[Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain]. / Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorlo.

OBJECTIVE: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. METHODS: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. RESULTS: Data for 159 patients (105 < or =65 years; 54 >65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. CONCLUSIONS: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale.

Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorio / Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain

Objetivo: Evaluar la concordancia entre la escala verbal numérica y la escala visual analógica en la valoración del seguimiento del dolor agudo postoperatorio durante 3 días consecutivos. Métodos: Recogida secuencial de datos a los pacientes sometidos a cirugía mayor subsidiaria de pauta de analgesia postoperatoria con opiáceos parenterales o técnicas neuroaxiales en un hospital terciario durante 2 meses consecutivos. Se interrogó a los pacientes durante 3 días consecutivos con intervalos de 24 horas mediante las escalas visual numérica (EVN) y visual analógica (EVA). Para valorar la concordancia entre variables cuantitativas se utilizó el coeficiente de correlación intraclase, y coeficiente de correlación de Spearman, estratificándose los resultados por edad (menos o mayor de 65 años). Resultados: Se analizaron datos de 159 pacientes (105 <= 65 años y 54 > 65 años). La valoración de la EVA no fue posible realizarla en 12 pacientes, mientras que la valoración de la EVN fue posible en todos los pacientes. Los valores del coeficiente de correlación interclase fueron globalmente > 0,70 durante los tres días, siendo más altos los coeficientes en mayores de 65 años. Conclusiones: La concordancia entre las EVA y EVN de dolor se puede considerar como buena o muy buena durante los tres días de seguimiento, siendo mejor en pacientes con edad superior a 65 años. El grado de colaboración para recoger los datos fue mejor para la EVN que para la EVA. En la comparación de las valores numéricos del dolor la EVN mostró repetidamente valores más altos que la EVA(AU)

Objective: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. Methods: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. Results: Data for 159 patients (105 65 years; 54 > 65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. Conclusions: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale(AU)

Ventilación mecánica no invasiva nasal en la sedación de un paciente con esclerosis lateral amiotrófica durante una gastrostomía endoscópica percutánea / No disponible

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Respuesta a la réplica al artículo "Bloqueo posterior del plexo lumbar en paciente con sarcoidosis cardíaca para cirugía en artritis séptica de cadera" / No disponible

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Bloqueo posterior del plexo lumbar en paciente con sarcoidosis cardíaca para cirugía en artritis séptica de cadera / No disponible

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Evaluación de una intervención educativa en el control del dolor agudo postoperatorio: estudio antes-después / Assessment of training in the control of acute postoperative pain based on analysis of pretraining and posttraining measures

OBJETIVO: Valorar la efectividad de las medidas deintervención educativas aplicadas por una unidad dedolor agudo (UDA) sobre la atención al dolor postoperatorioen los servicios de traumatología y ortopedia yCirugía General.MÉTODOS: Estudio prospectivo antes-después en unhospital terciario. Se realizó intervención educativa amédicos y enfermeras de los servicios quirúrgicos consistenteen charlas con apoyo gráfico y administración ydifusión de protocolos de tratamiento de la UDA. Comovariables respuesta se estudiaron la EVA, satisfaccióndel paciente, número de días de tratamiento pautado porla UDA y causas de cese del tratamiento. Se analizaronlos datos correspondientes al año previo a la intervencióneducativa y el posterior.RESULTADOS: Se analizaron los datos de 854 pacientesantes de la intervención y 971 con posterioridad. Nohubo diferencias en el número medio de días de tratamiento,ni en la satisfacción del paciente por especialidad(traumatología y ortopedia U=-0,379 p=0,352; C.general U= -0,927 p= 0,177). Encontramos diferencias enlos valores de EVA de actividad y reposo a partir delsegundo y tercer día, con valores de diferencias demedias menores de 0,5 puntos. Se mejoraron en ambasespecialidades los casos en los que la UDA finalizaba eltratamiento inicialmente prescrito.CONCLUSIONES: La utilización de mediadas educativassobre el personal sanitario en el control del dolor postoperatoriono influye en la satisfacción de los pacientes, apesar de encontrar una discreta mejoría en los valoresEVA de actividad y reposo. Estas medidas sí tienenrepercusión al valorar la cumplimentación total de lostratamientos instaurados por la UDA, mejorando significativamente(AU)

