Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty.

BACKGROUND: This randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%). METHODS: Sixty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=30) using 20 mL of adrenalized bupivacaine 0.50%, or periarticular local anesthetic infiltration (n=30) using 60 mL of adrenalized bupivacaine 0.25%. Both groups also received 30 mg of ketorolac, either intravenously (pericapsular nerve group block) or periarticularly (periarticular local anesthetic infiltration), as well as 4 mg of intravenous dexamethasone.Postoperatively, a blinded evaluator carried out sensory assessment and motor assessment (knee extension and hip adduction) at 3, 6 and 24 hours. Furthermore, the blinded observer also recorded static and dynamic pain scores at 3, 6, 12, 18, 24, 36 and 48 hours; time to first opioid request; cumulative breakthrough morphine consumption at 24 hours and 48 hours; opioid-related side effects; ability to perform physiotherapy at 6, 24 and 48 hours; as well as length of stay. RESULTS: There were no differences in quadriceps weakness at 3 hours between pericapsular nerve group block and periarticular local anesthetic infiltration (20% vs 33%; p=0.469). Furthermore, no intergroup differences were found in terms of sensory block or motor block at other time intervals; time to first opioid request; cumulative breakthrough morphine consumption; opioid-related side effects; ability to perform physiotherapy; and length of stay. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower static pain scores (at all measurement intervals) and dynamic pain scores (at 3 and 6 hours). CONCLUSION: For primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER: NCT05087862.

Microcirugía de hernia discal lumbar: revisión y análisis de 326 casos operados en el período 2002-2010 / Microsurgery of lumbar disc herniation: review and analysis of 326 cases operated in the period 2002-2010

Se revisan en forma retrospectiva las historias clínicas de los pacientes portadores de hernia discal lumbar sintomática, intervenidos en la Unidad de Neurocirugía del Hospital Base Osorno, Región de Los Lagos, Chile, durante el período comprendido entre los años 2002 y 2010. Se realiza un análisis demográfico así como de resultados y complicaciones.

We reviewed retrospectively the medical records of patients with symptomatic lumbar disc herniation, who underwent surgery in the Neurosurgery Unit at Osorno Hospital, Los Lagos Region, Chile, during the period between 2002 and 2010. Demographic and analysis of results and complications was performed.

[Quality of life of patients operated for gastric cancer]. / Análisis de calidad de vida en pacientes gastrectomizados por cáncer gástrico.

BACKGROUND: Gastric cancer is the first cause of death by cancer in Chile. Quality of Life is a multidimensional construct that explores functionality and well-being, including physiological, psychological and social aspects. AIM: To assess Quality of Life of patients operated for gastric cancer. PATIENTS AND METHODS: The European Organization Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30), translated into Spanish, was applied to 33 patients, aged 42 to 82 years (25 males), subjected to curative total or subtotal gastrectomy for gastric cancer, between January 2004 and December 2006. RESULTS: The average lapse from the moment of the surgical intervention to the interview, was 52.2 weeks. Fifty five percent perceived their Quality of Life in the "good" category. Male patients and those with less than 6 months of surgery, obtained better scores in psychological aspects of quality of life. CONCLUSIONS: A high percentage of patients operated for gastric cancer qualified their quality of life as good in spite of the severity of the underlying disease and invasiveness of the intervention. This is probably explained by the importance of psychological factors that influence quality of life.

Análisis de calidad de vida en pacientes gastrectomizados por cáncer gástrico / Quality of life of patients operated for gastric cancer

Background: Gastric cancer is the first cause of death by cáncer in Chile. Quality of Life is a multidimensional construct that explores functionality and well-being, including physiological, psychological and social aspects. Aim: To assess Quality of Life of patients operated for gastric cancer. Patients and methods: The European Organization Research and Treatment of Cáncer Quality of Life Questionnaire (EORTC QLQ-30), translated into Spanish, was applied to 33 patients, aged 42 to 82 years (25 males), subjected to curative total or subtotal gastrectomy for gastric cancer, between January 2004 and December 2006. Results: The average lapse from the moment of the surgical intervention to the interview, was 52.2 weeks. Fifty five percent perceived their Quality of Life in the "good" category. Male patients and those with less than 6 months of surgery, obtained better scores in psychological aspects of quality of life. Conclusions: A high percentage of patients operated for gastric cancer qualified their quality of life as good in spite of the severity of the underlying disease and invasiveness of the intervention. This is probably explained by the importance of psychological factors that influence quality of life.

Microanastomosis con lupa o microscopio: estudio experimental prospectivos y aleatorio / Comparison of vascular microanastomoses done using a microscope or a loupe in a experimental surgical model

Objetivos: El resultado final de un colgajo libre depende principalmente de la microanastomosis vascular. Se han descrito muchas técnicas para confeccionarla, sin embargo no existe consenso sobre cual es el medio de magnificación a utilizar. El objetivo de este trabajo es demostrar si la sutura con lupa o microscopio influye en la calidad y permeabilidad de la microanastomosis. Material y Método: En forma prospectiva y aleatoria se realizaron 60 microanastomosis arteriales, distribuidas de la siguiente forma: Grupo I (n=20 , diámetro menor a 1.5 mm), Grupo II (n=20 , entre 1,5-2,5 mm), Grupo III (n=20 , mayor a 2,5 mm). Se utilizaron como modelos arterias carótida de ratas Sprague-Dawley y arteria carótica y ahorta abdominal de conejos silvestres. En cada grupo se efectuaron 10 suturas con lupa Heine 2.5X y 10 con microscopios Zeiss OPMI-1. Participaron 4 microcirujanos en formación después de haber aprobado entrenamiento en modelos inanimados y biológicos. El tiempo total de anastomosis (TTA) se midió desde el primer punto hasta liberar las pinzas vasculares. A las 24 horas postoperatorias un segundo cirujano ciego al tipo de magnificación evaluó permeabilidad y calidad de la anastomosis. La permeabilidad se evaluó con el animal anestesiado seccionando el vaso a distal de la anastomosis y bajo visión directa, considerando permeabilidad adecuada la presencia de un flujo arterial tipo “jet”. Para evaluar la calidad de la anastomosis se utilizó la escala de Gorman. Para el análisis estadístico de las proporciones se utilizó la prueba exacta de Fisher y para las variables continuas se usó la t de Student o la prueba de Wilcoxon según su distribución. Se consideró un error alfa de 0,05 para significación estadística. Resultados: El TTA tuvo diferencias estadísticamente significativas a favor del microscopio en el análisis global de la muestra y en el Grupo I solamente. La escala de Gorman también arrojo diferencias a favor del microscopio al analizar las 60 microanastomosis y las del Grupo I solamente. La permeabilidad total para microscopio fue de 83 por ciento y para la lupa 40 por ciento (p<0,05). Un resultado semejante se observó para el Grupo I, sin diferencias en los otros grupos. El análisis histológico y la encuesta arrojaron resultados semejantes. Conclusiones: Las anastomosis con microscopio se realizan en menos tiempo, son de mejor calidad y tienen mayor permeabilidad que las efectuadas con lupa.