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1.
J Laryngol Otol ; 135(1): 80-82, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33478603

RESUMO

OBJECTIVE: A method is described for topical local anaesthesia of the tympanic membrane and ear canal using lidocaine and phenylephrine (Co-phenylcaine) spray and soaked micropatties. DISCUSSION: The advantages of this method are discussed in comparison to existing methods.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Meato Acústico Externo , Lidocaína/administração & dosagem , Fenilefrina/administração & dosagem , Aerossóis , Combinação de Medicamentos , Humanos
3.
J Am Acad Orthop Surg Glob Res Rev ; 4(12): e20.00100, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33332853

RESUMO

INTRODUCTION: Wide-awake local anesthesia no tourniquet (WALANT) presents a nonstandard anesthetic approach initially described for use in hand surgery that has gained interest and utilization across a variety of orthopaedic procedures. In response to operating room resource constraints imposed by the COVID-19 pandemic, our orthopaedic service rapidly adopted and expanded its use of WALANT. METHODS: A retrospective review of 16 consecutive cases performed by 7 surgeons was conducted. Patient demographics, surgical details, and perioperative outcomes were assessed. The primary end point was WALANT failure, defined as intraoperative conversion to general anesthesia. RESULTS: No instances of WALANT failure requiring conversion to general anesthesia occurred. In recovery, one patient (6%) required narcotics for pain control, and the average postoperative pain numeric rating scale was 0.6. The maximum pain score experienced was 4 in the patient requiring postoperative narcotics. The average time in recovery was 42 minutes and ranged from 8 to 118 minutes. CONCLUSION: The WALANT technique was safely and effectively used in 16 cases across multiple orthopaedic subspecialties, including three procedures not previously described in the literature. WALANT techniques hold promise for use in future disaster scenarios and should be evaluated for potential incorporation into routine orthopaedic surgical care.


Assuntos
Anestesia Local/métodos , Salas Cirúrgicas/organização & administração , Procedimentos Ortopédicos , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Hemostáticos/administração & dosagem , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Entorpecentes/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Pandemias , Estudos Retrospectivos , Vasoconstritores/administração & dosagem , Adulto Jovem
4.
Medicine (Baltimore) ; 99(46): e22540, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181643

RESUMO

BACKGROUND: Wound infiltration analgesia provides effective postoperative pain control in patients undergoing laparoscopic cholecystectomy (LC). However, the efficacy and safety of wound infiltration with different doses of ropivacaine is not well defined. This study investigated the analgesic effects and pharmacokinetic profile of varying concentrations of ropivacaine at port sites under laparoscopy assistance. METHODS: In this randomized, double-blinded study, 132 patients were assigned to 4 groups: Group H: in which patients were infiltrated with 0.75% ropivacaine; Group M: 0.5% ropivacaine; Group L: 0.2% ropivacaine; and Group C: 0.9% normal saline only. The primary outcome was pain intensity estimated using numeric rating scale (NRS) at discharging from PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration. Secondary outcomes included plasma concentrations of ropivacaine at 30 minutes after wound infiltration, rescue analgesia requirements after surgery, perioperative vital signs changes, and side effects. RESULTS: The NRS in Group C was significantly higher at rest, and when coughing upon leaving PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration (P < .05) and rescue analgesic consumption was significantly higher. Notably, these parameters were not significantly different between Groups H, Group M and Group L (P > .05). Intra-operative consumption of sevoflurane and remifentanil, HR at skin incision and MAP at skin incision, as well as 5 minutes after skin incision were significantly higher in Group C than in the other 3 groups (P < .01). In contrast, these parameters were not significantly different between Groups H, Group M and Group L (P > .05). The concentration of ropivacaine at 30 minutes after infiltration in Group H was significantly higher than that of Group L and Group M (P < .05). No significant differences were observed in the occurrence of side effects among the 4 groups (P > .05). CONCLUSIONS: Laparoscopy-assisted wound infiltration with ropivacaine successfully decreases pain intensity in patients undergoing LC regardless of the doses used. Infiltration with higher doses results in higher plasma concentrations, but below the systematic toxicity threshold.


