Pre-incisional local infiltration with levobupivacaine in laparoscopic cholecystectomy: a randomized and clinical trial.

OBJECTIVE: Laparoscopic cholecystectomy (LC), despite its minimally invasive nature, requires effective control of post-operative pain. The use of local anesthetics (LA) has been studied, but the level of evidence is low, and there is little information on important parameters such as health-related quality of life (HRQoL) or return to work. The objective of the study was to evaluate the efficacy of 0.50% levobupivacaine infiltration of incisional sites in reducing POP after LC. METHODS: This was a prospective, randomized, double-blind study. Patients undergoing elective LC were randomized into two groups: no infiltration (control group) and port infiltration (intervention group). POP intensity (numerical rating scale, NRS), need for rescue with opioid drugs, PONV incidence, HRQoL, and return to work data, among others, were studied. RESULTS: Two hundred and twelve patients were randomized and analyzed: 105 (control group) and 107 (intervention group). A significant difference was observed in the NRS values (control group mean NRS score: 3.41 ± 1.82 vs. 2.56 ± 1.96) (p < 0.05) and in the incidence of PONV (31.4% vs. 19.6%) (p = 0.049). CONCLUSIONS: Levobupivacaine infiltration is safe and effective in reducing POP, although this does not lead to a shorter hospital stay and does not influence HRQoL, return to work, or overall patient satisfaction.

OBJETIVO: la colecistectomía laparoscópica (CL), a pesar de su carácter mínimamente invasivo, requiere un control efectivo del dolor postoperatorio (POP). El uso de anestésicos locales (AL) ha sido estudiado pero el nivel de evidencia es bajo y existe poca información acerca de parámetros relevantes como la calidad de vida relacionada con la salud (CVRS) o la reincorporación laboral. El objetivo de este estudio es analizar la eficacia de la infiltración de los sitios incisionales con levobupivacaína 0,50% en la reducción del dolor postoperatorio tras la CL. MATERIAL Y MÉTODOS: estudio prospectivo, aleatorizado y doble ciego. Pacientes sometidos a CL programada fueron aleatorizados en dos grupos: sin infiltración (grupo control) y con infiltración preincisional (grupo intervención). La intensidad del dolor (escala de puntuación numérica, NRS), la necesidad de rescates con opioides, la incidencia de náuseas o vómitos postoperatorios (NVPO) y datos de CVRS o reincorporación laboral, entre otros, fueron recogidos. RESULTADOS: 212 pacientes fueron aleatorizados y analizados: 105 en el grupo control y 107 en el grupo de intervención. Se observó una diferencia estadísticamente significativa en la intensidad del dolor (puntuación media NRS: 3.41 ± 1.82 vs. 2.56 ± 1.96) (p < 0.05) y en la incidencia de NVPO (31.4% vs. 19.6%) (p = 0.049). CONCLUSIONES: La infiltración con levobupivacaína es segura y efectiva en la reducción del dolor postoperatorio, aunque esto no conlleva una menor estancia hospitalaria y no influye en los resultados de CVRS, reincorporación laboral o satisfacción del paciente.

Effect of thermo mechanical stimulation duringlocal anesthesia in pediatric dentistry: a pilot randomized clinical trial / Efeito de estimulação termomecânica durante anestesia local em odontopediatria: um ensaio clínico randomizado piloto

Objetivo: Avaliar a eficácia de um dispositivo de estimulação termomecânica (Buzzy®) em relação à dor, medo e ansiedade durante anestesia local em crianças. Materiais e métodos: Estudo realizado no período de maio de 2018 a julho de 2019, com crianças de 7 a 11 anos, sem experiência prévia envolvendo anestesia nos últimos 2 anos e que necessitassem de tratamento odontológico (extração, restauração ou endodontia) sob anestesia local em molares decíduos. A amostra foi randomizada em grupo controle, que recebeu anestesia convencional, e grupo intervenção, que recebeu anestesia com Buzzy®. Os níveis de ansiedade, medo e percepção de dor de ambos os grupos foram verificados por meio de: Venham Modified Picture Test (VPTM); frequência cardíaca; Escala Comportamental Venham; Faces Pain Scale ­ Revised (FPS-R) e Face, Legs, Activity, Cry, Consolability (FLACC). Resultados: A maioria das crianças (55%) apresentou baixa ansiedade antes e depois do tratamento (P<0,05). A aceitabilidade das crianças ao Buzzy® foi de 100% e a maioria (90%) gostaria de usar novamente. Discussão: O aparelho testado é uma ferramenta interessante para complementar as técnicas de manejo durante as consultas, tendo em vista a excelente aceitabilidade e interesse por parte dos pacientes e familiares. Conclusão: Este estudo demonstrou que o uso da estimulação termomecânica é viável na clínica odontológica, devido ao seu fácil uso e boa aceitabilidade no meio clínico, além de não apresentar riscos em seu uso.

Aim: To evaluate the effectiveness of a thermo mechanical stimulation device (Buzzy®) in relation to pain, fear and anxiety during local anesthesia in children. Materials and methods: Study carried out from May 2018 to July 2019, with children aged 7 to 11 years, without previous experience involving anesthesia in the last 2 years and who needed dental treatment (extraction, restoration or endodontic) under local anesthesia in deciduous molars. The sample was randomized into a control group, which received conventional anesthesia, and an intervention group, which received anesthesia with Buzzy®. The levels of anxiety, fear and pain perception of both groups were verified using: Come Modified Picture Test (VPTM); heart rate; Behavioral Scale Come; Faces Pain Scale ­ Revised (FPS-R) and Face, Legs, Activity, Cry, Consolability (FLACC). Results: Most children (55%) had low anxiety before and after treatment (P<0.05). The acceptability of the children to Buzzy® was 100% and the majority (90%) would like to use it again. Discussion: The tested device is an interesting tool to complement management techniques during consultations, in view of the excellent acceptability and interest on the part of patients and family members. Conclusion: This study demonstrated that the use of thermo mechanical stimulation is feasible in the dental clinic, due to its easy use and good acceptability in the clinical environment, in addition to not presenting risks in its use.

