Utilidad del bloqueo interpectoral continuo como técnica analgésica en cirugía oncológica de mama / The usefulness of interpectoral block as an analgesic technique in breast cancer surgery

Objetivo: Comparar la eficacia analgésica del bloqueo interpectoral continuo (BIPC) frente a la analgesia intravenosa (i.v.) tras cirugía de mama. Material y método: Estudio prospectivo, comparativo y aleatorizado sobre mujeres de 18-75años, ASAI-III, intervenidas de cirugía oncológica de mama. En el grupo1 (BIPC), tras la inducción de anestesia general se colocó un catéter interpectoral ecoguiado y se administró ropivacaína 0,5% 30ml a su través. Tras la incisión quirúrgica, si la frecuencia cardiaca y la presión arterial se incrementaron >15% se administró fentanilo i.v., 1μg·kg−1, repitiendo la dosis en caso necesario. En el postoperatorio se inició perfusión de ropivacaína 0,2% 5ml·h−1; con bolo PCA 5ml/30min por el catéter durante 24h, y se prescribió analgesia de rescate con cloruro mórfico 5mg subcutáneo. En el grupo2 (i.v.), tras la inducción de anestesia general se administró fentanilo i.v. en caso necesario de la misma forma que en el otro grupo. En el postoperatorio se administró metamizol 2g con dexketoprofeno 50mg y ondansetrón 4mg seguido de perfusión de metamizol 4%, tramadol 0,2% y ondansetrón 0,08% 2ml·h−1; con bolo PCA 2ml/20min durante 24h. Se prescribió el mismo rescate analgésico. Las variables principales registradas fueron dolor en reposo y durante el movimiento, según una escala verbal simple (EVA 0-1), y la analgesia de rescate precisada al alta de reanimación, a las 12 y a las 24h. Resultados: Se incluyeron 137 pacientes: 81 en el grupo1 (59,12%) y 56 en el grupo2 (40,87%). No se observaron diferencias significativas en analgesia entre grupos, pero sí en la dosis de fentanilo intraoperatorio (p<0,05). Se observaron diferencias no significativas en la analgesia de rescate requerida en reanimación (10% menor en el grupo1). Conclusiones: Ambas técnicas proporcionaron analgesia postoperatoria eficaz, pero el grupo BIPC precisó significativamente menos fentanilo intraoperatorio

Objective: To compare the analgesic efficacy of continuous interpectoral block (CIPB) compared to intravenous analgesia (IV) after breast surgery. Material and method: A prospective, comparative and randomised study of women aged from 18-75years, ASAI-III, operated for breast cancer. In group1 (CIPB) after general anaesthetic, an ultrasound-guided interpectoral catheter was placed and 30mL of 0.5% ropivacaine was administered through it. In the event of an increase in heart rate and blood pressure >15% after the surgical incision, intravenous fentanyl 1μg·kg−1 was administered, repeating the dose as necessary. In the postoperative period, perfusion of ropivacaine 0.2% 5mL·h−1; with PCA bolus 5mL/30minutes was administered through the catheter for 24hours and rescue analgesia prescribed with 5mg subcutaneous morphine chloride. In group2 (IV), after induction of general anaesthesia, intravenous fentanyl was administered in the same way as in the other group. The patients received metamizole 2g with dexketoprofen 50mg and ondansetron 4mg postoperatively followed by perfusion of metamizole 4%, tramadol 0.2% and ondansetron 0.08% 2ml·h−1; with PCA bolus 2mL/20min for 24hours. The same rescue analgesia was prescribed. The principal variables recorded were pain at rest and during movement, according to a simple verbal scale (VAS 0-10) and the rescue analgesia required on discharge from recovery, at 12 and at 24hours. Results: 137 patients were included: 81 in group1 (59.12%) and 56 in group2 (40.87%). No significant differences were observed in the analgesia between either group, but differences were observed in the dose of intraoperative fentanyl (P<.05). Differences that were not significant were observed in the rescue analgesia required on recovery (10% fewer on group1). Conclusions: Both techniques provided effective postoperative analgesia, but the CIPB group required significantly less intraoperative fentanyl

The usefulness of interpectoral block as an analgesic technique in breast cancer surgery. / Utilidad del bloqueo interpectoral continuo como técnica analgésica en cirugía oncológica de mama.