Assuntos
Anestesia Local/normas , Manejo da Dor/normas , Ropivacaina/administração & dosagem , Adulto , Análise de Variância , Anestesia Local/métodos , Anestesia Local/estatística & dados numéricos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Distribuição de Qui-Quadrado , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Estudos Prospectivos , Ropivacaina/uso terapêutico
5.
Minerva Chir ; 75(5): 320-327, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33210528

RESUMO

BACKGROUND: During Coronavirus disease (COVID-19) pandemic entire countries rapidly ran out of intensive care beds, occupied by critically ill infected patients. Elective surgery was initially halted and acute non-deferrable surgical care drastically limited. The presence of COVID-19 patients into intensive care units (ICU) is currently decreasing but their congestion have restricted our therapeutic strategies during the last months. METHODS: In the COVID-19 era eighteen patients (8 men, 10 women) with a mean age of 80 years, needing undelayable abdominal surgery underwent awake open surgery at our Department. Prior to surgery, all patients underwent COVID-19 investigation. In all cases locoregional anesthesia (LA) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. RESULTS: Mean operative time was 104 minutes. In only one case conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. Only one perioperative complication occurred. Early readmissions after surgery were never observed. CONCLUSIONS: On the basis of our experience awake laparotomy under LA resulted feasible, safe, painless and, in specific cases, the only viable option. For patients presenting fragile cardiovascular and respiratory, reserves and in whom general anesthesia (GA) would presumably increase morbidity and mortality we encourage LA as an alternative to GA. In the COVID-19 era, it has become part of our ICU-preserving strategy allowing us to carry out undeferrable surgeries.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Idoso Fragilizado , Laparotomia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Anestesia Local/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Emergências/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/prevenção & controle , Pandemias , Pneumonia Viral/diagnóstico , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
6.
PLoS One ; 15(10): e0237783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017397

RESUMO

A systematic review and meta-analysis was conducted to explore the effect of a eutectic mixture of local anaesthetics (EMLA) on pain reduction during extracorporeal shockwave lithotripsy (ESWL). PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomised controlled trials (RCTs) assessing the effect of EMLA for patients that underwent ESWL. The search strategy and study selection process were managed according to the PRISMA statement. Six RCTs were included in the meta-analysis. Overall, the results indicated that EMLA significantly reduced pain compared to the control group (RR = -2.98, 95% CI = -5.82 to -0.13, P = 0.04) with a heterogeneity of I2 = 57% (P = 0.04). Subgroup analysis showed that EMLA did not significantly reduce pain when the patients took an analgesic premedication (RR = -1.46, 95% CI = -5.89 to 2.98, P = 0.52) with a heterogeneity of I2 = 38% (P = 0.52). Conversely, studies without premedication showed a significant pain relief effect (RR = -4.08, 95% CI = -7.36 to -0.65, P = -0.80) with a heterogeneity of I2 = 48% (P = 0.14). Most studies showed there was no difference in the patient's need for analgesics. EMLA was effective for reducing pain during EWSL. However, this analgesic effect was limited and did not reduce the need for analgesics.


Assuntos
Anestésicos Combinados/administração & dosagem , Anestésicos Locais/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Litotripsia/métodos , Manejo da Dor/métodos , Administração Cutânea , Analgesia/métodos , Anestesia Local/métodos , Humanos , Litotripsia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico
7.
J Perioper Pract ; 30(9): 277-282, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32869726