Bloqueo en el plano del músculo erector de la columna frente a anestesia local infiltrativa para discectomía endoscópica percutánea transforaminal: ensayo controlado aleatorizado prospectivo / Erector spine plane block versus local infiltration anaesthesia for transforaminal percutaneous endoscopic discectomy: Prospective randomise controlled trial

Antecedentes: Casi el 60-80% de la población padece de dolor de espalda, lo cual convierte a esta situación en una de las causas más comunes de consulta. Uno de los tratamientos más efectivos para el dolor lumbar es la discectomía endoscópica percutánea transforaminal, que requiere diferentes opciones anestésicas. Nuestro objetivo primario fue probar la hipótesis de si el bloqueo en el plano del músculo erector de la columna (ESP) bilateral con sedación es similar a la infiltración tradicional local de anestésico con sedación. Materiales y métodos: Se asignó aleatoriamente a cincuenta y dos pacientes sometidos a discectomía endoscópica percutánea transforaminal a dos grupos: el G1 recibió sedación intravenosa con anestesia local infiltrativa; G2 recibió sedación intravenosa con ESP bilateral. Resultado primario: cantidad de fentanilo y propofol durante la cirugía. Resultados secundarios: episodios adversos durante la sedación utilizando la herramienta de reporte sobre episodios adversos de la sedación de la Society of Intravenous Anaesthesia (SIVA), nivel de sedación postoperatoria utilizando la escala Richmond Agitation-Sedation Scale (RASS), intensidad del dolor tras la cirugía utilizando la escala visual analógica (EVA), umbral del dolor mecánico (MPT) utilizando microfilamentos de von Frey, medido en ambas extremidades inferiores, y satisfacción con la analgesia aplicando la escala Likert de 5 puntos. Resultados: La cantidad de fentanilo, propofol y el nivel de sedación postoperatoria fueron significativamente menores en G2 (p<0,001). No se produjo diferencia en cuanto a intensidad del dolor, satisfacción con la analgesia y umbral del dolor mecánico tras la cirugía en ambos grupos. No se produjeron episodios adversos en el grupo G2 en comparación con G1 (2 pacientes descriptores del riesgo mínimo, 5 descriptores del riesgo menor y 1 descriptor del riesgo centinela) que requirieron medicación adicional o ventilación de rescate...(AU)

Background: About 60% to 80% of the population suffers from back pain, making it one of the most common health complaints. One of an effective treatments of low back pain is transforaminal percutaneous endoscopic discectomy (TPED) which requires different options for anaesthesia. Our primary objective was to test the hypothesis if the bilateral erector spine plane block (ESP) with sedation is similar to traditional infiltrative local anaesthesia with sedation. Materials and methods: Fifty-two patients that underwent TPED were randomly assigned in two groups: G1 received intravenous sedation with infiltrative local anaesthesia; G2 received intravenous sedation with bilateral ESP. Primary outcome: amount of fentanyl and propofol during surgery. Secondary outcomes: adverse events during sedation employing World Society of Intravenous Anaesthesia (SIVA) adverse sedation event reporting tool, level of postoperative sedation with Richmond Agitation-Sedation Scale (RASS), intensity of pain after surgery engaging a visual analogue scale (EVA), the mechanical pain threshold (MPT) with von Frey monofilaments measured on both lower extremities, satisfaction with analgesia applying 5-point Likert scale. Results: Amount of fentanyl, propofol and level of postoperative sedation was significantly lower in G2 (p<0.001). There was no difference in intensity of pain, satisfaction with analgesia, and the mechanical pain threshold after surgery in both groups. There were no adverse events in G2 group in contradistinction to G1 (2 patients minimal risk descriptors, 5 minor risk descriptors and 1 sentinel risk descriptors) which required additional medication or rescue ventilation...(AU)

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius / Bloqueio supracondilar de nervo radial versus bloqueio de hematoma de fratura. Comparativo de sua eficácia em casos de fraturas do terço distal do rádio

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

Bloqueo del tobillo con lidocaína y bupivacaina para amputación de los radios del pie. Hospital General del Sur "Dr. Pedro Iturbe" / Ankle block with lidocaine and bupivacaine for foot rays amputation. Hospital General del Sur "Dr. Pedro Iturbe"

El objetivo de este trabajo es determinar la utilidad del bloqueo del tobillo con lidocaína y Bupivacaína para amputación de los radios del pie en pacientes atendidos en el Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Venezuela, desde mayo 2019 hasta mayo 2021. Se realizó un estudio pre-experimental, prospectivo y longitudinal. Se incluyeron pacientes de ambos sexos, entre 18 a 90 años, con amputaciones traumáticas, pie diabético e insuficiencia vascular periférica. Se incluyeron 50 pacientes, con edad promedio de 50,76 ± 25,0 años, 35(70,0%) de sexo masculino. Con antecedente de diabetes 13(26,0%) pacientes, fumadores 4(8,0%), cardiópatas 4(8,0%), hipertensos/diabéticos 6(12,0%), obesidad 5(10,0%), trauma 6(12,0%), nefrópatas 2(4,0%), drogas 1(2,0%) y sin antecedentes 9(18,0%). Diagnóstico preoperatorio predominante: amputación traumática 19 pacientes (38,0%), El promedio de tiempo de inicio del bloqueo fue 5-15min en 21(42,0%) casos. El bloqueo fue satisfactorio en 46(92,0%) pacientes. La duración del bloqueo en 22(44,0%) pacientes fue prolongada. Según la EVA del dolor en 19(38,0%) casos fue leve. No se evidenciaron complicaciones asociadas al procedimiento en 50(100,0%) pacientes. El bloqueo con lidocaína y bupivacaína es una técnica útil en la amputación de los radios del pie, inmediata, ambulatoria, a bajo costo, de duración prolongada y satisfactoria, de bajo dolor postoperatorio, poco requerimiento de analgésicos y con bajas complicaciones(AU)

The objective to determine the usefulness of the ankle block with lidocaine and Bupivacaine for amputation of the foot rays in patients treated at the Hospital General del Sur Dr. Pedro Iturbe during the period May 2019 to May 2021. A pre-experiment, prospective and longitudinal study was made. Patients of both sexes, between 18 and 90 years old, with traumatic amputations, diabetic foot and peripheral vascular Insufficiency were included. A descriptive statistical analysis was applied. Mean age 50,76±25,0 years, 35(70,0%) male patients. Patients history: Diabetes 13(26,0%), smokers 4(8,0%), heart patients 4(8,0%), hypertensive/diabetics 6(12,0%) patients, obesity 5(10,0%), trauma 6(12,0%), kidney disease 2(4,0%), drugs 1(2,0%), no history 9(18,0%). Predominant preoperative diagnosis: traumatic amputation 19(38,0%) patients, Block onset time: medium (5-15min) 21(42,0%) patients. The blockade was satisfactory in 46 patients (92.0%). Block duration in 22(44,0%) patients was prolonged. Pain scale 19(38,0%) patients mild pain. There were no complications associated with the procedure in 50(100,0%) patients. Conclusions: The blockade with lidocaine and bupivacaine is useful in the amputation of the foot rays since it is performed immediately, on an outpatient basis, at low cost, with a long and satisfactory duration, presenting mild postoperative pain, little need for analgesics and they do not represent a risk for the patient since there were no complications related to the technique(AU)

Ultrasound-Guided WALANT Technique in Carpal Tunnel Decompression Surgery* / Técnica WALANT guiada por ultrassom na cirurgia de descompressão do túnel do carpo

Abstract Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the human body. Its symptoms result from compression of the median nerve in the carpus. The treatment can be conservative, with medications and/or infiltrations that alleviate the symptoms, or surgical, which is more effective, with decompression of the median nerve by surgical section of the flexor retinaculum of the carpus. The anesthetic technique varies according to the anesthesia method: sedation, venous locoregional anesthesia and, more recently, wide-awake local anesthesia no tourniquet (WALANT), which can be performed by the surgeons themselves. The WALANT technique uses local anesthesia with a vasoconstrictor, and does not require the use of a tourniquet on the upper limb nor sedation. The median nerve block in ultrasound-guided WALANT provides better accuracy to the technique, with greater patient safety; in the present article, its use in the performance of carpal tunnel decompression is described, and the literature is reviewed.