OBJECTIVE: To compare the analgesic efficacy of continuous interpectoral block (CIPB) compared to intravenous analgesia (IV) after breast surgery. MATERIAL AND METHOD: A prospective, comparative and randomised study of women aged from 18-75years, ASAI-III, operated for breast cancer. In group1 (CIPB) after general anaesthetic, an ultrasound-guided interpectoral catheter was placed and 30mL of 0.5% ropivacaine was administered through it. In the event of an increase in heart rate and blood pressure >15% after the surgical incision, intravenous fentanyl 1µg·kg-1 was administered, repeating the dose as necessary. In the postoperative period, perfusion of ropivacaine 0.2% 5mL·h-1; with PCA bolus 5mL/30minutes was administered through the catheter for 24hours and rescue analgesia prescribed with 5mg subcutaneous morphine chloride. In group2 (IV), after induction of general anaesthesia, intravenous fentanyl was administered in the same way as in the other group. The patients received metamizole 2g with dexketoprofen 50mg and ondansetron 4mg postoperatively followed by perfusion of metamizole 4%, tramadol 0.2% and ondansetron 0.08% 2ml·h-1; with PCA bolus 2mL/20min for 24hours. The same rescue analgesia was prescribed. The principal variables recorded were pain at rest and during movement, according to a simple verbal scale (VAS 0-10) and the rescue analgesia required on discharge from recovery, at 12 and at 24hours. RESULTS: 137 patients were included: 81 in group1 (59.12%) and 56 in group2 (40.87%). No significant differences were observed in the analgesia between either group, but differences were observed in the dose of intraoperative fentanyl (P<.05). Differences that were not significant were observed in the rescue analgesia required on recovery (10% fewer on group1). CONCLUSIONS: Both techniques provided effective postoperative analgesia, but the CIPB group required significantly less intraoperative fentanyl.

[Influence of femoral catheter stimulation intensity on post-surgical analgesia after total knee replacement]. / Influencia de la intensidad de estimulación del catéter femoral sobre analgesia postoperatoria tras prótesis de rodilla.

INTRODUCTION: Stimulating catheters allow the catheter point to be positioned near the nerve, thus reducing the amount of local anaesthetic required for a successful block. There is currently a debate on what is the stimulation intensity required to provide adequate analgesia, although it does seem that if it is obtained with 1mAmp or less the block is more effective. The objective of the study was to demonstrate whether different neurostimulation intensities with the stimulating catheter at femoral nerve level, had an influence on the adequacy of post-surgical analgesia during the 48h after total knee arthroplasty. MATERIAL AND METHODS: A comparative, prospective and randomised study was conducted on patients subjected to total knee replacement. After surgery with subarachnoid anaesthesia, a continuous femoral block was performed with a stimulating catheter at a neurostimulation intensity 0.2 and 0.5mAmp in Group 1, between 0.6 and 1mAmp in Group 2, equal or higher than 1.1mAmp in Group 3, and in Group 4 the catheter was introduced between 3-5cm without looking for a motor response. A dose of 0.2% ropivacaine 0.4mL/kg and an infusion at 5mL/h, with boluses of 10mL/30min, was administered via the catheter. Sciatic nerve block was also performed on all patients with 20ml of 0.5% ropivacaine. The patient demographics were recorded, as well as, post-surgical analgesia details, sensory and motor block in each area, boluses requested, rescue analgesia, and undesirable effects at 8, 16, 24, 36 and 48h. RESULTS: A total of 124 patients were included, 32 in Group 1 (25.8%), 21 in Group 2 (16.9%), 31 in Group 3 (25%), and 40 in group 4 (32.3%). The 4 groups were homogeneous as regards age, height, weight and ASA. There were no statistically significant differences found in the post-operative pain, except during movement in the femoral area at 36 hours (p=.032). There were also no statistically significant differences found in the sensory block in the femoral area at 48 hours (p=.019) and in the femoral cutaneous nerve block at 8 hours (p=.049) or at 24 hours (p=.045). As regards motor block, differences were only found in the obturator nerve at 24 hours (p=.016). There were no differences in rescue analgesia, patient controlled analgesia (PCA) boluses requested or administered, except that the number of boluses requested at 16 hours was less in Group 3 (p=.049). There were also no significant differences in undesirable effects or in the level of satisfaction of the patients between the four groups. CONCLUSIONS: In our study, no influence was found on the level of analgesia provided after knee replacement surgery with the neurostimulation intensity to which the neuromuscular system involved responded when a stimulating catheter is inserted at femoral level.

