la neuropatia post-herpetica. Existe literatura sobre su utilidad en otros modelos de dolor. Presentamos tres pacientes con dolor postquirurgico en cirugía de torax, a pesar del tratamiento convencional, y su buena respuesta analgesica tres la aplicacion de parche de lidocaina 5% (AU)

Sub-optimal management of acute post-thoracotomy pain is associated to pulmonary complications and has been identified as an independent factor for a post-thoracotomy pain syndrome. Epidural analgesia and paravertebral catheter are the most effective in a multimodal analgesia regime. Lidocaine patch 5 % is for a treatment for post-herpetic neuralgia. Some literature suggests its use in other types of pain. We present three patients after different thoracic procedures with uncontrolled pain despite conventional treatment, and their good pain response to lidocaine patch 5 % (AU)

Foramen oval permeable diagnosticado con comprobación ecocardiográfica de catéter venoso central / Patent foramen ovale diagnosed with echocardiographic checking of the positioning of a central venous catheter

No disponible

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.

We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.

Modern hydroxyethyl starch and acute kidney injury after cardiac surgery: a prospective multicentre cohort.

BACKGROUND: Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients. METHODS: In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals. RESULTS: We identified 350 patients (33%) administered 6% HES 130/0.4 intraoperatively and postoperatively, and 377 (36%) experienced postoperative AKI (AKI Network criteria). In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES group had higher Euroscore and more comorbidities including unstable angina, preoperative cardiogenic shock, preoperative intra-aortic balloon pump use, peripheral arterial disease, and pulmonary hypertension. The non-HES group received more intraoperative vasopressors and had longer cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES 130/0.4 use was not associated with significantly increased risks of AKI (adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were confirmed by propensity score-matched pairs analyses. CONCLUSIONS: The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.

Fibrinogen: A Clinical Update on Liver Transplantation.

INTRODUCTION: Hemostatic and coagulation disorders related to severe liver disease may cause massive bleeding beyond what can be expected from surgical trauma in liver transplantation. Fluid resuscitation and fibrinolysis may aggravate the problem, as plasma fibrinogen decreases in all patients. The objective of this review was to update the criteria for fibrinogen replacement in liver transplantation. METHODS: A PubMed and Scopus search from 1990 to 2015 was made. The following key words were used: fibrinogen, liver transplantation, coagulation, and blood product replacement. Controlled trials and observational studies were selected on the basis of clinical relevance. RESULTS: There is a scarcity of published controlled studies on perioperative fibrinogen replacement. Most articles refer to expert opinion; therefore, criteria for the administration of fibrinogen have been empirically established. The response to cryoprecipitate or fibrinogen concentrate administration in liver transplantation has not been established. Viscoelastic platelets free tests have been reported to have a good correlation with Clauss-measured plasma fibrinogen concentration. In surgical patients, the median increase in fibrinogen plasma level per gram injected has been determined in 0.2375 g/L. Alternatively, fibrinogen replacement can be guided based on viscoelastic hemostatic assays. CONCLUSIONS: In liver transplantation, plasma fibrinogen levels are low in most patients during surgery. Fibrinogen administration to correct hypofibrinogenemia has a positive impact on surgical bleeding. However, there is a scarcity of literature about fibrinogen administration; therefore, administration should be adjusted to replace plasma fibrinogen levels in the range of normal and guided by thromboelastometry.

El bloqueo ecoguiado del nervio safeno resulta efectivo para la analgesia perioperatoria en los procedimientos ambulatorios artroscópicos realizados en el compartimento interno de la rodilla / Ultrasound-guided saphenous nerve block is an effective technique for perioperative analgesia in ambulatory arthroscopic surgery of the internal knee compartment