Resumo A síndrome do túnel do carpo (STC) é a neuropatía compressiva mais comum do corpo humano. Seus sintomas decorrem da compressão do nervo mediano no carpo. O tratamento pode ser incruento, com medicações e/ou infiltrações que amenizam os sintomas, ou cruento, mais eficaz, com a descompressão do nervo mediano pela seção cirúrgicadoretináculodos flexores do carpo. A técnica anestésica varia de acordo com o serviço de anestesia: sedação, anestesia locorregional venosa e, mais recentemente, a anestesia local com o paciente acordado e sem torniquete (wide-awake local anesthesia no tourniquet, WALANT), que pode ser realizada pelo próprio cirurgião. Por utilizar anestesia local com vasoconstritor, essa técnica dispensa o uso de torniquete no membro superior e a necessidade de sedação. O bloqueio do nervo mediano na WALANT guiada por ultrassonografiaconfere melhor precisão àtécnica,e mais segurança ao paciente, e, neste artigo seu uso na realização da descompressão do túnel do carpo é descrito, e a literatura, revisada.

Conhecimento de acadêmicos de Odontologia sobre o uso de anestésicos locais / Conocimiento de los estudiantes de odontología sobre el uso de anestésicoslocales / Dentistry students' knowledge about the use of local anesthetics

O presente estudo teve como objetivo avaliar o conhecimento de estudantes de graduação do curso de Odontologia em relação à indicação e uso dos anestésicos locais nos procedimentos clínicos e cirúrgicos. Trata-se de um estudo prospectivo, observacional tendo como instrumento de coleta um questionário composto de perguntas abertas e fechadas sobre a temática. Após assinatura do termo de consentimento livre e esclarecido, 59 acadêmicos que obedeciam aos critérios de inclusão e exclusão participaram do estudo respondendo ao questionário. A amostra apresentou média de idade de 22,75 anos, 17 (29,31%) eram do sexo masculino e 41 (70,68%) do feminino, sendo que um participante não declarou o sexo. A média de tempo cursando Odontologia foi de 4 anos, sendo que 19 alunos (31%) cursavam o 6º período, 22 (37,9%) o 8º período e 18 (31%) o 10º período do curso. Situações relacionadas à toxicidade do anestésico foram corretamente identificadas por 20 participantes (57,2% dos 35 que responderam à pergunta), 56 (94,9%) realizaram anamnese direcionada e 55 (93,2%) fizeram a escolha do sal anestésico de acordo com a condição sistêmica do paciente. Porém, quando questionados sobre a dose anestésica máxima em determinada situação clínica, apenas 6 (10,2%) responderam corretamente. Considerando a disponibilidade de anestésicos para uma exodontia simples em paciente hipertenso ou diabético controlado, gestante, lactante e criança, pouco mais que a metade dos alunos (62,7% a 52,5%) souberam indicar corretamente solução anestésica,considerando a lidocaína com vasoconstritor o anestésico de escolha. Foram observadas diferenças estatisticamente significativas quando comparado o gênero dos acadêmicos em relação ao uso de anestésico tópico (p=0,018) e uso de anestesia local para o procedimento de raspagem periodontal subgengival (p = 0,008), sendo as duas indicações mais comuns na parcela feminina da amostra. Conclui-se que a maioria dos acadêmicos possui conhecimentos necessários para escolha do sal anestésico e sucesso quanto ao emprego da técnica, entretanto não realizaram de forma correta o cálculo da dose máxima recomendada diante de uma situação clínica hipotética, necessitando, neste e em outros parâmetros, de revisão de conceitos, procedimentos e condutas clínicas (AU).

El presente estudio tuvo como objetivo evaluar el conocimiento de estudiantes de graduación en odontologíasobre la indicación y uso de anestésicos locales en procedimientos clínicos y quirúrgicos. Se trata de un estudio observacional prospectivo que utiliza como instrumento de recogida de datos un cuestionario compuesto por preguntas abiertas y cerradas sobreel tema. Después de firmar el formulario de consentimiento libre e informado, 59 estudiantes que cumplieron con los criterios de inclusión y exclusión participaron en el estudio respondiendo el cuestionario. La muestra tenía una edad media de 22,75 años, 17 (29,31%) eran del sexo masculino y 41 (70,68%) del sexo femenino, y un participante no declaró el sexo. El tiempo promedio de estudio de Odontología fue de 4 años, con 19 alumnos (31%) cursando el 6° período, 22 (37,9%) el 8° período y 18 (31%) el 10° período de la carrera. Las situaciones relacionadas con la toxicidad del anestésico fueron identificadas correctamente por 20 participantes (57,2% de los 35 que respondieron la pregunta), 56 (94,9%) realizaron anamnesis dirigida y 55 (93,2%) eligieron la sal del anestésico según el estado sistémico del paciente. Sin embargo, cuando se les preguntó sobre la dosis máxima de anestésico en una situación clínica dada, solo 6 (10,2%) respondieron correctamente. Considerando la disponibilidad de anestésicos para una extracción dental simple en pacientes hipertensos o diabéticos controlados, gestantes, lactantes y niños, poco más de la mitad de los estudiantes (62,7% a 52,5%) sabían indicar correctamente la solución anestésica, considerando la lidocaína con vasoconstrictor el anestésico de elección. Se observaron diferencias estadísticamente significativas al comparar el sexo de los estudiantes en relación con el uso de anestésico tópico (p=0,018) y uso de anestesia local para el procedimiento de raspado periodontal subgingival (p=0,008), las dos indicaciones más comunes en la porción femenina de la muestra. Se concluye que la mayoría de los académicos tienen los conocimientos necesarios para elegir la sal anestésica y lograr el uso de la técnica, sin embargo, no calcularon correctamente la dosis máxima recomendada en una situación clínica hipotética, requiriendo, en este y otros parámetros, revisar conceptos, procedimientos y enfoques clínicos (AU).

The objective of the present study was to evaluate the knowledge of undergraduate dental students regarding the indication and use of local anesthetics in clinical and surgical procedures. This is a prospective, observational study, using a questionnaire with open and closed questions about the subject as a collection tool. After signing the ICF, 59 students who met the inclusion and exclusion criteria participated in the study by answering the questionnaire. The students included in the study had a mean age of 22.75 years, 29.31% (n=17) were male and 70.68% (n=41) were female, and one student did not declare. The average number of years in college was 4 years, with 19 students (31%) in 6th period, 22 (37.9%) in 8th period and 18 (31%) in 10th period. Fifty-seven percent identified situations related to anesthetic toxicity, 94.9% performed directed anamnesis, and 93.2% chose the anesthetic salt according to the general condition of the patient. However, when questioned about the maximum anesthetic dose in a given clinical situation, only 10.2% answered correctly. For anesthetic application procedures, 89.8% considered that controlling the volume of anesthetic solution injected was an important factor, and 72.9% informed that prior aspiration was done before starting the injection of the anesthetic. Regarding the success of the technique, 78% reported success. Considering the availabilityof anesthetics, the indication for patients with some systemic condition, 62.7% knew how to correctly indicate the anesthetic solution. Statistically significant differences were observed when comparing the gender of the students regarding the use of topical anesthetic (p = 0.018) and the use of local anesthesia for subgingival periodontal scaling (p = 0.008), both indications being more common in female students. It was concluded that most of the students had the necessary knowledge to choose the anesthetic salt and were successful in using the technique, however, they did not correctly calculate the maximum dose recommended for a clinical situation presented as an assumption, requiring, in this and other parameters, a review of concepts, procedures, and clinical conducts (AU).