Influencia de la intensidad de estimulación del catéter femoral sobre analgesia postoperatoria tras prótesis de rodilla / Influence of femoral catheter stimulation intensity on post-surgical analgesia after total knee replacement

Introducción. Nuestro objetivo fue comprobar si distintas intensidades de neuroestimulación con el catéter estimulador a nivel del nervio femoral, influyen en la adecuación de la analgesia postoperatoria durante las primeras 48h del postoperatorio tras prótesis total de rodilla. Los catéteres estimuladores permiten posicionar la punta del catéter en la proximidad del nervio y, por tanto, reducir la cantidad de anestésico local necesaria para un bloqueo con éxito. En la actualidad, está debatida cuál es la intensidad de estimulación a la que se deben colocar para proporcionar analgesia adecuada, aunque parece ser que si se obtiene con 1mAmp o menos, el bloqueo es más efectivo. Material y métodos. Estudio comparativo, prospectivo y aleatorizado en pacientes intervenidos de prótesis total de rodilla. Tras la cirugía con anestesia subaracnoidea, se realizó un bloqueo femoral continuo con un catéter estimulador a una intensidad de neuroestimulación de entre 0,2 y 0,5mAmp en el grupo 1, entre 0,6 y 1mAmp en el grupo 2, igual o superior a 1,1mAmp en el grupo 3, y en el grupo 4 se introdujo el catéter entre 3-5cm sin buscar respuesta motora. Se administró a través del catéter ropivacaína 0,2% 0,4mL/kg y perfusión a 5mL/h, con bolos de 10mL/30min. En todos los pacientes se efectuó también un bloqueo del nervio ciático con 20ml de ropivacaína 0,5%. Se registraron los datos demográficos de los pacientes, características de la analgesia postoperatoria, bloqueo sensitivo y motor en cada territorio, bolos solicitados y administrados, analgesia de rescate y efectos indeseables a las 8, 16, 24, 36 y 48h. Resultados. Se incluyó a 124 pacientes, 32 en grupo 1 (25,8%), 21 en grupo 2 (16,9%), 31 en grupo 3 (25%) y 40 en grupo 4 (32,3%). Los 4 grupos fueron homogéneos respecto a edad, talla, peso y ASA. En el dolor postoperatorio no se encontraron diferencias estadísticamente significativas, excepto durante el movimiento a las 36h en el territorio femoral (p=0,032). También se encontraron diferencias estadísticamente significativas en el bloqueo sensitivo en territorio femoral a las 48h (p=0,019) y en el femorocutáneo a las 8 (p=0,049) y a las 24h (p=0,045). Con relación al bloqueo motor, tan solo se encontraron diferencias en el nervio obturador a las 24h (p=0,016). No hubo diferencias en la analgesia de rescate, bolos PCA solicitados y administrados, excepto en el número de bolos solicitados a las 16h, que fueron menores en el grupo 3 (p= 0,049). Tampoco hubo diferencias significativas en los efectos indeseables ni en el grado de satisfacción de los pacientes entre los 4 grupos. Conclusiones. En nuestro estudio, no se ha encontrado influencia de la intensidad de neuroestimulación a la que responde el sistema neuromuscular implicado cuando se coloca un catéter estimulador a nivel femoral sobre la analgesia que proporciona tras la cirugía protésica de rodilla(AU)

