[Cranial nerve block with bupivacaine for postoperative analgesia following supratentorial craniotomy]. / Bloqueo craneal con bupivacaína para analgesia postoperatoria en craneotomía supratentorial.

OBJECTIVE: To assess the effectiveness of analgesia by cranial nerve block with bupivacaine in the first 24 hours following elective supratentorial craniotomy. PATIENTS AND METHODS: A prospective, randomized, double-blind study was performed in 30 patients who underwent craniotomy for excision of a tumor. The cranial nerve block was performed using saline (control group, n=15) or 0.25% bupivacaine with epinephrine at 1:200 000 (bupivacaine group, n=15). Morphine (2 mg, intravenous bolus) was used for rescue analgesia. Pain was assessed on a visual analog scale (VAS) at 2, 4, 8, 12, 16, and 24 hours following the cranial nerve block. The following data were recorded: time elapsed until appearance of pain, use of rescue analgesia, and incidence of adverse effects. RESULTS: The use of morphine was significantly lower in the group of patients who received a cranial nerve block with bupivacaine than in the control group (mean [SD], 3.7 [1.6] mg vs 172 [2.5] mg). The mean time to the first requirement for rescue analgesia was longer in the bupivacaine group than in the control group (731 [247] minutes vs 80 [71] minutes). The VAS score during the first 16 hours was significantly lower in the bupivacaine group than in the control group. The incidence of nausea and vomiting was significantly higher in the control group (67% vs 13%). CONCLUSIONS: Cranial nerve block with 0.25% bupivacaine following supratentorial craniotomy improves postoperative analgesia, reduces the requirement for morphine, and contributes to reducing nausea and vomiting.

Bloqueo craneal con bupivacaína para analgesia postoperatoria en craneotomía supratentorial / Cranial nerve block with bupivacaine for postoperative analgesia following supratentorial craniotomy

OBJETIVO: Valorar la efectividad analgésica del bloqueocraneal con bupivacaína en las primeras 24 horasdel postoperatorio en pacientes sometidos a craneotomíasupratentorial electiva.PACIENTES Y MÉTODOS: Estudio prospectivo, aleatorio ydoble ciego de 30 pacientes sometidos a craneotomía porneoplasia. El bloqueo fue realizado con bupivacaína al0,25% con epinefrina 1:200.000 (grupo bupivacaína,n = 15) y con salino (grupo control, n = 15). Se utilizócomo analgesia de rescate morfina en bolo intravenoso de2 mg. Se analizó el grado de dolor mediante la escala analógicavisual (EAV) a las 2, 4, 8, 12, 16 y 24 h tras el bloqueo.Se registró el tiempo transcurrido hasta la apariciónde dolor, consumo analgésico e incidencia de efectosadversos.RESULTADOS: El consumo de morfina fue significativamentemenor en el grupo de pacientes que recibieronbupivacaína para el bloqueo craneal que en el grupocontrol (3,7 ± 1,6 mg frente 17,2 ± 2,5 mg). El tiempomedio del primer requerimiento de analgesia fue mayoren el grupo bupivacaína que en el grupo control (731 ±247 min frente a 80 ± 71). La puntuación de la EAV fuesignificativamente menor en el grupo bupivacaínadurante las primeras 16 horas que en el grupo control.La incidencia de NVPO fue significativamente superioren el grupo control (67% frente 13%).CONCLUSIONES: El bloqueo craneal con bupivacaínaal 0,25% tras craneotomía supratentorial mejora lacalidad de la analgesia postoperatoria, disminuye losrequerimientos de morfina y contribuye a reducir lasNVPO

OBJETIVO: To assess the effectiveness of analgesia by cranial nerve block with bupivacaine in the first 24 hours following elective supratentorial craniotomy. PATIENTS AND METHODS: A prospective, randomized, double-blind study was performed in 30 patients who underwent craniotomy for excision of a tumor. The cranial nerve block was performed using saline (control group, n=15) or 0.25% bupivacaine with epinephrine at 1:200 000 (bupivacaine group, n=15). Morphine (2 mg, intravenous bolus) was used for rescue analgesia. Pain was assessed on a visual analog scale (VAS) at 2, 4, 8, 12, 16, and 24 hours following the cranial nerve block. The following data were recorded: time elapsed until appearance of pain, use of rescue analgesia, and incidence of adverse effects. RESULTS: The use of morphine was significantly lower in the group of patients who received a cranial nerve block with bupivacaine than in the control group (mean [SD], 3.7 [1.6] mg vs 17.2 [2.5] mg). The mean time to the first requirement for rescue analgesia was longer in the bupivacaine group than in the control group (731 [247] minutes vs 80 [71] minutes). The VAS score during the first 16 hours was significantly lower in the bupivacaine group than in the control group. The incidence of nausea and vomiting was significantly higher in the control group (67% vs 13%). CONCLUSIONS: Cranial nerve block with 0.25% bupivacaine following supratentorial craniotomy improves postoperative analgesia, reduces the requirement for morphine, and contributes to reducing nausea and vomiting

Cateterización accidental de catéter de Swan-Ganz en cava inferior. Monitorización radiológica / Accidental catheterization of the inferior vena cava with a Swan-Ganz catheter: radiologic monitoring

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