Ensayo clínico aleatorizado. Efecto de dos tipos de ayuno en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local en un servicio de hemodinámica en Medellín, 2019 / Randomized clinical trial. Effect of two types of fasting in patients undergoing percutaneous intervention procedures under local anesthesia in a hemodynamic service in Medellín, 2019 / Ensaio clínico randomizado. Efeito de dois tipos de jejum em pacientes submetidos a procedimentos de intervenção percutânea sob anestesia local em um serviço de hemodinâmica em Medellín, 2019

Objetivo: determinar el efecto de dos tipos de ayuno sobre parámetros de satisfacción, náuseas, vómito, presión arterial y glucometría en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local en un servicio de hemodinámica en Medellín, 2019. Metodología: ensayo clínico aleatorizado abierto de dos brazos en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local durante tres meses. Cada brazo con 153 participantes; se asignó un ayuno de seis horas y al grupo de exposición un ayuno de dos horas para alimentos de fácil digestión; no hubo cega­miento, se realizó cálculo de muestra, y se hizo análisis univariado, bivariado y modelo de regresión logística con la variable satisfacción. Resultados: en el grupo de ayuno de seis horas el 2.6% presentó náuseas y en el grupo de exposición el 1.3%; se observó un caso de vómito. La presión arterial y glucometría mostraron diferencias estadísticas sin relevancia clínica. Se encontró significancia esta­dística para mareo, cefalea, hambre, sed y tipo de ayuno respecto con la satisfacción del paciente. Los pacientes con ayuno tuvieron un puntaje de satisfacción entre 60 y 100 y los de dieta ligera entre 82.5 y 100 puntos. Conclusiones: El ayuno de dos horas en dieta ligera mejora la satisfacción de los pa­cientes, disminuye la sensación de hambre, sed, presencia de cefalea y mareo, compa­rado con un ayuno de seis horas. Este estudio no encontró diferencias en las variables hemodinámicas ni en la frecuencia de náuseas y vómito.

Objective: to determine the effect of two types of fasting on parameters of satisfaction, nausea, vomiting, blood pressure and glucose measurement in patients undergoing percutaneous intervention procedures under local anesthesia in a hemodynamic service in Medellín, 2019. Methodology: Two-arm open-label randomized clinical trial in patients undergoing percutaneous interventional procedures under local anesthesia for three months, each arm with 153 participants, who were assigned a six-hour fast and the exposure group a two-hour fast for easily digestible foods. There was no blinding, sample calculation was performed, and univariate and bivariate analysis and logistic regression model were performed with the satisfaction variable. Results: in the six-hour fasting group, 2.6% presented nausea and in the exposure group, 1.3%; one case of vomiting was observed. Blood pressure and blood glucose showed statistical differences without clinical relevance. Statistical significance was found for dizziness, headache, hunger, thirst, and type of fasting with respect to patient satisfaction. Fasting patients had a satisfaction score between 60 and 100 and those on a light diet between 82.5 and 100 points. Conclusions: Fasting for two hours on a light diet improves patient satisfaction, decreases the sensation of hunger, thirst, headache and dizziness, compared to a six-hour fast. This study found no differences in the hemodynamic variables, nor in the frequency of nausea and vomiting.

Objetivo: determinaro efeito de dois tipos de jejum nos parâmetros de satisfação, náuseas, vômitos, pressão arterial e glicemia em pacientes submetidos a procedimentos de intervenção percutânea sob anestesia local em um serviço de hemodinâmica em Medellín, 2019. Metodologia: Ensaio clínico randomizado aberto de dois braços em pacientes submetidos a procedimentos intervencionistas percutâneos sob anestesia local por três meses. Cada braço com 153 participantes; um jejum de seis horas foi designado e o grupo de desafio um jejum de duas horas para alimentos facilmente digeríveis; não houve cegamento, foi realizado cálculo amostral, análise univariada, bivariada e modelo de regressão logística com a variável satisfação. Resultados: no grupo de jejum de seis horas, 2,6% apresentaram náuseas e no grupo de exposição, 1,3%; foi observado um caso de vômito. A pressão arterial e a glicemia apresentaram diferenças estatísticas sem relevância clínica. Foi encontrada significância estatística para tontura, dor de cabeça, fome, sede e tipo de jejum em relação à satisfação do paciente. Os pacientes em jejum tiveram um escore de satisfação entre 60 e 100 e os em dieta light entre 82,5 e 100 pontos. Conclusões: O jejum de duas horas com dieta leve melhora a satisfação do paciente, diminui a sensação de fome, sede, dor de cabeça e tontura, em comparação com o jejum de seis horas. Este estudo não encontrou diferenças nas variáveis hemodinâmicas ou na frequência de náuseas e vômitos.

Complicaciones de la técnica anestésica mandibular Spix en la clínica odontológica de la Universidad Andrés Bello / Incidence of complications of mandibular anesthetic Spix techniques in the Andrés Bello University dental clinic

Objetivo: Determinar la incidencia de complicaciones de la técnica anestésica Spix en procedimientos odontológicos a pacientes atendidos en la clínica de la Universidad Andrés Bello (UNAB). Material y Métodos: Se analizó a 37 pacientes que fueron atendidos por alumnos de cuarto y quinto año de la clínica odontológica, a los cuales se le realizó la técnica anestésica Spix para realizar el procedimiento odontológico. Se consignó mediante la observación la presencia de formación de hematomas intraorales en el sitio de punción, rotura de la aguja, cantidad de tubos de solución anestésica inyectados, presencia de dolor a la inyección de solución anestésico y la presencia o no de parálisis facial. Mediante la recolección de datos y posterior encuesta a los participantes se consignó la presencia de trismus al día siguiente de la atención y parestesia persistente al día siguiente de la atención. Resultados: De 37 pacientes estudiados que recibieron la técnica anestésica Spix, 6 presentaron hematoma intraoral (16,2%), ninguno reportó rotura de la aguja, 1 presentó parálisis facial (2,7%), 1 presentó parestesia persistente al día siguiente (2,7%), 12 presentaron trismus posterior a la inyección (32,4%). El rango de dolor reportado fue entre 1 y 4 según la escala EVA. Conclusión: Hay una baja incidencia de las complicaciones asociadas a la técnica anestésica Spix en la clínica odontológica de la UNAB, siendo el trismus la complicación más frecuente. Se necesita un mayor número de muestra para entender mejor esta realidad.