Introduction. Stimulating catheters allow the catheter point to be positioned near the nerve, thus reducing the amount of local anaesthetic required for a successful block. There is currently a debate on what is the stimulation intensity required to provide adequate analgesia, although it does seem that if it is obtained with 1mAmp or less the block is more effective. The objective of the study was to demonstrate whether different neurostimulation intensities with the stimulating catheter at femoral nerve level, had an influence on the adequacy of post-surgical analgesia during the 48h after total knee arthroplasty. Material and methods. A comparative, prospective and randomised study was conducted on patients subjected to total knee replacement. After surgery with subarachnoid anaesthesia, a continuous femoral block was performed with a stimulating catheter at a neurostimulation intensity 0.2 and 0.5mAmp in Group 1, between 0.6 and 1mAmp in Group 2, equal or higher than 1.1mAmp in Group 3, and in Group 4 the catheter was introduced between 3-5cm without looking for a motor response. A dose of 0.2% ropivacaine 0.4mL/kg and an infusion at 5mL/h, with boluses of 10mL/30min, was administered via the catheter. Sciatic nerve block was also performed on all patients with 20ml of 0.5% ropivacaine. The patient demographics were recorded, as well as, post-surgical analgesia details, sensory and motor block in each area, boluses requested, rescue analgesia, and undesirable effects at 8, 16, 24, 36 and 48h. Results. A total of 124 patients were included, 32 in Group 1 (25.8%), 21 in Group 2 (16.9%), 31 in Group 3 (25%), and 40 in group 4 (32.3%). The 4 groups were homogeneous as regards age, height, weight and ASA. There were no statistically significant differences found in the post-operative pain, except during movement in the femoral area at 36hours (p=.032). There were also no statistically significant differences found in the sensory block in the femoral area at 48hours (p=.019) and in the femoral cutaneous nerve block at 8hours (p=.049) or at 24hours (p=.045). As regards motor block, differences were only found in the obturator nerve at 24hours (p=.016). There were no differences in rescue analgesia, patient controlled analgesia (PCA) boluses requested or administered, except that the number of boluses requested at 16hours was less in Group 3 (p=.049). There were also no significant differences in undesirable effects or in the level of satisfaction of the patients between the four groups. Conclusions. In our study, no influence was found on the level of analgesia provided after knee replacement surgery with the neurostimulation intensity to which the neuromuscular system involved responded when a stimulating catheter is inserted at femoral level(AU)

[Neurologic complications of central neuraxial blocks]. / Complicaciones neurológicas en los bloqueos centrales.

Central neuraxial blocks, which are associated with a low incidence of complications, are safe. When complications do occur, however, the resulting morbidity and mortality is considerable. The reported incidence of complications in all series is under 4 per 10000 patients, but given the absence of formal registries and notification procedures, which have legal implications, the real rate of occurrence of these rare events is uncertain. We searched the literature through PubMed and the Cochrane Plus Library for a 5-year period, using the search terms epidural anesthesia AND safety, spinal anesthesia AND safety, complications AND epidural anesthesia, complications AND spinal anesthesia, neurologic complications AND epidural anesthesia, and neurologic complications AND spinal anesthesia. Neuraxial injury after a central blockade may be the result of anatomical and/or physiological lesions affecting the spinal cord, spinal nerves, nerve roots, or blood supply. The pathophysiology of neuraxial injury may be related to mechanical, ischemic, or neurotoxic damage or any combination. When a complication occurs, factors related to the technique will have interacted with pre-existing patient-related conditions. Various scientific societies have published guidelines for managing the complications of regional anesthesia. Recently published clinical practice guidelines recommend ultrasound imaging as a useful tool in performing a central neuraxial block.

Estudio comparativo de la eficacia del bloqueo supraclavicular en la artroscopia de hombro / Comparative study of the efficacy of the supraclavicular block for arthroscopic shoulder surgery

