Peri-operative Hemi-diaphragmatic Variations After Brachial Plexus Block Above the Clavicle: A Prospective Observational Study of the Contralateral Side.

OBJECTIVE: Hemi-diaphragm palsy after brachial plexus block above the clavicle (BPBAC) occurs frequently, but few patients develop post-operative pulmonary complications (PPC). We hypothesized that contralateral hemidiaphragm function increases after BPBAC. This contralateral function preserves global diaphragmatic function, avoiding PPC in the case of ipsilateral hemi-diaphragm palsy. METHODS: This prospective observational cohort study included 64 adult patients undergoing shoulder surgery with planned BPBAC (interscalene brachial plexus block and supraclavicular block). The Thickening Fraction (TF) was measured by ultrasound in both hemi-diaphragms, ipsilateral (TF ipsilateral) and contralateral (TFcontralateral) to the BPBAC, before and after the surgery. TFglobal is the sum of TFipsilateral and TFcontralateral. PPC were defined as occurrences of dyspnea, tachypnea, SpO2 <90% or SpO2/FiO2 <315. RESULTS: TFcontralateral increased significantly (an average of 40%) after BPBAC (p = 0.001), and TFipsilateral decreased (an average of 72%). After BPBAC, 86% of patients had a decreased TFipsilateral and 59% of patients an increased TFcontralateral at post-operatively. Only 17% of patients have PPC. CONCLUSION: After BPBAC, global diaphragm function decreases because of ipsilateral hemi-diaphragm reduction, but less than expected because of increased contralateral hemi-diaphragm function. As a part of diaphragm function, contralateral hemi-diaphragm function must be checked.

Intubation with vivasight double-lumen tube versus conventional double-lumen tube in adult patients undergoing lung resection: A retrospective analysis.

Objectives: The present study was designed to compare outcomes in patients undergoing thoracic surgery using the VivaSight double-lumen tube (VDLT) or the conventional double-lumen tube (cDLT). Design: A retrospective analysis of 100 patients scheduled for lung resection recruited over 21 consecutive months (January 2018-September 2019). Setting: Single-center university teaching hospital investigation. Participants: A randomized sample of 100 patients who underwent lung resection during this period were selected for the purpose to compare 50 patients in the VDLT group and 50 in the cDLT group. Interventions: After institutional review board approval, patients were chosen according to inclusion and exclusion criteria and we created a general database. The 100 patients have been chosen through a random process with the Microsoft Excel program (Microsoft 2018, Version 16.16.16). Measurements and Main Results: The primary endpoint of the study was to analyze the need to use fiberoptic bronchoscopy to confirm the correct positioning of VDLT or the cDLT used for lung isolation. Secondary endpoints were respiratory parameters, admission to the intensive care unit, length of hospitalization, postoperative complications, readmission, and 30-day mortality rate. The use of fiberoptic bronchoscopy was lower in the VDLT group, and the size of the tube was smaller. The intraoperative respiratory and hemodynamics parameters were optimal. There were no other preoperative, intraoperative, or postoperative differences between both groups. Conclusions: The VDLT reduces the need for fiberoptic bronchoscopy, and it seems that a smaller size is needed. Finally, VDLT is cost-effective using disposable fiberscopes.

Neuroestimulación medular. Análisis de las indicaciones diagnósticas / Spinal cord stimulation. Analysis of the diagnostic indications

INTRODUCCIÓN: La neuroestimulación medular (NM) es una forma de tratamiento del dolor crónico que ha demostrado su efectividad en pacientes que han respondido mal a otras terapias. Las indicaciones actuales para los dispositivos de NM son muy variadas. El objetivo de nuestro estudio es analizar las indicaciones diagnósticas de la terapia con NM durante los últimos 5 años en nuestro hospital, conocer cuáles son las causas de dolor más frecuentes para la indicación del implante del dispositivo y qué porcentaje de mejoría presentan los pacientes, así como estudiar la relación con el género y la edad. MATERIAL Y MÉTODOS: Se trata de un estudio observacional, descriptivo y retrospectivo. Los pacientes fueron identificados desde el registro de actividad quirúrgica de la Unidad del Dolor del Hospital General de Valencia. RESULTADOS: El número final de pacientes incluidos fue de 179. El síndrome de cirugía fallida de espalda (SCFE) fue la indicación diagnóstica en 112 pacientes (62,57 %). La media del porcentaje de mejoría descrita por los pacientes tras el implante del NM fue de 47,99 ± 27,3 %. No se observaron diferencias en la mejoría respecto a la edad o el género. DISCUSIÓN: A pesar de la variabilidad de diagnósticos en los que puede estar indicada esta terapia, es destacable que en más de la mitad de los casos la indicación es por SCFE

INTRODUCTION: Spinal cord stimulation (SCS) is a form of chronic pain treatment that has been shown to be effective in patients who have responded poorly to other therapies. The current indications for SCS devices are very varied. The aim of our study is to analyze the diagnostic indications of SCS therapy during the last 5 years in our hospital, to know the most frequent causes of pain for the indication of the implant of the device and what percentage of improvement patients present, as well as to study the relationship with gender and age. MATERIAL AND METHODS: This is an observational, descriptive, retrospective study. The patients were identified from the surgical activity register of the Pain Unit of the General Hospital of Valencia. RESULTS: The final number of patients included was 179. The Failed back surgery syndrome (FBSS) was the diagnostic indication in 112 patients (62.57 %). The mean percentage of improvement described by the patients after the SCS implant was 47.99 ± 27.3 %. There were no differences in the improvement with respect to age or gender. DISCUSSION: In spite of the variability of diagnoses in which this therapy may be indicated, it is noteworthy that in more than half of the cases the indication is by FBSS

The erector spinae plane block: a narrative review.

Regional anesthesia and pain management have experienced advances in recent years, especially with the advent of fascial plane blocks. The erector spinae plane block is one of the newest techniques to be described. In the past two years, publications referring to ESP block have increased significantly. The objective of this review is to analyze the articles about ESP block that have been published to date. We performed a search in the main databases and identified 368 articles. After a selection of the relevant articles, 125 studies were found eligible and were included in the review. The ESP block is performed by depositing the local anesthetic in the fascial plane, deeper than the erector spinae muscle at the tip of the transverse process of the vertebra. Many cases of its use have been described with satisfactory results in the treatment of both acute pain and chronic pain. The applicability of the technique covers many clinical scenarios. Of the 98 case reports reviewed, 12 and 87 articles, respectively described the technique as a treatment for chronic pain and acute pain. The single-shot was the most frequently used technique. As described in the articles published to date, the technique is easy to perform and has a low rate of complications. However, despite the effectiveness of the technique, further studies are necessary to obtain more evidence of its actions.