Objective: To determine the incidence of complications of the Spix anesthetic technique in the dental procedures of patients attended at the Andrés Bello University dental clinic. Material and Methods: 37 patients who were cared for by fourth- and fifth-year students from the dental clinic of the Andrés Bello University were analyzed, who underwent the Spix anesthetic technique to perform the dental procedure. The presence of intraoral hematoma formation at the puncture site, needle breakage, number of injected anesthesia tubes, presence of pain upon injection of anesthetic and the presence or not of facial paralysis were recorded. Through data collection and subsequent survey of the participants, the presence of trismus was recorded the day after care. Results. Of the 37 cases of patients studied who received the Spix anesthetic technique, 6 had intraoral hematoma (16.2%), no needle break was reported, 1 had facial paralysis (2.7%), 1 had persistent paresthesia at the next day (2.7%), 12 presented trismus after the injection (32.4%), the pain range was between 1 and 4 according to the VAS scale. Conclusion. There is a low incidence of complications associated with the Spix anesthetic technique in the Andrés Bello University dental clinic, trismus being the most frequent (32.4%). A larger sample number should be needed to better understand this reality.

Técnica de WALANT en cirugías ambulatorias de mano en pacientes post COVID-19 / Walant technique in outpatient hand surgeries in post COVID-19 patients

El objetivo de esta investigación es evaluar la utilidad de la Técnica de WALANT en cirugías ambulatorias de mano en pacientes post Covid-19 en el Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Estado Zulia, durante el periodo de julio del 2020 a octubre del 2021. Se realizó un estudio pre-experimental, longitudinal y prospectivo. El muestreo fue probabilístico al azar simple. Se aplicó un análisis estadístico de tipo descriptivo. Se incluyeron 50 pacientes con edad promedio de 37,02+/- 14,1(18-64) años, 52% de sexo femenino y 48% masculino. De ocupación 46% comerciante y obrero. Ama de casa y oficinista 44%, otros 10%. Con diagnóstico de dedo en gatillo 20%, síndrome del túnel carpiano 24%. Con la técnica se realizaron procedimientos quirúrgicos tipo neuroadhesiolisis del nervio mediano 24%, exéresis 22%. Tiempo quirúrgico de 5 a 10 minutos de duración en 56,9% de los casos. Se encontró punta de EVA: preoperatorio 56% de 7-10 ptos, Intraoperatorio 64% 0 ptos y postoperatorio 66% 0 ptos. Analgesia de rescate 92%. 88% sin complicaciones. La estancia Hospitalaria en 92% de los casos fue 1 hora. Reintegro a sus actividades 90%. Tiempo de reintegro en 46% de los casos de 1-5 días. 86% de los pacientes se sintieron satisfechos. En conclusión, la Técnica de WALANT en pacientes post Covid-19 es de gran utilidad para la realización de cirugías ambulatorias de bajo riesgo de mano, presentó pocas complicaciones, el tiempo quirurgo fue corto, el reintegro a sus actividades fue rápido y la satisfacción del paciente fue buena(AU)

The objective of this study is to evaluate the usefulness of the WALANT Technique in ambulatory hand surgeries in post- Covid-19 patients at the Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Estado Zulia, during the period from July 2020 to October 2021. A pre-experimental, longitudinal and prospective study was made. Sampling was simple random probabilistic. A descriptive statistical analysis was applied. 50 patients were included with an average age of 37,02+/-14,1(18-64) years, 52,0% female and 48,0% male. Occupation 46,0% merchant and worker. Housewife and office 44,0%, others 10,0%. With a diagnosis of trigger finger 20,0%, carpal tunnel syndrome 24,0%. With the technique, 24,0% median nerve neuroadhesiolysistype surgical procedures were performed, 22,0% exeresis. Surgical time from 5 to 10 minutes in 56,9% of cases. A VAS tip was found: preoperative 56,0% 7-10 points, intraoperative 64,0% 0 points and postoperative 66,0% 0 points. Rescue analgesia 92,0%. 88,0% without complications. Hospital stay in 92,0% of cases was 1 hour. Refund to their activities 90,0%. Refund time in 46,0% of cases from 1-5 days. 86,0% of the patients felt satisfied. In conclusion, the WALANT Technique in post-COVID-19 patients is very useful for performing low-risk outpatient hand surgeries, it presented few complications, the surgical time was short, the return to their activities was fast and the satisfaction of the patient. patient was good(AU)

Comparación en técnica anestésica de bloqueo del nervio alveolar inferior en estudiantes de Odontología de diferente año académico / Comparison in technique to the inferior alveolar nerve in dental students from different academic years

Introducción: Se comparó la técnica anestésica con el nervio alveolar inferior (NAI) realizada por estudiantes de cuarto y quinto año de la carrera de Odontología de la Universidad Andrés Bello, Santiago. El objetivo: Fue evaluar la ejecución y éxito de la técnica previo a una extracción dental simple. Metodología: Los estudiantes fueron invitados a participar y firmaron un consentimiento. Se realizó una encuesta que contenía un protocolo informativo para el alumno con los pasos por seguir, luego, al finalizar su atención clínica debía responder una serie de preguntas de selección múltiple. Mediante esta encuesta se evaluó cuántos estudiantes pudieron lograr un correcto bloqueo del nervio alveolar inferior con solo 1 tubo de anestesia lidocaína al 2% y cuántos de estos requirieron de anestesia adicional después de haber inyectado el primer tubo de anestesia, antes de iniciar el procedimiento quirúrgico. También se cuantificó la cantidad de tubos de anestesia que usaron los alumnos para realizar la exodoncia de forma indolora y cuántos requirieron de un refuerzo anestésico adicional durante el intraoperatorio. Así se pudo realizar un análisis comparativo entre ambas generaciones de alumnos en relación con el empleo de la técnica anestésica. Resultados: De los 104 encuestados se obtuvo que un 57% de los estudiantes de 4º y un 65% de los de 5º año, lograron una correcta técnica anestésica al NAI con 1 solo tubo de anestesia. Conclusión: No existieron diferencias significativas con respecto al año académico y las variables estudiadas, exceptuando la necesidad de un refuerzo anestésico posterior a la comprobación de una técnica anestésica exitosa, donde los alumnos de 4to año necesitaron efectuar un mayor control del dolor intraoperatorio.

Introduction: The anesthetic technique to the inferior alveolar nerve (NAI) was compared between the performance by fourthand fifth-year students of the Dentistry career at the Andrés Bello University, Santiago. Objective: Was to evaluate the performance and success of the technique before a simple dental extraction. Methods: The students invited to participate signed an informed consent. A survey was conducted that contained an informative protocol for the student with the steps to follow, then, at the end of their clinical care, had to answer a series of multiple-choice questions. Through this survey, it was evaluated how many students could achieve a correct inferior alveolar nerve block with only 1 tube of anesthesia lidocaine 2% and how many required additional anesthesia after having injected the first tube of anesthesia, before starting the surgical procedure. Also, the amount of anesthesia tubes that the students used to perform the extraction in a painless way was quantified and how many required an additional anesthetic reinforcement intraoperatively. Thereby, a comparative analysis between both generations of students was carried out in relation to the use of the anesthetic technique. Results: Of the 104 participants, it was found that 57% of the 4th year students and 65% of the 5th year students achieved a correct anesthetic technique at the NAI with a single tube of anesthesia. Conclusion: There were no significant differences in relation to the academic year completed and the variables studied except for the need for anesthetic reinforcement after a successful anesthetic technique, where 4th year students needed to perform more intraoperative pain control.