RESUMO

INTRODUCTION: COVID-19 has changed the approach to operating on breast cancer for the benefit of patients, staff and the general population. One approach involves the switch from operating under general to local anaesthetic. We assess whether diluational local anaesthetic is as effective as the current standard approach. METHODS: Postoperative pain was recorded in prospective, consecutive patients undergoing wide local excision under dilutional local anaesthetic (concentration < 1mg/ml). Pain scores were documented at 0, 30 and 60 minutes and compared to a control group consisting of combined general with local anaesthetic. RESULTS: Pain significantly increased in the control group during the postoperative recovery. This was not seen in the dilutional local anaesthetic group that was non-inferior to the standard approach at 0, 30 and 60 minutes. CONCLUSION: Dilutional local anaesthetic provides a safe and effective alternative approach to operating on breast cancer patients whilst avoiding risky general anaesthetic in a COVID-19 pandemic environment.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/uso terapêutico , Neoplasias da Mama/cirurgia , Infecções por Coronavirus , Dor Pós-Operatória/prevenção & controle , Pandemias , Pneumonia Viral , Estudos de Casos e Controles , Difusão , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
8.
Bone Joint J ; 102-B(10): 1354-1358, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993329

RESUMO

AIMS: In the UK, fasciectomy for Dupuytren's contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. METHODS: Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks. RESULTS: The mean preoperative contractures were 35.3° (0° to 90°) at the metacarpophalangeal joint (MCPJ), 32.5° (0° to 90°) at proximal interphalangeal joint (PIPJ) (a combined deformity of 67.8°). The mean correction was 33.6° (0° to 90°) for the MCPJ and 18.2° (0° to 70°) for the PIPJ leading to a combined correction of 51.8°. There was a complete deformity correction in 21 fingers (59.5%) and partial correction in 14 digits (37.8%) with no correction in one finger. The mean residual deformities for the partial/uncorrected group were MCP 4.2° (0° to 30°), and PIP 26.1° (0° to 85°). For those achieving a full correction the mean preoperative contracture was less particularly at the PIP joint (15.45° (0° to 60°) vs 55.33° (0° to 90°)). Mean preoperative URAM scores were higher in the fully corrected group (17.4 (4 to 31) vs 14.0 (0 to 28)), but lower at three months post-surgery (0.5 (0 to 3) vs 4.40 (0 to 18)), with both groups showing improvements. Infections occurred in two patients (three digits) and both were successfully treated with oral antibiotics. No other complications were noted. The estimated cost of a fasciectomy under local anaesthetic in the community was £184.82 per patient. The estimated hospital theatre costs for a fasciectomy was £1,146.62 under general anaesthetic (GA), and £1,085.30 under an axillary block. CONCLUSION: This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. Local anaesthetic fasciectomy in a community setting achieves a saving of £961.80 for a GA and £900.48 for an axillary block per case. Cite this article: Bone Joint J 2020;102-B(10):1354-1358.


Assuntos
Anestesia Local/economia , Anestesia Local/métodos , Contratura de Dupuytren/cirurgia , Fasciotomia/economia , Fasciotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Custos e Análise de Custo , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reino Unido
9.
J Am Acad Orthop Surg ; 28(15): e642-e650, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732655

RESUMO

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.


Assuntos
Procedimentos Ortopédicos/métodos , Dedo em Gatilho/cirurgia , Corticosteroides/administração & dosagem , Adulto , Anestesia Local/economia , Anestesia Local/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Redução de Custos , Mãos/cirurgia , Humanos , Imobilização/métodos , Injeções Intralesionais , Curva de Aprendizado , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/educação , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/terapia
10.
Rev Bras Anestesiol ; 70(2): 159-164, 2020.
Artigo em Português | MEDLINE | ID: mdl-32600800

RESUMO

Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the postoperative period and provides safety to pati ents and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.