OBJECTIVE: To assess the efficacy of an acute painunit’s training on postoperative pain control for staffof trauma-orthopedic and general surgerydepartments.METHODS: Prospective pretest-posttest study in atertiary care hospital. Physicians and nurses in the 2surgical departments were given training sessions thatincluded discussion with visual support andpresentation of the acute pain unit's treatmentprotocols. Outcome measures used were visual analogscale (VAS) scores, patient satisfaction scores, numberof days of treatment in accordance with the acute painunit's protocol, and reasons for stopping treatment.Data for the year before and after the training programwere analyzed.RESULTS: Data for 854 patients before training and971 after training were analyzed. There were nodifferences between surgical specialties in the meannumber of days of treatment. Nor did patientsatisfaction scores differ (trauma-orthopedic surgery,–0.379, P=.352; general surgery, –0.927, P=.177). VASscore differences of less than 0.5 points were found inactive and resting pain from the second and thirddays, respectively. There was improvement in bothspecialties in terms of the number of patients whocompleted the treatment initially prescribed by theacute pain unit.CONCLUSIONS: The staff training in postoperative paincontrol did not affect patient satisfaction, though a smallimprovement in active and resting VAS scores wasnoted. The training did have an effect on significantlyimproving overall compliance with the acute pain unit'streatment protocols(AU)

[Assessment of training in the control of acute postoperative pain based on analysis of pretraining and posttraining measures]. / Evaluación de una intervención educativa en el control del dolor agudo postoperatorio: estudio antes-después.

OBJECTIVE: To assess the efficacy of an acute pain unit's training on postoperative pain control for staff of trauma-orthopedic and general surgery departments. METHODS: Prospective pretest-posttest study in a tertiary care hospital. Physicians and nurses in the 2 surgical departments were given training sessions that included discussion with visual support and presentation of the acute pain unit's treatment protocols. Outcome measures used were visual analog scale (VAS) scores, patient satisfaction scores, number of days of treatment in accordance with the acute pain unit's protocol, and reasons for stopping treatment. Data for the year before and after the training program were analyzed. RESULTS: Data for 854 patients before training and 971 after training were analyzed. There were no differences between surgical specialties in the mean number of days of treatment. Nor did patient satisfaction scores differ (trauma-orthopedic surgery, -0.379, P = .352; general surgery, -0.927, P = .177). VAS score differences of less than 0.5 points were found in active and resting pain from the second and third days, respectively. There was improvement in both specialties in terms of the number of patients who completed the treatment initially prescribed by the acute pain unit. CONCLUSIONS: The staff training in postoperative pain control did not affect patient satisfaction, though a small improvement in active and resting VAS scores was noted. The training did have an effect on significantly improving overall compliance with the acute pain unit's treatment protocols.

[Comparison of intrathecal fentanyl and bupivacaine in combined spinal-epidural obstetric analgesia]. / Comparación del efecto de fentanilo frente a bupivacaína intratecal en una técnica anestésica combinada durante la analgesia obstétrica.

OBJECTIVES: To compare intrathecal injection of the opioid fentanyl to injection of bupivacaine, in terms of their effect of labour in the context within the combined spinal-epidural analgesia. METHODS: Prospective single-blind trial in primiparas randomized to 2 groups for sedation with 25 microg of fentanyl or 2.5 mg of bupivacaine, followed in both cases by epidural infusion of ropivacaine. We measured time from puncture to delivery of the neonate, rescue analgesia, pain assessed on a visual analog scale (VAS), motor block, side effects, sensory level, Apgar score, and maternal satisfaction. RESULTS: Sixty-four women were studied. The mean time elapsed between puncture and birth was 168.59 minutes (95% confidence interval [CI], 134.16 to 203.03 minutes) in the bupivacaine group and 189.13 minutes (95% CI, 151.93 to 226.32 minutes) in the fentanyl group. The mean difference was -20.53 minutes (95% CI, -70.21 to 29.15 minutes). Survival analysis applied to duration of labor, using type of delivery as the final outcome, also failed to show a significant between-group difference (chi2=0.59, P=.447). No significant differences in use of rescue analgesia, VAS scores, or motor block were observed. The incidence of pruritus in the fentanyl group was 34.37%, but there were no differences in maternal satisfaction. CONCLUSIONS: Our findings do not support the use of intradural fentanyl with the aim of shortening labor. Fentanyl leads to more pruritus, although this side effect does not affect maternal satisfaction.