WALANT Technique in Percutaneous Scaphoid Osteosynthesis / WALANT na osteossíntese percutânea do escafoide

Abstract Scaphoid fractures account for 50 to 70% of all carpal bone fractures. Percutaneous scaphoid osteosynthesis can use the dorsal or volar approach, both with good results, and is most commonly performed under general anesthesia or regional nerve block. The wide-awake local anesthesia no tourniquet (WALANT) technique is already considered a safe and cost-effective technique in hand surgery around the world. Local anesthesia with epinephrine causes vasoconstriction, which obviates the need for tourniquet and, consequently, the need to use patient sedation. Thus, the possibility of testing fixation stability under physiological forces is another great advantage of using local anesthesia. In the technique described in the present paper, active wrist and hand motion can be tested immediately after scaphoid fixation. Wide-awake local anesthesia no tourniquet has been increasingly used in soft-tissue hand surgery and in the fixation of metacarpal and phalangeal fractures. However, to date, there is no published literature addressing the use of this technique in percutaneous scaphoid osteosynthesis. The purpose of the present technical note is to describe the use of WALANT for both the dorsal and volar approaches in percutaneous scaphoid osteosynthesis.

Resumo As fraturas do escafoide representam entre 50 e 70% de todas as fraturas dos ossos do carpo. A osteossíntese percutânea do escafoide pode usar a abordagem dorsal ou volar, ambas com bons resultados. É mais comumente realizada sob anestesia geral ou bloqueio nervoso regional. A técnica de anestesia local com o paciente totalmente acordado e sem torniquete (WALANT, na sigla em inglês) já é considerada uma técnica segura e eficaz na cirurgia da mão. A anestesia local com epinefrina causa vasoconstrição, o que evita o uso de torniquete e, consequentemente, a necessidade de sedação do paciente. Assim, a possibilidade de testar a estabilidade da fixação sob forças fisiológicas é outra grande vantagem do uso da anestesia local. Na técnica descrita aqui, o movimento ativo do punho e da mão pode ser testado imediatamente após a fixação escafoide. A técnica WALANT tem sido cada vez mais utilizada na cirurgia da mão em partes moles e na fixação de fraturas de metacarpo e falanges. No entanto, até o momento, não há literatura publicada abordando o uso dessa técnica na osteossíntese percutânea do escafoide. O objetivo desta nota técnica é descrever o uso de WALANT tanto para a abordagem dorsal quanto volar na osteossíntese percutânea do escafoide.

Corporoplasty under local anesthesia: Cost-effective improvement of the surgical treatment of Peyronie's disease / Corporoplastia bajo anestesia local: mejora del coste-efectividad del tratamiento quirúrgico de la enfermedad de Peyronie

Introduction and objectives: Peyronie's disease produces penile curvature that leads, in certain cases, to difficulties in having satisfactory sexual relations. The objective of this study is to evaluate the functional and cost-effectiveness results obtained in the surgical treatment of penile curvature due to Peyronie's disease under local anesthesia, comparing them with those performed under a general–spinal anesthesia regimen. Material and methods: Two groups of patients undergoing corporoplasty are compared according to the type of anesthesia used. Group 1 consists of 32 patients who underwent major outpatient surgery and under local anesthesia from June 2016 to June 2019. Their data are collected prospectively. Group 2 consists of 30 patients who underwent surgery under general/spinal anesthesia with hospital admission, from January 2013 to December 2015, with their data collected retrospectively. Anesthetic and surgical procedure, postoperative functional results, degree of satisfaction and hospital costs between both groups are analyzed, considering p≤0.05 as statistical significance and analyzing the results with the SPSS 20.0 program. Results: Of the 32 patients included in group 1, none required admission for intra or postoperative complications. In both groups, an improvement of the PDQ-test was observed without statistically significant differences, with the degree of global satisfaction above 95% in both groups. There were also no differences in the appearance of complications secondary to the anesthetic procedure or the hospital regime. We observed differences in hospital costs, being 44% lower for the group performed with local anesthesia. (AU)

Introducción y objetivos: La enfermedad de Peyronie produce una curvatura del pene que conduce, en ciertos casos, a dificultades para tener relaciones sexuales satisfactorias. El objetivo de este estudio es evaluar los resultados funcionales y de coste-efectividad obtenidos en el tratamiento quirúrgico de la curvatura peneana por enfermedad de Peyronie bajo anestesia local, comparándolos con los conseguidos bajo un régimen de anestesia general-raquídea. Material y métodos: Se comparan 2 grupos de pacientes sometidos a corporoplastia según el tipo de anestesia utilizada. El grupo 1 está formado por 32 pacientes que se sometieron a cirugía mayor ambulatoria y bajo anestesia local desde junio de 2016 a junio de 2019. Sus datos se recogen de forma prospectiva. El grupo 2 está formado por 30 pacientes intervenidos bajo anestesia general/raquídea con ingreso hospitalario, desde enero de 2013 hasta diciembre de 2015, con sus datos recogidos de forma retrospectiva. Se analiza el procedimiento anestésico y quirúrgico, los resultados funcionales postoperatorios, el grado de satisfacción y los costos hospitalarios entre ambos grupos, considerando p≤0,05 como significación estadística y analizando los resultados con el programa SPSS® 20.0. Resultados: De los 32 pacientes incluidos en el grupo 1, ninguno requirió ingreso por complicaciones intra o postoperatorias. En ambos grupos se observó una mejora en el test PDQ sin diferencias estadísticamente significativas, con un grado de satisfacción global superior al 95% en ambos grupos. Tampoco hubo diferencias en la aparición de complicaciones secundarias al procedimiento anestésico o al régimen hospitalario. Observamos diferencias en los costos hospitalarios, siendo un 44% menor para el grupo en el que se utilizó anestesia local. (AU)

Lingual supplementation may not be required after articaine buccal infiltration anesthesia for lower molar extraction: a clinical comparative study / La suplementación lingual opcional después de la anestesia por infiltración bucal con articaína para la extracción de molares inferiores: un estudio clínico comparativo

Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth. Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant. Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.