Assuntos
Anestesia por Condução/métodos , Anestesia Local/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Anestesia por Condução/efeitos adversos , Anestesia Local/efeitos adversos , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão , Período Pós-Operatório
11.
Am J Emerg Med ; 38(9): 1984.e1-1984.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32505475

RESUMO

INTRODUCTION: Systemic reactions from local tetracaine use are often an anomaly - not only is tetracaine short-acting and quickly metabolized by the pseudocholinesterase system leading to very limited systemic uptake, but most adverse reactions are usually associated with dental or spinal anesthesia. Furthermore, reactions to local anesthetics manifest in standard allergy-type reactions. When local anesthetics lead to nervous or cardiac system abnormalities, it is termed a local anesthetic systemic toxicity - an event with an incidence currently estimated to be 0.03%. CASE PRESENTATION: We present a case of a 56-year-old female who experienced a systemic reaction to tetracaine 1% while undergoing a fine needle biopsy of a thyroid nodule. The patient had previous allergic reactions to lidocaine. Upon conclusion of the procedure, the patient began convulsing and became rigid and non-verbal. She was able to move all extremities, had no respiratory distress, no swelling, hives, or redness, and was swallowing without difficulty. After about 5 min, the patient began to improve and experienced reversal of all previous symptoms. Her physical exam and labs were otherwise normal, she returned to her baseline functioning, and was discharged without any medical interventions. DISCUSSION: This case illustrates a case of LAST in a patient with previous Lidocaine allergy without any other obvious risk factors. There have been no cases of cross-reaction between lidocaine and tetracaine so it explores the possibility of patients having cross reaction to those two different kinds of local anesthetic.


Assuntos
Anestésicos Locais/toxicidade , Convulsões/induzido quimicamente , Tetracaína/toxicidade , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Nódulo da Glândula Tireoide/patologia
12.
Acta Orthop Belg ; 86(1): 33-37, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32490771

RESUMO

To determine whether local infiltration analgesia by catheter infusion was superior to conventional analgesia in terms of postoperative pain control after THR. A randomized double-blind clinical trial was performed. There were four groups based on catheter placement and the infusion constituents : 1) Intraarticular catheter + anesthetics ; 2) Intraarticular catheter +placebo ; 3) Subfascial catheter + anesthetics ; 4) Subfascial catheter + placebo. The anesthetic infusion contained bupivacaine (bolus + continuous perfusion up to 36 hours). The placebo solution was physiological serum. The same conventional analgesic schedule was prescribed to all patients. Pain was evaluated by means of PCA shots and the VAS. Side effects, time to start rehabilitation and time to discharge were also analyzed. 100 patients (25 for group). Mean age was 67 years old (SD 12 y/o) and 53% were male. Mean PCA shots was 27 [range 2-87] and mean VAS was 1 [range 0-7]. No differences were found (p>0.05) when these variables were compared between the groups. The use of LIA with bupivacaine using a catheter infusion does not provide better pain control after THR.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril , Bupivacaína/administração & dosagem , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor
13.
Plast Reconstr Surg ; 146(1): 54e-60e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590653

RESUMO

BACKGROUND: The wide-awake local anesthesia no tourniquet (WALANT) technique in hand surgery is gaining popularity. The authors aimed to prospectively analyze the frequency and type of arrhythmias in patients undergoing hand surgery under local anesthesia and to examine whether the addition of adrenaline affects their incidence. METHODS: Adult patients undergoing hand surgery under local anesthesia were randomized into two groups: group 1, local anesthesia with lidocaine and tourniquet; and group 2, local anesthesia with lidocaine and adrenaline (WALANT). Patients with a history of arrhythmias were excluded. Patients were connected to Holter electrocardiographic monitoring before surgery and up until discharge. The records were blindly compared between the groups regarding types of arrhythmias, and frequency and timing relative to injection and tourniquet inflation. RESULTS: One hundred two patients were included between August of 2018 and August of 2019 (age, 59.7 ± 13.6 years; 71 percent women; 51 in each group). No major arrhythmia (ventricular tachycardia, ventricular fibrillation, atrial fibrillation) or arrhythmia-related symptoms were recorded for either group. Minor arrhythmias (including atrial premature beats, ventricular premature beats, and atrial tachycardia) were recorded in 68 patients (66.6 percent), with no statistical difference between the groups. There were three patients with minor arrhythmias during inflation of the tourniquet. Patients in the adrenaline group had 2 percent sinus tachycardia during injection and 4 percent asymptomatic bradyarrhythmias. These findings do not require any further treatment. CONCLUSIONS: The authors' results show that hand operations using WALANT technique in patients with no history of arrhythmia are safe and are not arrhythmogenic; therefore, there is no need for routine perioperative continuous electrocardiographic monitoring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Anestesia Local/métodos , Arritmias Cardíacas , Epinefrina/efeitos adversos , Mãos/cirurgia , Vasoconstritores/efeitos adversos , Adulto , Idoso , Anestesia Local/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Medicine (Baltimore) ; 99(22): e20640, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481477

