Role of adjuvants in regional anesthesia: A systematic review.

The combination of drugs and routes of administration produces a synergistic effect, and one of the most important components of multimodal analgesic strategies are, therefore, nerve blocks for pain management. The effect of a local anaesthetic can be prolonged by administering an adjuvant. In this systematic review, we included studies on adjuvants associated with local anaesthetics in peripheral nerve blocks published in the last 5 years in order to evaluate their effectiveness. The results were reported according to the PRISMA guidelines. The 79 studies selected using our criteria showed a clear prevalence of dexamethasone (n=24) and dexmedetomidine (n=33) over other adjuvants. Different meta-analyses comparing adjuvants suggest that dexamethasone administered perineurally achieves superior blockade with fewer side effects than dexmedetomidine. Based on the studies reviewed, we found moderate evidence to recommend the use of dexamethasone as an adjuvant to peripheral regional anaesthesia in surgeries that can cause moderate to severe pain.

Papel de los coadyuvantes en la anestesia regional: revisión sistemática / Role of adjuvants in regional anesthesia: a systematic review

La combinación de fármacos y vías de administración consigue un efecto sinérgico, por eso las estrategias analgésicas multimodales incorporan bloqueos periféricos como componente imprescindible para un buen control del dolor. La asociación de un coadyuvante al anestésico local prolongaría su efecto. Esta revisión sistemática ha incluido estudios sobre coadyuvantes asociados a anestésicos locales en bloqueos periféricos publicados en los últimos cinco años. El objetivo principal ha sido evaluar su eficacia. Los resultados de la búsqueda se informaron de acuerdo con los elementos PRISMA. Los 79 artículos seleccionados según criterios, mostraron una clara prevalencia de dexametasona (n=24) y dexmedetomidina (n=33) sobre los demás coadyuvantes. Diferentes metaanálisis que comparan a los coadyuvantes sugieren un bloqueo de características superiores y menores efectos adversos con dexametasona vs. dexmedetomidina perineuralmente. Con base en los estudios, encontramos una evidencia moderada en el empleo de dexametasona como coadyuvante de la anestesia regional periférica en cirugías que generen dolor moderado- severo, lo que haría recomendable su empleo.(AU)

The combination of drugs and routes of administration produces a synergistic effect, and one of the most important components of multimodal analgesic strategies are, therefore, nerve blocks for pain management. The effect of a local anaesthetic can be prolonged by administering an adjuvant. In this systematic review, we included studies on adjuvants associated with local anaesthetics in peripheral nerve blocks published in the last 5 years in order to evaluate their effectiveness. The results were reported according to the PRISMA guidelines. The 79 studies selected using our criteria showed a clear prevalence of dexamethasone (n=24) and dexmedetomidine (n=33) over other adjuvants. Different meta-analyses comparing adjuvants suggest that dexamethasone administered perineurally achieves superior blockade with fewer side effects than dexmedetomidine. Based on the studies reviewed, we found moderate evidence to recommend the use of dexamethasone as an adjuvant to peripheral regional anaesthesia in surgeries that can cause moderate to severe pain.(AU)

Sedaciones en procedimientos diagnósticos y/o terapéuticos: recomendaciones de calidad y seguridad / Sedations in diagnostic and/or therapeutic procedures: quality and safety recommendations

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El test cuantitativo sensorial y su importancia en la valoración de la radiculopatía lumbosacra / Quantitative sensory testing and its importance in the assessment of lumbosacral radiculopathy

La lumbalgia crónica constituye hasta dos tercios de los motivos de consulta en las Unidades de Dolor. La radiculopatía secundaria a hernia discal lumbar constituye una de las causas más importantes de lumbalgia crónica. Conocer los mecanismos nociceptivos y valorar de forma objetiva el dolor neuropático secundario a esta entidad, es de gran importancia para el enfoque terapéutico óptimo de estos pacientes. En este contexto, el Test Cuantitativo Sensorial (QST) se establece como una prueba psicofísica no invasiva que permite determinar la alteración de las fibras del Sistema Somatoensorial, o detectar precozmente neuropatí- as periféricas cuyo resultado es normal con otros exámenes de rutina, entre otras muchas utilidades prácticas. Ello hace que esta técnica sea de especial interés en el estudio de la génesis del dolor

Low back chronic pain extends up to two-thirds of the consultations in Pain Units. Radiculopathy secondary to lumbar disc herniation is one of the most important causes of low back pain. Knowing the nociceptive mechanisms and objectively assessing secondary neuropathic pain implies a great importance for the optimal therapeutic approach of these patients. In this context, the Quantitative Sensory Testing (QST) is an non invassive examination that allows to determine the alteration of the fibers of the Somato-Sensory System, or to detect early peripheral neuropathies whose result is normal with other routine exams, among many other practical uses. This technique brings a special interest in the study of pain genesis

Revisión de la seguridad en anesthesia ante un incendio en quirófano / Review: safety in anesthesia in case of fire in the operating room

Los incendios en quirófano son poco frecuentes pero potencialmente catastróficos. Suponen un peligro potencial en la práctica de la anestesia quirúrgica. El anestesiólogo debe prevenir este tipo de eventos, mediante el chequeo del funcionamiento de equipos y materiales, y la prevención de circunstancias que podrían llevar a la producción de fuego. Presentamos una revisión sobre las consideraciones principales en la seguridad intraoperatoria, a propósito de un caso acontecido en nuestro quirófano que precisó el empleo de sierra radial

Fires at operating are rare but catastrophic, supposing a potential hazard during the practice of surgical anesthesia. It is essential for the anesthesiologist the prevention of these events by identifiying the elements that could cause such situations, performing a correct checking of the equipment and materials, and taking extreme care with circumstances which could lead to the production of fire. We present main considerations about safety at operating room, by explaining our experience while using a radial jaw during an intestinal surgery

Cesárea electiva en una paciente con síndrome de sensibilidad química múltiple / Elective cesarean section in a patient with multiple chemical sensitivity syndrome

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sobre los enantiómeros y los anéstesicos locales / On enantiomers and local anesthetics

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Sobre los enantiómeros y los anestésicos locales / About enantiomers and locals anesthetics

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[Use of inhaled bronchodilators by primary care patients]. / Estudio sobre el empleo de broncodilatadores inhalados por los pacientes de atención primaria.

OBJECTIVE: To find how widespread incorrect inhalation techniques are in patients on long-term inhalation treatments, comparing different methods and the health control standard. DESIGN: A descriptive crossover study. SETTING: Three Health Centres in Burgos. PATIENTS: People over 15 with at least a month on inhalation treatment. MEASUREMENTS AND MAIN RESULTS: A questionnaire was composed to find the characteristics of the patients and their illness. Then their inhalation method was qualified as correct, acceptable or incorrect, using a scale based on Newman's classic criteria. Average age was 63.8 +/- 15.6, with 66.5% men. 11.6% of patients were active smokers. The most common diagnosis was COPD (61.6%). 65% of the patients were monitored within primary care (PC). The most common inhalation method was pressurised aerosol (61%); 26.2% of patients used two or more different methods. Only 21.3% of patients correctly performed the technique of inhalation, with better results for patients under specialist care (SC) than PC. 10.5% of patients had never received instruction on an inhalation technique. The method with the best results was the dry dust one, with differences close to statistical significance. CONCLUSIONS: There is widespread incorrect use of methods of inhalation. Most people use a pressurised aerosol. There are a large number of patients who have never been shown the correct way to inhale.