Objetivo: Investigar la efectividad anestésica de la infiltración bucal (BI) versus la infiltración bucal más lingual (BI+LI) de articaína al 4% para la extracción intraalveolar de molares mandibulares erupcionados. Material y Métodos: Ochenta pacientes fueron incluidos en este estudio clínico prospectivo. Se dividieron aleatoriamente en 1 de 2 grupos iguales: el primer grupo recibió BI de articaína al 4% 1,8 ml y LI de 0,5 ml, mientras que el segundo grupo recibió articaína al 4% 1,8 ml BI más 0,5 ml LI de solución salina normal. Se administró otro BI de articaína de 1,8 ml si la anestesia inicial era inadecuada. Las variables de resultado incluyeron el dolor, que los pacientes calificaron en 3 intervalos mediante una escala analógica visual, y la anestesia lingual y la satisfacción de los pacientes, que se midieron mediante una escala de calificación verbal de 5 puntos. Los análisis de datos utilizados fueron estadística descriptiva, prueba t, prueba χ2 y coeficiente de correlación de Pearson. Se consideró significativo el valor del valor de pinferior a 0,05. Resultados: Hubo 46 mujeres y 34 hombres y la edad media fue de 35,3 años. Todas las variables de resultado fueron comparables entre los dos grupos de estudio (p=0,05). La anestesia fue exitosa en el 78% y 88% de los casos en los grupos (BI) y (BI+LI) respectivamente sin diferencia significativa (p=0,2392). El volumen medio de articaína utilizado fue de 2,5 ml y 2,87 ml respectivamente sin diferencia significativa (p=0,090). Conclusión: La eficacia anestésica de (BI) solo y (BI+LI) de articaína al 4% fue comparable. Cuando se administra en una dosis adecuada, la articaína (BI) sola podría estar justificada para la extracción intraalveolar de molares mandibulares.

Corporoplasty under local anesthesia: Cost-effective improvement of the surgical treatment of Peyronie's disease.

INTRODUCTION AND OBJECTIVES: Peyronie's disease produces penile curvature that leads, in certain cases, to difficulties in having satisfactory sexual relations. The objective of this study is to evaluate the functional and cost-effectiveness results obtained in the surgical treatment of penile curvature due to Peyronie's disease under local anesthesia, comparing them with those performed under a general-spinal anesthesia regimen. MATERIAL AND METHODS: Two groups of patients undergoing corporoplasty are compared according to the type of anesthesia used. Group 1 consists of 32 patients who underwent major outpatient surgery and under local anesthesia from June 2016 to June 2019. Their data are collected prospectively. Group 2 consists of 30 patients who underwent surgery under general/spinal anesthesia with hospital admission, from January 2013 to December 2015, with their data collected retrospectively. Anesthetic and surgical procedure, postoperative functional results, degree of satisfaction and hospital costs between both groups are analyzed, considering p≤0.05 as statistical significance and analyzing the results with the SPSS 20.0 program. RESULTS: Of the 32 patients included in group 1, none required admission for intra or postoperative complications. In both groups, an improvement of the PDQ-test was observed without statistically significant differences, with the degree of global satisfaction above 95% in both groups. There were also no differences in the appearance of complications secondary to the anesthetic procedure or the hospital regime. We observed differences in hospital costs, being 44% lower for the group performed with local anesthesia. CONCLUSIONS: Surgical treatment of penile curvature under local anesthesia improves the cost-effectiveness ratio with the same quality of care, degree of satisfaction and postoperative functional results, maintaining a similar rate of intra/postoperative complications. For this reason, we consider that corporoplasty can be successfully performed under local anesthesia.

Effects of different forms of practicing a sport on athletes' nerve function / Efeitos de diferentes modos de prática de um esporte no desempenho neural de atletas / Efectos de diferentes modos de práctica de un deporte en el desempeño neural de atletas

ABSTRACT Introduction: Poor reaction time can cause irritability, easier distractions, and interfere with normal activities that require concentration. Objective: To study the impact of simulated hypoxic training on the immune system of female middle- and long-distance runners. Methods: Observation of 50 female middle- and long-distance runners living high and training low (HiHiLo) in regard to changes in CD3+, CD4+, CD8+, NK cells and NKT cells during the process of living low and training high (LoHi). Research indicates: HiHiLo training does have a significant effect on these indicators to enhance the antioxidant capacity of the brain and nervous system. Results: Living high and training low (HiHiLo) can improve the excitability of the nervous system of long-distance endurance athletes and has a very significant impact on the stability of the nervous system. This improves cardiopulmonary function under hypoxic conditions and has a role in promoting the ability to mobilize the skeletal muscles. Conclusions: It has been proved that different forms of exercise can effectively improve the athlete's nervous response. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Um tempo de reação precário pode levar a irritabilidade, falta de concentração, e interferir em atividades diárias que exigem raciocínio. Objetivo: Estudar o impacto de treinamento hipóxico simulado no sistema imune de corredoras de média e longa distância. Métodos: Observação de 50 corredoras de média e longa distância que vivem em elevadas altitudes e treinam em baixas altitudes (HiHiLo) quanto a mudanças em CD3+, CD4+, CD8+, células NK e NKT, durante o processo de viver em regiões de baixa altitude e treinar em regiões de alta atitude (LoHi). A pesquisa indica que o treino HiHiLo tem um efeito significativo nesses indicadores no que diz respeito ao aumento da capacidade antioxidante do cérebro e do sistema nervoso. Resultados: O treino HiHiLo pode aumentar a excitação do sistema nervoso de atletas de resistência e longa distância, e tem um impacto muito significativo na estabilidade do sistema nervoso. Isso traz melhorias à função cardiopulmonar em condições de hipóxia e age de modo a promover a habilidade de movimentar os músculos esqueléticos. Conclusões: Foi provado que diferentes tipos de exercício podem efetivamente aprimorar a resposta nervosa de atletas. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: Un tiempo de reacción precario puede causar irritabilidad, falta de concentración e interferir en actividades diarias que exigen raciocinio. Objetivo: Estudiar el impacto de entrenamiento hipóxico simulado en el sistema inmune de corredores de media y larga distancia. Métodos: Observación de 50 corredores de media y larga distancia que viven en altitudes elevadas y entrenan en altitudes bajas (HiHiLo) en relación con los cambios en las células CD3+, CD4+, CD8+, NK y NKT durante el proceso de vivir en regiones de baja altitud y entrenar en regiones de alta actitud (LoHi). La investigación indica que el entrenamiento HiHiLo tiene un efecto significativo sobre estos indicadores en lo que respecta al aumento de la capacidad antioxidante del cerebro y del sistema nervioso. Resultados: El entrenamiento HiHiLo puede aumentar la excitación del sistema nervioso de atletas de resistencia y larga distancia y tiene un impacto significativo en la estabilidad del sistema nervioso. Esto aporta mejorías en la función cardiopulmonar en condiciones de hipoxia y actúa favoreciendo en la capacidad de movimiento de los músculos esqueléticos. Conclusiones: Fue probado que diferentes tipos de ejercicio pueden efectivamente mejorar la respuesta nerviosa de atletas. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

El auge y la caída del mito de la epinefrina en la mano / The Rise and Fall of the Epinephrine Myth in the Hand

La posibilidad de operar a los pacientes con afecciones de la mano bajo anestesia local con la lidocaína y la epinefrina usando la técnica WALANT provocó una revolución en la cirugía de la mano, que facilitó la vida de los pacientes y disminuyó los costos de los servicios hospitalarios. Es necesario que los cirujanos conozcan la técnica y la historia de esta técnica. El objetivo fue identificar los orígenes del auge y la caída del mito y del dogma de la prohibición de la adrenalina en los bloqueos anestésicos de los dedos. Se realizó un análisis crítico de los principales textos de los artículos y los libros sobre el uso de la epinefrina en la anestesia de los dedos. La creación del mito de prohibir el uso de la epinefrina en los bloqueos anestésicos de los dedos se produjo debido a la mala interpretación de los informes de los casos de necrosis ocurridos que, en realidad, no fueron causados por la epinefrina. Ese mito influyó en la aparición de un dogma. La historia del uso de la epinefrina en los bloqueos de los dedos anestésicos demuestra que las interpretaciones superficiales y erróneas de las complicaciones clínicas publicadas como informes de casos pueden generar mitos y dogmas. Solo la ciencia puede prevenir y destruir tales mitos y dogmas médicos(AU)

