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.

Déficit motor asociado a analgesia epidural en paciente con patología neurológica preexistente no conocida / No disponible

Existen múltiples estudios que afirman que las complicaciones neurológicas asociadas a la práctica de un bloqueo neuroaxial pueden tener una mayor incidencia en los pacientes que presentan enfermedades neurológicas preexistentes como la estenosis espinal. Esta incidencia puede ser especialmente relevante si no se cuenta con un diagnóstico previo de dichas patologías. En el presente trabajo describimos nuestra experiencia con una mujer de 60 años de edad, diagnosticada de isquemia crónica de miembro inferior derecho, que presentó un déficit motor importante tras la colocación de un catéter epidural para el manejo del dolor (AU)

There are many studies that suggest that the neurological complications associated with the practice of neuraxial blockade may have a higher incidence in patients with preexisting neurological conditions such as spinal stenosis. This effect may be particularly relevant if there is no previous diagnosis of these pathologies. We describe our experience with a 60-year-old woman diagnosed with chronic ischemia of the right leg which presented an important motor deficit following epidural catheter insertion for pain management (AU)

Cumplimiento terapéutico en pacientes con hipertensión arterial y diabetes mellitus 2 / Therapeutic compliance in patients with arterial hypertension and type 2 diabetes mellitus

Objetivos. 1) Determinar las diferencias de género en el cumplimiento terapéutico en pacientes con hipertensión arterial y diabetes mellitus tipo 2. 2) Detectar diferencias en función de la edad. 3) Determinar las relaciones existentes entre el nivel de cumplimiento según el test de Morisky-Green, el test de Batalla, y el recuento de comprimidos expresado en porcentaje de cumplimiento. Método. Estudio descriptivo, transversal, realizado durante 7 meses en atención primaria, Centro de Salud Rentería-Beraun (Guipúzcoa), Sistema Vasco de Salud (Osakidetza), con una muestra incidental de 100 pacientes diagnosticados de hipertensión y diabetes tipo 2 con tratamiento oral. Variables principales: edad y género. Variables condicionantes: años de evolución de cada una de las patologías, número de fármacos prescritos, tiempo de recogida de recetas, test de Morisky-Green, test de Batalla y recuento de comprimidos. Resultados. El análisis estadístico evidenció un cumplimiento similar en hombres y mujeres y en los distintos rangos de edad (Morisky-Green y recuento). Aproximadamente el 50% de los pacientes tuvieron un cumplimiento adecuado con al menos uno de los 3 tests empleados. Se halló mayor relación entre el Morisky-Green y el recuento de comprimidos y se comprobó que el cumplimiento mejoró con un mayor nivel de conocimiento de la enfermedad y un menor número de pastillas prescritas. Conclusiones. El cumplimiento varía según el instrumento de evaluación utilizado, el incumplimiento es elevado y el nivel de conocimiento de la enfermedad ayuda al cumplimiento. Esto sugiere la conveniencia de revisar sistemáticamente los tratamientos y proporcionar mayor información a los pacientes (AU)

Objective. 1) To determine gender differences regarding therapeutic adherence in patients with arterial hypertension and type 2 diabetes mellitus. 2) To detect differences in terms of age. 3) To determine existing relationships in patient compliance levels between Morisky-Green's test, Batalla's test and the pill count expressed as a percentage of compliance. Method. Descriptive, transversal study, carried out for a period of 7 months in the Primary Health Care, Health Centre in Rentería-Beraun (Guipúzcoa), Basque Health Service (Osakidetza), with an incidental sample of 100 patients diagnosed with hypertension and type 2 diabetes mellitus and receiving oral treatment. Principal variables: age, gender. Conditioning variables: years of evolution of each pathology, number of prescribed medicines, time lapse of prescription collection, Morisky-Green's test, Batalla's test and pill count. Results. The statistical analysis yielded similar compliance for men and women, and for different age groups (Morisky-Green and pill count). Approximately 50% of the patients had adequate compliance according to at least one of the 3 tests. A greater relationship was found between Morisky-Green's test and the pill count method, and medication adherence improved when knowledge of the disease increased, and when the number of prescribed pills became smaller. Conclusions. Adherence varies according to the evaluation tool used, non-adherence is high and knowledge of the disease helps compliance. This suggests the convenience of systematically reviewing treatments and supplying more information to patients (AU)

[Therapeutic compliance in patients with arterial hypertension and type 2 diabetes mellitus]. / Cumplimiento terapéutico en pacientes con hipertensión arterial y diabetes mellitus 2.

OBJECTIVE: 1) To determine gender differences regarding therapeutic adherence in patients with arterial hypertension and type 2 diabetes mellitus. 2) To detect differences in terms of age. 3) To determine existing relationships in patient compliance levels between Morisky-Green's test, Batalla's test and the pill count expressed as a percentage of compliance. METHOD: Descriptive, transversal study, carried out for a period of 7 months in the Primary Health Care, Health Centre in Rentería-Beraun (Guipúzcoa), Basque Health Service (Osakidetza), with an incidental sample of 100 patients diagnosed with hypertension and type 2 diabetes mellitus and receiving oral treatment. Principal variables: age, gender. Conditioning variables: years of evolution of each pathology, number of prescribed medicines, time lapse of prescription collection, Morisky-Green's test, Batalla's test and pill count. RESULTS: The statistical analysis yielded similar compliance for men and women, and for different age groups (Morisky-Green and pill count). Approximately 50% of the patients had adequate compliance according to at least one of the 3 tests. A greater relationship was found between Morisky-Green's test and the pill count method, and medication adherence improved when knowledge of the disease increased, and when the number of prescribed pills became smaller. CONCLUSIONS: Adherence varies according to the evaluation tool used, non-adherence is high and knowledge of the disease helps compliance. This suggests the convenience of systematically reviewing treatments and supplying more information to patients.