Objetivos. La cirugía artroscópica de rodilla es una técnica mínimamente invasiva con un dolor moderado durante las primeras 24 h. Nuestro objetivo principal ha sido determinar el valor del bloqueo ecoguiado del nervio safeno como método de control analgésico intraoperatorio y postoperatorio inmediato. Material y métodos. Estudio observacional y prospectivo. Todos los pacientes recibieron anestesia general con mascarilla laríngea. En el grupo de bloqueo safeno se realizó el bloqueo con 10 ml de ropivacaína al 0,475%. Se determinó la localización de la cirugía (grupo compartimento externo/grupo compartimento interno), el consumo de morfina, la EVA a los 5, 30, 60 y 120 min después de la cirugía y a las 24 h, la necesidad de fármaco de rescate, la aparición de náuseas y vómitos, el tiempo de estancia en la URPA, el retraso en el alta y el grado de satisfacción. Resultados. Se incluyeron 73 pacientes; en 46 la cirugía fue realizada con bloqueo safeno y en 27 sin bloqueo. El consumo de morfina intraoperatorio, postoperatorio y total fue significativamente menor en el grupo safeno, así como la EVA a las 24 h. En el subgrupo de cirugía de compartimento interno se mantuvieron las diferencias en la EVA 24 h, el consumo de morfina y el tiempo de estancia en la URPA. Conclusiones. El bloqueo ecoguiado del nervio safeno, especialmente en la cirugía artroscópica del compartimento interno de la rodilla, disminuye los requerimientos analgésicos obteniendo una mejor calidad en el control del dolor, mayoritariamente a las 24 h de la realización de la cirugía y sin ningún efecto secundario (AU)

Objectives. Arthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24 h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery. Material and methods. A prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10 ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120 min and 24 h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated. Results. The study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn’t receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24 h. In the subgroup of internal compartment surgery differences in VAS 24 h, morphine consume and lenght of stay in PACU were mantained. Conclusions. The ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24 h postoperatively and without any known side effects (AU)

Ultrasound-guided saphenous nerve block is an effective technique for perioperative analgesia in ambulatory arthroscopic surgery of the internal knee compartment.

OBJECTIVES: Arthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery. MATERIAL AND METHODS: A prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10 ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120 min and 24 h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated. RESULTS: The study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn't receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24 h, morphine consume and lenght of stay in PACU were mantained. CONCLUSIONS: The ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24 h postoperatively and without any known side effects.

Postoperative analgesia with continuous wound infusion of local anaesthesia vs saline: a double-blind randomized, controlled trial in colorectal surgery.

AIM: The aim of this prospective double-blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion (CWI) of the local anaesthetic ropivacaine after either laparotomy or video-assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine. METHOD: Patients scheduled for colorectal surgery randomly received a 48-h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy. The primary end-point was total morphine consumption in surgery and afterwards through a patient-controlled analgesia device. Results in the laparotomy and laparoscopy subgroups were also compared. RESULTS: Sixty-seven patients were included, 33 in the ropivacaine CWI group and 34 in the saline group. Median [interquartile range (IQR)] morphine consumption was lower in the ropivacaine group [23.5 mg (11.25-42.75)] than in the saline group [52 mg (24.5-64)] (P = 0.010). Morphine consumption was also lower in the laparotomy subgroup receiving ropivacaine [21.5 (15.6-34.7)] than in the saline group [52.5 (22.5-65) ml] (P = 0.041). Consumption was statistically similar in laparoscopy patients on ropivacaine or saline. No side effects were observed. Sixteen patients had a surgical wound infection (23.9%); 11 (16.4%) presented wound infection and five (7.5%) organ space infection. Forty-six catheter cultures were obtained; 10 (21.7%) were positive, assessed to be due to contamination. CONCLUSION: Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.

Postoperative respiratory outcomes in laparoscopic bariatric surgery: Comparison of a prospective group of patients whose neuromuscular blockade was reverted with sugammadex and a historical one reverted with neostigmine / Resultados respiratorios postoperatorios en cirugía bariátrica laparoscópica: comparación entre un grupo prospectivo de pacientes cuyo bloqueo neuromuscular fue revertido con sugammadex frente a uno histórico revertido con neostigmina

Purpose. Bariatric surgery patients are at high risk of perioperative respiratory adverse events. We hypothesized that the use of sugammadex to reverse neuromuscular blockade could improve postoperative respiratory outcomes. Methods. Prospective observational series of consecutive patients scheduled for laparoscopic bariatric surgery in whom neuromuscular blockade was reverted with sugammadex were compared with a historical matched cohort of patients reverted with neostigmines. The necessity of postoperative mechanical ventilation or pathological changes in postoperative chest X-ray were two of the comparisons done. Results. We enrolled 160 patients in each group (Sugammadex - SG and Historical - HG). Two patients (mean, CI 95%), (1.25, 0.34-4.4) in the SG and five patients in the HG (mean, CI 95%), (3.13, 1.34-7.11) required mechanical ventilation immediately after surgery (p = 0.38, chi-square test). Significantly less chest X-ray postoperative changes were observed in the SG: 11 patients (6.9%) versus 26 patients (16.3%) in the HG (Odds ratio OR, CI 95%) (0.36, 0.18-0.8). Conclusion. Requirement of mechanical ventilation is not associated to the reversal agent employed. Less pathological postoperative chest X-ray changes were found in the group of patients whose neuromuscular blockade was reverted with sugammadex (AU)

