Robotically assisted laparoscopic radical prostatectomy induces lower tissue trauma than radical retropubic prostatectomy.

To compare tissue trauma between Retropubic Radical Prostatectomy and Robotically Assisted Laparoscopic Radical Prostatectomy by inflammatory mediators. Serum samples from 40 patients submitted to RALP and 20 patients submitted to RRP were withdrawn at four different time points. The cytokines IL-4, IL-8, IL-6, IL-1B, IL-10 and TNF-α were detected using ELISA/Multiplex assays and xMAP-Luminex®. With both techniques, IL-10 and IL-6 were higher in T4 than in T1-T3 (p = 0.001). IL-10 and IL-6 were higher in T4 in open surgery than in robotic surgery (p = 0.000 and p = 0.001, respectively). Compared with both groups, IL-6 and IL-10 were higher in T4 in open surgery than in robotic surgery. Thus, we can postulate that RALP causes less tissue trauma than classical RRP, as indicated by the more limited increase in inflammatory mediators such as IL-6 and IL-10.

Digital block with or without the addition of epinephrine in the anesthetic solution / Bloqueios em dedos de mãos com epinefrina incluída ou não nas soluções anestésicas

BACKGROUND AND OBJECTIVES: Review of various techniques for digital blocks with local anesthetic, with or without epinephrine. CONTENTS: Description of various procedures and comparison of results reported in the literature, mainly on latency and quality of anesthesia, details on vasoconstrictor effect of epinephrine, intraoperative bleeding, necessity of tourniquet use, duration of anesthesia and postoperative analgesia, blood flow and digital SpO2 behavior, local and systemic complications, and also approaches and drugs to be used in certain situations of ischemia. CONCLUSIONS: The advantages of adding epinephrine to the anesthetic solution are minor when compared to the risks of the procedure, and it seems dangerous to use a vasoconstrictor in the fingers, unless the safety of the technique and the possibility of discarding the tourniquet are definitely proven.

JUSTIFICATIVA E OBJETIVOS: Revisão das diversas técnicas para bloqueios em dedos de mãos, com anestésico local associado ou não à epinefrina. CONTEÚDO: São descritos os procedimentos usados e comparados os resultados obtidos na literatura, principalmente em relação a: latência e qualidade da anestesia, detalhes sobre o efeito vasoconstritor da epinefrina, sangramento intraoperatório, necessidade ou não do uso de torniquete, duração da anestesia e da analgesia pós-operatórias, comportamento do fluxo arterial e da SpO2 digitais, complicações locais e sistêmicas e, ainda, condutas e medicamentos a serem usados em determinadas situações de isquemia. CONCLUSÕES: As vantagens da inclusão de epinefrina na solução anestésica são de pouca importância quando comparadas aos riscos do procedimento e parece perigoso usar o vasoconstritor em dedos de mão, a não ser que fiquem definitivamente comprovadas a inocuidade da técnica e a possibilidade do descarte do torniquete.

Digital block with or without the addition of epinephrine in the anesthetic solution.

BACKGROUND AND OBJECTIVES: Review of various techniques for digital blocks with local anesthetic, with or without epinephrine. CONTENTS: Description of various procedures and comparison of results reported in the literature, mainly on latency and quality of anesthesia, details on vasoconstrictor effect of epinephrine, intraoperative bleeding, necessity of tourniquet use, duration of anesthesia and postoperative analgesia, blood flow and digital SpO2 behavior, local and systemic complications, and also approaches and drugs to be used in certain situations of ischemia. CONCLUSIONS: The advantages of adding epinephrine to the anesthetic solution are minor when compared to the risks of the procedure, and it seems dangerous to use a vasoconstrictor in the fingers, unless the safety of the technique and the possibility of discarding the tourniquet are definitely proven.

[Digital block with or without the addition of epinephrine in the anesthetic solution]. / Bloqueios em dedos de mãos com epinefrina incluída ou não nas soluções anestésicas.

BACKGROUND AND OBJECTIVES: Review of various techniques for digital blocks with local anesthetic, with or without epinephrine. CONTENTS: Description of various procedures and comparison of results reported in the literature, mainly on latency and quality of anesthesia, details on vasoconstrictor effect of epinephrine, intraoperative bleeding, necessity of tourniquet use, duration of anesthesia and postoperative analgesia, blood flow and digital SpO2 behavior, local and systemic complications, and also approaches and drugs to be used in certain situations of ischemia. CONCLUSIONS: The advantages of adding epinephrine to the anesthetic solution are minor when compared to the risks of the procedure, and it seems dangerous to use a vasoconstrictor in the fingers, unless the safety of the technique and the possibility of discarding the tourniquet are definitely proven.