Analgesia perioperatoria mediante bloqueo del plano erector espinal en implante de asistencia ventricular izquierda / Perioperative analgesia by erector spinae plane block in left ventricular assist implant

Los dispositivos de asistencia ventricular izquierda se han convertido en los últimos años en un elemento importante para el manejo del fallo ventricular izquierdo refractario a tratamiento farmacológico. Su implantación (realizada mediante toracotomía izquierda o esternotomía) genera un importante dolor perioperatorio, que puede ser manejado con técnicas de anestesia locorregional. Sin embargo, existe gran controversia sobre su realización en cirugía cardíaca debido a la interferencia con la terapia anticoagulante necesaria en estos pacientes.El bloqueo del plano erector espinal constituye una alternativa a las técnicas locorregionales clásicas, al no producir alteraciones hemodinámicas y no interferir con la terapia antiagregante y anticoagulante, siendo una alternativa a tener en cuenta en cirugía cardíaca. Presentamos un caso de implantación de asistencia ventricular izquierda con realización de dicho bloqueo previo al procedimiento quirúrgico e infusión postoperatoria a través de catéter, obteniéndose resultados satisfactorios en el manejo del dolor perioperatorio.(AU)

In recent years, left ventricular assist devices have become an important element in the management of left ventricular failure refractory to pharmacological treatment. Their implantation (performed by left thoracotomy or sternotomy) generates significant perioperative pain, which can be managed with locoregional anesthesia techniques. However, opinions vary on their use in cardiac surgery due to interference with the anticoagulant therapy required in these patients.The erector spinae plane block is an alternative to classic locoregional techniques. It does not produce hemodynamic alterations and does not interfere with antiplatelet and anticoagulant therapy, and is therefore an alternative to be considered in cardiac surgery. We present a case of left ventricular assist device implantation under this block prior to the surgical procedure and postoperative infusion through a catheter, obtaining satisfactory results in the management of perioperative pain.(AU)

Perioperative analgesia by erector spinae plane block in left ventricular assist implant.

In recent years, left ventricular assist devices have become an important element in the management of left ventricular failure refractory to pharmacological treatment. Their implantation (performed by left thoracotomy or sternotomy) generates significant perioperative pain, which can be managed with locoregional anaesthesia techniques. However, opinions vary on their use in cardiac surgery due to interference with the anticoagulant therapy required in these patients. The erector spinae plane block is an alternative to classic locoregional techniques. It does not produce hemodynamic alterations and does not interfere with antiplatelet and anticoagulant therapy, and is therefore an alternative to be considered in cardiac surgery. We present a case of left ventricular assist device implantation under this block prior to the surgical procedure and postoperative infusion through a catheter, obtaining satisfactory results in the management of perioperative pain.

Omeprazole and ranitidine in long-term treatment of duodenal ulcer: a double-blind comparison of length of time in remission.

In most patients duodenal ulcer is a chronic relapsing disease. If no active maintenance treatment or eradication therapy is given after healing, around 70-100% of patients have a relapse during the first year. We conducted a double-blind multicenter study in 472 patients with duodenal ulcer. They were treated with omeprazole 20 mg every morning for four or eight weeks and when healed were randomly allocated to maintenance treatment with either omeprazole 20 mg every morning or ranitidine 150 mg at bedtime for up to six months. The patients were assessed by endoscopy at monthly intervals until healing occurred. Thereafter scheduled endoscopy was carried out after 1, 3, and 6 months of maintenance treatment or immediately in the event of a suspected relapse. Healing status (intention to treat approach) was 87% at four weeks and 93% at eight weeks. At six months the estimated remission rate was 90% for omeprazole and 82% for ranitidine (P = 0.03, 95% CI 1-15%). The incidence of adverse events was similar during the two maintenance treatments. Treatment with omeprazole 20 mg every morning maintained significantly more patients in remission than treatment with ranitidine 150 mg at bedtime.