Comparación del efecto de fentanilo frente a bupivacaína intratecalen una técnica anestésica combinada durante la analgesia obstétrica / Comparison of intrathecal fentanyl and bupivacaine in combined spinal-epidural obstetric analgesia

OBJETIVOS: Valorar el efecto de los opiáceos intratecalessobre la progresión del trabajo de parto, comparando elefecto del fentanilo frente a bupivacaína.MÉTODOS: Estudio prospectivo randomizado simple ciegoa parturientas primíparas divididas en dos grupos; grupoF en el que se administraron 25 μg de fentanilo, y grupoB tratado con 2,5 mg de bupivacaína, seguidos ambosde perfusión de ropivacaína epidural. Las variables medidasfueron tiempo desde punción hasta nacimiento delfeto, analgesia rescate, EVA, bloqueo motor, efectos secundarios,nivel sensitivo, Apgar y satisfacción.RESULTADOS: Se analizaron 64 parturientas, siendo laduración media desde el momento de la punción hasta elnacimiento en el grupo B de 168,59 min. (IC 95%: 134,16a 203,03) por 189,13 min. (IC95%: 151,93 a 226,32) en elgrupo F, diferencia de medias -20,53 min. (IC 95%: -70,21a 29,15). El análisis de supervivencia de la duración delparto valorando como resultado final el tipo de parto tampocoobjetivó diferencias entre grupos, χ2 = 0,59 p = 0,447.No se encontraron diferencias estadísticamente significativasen la analgesia de rescate, EVAy bloqueo motor. Huboun 34,37% de casos de prurito en el grupo F, sin mostrardiferencias en el grado de satisfacción.CONCLUSIONES: No se evidencian datos que justifiquenla utilización del fentanilo intradural con el objetivo deacortar el tiempo del trabajo de parto. El fentanilo produceun mayor número de efectos adversos en modo de prurito,a pesar de no tener repercusión sobre el grado desatisfacción de la parturienta (AU)

OBJECTIVES: To compare intrathecal injection of theopioid fentanyl to injection of bupivacaine, in terms oftheir effect of labour in the context within the combinedspinal-epidural analgesia.METHODS: Prospective single-blind trial in primiparasrandomized to 2 groups for sedation with 25 μg of fentanylor 2.5 mg of bupivacaine, followed in both cases by epiduralinfusion of ropivacaine. We measured time from punctureto delivery of the neonate, rescue analgesia, pain assessed ona visual analog scale (VAS), motor block, side effects,sensory level, Apgar score, and maternal satisfaction.RESULTS: Sixty-four women were studied. The meantime elapsed between puncture and birth was 168.59minutes (95% confidence interval [CI], 134.16 to 203.03minutes) in the bupivacaine group and 189.13 minutes(95% CI, 151.93 to 226.32 minutes) in the fentanylgroup. The mean difference was –20.53 minutes (95%CI, –70.21 to 29.15 minutes). Survival analysis applied toduration of labor, using type of delivery as the finaloutcome, also failed to show a significant between-groupdifference (χ2=0.59, P=.447). No significant differences inuse of rescue analgesia, VAS scores, or motor block wereobserved. The incidence of pruritus in the fentanylgroup was 34.37%, but there were no differences inmaternal satisfaction.CONCLUSIONS: Our findings do not support the use ofintradural fentanyl with the aim of shortening labor.Fentanyl leads to more pruritus, although this side effectdoes not affect maternal satisfaction(AU)

Hemorragia grave de la arteria radial secundaria a punción para gasometría en un insuficiente renal en tratamiento con antiagregantes / No disponible

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Bloqueo axilar incompleto y sedación con ketamina en un paciente con distrofia miotónica / No disponible

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