The possibility of operating patients with hand conditions under local anesthesia, with lidocaine and epinephrine, using WALANT technique caused a revolution in hand surgery, which made life easier for patients and lowered the costs of hospital services. Surgeons need to be aware of the possibilities and history of WALANT technique. The objective was to identify the origins of the rise and fall of the myth and dogma of the prohibition of adrenaline in anesthetic finger blocks. A critical analysis of the main texts of the articles and books on the use of epinephrine in finger anesthesia was carried out. The conception of the myth of banning the use of epinephrine in anesthetic finger blocks occurred due to misinterpretation of reports of necrosis occurring, which were not actually caused by epinephrine. That myth influenced the appearance of a dogma. The history of the use of epinephrine in anesthetic finger blocks demonstrates that superficial and misleading interpretations of clinical complications published as case reports can breed myth and dogma. Only science can prevent and destroy such medical myths and dogmas(AU)

Evaluation of pain and opioid consumption in local preemptive anesthesia and the erector spine plane block in thoracoscopic surgery: A randomized clinical trial / Avaliação da dor e consumo de opioides em anestesia preemptiva local e do plano eretor da espinha em cirurgia torácica videotoracoscópica: Um ensaio clínico randomizado

ABSTRACT Objective: assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. Methods: ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. Results: the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. Conclusion: local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.

RESUMO Objetivo: avaliar a dor e o consumo de opioides dos pacientes submetidos a técnicas anestésicas de bloqueio do plano eretor da espinha (ESPB) e bloqueio anestésico local (LBA) em cirurgia torácica vídeo assistida no período pós-operatório imediato (POI). Métodos: noventa e dois pacientes submetidos a cirurgia torácica videotoracoscópica foram randomizados aleatoriamente para receberem ESPB ou LBA antes do início do procedimento cirúrgico. O desfecho primário avaliado foi a dor do paciente no POI através da escala verbal numérica. O desfecho secundário avaliou o consumo de opioides através da quantificação da medicação usada em dose equianalgésica de morfina expressa em miligramas, no período de recuperação pós-anestésica imediata, 6h, 12h e 24h após a cirurgia. Resultados: os escores da Escala Verbal Numérica de dor (EVN) no grupo LBA e ESPB no POI, respectivamente, tiveram média de 0,8 (±1,89) vs 0,58 (±2,02) na sala de recuperação pós anestesia (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) em 6 horas do POI, 0,84 (±1,74) vs 1,19 (±2,01) em 12 horas do POI e 0,95 (±1,88) vs 1 ( ±1,66) em 24 horas do POI, todos com p>0,05. O consumo médio de opioides no grupo LBA e ESPB foi de 12,9 (±10,4) mg vs 14,9 (±10.2) mg, respectivamente, com p=0.416. Dezesseis participantes do grupo ESPB e dezessete do grupo LBA não utilizaram opioides durante as primeiras 24 horas do PO. Conclusões: as técnicas de bloqueio LBA e ESPB apresentaram resultados semelhantes em termos de baixos escores de dor e consumo de opioides durante o período avaliado.

Disminución de la agudeza visual tras un procedimiento odontológico: A propósito de un caso / Unilateral visual impairment after a dental procedure: Case report

El uso de anestésicos locales para la realización de procedimientos odontológicos es una práctica ampliamente extendida que puede causar efectos adversos. Sin embargo, muy infrecuentemente puede causar complicaciones oculares como diplopía, ptosis, visión borrosa, miosis, disminución de la agudeza visual o amaurosis. Presentamos un caso de un paciente varón de 26 años que se presentó a la consulta por una disminución de la agudeza visual en su ojo derecho 48h después de una intervención odontológica del lado ipsilateral, logrando una recuperación de la misma en los 6 meses posteriores, sin tratamiento alguno. Diferentes teorías que justifiquen la aparición de complicaciones oculares como consecuencia de esta clase de procedimientos han sido propuestas en la literatura. En nuestro caso, una inyección intravenosa inadvertida habría sido la causa posible del hecho (AU)

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause (AU)

Comparison of two volumes for sciatic perineural injection using 1% methylene blue in rabbit cadavers / [Comparação de dois volumes para injeção perineural no nervo isquiático utilizando azul de metileno 1% em cadáveres de coelhos]

The purpose of this study was to assess the efficacy of a blind technique for sciatic and femoral nerve block in rabbit cadavers by evaluating the spread of 1% methylene blue at two different volumes. Nine recently euthanized rabbits weighing 2.5(0.3kg were used. The sciatic (SN) and femoral (FN) nerves of each limb were randomly assigned for injection with 1% methylene blue at 0.2mL/kg (G0.2) or 0.3mL/kg (G0.3). Nerves were dissected and measured for depth and extension of staining (cm). Mean comparisons were performed using paired t test. The relation between volume and nerve staining ( 2cm was assessed using chi-square test. The mean depth of SN was 1.9±0.2 and 1.6±0.3cm and staining 1.9±1.4 and 2.0±1.2cm, respectively in G0.2 and G0.3. No relation was found between depth and dye spread and there was no association between nerve staining ( 2.0cm and volume of solution. The FN failed to be stained in all subjects. In conclusion, SN injection can be successfully performed without guidance in rabbits. The lower volume (0.2mL/kg) is recommended to avoid systemic toxicity.(AU)

O objetivo deste estudo foi avaliar a eficácia de uma técnica para bloqueio às cegas dos nervos isquiático e femoral em cadáveres de coelhos, por meio da avaliação da dispersão de azul de metileno 1% em dois volumes distintos. Nove coelhos recém-eutanasiados, com peso 2,5(0,3kg, foram utilizados. Os nervos isquiático (NI) e femoral (NF) de cada membro foram aleatoriamente designados para injeção com azul de metileno 1% a 0,2mL/kg (G0,2) ou 0,3mL/kg (G0,3). Em seguida, foram dissecados e mensurados em relação à sua profundidade e extensão corada (cm). As médias foram comparadas por meio de teste t pareado. A relação entre volume e extensão corada ( 2cm foi avaliada utilizando-se teste de qui-quadrado. A profundidade média do NI foi 1,9±0,2 e 1,6±0,3cm, e a extensão corada 1,9±1,4 e 2,0±1,2cm, respectivamente, no G0,2 e no G0,3. Não houve relação entre a profundidade e a extensão corada ou entre a extensão corada ( 2,0cm e o volume de solução. Não foi observada coloração do NF em nenhum cadáver. Concluiu-se que a injeção do NI pode ser realizada com sucesso sem auxílio de tecnologias em coelhos. O menor volume (0,2mL/kg) é recomendado para evitar toxicidade sistêmica.(AU)