Introducción. Nuestro objetivo es valorar la eficacia de dos técnicas anestésicas en el tratamiento del dolor postoperatorio, así como su influencia en la estancia hospitalaria, tras la cirugía artroscópica de hombro. Material y métodos. Estudio retrospectivo basado en la recogida de datos de las historias de anestesiología y de nuestra unidad de dolor agudo (UDA), durante un período de 6 meses, seleccionando los casos de artroscopias de hombro realizadas y distribuyendo los pacientes en 2 grupos en función de la técnica anestésica empleada. En el grupo i se incluyó a pacientes con anestesia locorregional (bloque interescalénico e interesternocleidomastoideo) combinado con anestesia general. En el grupo ii se incluyeron los casos de anestesia general con analgesia por vía intravenosa con bolos de fentanilo. Material y métodos. Las variables registradas fueron: dolor posoperatorio, tanto en reposo como en movimiento, en las primeras 24h, utilizando una escala verbal simple (EVS), la presencia de efectos secundarios, la necesidad de rescate analgésico y el tiempo quirúrgico empleado. Material y métodos. En los casos en que los pacientes fueron dados de alta en las primeras 24h, se realizó una consulta telefónica para valoración de dichas variables. Material y métodos. El análisis estadístico se realizó mediante prueba de la t de Student (para variables numéricas) y prueba de la X2 (para analizar las relaciones entre variables cualitativas), considerando el estudio estadísticamente significativo si se obtuvo una p<0,05. Resultados. Se incluyó a un total de 26 pacientes (14 casos en el grupo i y 12 casos en el grupo ii). El análisis del dolor posoperatorio en las primeras 24h reveló que la EVS en reposo del grupo i fue de 1 para el percentil 75, mientras que en el grupo ii fue de 2. El dolor en movimiento obtuvo una EVS de 2,25 para el grupo i y de 3 para el grupo ii (p<0,05). Resultados. La necesidad de rescate se dio en un 1 (0,07%) caso en el primer grupo frente a 5 casos (0,41%) en el segundo grupo (p<0,05). Resultados. El análisis de las náuseas y los vómitos postoperatorios puso de manifiesto que en el grupo de la anestesia combinada no se presentó en ningún caso, mientras que en el grupo de la anestesia general se observó en 4 (0,33%) (p<0,05). Resultados. El tiempo quirúrgico estimado para el primer grupo fue de 125min de media, frente 116min del grupo ii (p>0,05). Resultados. En el grupo de la anestesia combinada el tiempo medio de estancia fue de 36h, frente a las 60h de media en el grupo de anestesia general (p<0,05). Conclusiones. El bloqueo del plexo braquial por encima de la clavícula combinado con anestesia general ha mostrado mayor eficacia en el control del dolor perioperatorio, tanto en reposo como con el movimiento, que la anestesia general con analgesia por vía intravenosa. Además, la incidencia de efectos indeseables, la necesidad de rescate y el tiempo de ingreso hospitalario fueron menores sido menor en el grupo de pacientes intervenidos con la técnica combinada, sin repercusión significativa en el tiempo de ocupación del quirófano (AU)

Objectives. Our aim is to evaluate the efficacy of two anesthetic techniques for the treatment of the postoperative pain, as well as their influence on hospital stay, after surgery arthroscopic of shoulder. Materials and methods. Retrospective study based on the collection of data from anesthesia histories and from of our postoperative acute pain unit, during a 6-months period. Cases of shoulder arthroscopies carried out during this period were selected and the patients were distributed in 2 groups depending on the anesthetic technique used: group I consisted of patients treated with locoregional anesthesia (interscalene and inter-sternocleidomastoid block) combined with general anesthesia. Group II was general anesthesia cases with intravenous analgesia. Materials and methods. The recorded variables were the following: postoperative pain, both at rest and during exercise in the first 24h, using a simple verbal scale (SVS); the presence of side effects, need of analgesic rescue and duration of hospital stay. Materials and methods. In the cases where the patients were discharged from hospital in the first 24h, a telephone consultation was carried out for the evaluation of the abovementioned variables. Materials and methods. Statistical analysis: Student-t and Chi-square tests. A P<.05 was considered statistically significant. Results. A total of 26 patients were included (14 cases in group I and 12 cases in group II). The analysis of the postoperative pain at rest in the first 24h revealed that the SVS in group I was 1 for the percentile 75, whereas in group II it was 2. The pain on movement was 2.25 for group I, and 3 for group II, (P<.05). Results. There was only 1 case with need of rescue (7%) in the first group, compared to the 5 cases (41%) in the second group (P<.05). Results. There were no cases of postoperative nausea and vomiting in the combined anesthesia group, whereas in the group with general anesthesia there were 4 cases (33%), (P<.05). Results. The estimated surgical time for the first group was 125min, compared to the estimated 116min for group II (p>.05). Results. In the group of combined anesthesia the average duration of hospital stay was 36h, compared to the 60h average duration in the group of General Anesthesia. (P<.05). Discussion. The blockade of the brachial plexus over the clavicle combined with general anesthesia has shown greater efficacy in the control of perioperative pain, both at rest and during exercise than the general anesthesia with intravenous analgesia. In addition, the incidence of undesirable effects, the need of rescue and the duration of hospital stay were lower in the group of patients with the combined technique, without significant effects on the duration of operating room occupation (AU)

