The attitude of anesthesiologists and anesthesiology residents of the CET/SBA regarding upper and lower limb nerve blocks.

BACKGROUND AND OBJECTIVES: The use of regional blocks especially peripheral nerve blocks (PNB) has been increasing in anesthesiology due to the reduced need to manage the airways, lower cost, and excellent postoperative analgesia. However, its use has restrictions due to the lack of training, that it takes longer to be done, fear of neurological complications, and systemic toxicity. The objective of this study was to measure the attitude of anesthesiologists and anesthesiology residents at Teaching and Training Centers (CET/SBA) regarding PNBs. METHODS: A 25-item questionnaire was developed and it was available, via the Internet and by mail, to those responsible for the 80 CETs, their instructors and residents. RESULTS: Forty-two CETs (52.5%) returned 188 questionnaires, 62 (32%) from anesthesiology residents and 126 (68%) from anesthesiologists. The Cronbach's alpha coefficient of the questionnaire was 0.79. Factor analysis revealed six factors that explain 53% of scores variance: factor 1 - positive attitude, responsible for 18.34% of the variance; factor 2 - training/use, responsible for 11.73% of the variance; factor 3 - negative aspects, responsible for 7.11% of the variance; factor 4 - limiting factors, responsible for 6.39% of the variance; and factor 5 - regional block as a competence differential, responsible for 5.79% of the variance; and factor 6 - respect for the patient, responsible for 5.4% of the variance. CONCLUSIONS: The questionnaire proved to be a reliable tool to measure the attitude regarding regional blocks. Anesthesiologists demonstrated greater interest for patient-related aspects, while the main focus of residents was the acquisition of technical abilities.

Critical reading of the statistical data in scientific studies.

BACKGROUND AND OBJECTIVES: Statistics are a valuable tool that validates the conclusions of scientific works. The objective of this review was to present some concepts related to statistic calculations that are fundamental for the critical reading and analysis of medical literature. CONTENTS: In general, authors present the results of their studies as charts, boxes, and tables with quantitative data, along with descriptive statistics (means, standard deviations, medians), and almost always mention the statistic tests used. After reviewing several studies, it was difficult to find the value attributed to the statistical test. Thus, it is up to the reader to evaluate the adequacy of the information, and to search for evidence that contradict possible mistakes that could threaten the validity of their conclusion. CONCLUSIONS: Examining the design of the studies one observes that, in many of them, excessive importance is given to statistical calculations as definitive factors, irrefutable evidence of arguable, or equivocal, conclusions.

Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patients.

BACKGROUND: Tonsillectomy has a high incidence of postoperative pain. The aim of the present study was to determine whether the use of low-dose IV ketamine, before the start of surgery or after the end of the operation, would lead to significantly improved pain control after tonsillectomy in pediatric patients. METHODS: Ninety children, 5-7 years old, scheduled for elective tonsillectomy were randomly assigned to one of three groups of 30 patients each; groups I, II and III. Patients in group I received no ketamine. Patients in group II received 0.5 mg x kg(-1) of ketamine before the surgical start and for group III the same dose was given after the operation ended. Postoperative pain was scored by the Oucher scale. Systolic and diastolic pressures and heart rate were recorded perioperatively. Unwanted side effects were recorded by the ward staff personnel on a 24-h study-specific questionnaire. Statistical tests consisted of Student's t-test, chi-square and anova as appropriated. RESULTS: The number of patients complaining of pain was greater in group I compared with patients in groups II and III with a significative statistical difference (P < 0.05). The degree of postoperative pain was significantly higher in patients of group I compared with groups II and III (P < 0.05). Eight patients in group I needed rescue doses of morphine, three for group II and none for group III. In group I, three of eight patients required two doses of morphine during the first 249 h postoperatively. No unwanted side effects were noted. CONCLUSIONS: The use of a single small dose of ketamine in a pediatric population undergoing tonsillectomy could reduce the frequency or even avoid the use of rescue analgesia in the postoperative period independent of whether used before or after the surgical procedure.