Objetivos. Los pacientes candidatos a cirugía bariátrica presentan mayor riesgo de eventos respiratorios adversos. Nuestra hipótesis fue que la utilización de sugammadex para revertir el bloqueo neuromuscular podría mejorar los resultados postoperatorios desde el punto de vista respiratorio. Métodos. Se comparó una serie prospectiva de pacientes sometidos a cirugía bariátrica laparoscópica revertidos con sugammadex con una cohorte histórica cotejada de pacientes sometidos a la misma cirugía revertidos con neostigmina. Se compararon, entre otros datos, la necesidad de ventilación mecánica postoperatoria y la aparición de cambios radiológicos patológicos tras la operación. Resultados. Se incluyeron 160 pacientes en cada grupo (Sugammadex [SG] e Histórico HG). Dos pacientes (media 1,25%, IC 95% 0,34-4,4) en el SG y 5 en el HG (media 3,13%, IC 95% 1,34-7,11) precisaron ventilación mecánica inmediatamente después de la cirugía (p = 0,38 test chi-cuadrado). Se observaron significativamente menos cambios en la radiografía posoperatoria de tórax en el grupo SG que en el HG: 11 pacientes (6,9%) frente a 26 (16,3%) (odds ratio 0,36, IC 95% 0,18-0,8). Conclusión. Las necesidades de ventilación mecánica no se asocian al agente reversor empleado. Se observaron menos cambios patológicos en la radiografía postoperatoria de tórax en el grupo de pacientes cuyo bloqueo neuromuscular fue revertido con sugammadex (AU)

Neuroapraxia del nervio hipogloso tras hemiartroplastia de hombro / Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty

Se describe un caso de afectación del nervio hipogloso después de un recambio de hemiartroplastia de hombro con anestesia general con intubación orotraqueal sin complicaciones. Previamente se había realizado un bloqueo interescalénico guiado por ultrasonidos con el paciente despierto. La cirugía se llevó a cabo en posición de semisedestación. Tras la intervención, el paciente refirió clínica compatible con parálisis del nervio hipogloso derecho, iniciada de forma paulatina, que desapareció 4 semanas después. Varios mecanismos se han descrito como causantes de esta alteración neurológica, entre ellos la hiperextensión de la cabeza en el momento de la intubación, la presión ejercida por el neumotaponamiento, o la posición excesivamente hiperextendida o lateralizada de la cabeza durante la cirugía. Se discuten las posibles causas, los factores predisponentes y se sugieren medidas de prevención (AU)

We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in «beach chair» position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures (AU)

Postoperative respiratory outcomes in laparoscopic bariatric surgery: comparison of a prospective group of patients whose neuromuscular blockade was reverted with sugammadex and a historical one reverted with neostigmine.

PURPOSE: Bariatric surgery patients are at high risk of perioperative respiratory adverse events. We hypothesized that the use of sugammadex to reverse neuromuscular blockade could improve postoperative respiratory outcomes. METHODS: Prospective observational series of consecutive patients scheduled for laparoscopic bariatric surgery in whom neuromuscular blockade was reverted with sugammadex were compared with a historical matched cohort of patients reverted with neostigmines. The necessity of postoperative mechanical ventilation or pathological changes in postoperative chest X-ray were two of the comparisons done. RESULTS: We enrolled 160 patients in each group (Sugammadex - SG and Historical - HG). Two patients (mean, CI 95%), (1.25, 0.34-4.4) in the SG and five patients in the HG (mean, CI 95%), (3.13, 1.34-7.11) required mechanical ventilation immediately after surgery (p=0.38, chi-square test). Significantly less chest X-ray postoperative changes were observed in the SG: 11 patients (6.9%) versus 26 patients (16.3%) in the HG (Odds ratio OR, CI 95%) (0.36, 0.18-0.8). CONCLUSION: Requirement of mechanical ventilation is not associated to the reversal agent employed. Less pathological postoperative chest X-ray changes were found in the group of patients whose neuromuscular blockade was reverted with sugammadex.

Low plasma fibrinogen levels and blood product transfusion in liver transplantation.

