The erector spinae plane block (ESPB) in the management of chronic thoracic pain. Correlation of pain/analgesia areas and long term effect of the treatment in three cases / El bloqueo del plano del erector espinal en el manejo del dolor torácico crónico. Correlación de las áreas de dolor/analgesia y efecto a largo plazo del tratamiento en 3 casos

The erector spinae plane block (ESPB) is a technique that is used both as perioperative analgesia and in the management of chronic pain. This has been described recently and is being a resource increasingly used for its easy implementation and low rate of complications. However, the correlation between pain and analgesia, as well as its long-term effect on chronic pain, should be studied. We present a series of 3 cases in which the effectiveness of the ESPB in patients with chronic chest pain was evaluated. The block was performed in all cases by depositing 20ml of 0.2% Ropivacaine in the fascial plane of the erector spinae muscle. The pain was measured using a numerical scale prior to the block, at 30minutes and a month. The areas were marked on the skin with different colours for comparison

El bloqueo del plano del erector espinal (ESPB, por sus siglas en inglés) es una técnica que se emplea tanto como analgesia perioperatoria como en el manejo del dolor crónico. Esta ha sido descrita recientemente y está siendo un recurso cada vez más utilizado por su fácil realización y su baja tasa de complicaciones. No obstante, la correlación entre dolor y analgesia, así como su efecto a largo plazo en el dolor crónico deben ser estudiados. Presentamos una serie de 3 casos en los que se evaluó la eficacia del ESPB en pacientes con dolor torácico crónico. El bloqueo fue realizado en todos los casos depositando 20ml de ropivacaína al 0,2% en el plano fascial del músculo rector espinal. El dolor fue medido mediante escala numérica previo al bloqueo, a los 30min y al mes. Las áreas fueron marcadas en la piel con colores diferentes para su comparación

The erector spinae plane block (ESPB) in the management of chronic thoracic pain. Correlation of pain/analgesia areas and long term effect of the treatment in three cases.

The erector spinae plane block (ESPB) is a technique that is used both as perioperative analgesia and in the management of chronic pain. This has been described recently and is being a resource increasingly used for its easy implementation and low rate of complications. However, the correlation between pain and analgesia, as well as its long-term effect on chronic pain, should be studied. We present a series of 3 cases in which the effectiveness of the ESPB in patients with chronic chest pain was evaluated. The block was performed in all cases by depositing 20ml of 0.2% Ropivacaine in the fascial plane of the erector spinae muscle. The pain was measured using a numerical scale prior to the block, at 30minutes and a month. The areas were marked on the skin with different colours for comparison.

Utilidad de la ecografía diafragmática en el diagnóstico precoz de parálisis frénica tras cirugía de hombro para prevenir complicaciones respiratorias postoperatorias / Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications

El bloqueo del nervio frénico es una complicación que puede producirse tras la anestesia del plexo braquial por encima de la clavícula. La principal consecuencia de este bloqueo es la parálisis diafragmática ipsolateral, que en ocasiones puede suponer aparición de complicaciones respiratorias postoperatorias. Presentamos un caso clínico de una mujer que tras ser intervenida de una prótesis total de hombro presentó disnea en la unidad de recuperación posquirúrgica. Se realizó una ecografía diafragmática que permitió un diagnóstico rápido de parálisis completa del hemidiafragma ipsolateral. Ante la sospecha de bloqueo del nervio frénico, la ecografía ha demostrado ser una herramienta diagnóstica rápida con alta sensibilidad y especificidad. Su empleo puede anticipar el posible desarrollo de complicaciones inmediatas, y orientarnos para escoger la estrategia terapéutica adecuada para cada caso de una manera precoz. En nuestro caso nos permitió tratar de forma precoz mediante oxigenoterapia, retirada de catéter interescalénico y vigilancia intensiva

Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance

Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications. / Utilidad de la ecografía diafragmática en el diagnóstico precoz de parálisis frénica tras cirugía de hombro para prevenir complicaciones respiratorias postoperatorias.

Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance.

Propuesta de algoritmo para el manejo de la vía aérea del paciente tras inhalación de humo / Proposal for an algorithm for the management of the patient's airway after smoke inhalation

La inhalación de humo representa la principal causa de morbimortalidad en pacientes quemados. Dadas las lesiones que pueden producirse en la vía aérea tras esta exposición, es imprescindible evaluar en el servicio de urgencias, e incluso en el lugar de primera asistencia por personal sanitario, la necesidad de realizar una intubación orotraqueal. Puesto que los signos clínicos son pobres predictores de la severidad de la lesión, en casos seleccionados es recomendable la realización de una fibroscopia diagnóstica. Presentamos un caso clínico de un paciente con lesión por inhalación de humo en el que la realización de la fibroscopia fue determinante para proceder a la intubación, y proponemos un algoritmo de actuación para el manejo de la vía aérea en este tipo de pacientes (AU)

Smoke inhalation represents the leading cause of mortality and morbidity in burns patients. Given the injuries that can occur in the airway after this exposure, it is imperative to evaluate the need for orotracheal intubation in the emergency department and even in the place of first assistance by healthcare workers. Since the clinical signs are poor predictors of the severity of the lesion, in selected cases, it is advisable to perform a diagnostic fibroscopy. We present a case report of a patient with a smoke inhalation lesion in which the fibroscopy was determinant to proceed to intubation, and we propose an algorithm of action for the management of the airway in this type of patients (AU)

Proposal for an algorithm for the management of the patient's airway after smoke inhalation. / Propuesta de algoritmo para el manejo de la vía aérea del paciente tras inhalación de humo.

Smoke inhalation represents the leading cause of mortality and morbidity in burns patients. Given the injuries that can occur in the airway after this exposure, it is imperative to evaluate the need for orotracheal intubation in the emergency department and even in the place of first assistance by healthcare workers. Since the clinical signs are poor predictors of the severity of the lesion, in selected cases, it is advisable to perform a diagnostic fibroscopy. We present a case report of a patient with a smoke inhalation lesion in which the fibroscopy was determinant to proceed to intubation, and we propose an algorithm of action for the management of the airway in this type of patients.