Consideraciones sobre el bloqueo del plexo lumbar posterior en cirugía de la cadera / No disponible

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Recomendaciones para el manejo de la vía aérea difícil mediante dispositivos extraglóticos en el paciente adulto sometido a cirugía ambulatoria / No disponible

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Bloqueo femoral continuo para analgesia postoperatoria en un paciente con poliomielitis / No disponible

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Bloqueo combinado del plexo lumbar por vía posterior y plexosacro para tratamiento quirúrgico urgente de la fractura de cadera / Combined posterior lumbar plexus and sacral block for emergency surgery to treat hip fracture

En la actualidad, la realización de bloqueos nerviososperiféricos y el empleo de la ultrasonografía para su ejecuciónconstituyen una práctica creciente en el ámbitode la anestesiología moderna. En la cirugía de la extremidadinferior, en general, y de la fractura de la cadera,en particular, la técnica anestésica más frecuentementeempleada es la anestesia intradural. Sin embargo, el bloqueocombinado de los plexos lumbar y sacro puedeconstituir una alternativa a otras técnicas de anestesialocorregional y a la anestesia general en situacionesespeciales como las de pacientes con patología grave asociaday con tratamiento que afecta a la agregación plaquetaria.Presentamos dos casos clínicos de pacientescon indicación quirúrgica urgente por fractura de cadera,con severa cardioneumopatía y doble antiagregación,y con predictores de vía aérea difícil e hipertensiónintracraneal, en los que dicho bloqueo proporcionó adecuadascondiciones para la cirugía, estabilidad hemodinámicay analgesia postoperatoria, sin morbilidad (AU)

Ultrasound-guided peripheral nerve blocks are beingused more widely in modern anesthesiology, yet spinalanesthesia remains the most commonly used techniquefor lower limb surgery in general and for hip fracture inparticular. A combined lumbar plexus and sacral blockmay provide an alternative to other local and regionalanesthetic techniques in special situations such as thetreatment of patients with serious concomitant diseasewho are on treatment that affects platelet aggregation.We report 2 cases in which patients underwentemergency surgery for hip fracture. Patient historiesincluded serious heart and lung conditions, doubleantiplatelet therapy, risk factors for difficult airway, andintracranial hypertension. The aforementioned nerveblock provided appropriate conditions for surgery,hemodynamic stability, and postoperative analgesiawithout complications (AU)

Bloqueo ciático continuo con catéter estimulador guiado mediante ecografía para tratamiento del miembro fantasma doloroso / Ultrasound-guided continuous sciatic nerve block with stimulating catheter for the treatment of phantom limb pain

Los bloqueos nerviosos periféricos pueden ser una alternativa a la analgesia intravenosa y epidural en el tratamiento del miembro fantasma doloroso. La dificultad en la localización del nervio ciático mediante neuroestimulación en pacientes con arteriopatía periférica y neuropatía puede verse aumentada por el hecho de presentar una amputación del miembro inferior, que imposibilita la observación de una respuesta motora en el pie coincidiendo con la localización del nervio. En estos casos, la ecografía puede convertirse en una técnica de localización nerviosa determinante del éxito de la analgesia yaqué permite la identificación del nervio, así como la visualización en tiempo real de la posición relativa de la aguja y catéter respecto al nervio y la difusión del anestésico local administrado. Se presenta el caso de un paciente con miembro fantasma doloroso resistente al tratamiento convencional que se controló con un bloqueo ciático continuo con catéter estimulador guiado con ecografía (AU)