BACKGROUND: Risk of bleeding in liver transplantation is determined by surgical technique, preoperative hemoglobin and antifibrinolitic therapy. We hypothesized that keeping these confounders factors identical, preoperative plasma fibrinogen level of ≤2 g/L influenced on blood product requirements. METHODS: Adult patients underwent orthotropic liver transplantation (LT) during the period between January 1998 and December 2009. Cases were selected according to a propensity matching analysis meeting the following criteria: surgical vena cava preservation, tranexamic acid administration and hemoglobin range between 90 to 120 g/L. Intraoperative management was protocolized. The main variable was the percentage of patients that did not require red blood cells (RBC's). RESULTS: Six hundred sixty-four patients with LT, 208 excluded, 266 who cannot be matched, the analysis was performed on 190 patients. Two cohorts: Low fibrinogen (≤2 g/L) (61 cases) and standard fibrinogen (>2 g/L) (129 cases) were analyzed. Preoperative platelet count (73.5±52 vs. 104±65; 103/mm3) was different in contrast to the hemoglobin (104.2±8.6 vs. 105.6±8.3; g/L). Use of RBC's resulted significantly higher in the low fibrinogen group (median, 3 vs. 2). The number of patients with no blood product requirements was fewer in the low fibrinogen group (8 cases, 13% vs. 45 cases, 35%). The critical level of plasma fibrinogen (1 g/L) was reached after graft reperfusion in 7 cases (5.5%) in the standard fibrinogen group vs. 24 cases (39%) in the low fibrinogen group. CONCLUSION: Our data suggest that preoperative plasma fibrinogen level of ≤2 g/L increases requirements for blood products during the surgical procedure of liver transplantation.

[Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty]. / Neuroapraxia del nervio hipogloso tras hemiartroplastia de hombro.

We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in "beach chair" position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures.

Complicaciones neurológicas asociadas a bloqueos interescalénico y supraclavicular guiados con ecografía en cirugía electiva de hombro y extremidad superior. Estudio observacional prospectivo en un hospital universitario / Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital

Objetivos. La incidencia de síntomas neurológicos postoperatorios tras la realización de bloqueo interescalénico varía entre un 4 y un 16%. La mayoría de los casos se resuelven de forma espontánea antes de un año, pero algunos pacientes mantienen sus síntomas de forma permanente. Nuestro objetivo fue valorar la incidencia de síntomas neurológicos postoperatorios tras la realización de los bloqueos anestésicos ecoguiados interescalénico y supraclavicular. Material y métodos. Estudio prospectivo, observacional. Se incluyeron, de forma consecutiva, pacientes sometidos a cirugía de extremidad superior en un hospital universitario, en los que se realizó un bloqueo interescalénico o supraclavicular como técnica aislada o con anestesia general. Siete días después de la intervención se realizó una entrevista telefónica enfocada a la detección de síntomas neurológicos en la extremidad intervenida. En los pacientes con síntomas se realizaron nuevas entrevistas seriadas (al cabo de uno, 3 y 6 meses, y al año de la intervención) hasta la resolución de la sintomatología. A aquellos pacientes con persistencia de sintomatología al cabo de un año se les ofreció la posibilidad de evaluación neurológica. Resultados. Fueron incluidos 121 pacientes, en los que se realizaron 96 bloqueos interescalénicos y 22 bloqueos supraclaviculares. Un 9,9% (IC 95% 5-15%) de los pacientes presentaron algún síntoma neurológico postoperatorio durante la primera semana. No hubo diferencias significativas entre el bloqueo interescalénico (9%) y el supraclavicular (14%). A los 3 meses los síntomas se mantuvieron en 9 pacientes (7,4%), permaneciendo en 4 de ellos (3,3%) la sintomatología al cabo de 1,5 años. Se realizó electromiograma en 3 de ellos, con resultado positivo para lesión nerviosa en todos ellos. Conclusiones. Observamos una elevada incidencia de síntomas neurológicos postoperatorios, así como un preocupante porcentaje de permanencia de la sintomatología. No se evidenciaron diferencias relevantes en la incidencia según el tipo de bloqueo, y tampoco se identificó ninguna característica del paciente o del procedimiento anestésico que estuvieran asociadas con la incidencia de dichos síntomas, salvo una relación marginal con la edad. Basados en estos resultados, es imprescindible la explicación detallada de esta complicación a los pacientes antes de realizar estos bloqueos(AU)

Objectives. The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. Material and methods. A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. Results. A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI , 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. Conclusions. A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the patients before performing these blocks(AU)