Peripheral nerve blocks can be an alternative to intravenous and epidural analgesia in the treatment of phantom limb pain. The difficulty of localizing the sciatic nerve through neurostimulation in patients with peripheral arteriopathy and neuropathy can eincreased by lower limb amputation, making it impossible to observe a motor response in the foot coinciding with localization of the nerve. In these cases, ultrasonography can become a technique for nerve localization and determine the success of analgesic strategy, since it allows nerve identification, as well as visualization in real time of the relative position of the needle and catheter with respect to the nerve and the diffusion of the local anesthetic administered. We report the case of a patient with phantom limb pain refractory to conventional treatment, in whom pain control was achieved by ultrasound-guided continuous sciatic block with stimulating catheter (AU)

Complicaciones de los bloqueos centrales y bloqueos nerviosos periféricos / No disponible

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Quilotórax tardío tras nutrición parenteral a través de catéter en vena yugular interna / No disponible

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Bloqueos nerviosos periféricos: una alternativa en cirugía mauor ambulatoria / Peripheral nerve blocks: an alternative technique in ambulatory surgery

Recientes investigaciones han puesto de manifiesto que los bloqueos nerviosos periféricos se asocian con mejores resultados que la anestesia general y que constituyen una práctica cada vez más frecuente en el ámbito de la cirugía ambulatoria. Nuestro objetivo es poner de manifiesto la situación actual de los bloqueos nerviosos periféricos en nuestra Unidad de Cirugía Mayor Ambulatoria y cómo ésta ha modificado la práctica habitual. MATERIAL Y MÉTODOS: Revisión retrospectiva de los bloqueos realizados en los dos últimos años, mediante el análisis de una hoja de bloqueos en la que se incluyen múltiples variables: datos del paciente, características del bloqueo, técnica de neuroestimulación y otras. RESULTADOS: Se realizaron 185 bloqueos en régimen de C.M.A., todos ellos en cirugía ortopédica y la mayoría en la extremidad inferior. El anestésico local empleado habitualmente fue mepivacaína. El bloqueo que se realizó con mayor frecuencia fue el bloqueo del nervio ciático en la fosa poplítea mediante abordaje latral. En la extremidad superior el abordaje del plexo braquial más frecuente fue a nivel axilar. Todos los pacientes fueron dados de alta a las 6 horas tras la realización de la técnica. DISCUSIÓN: En nuestra Unidad la práctica de bloqueos nerviosos periféricos en cirugía ambulatoria ortopédica está adquiriendo popularidad y en los últimos años se ha incrementado de manera muy importante. El empleo de bloqueos selectivos ajustados a las necesidades quirúrgicas con anestésico local de corta duración permiten una regresión temprana del bloqueo y el alta hospitalaria precoz (AU)

INTRODUCTION: Current investigations have demostrated that peripheral nerve block is associated with a superior outcome than general anestesia and it constitutes an useful and frequent technique in ambulatory surgery. The purpose of this manuscript is to show actual situation of peripheral nerve blocks in our Unit of Ambulatory Surgery and how it has modified our usual practice. MATERIAL AND METHODS: We made a prospective revision of peripheral nerve blocks used over the last two years. We analyzed a lot of variables onthe nerve block control sheet: patients´ data type of block, nerve stimulation technique and others. RESULTS: We registered 185 blocks in ambulatory surgery. All of them were for orthopaedic surgery and the majority in the lower limb. The local anesthetic most used was mepivacaine. Lateral popliteal block was the most frequent approach. Axillary block was the most frequent brachial plexus approach. All the patients were discharged six hours after the block. DISCUSSION: Today, peripheral nerve blocks are more popular than some years ago inour Unit for Ambulatory surgery. Selective peripheral nerve blocks, depending on the type and location of surgery, using a short acting local anesthetic allow an early discharge of patients (AU)

Bloqueos del plexo lumbar posterior y ciático glúteo para by-pass femoropoplíteo en paciente con shock cardiogénico / Posterior lumbar plexus and gluteal sciatic nerve blocks for a femoropopliteal bypass operation in a patient with cardiogenic shock

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