RESUMO

BACKGROUND: Local infiltration analgesia (LIA) has become popular in postoperative pain relief after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The aim of this meta-analysis was to compare the efficacy and safety of LIA with intrathecal morphine and epidural analgesia after THA and TKA. METHODS: A systematic article search was performed from PubMed, Embase, and Web of Science databases, up to February 21, 2019. The main outcomes included visual analog scale for assessment of pain, morphine equivalent consumption, length of hospital stay, and adverse events. The data were calculated using weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (95% CIs). RESULTS: Eleven studies with a total of 707 patients met the inclusion criteria and were included in this meta-analysis. LIA provided better pain control than other 2 techniques at 24-hour (WMD = 10.61, 95% CI: 3.36-17.87; P = .004), 48-hour (WMD = 16.0, 95% CI: 8.87-23.13; P < .001), and 72-hour (WMD = 11.31, 95% CI: 3.78-18.83; P < .001). Moreover, LIA had similar morphine consumption and duration of hospital stay with intrathecal morphine and epidural analgesia. There was significantly lower incidence of adverse events with LIA than with the other 2 techniques. CONCLUSION: LIA provided better postoperative pain control and less adverse events than intrathecal morphine and epidural analgesia after THA and TKA.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Rev. Soc. Esp. Dolor ; 27(3): 221-226, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196769

RESUMO

INTRODUCCIÓN: La neuralgia occipital es una entidad con componentes bien definidos, pero ocasionalmente subdiagnosticada, que tiende a mantener un comportamiento insidioso y generar cierta resistencia al tratamiento médico, manteniendo una buena respuesta al manejo intervencionista con un mínimo índice de complicaciones asociadas y un alivio del dolor satisfactorio y prolongado. DESCRIPCIÓN DEL CASO: Presentamos 5 casos de pacientes con criterios definidos para neuralgia occipital por la (IHS), los cuales fueron manejados mediante descompresión suboccipital percutánea, evaluados por la escala numérica análoga y escala verbal análoga durante un periodo de 90 días. Los procedimientos se realizaron sin complicaciones ni eventos adversos. El resultado fue un alivio satisfactorio para el paciente del dolor crónico, con una adecuada especificidad del sitio del padecimiento, así como mejoría en la calidad de vida, el estado de ánimo, el consumo de medicamentos y la satisfacción de la paciente. CONCLUSIONES: Consideramos que el uso de la descompresión percutánea del nervio occipital mayor vía suboccipital puede ser tomada como una alternativa en pacientes con neuralgia occipital, con una alta probabilidad de obtener un beneficio analgésico y una baja probabilidad de presentar algún efecto adverso o complicación


INTRODUCTION: Occipital neuralgia is an entity with welldefined components, but occasionally underdiagnosed that tends to maintain insidious behavior and generate some resistance to medical treatment, maintaining a good response to interventional management with a minimum rate of associated complications and pain relief. Satisfactory and prolonged. CASE DESCRIPTION: We present 5 cases of patients with defined criteria for occipital neuralgia by (IHS) which were managed by suboccipital decompression, evaluated by the analog numerical scale and analogous verbal scale over a period of 90 days. The procedures were performed without complications or adverse events. The result was a satisfactory relief for the patient of chronic pain, with adequate specificity of the site of the condition; as well as improvement in the quality of life, mood, medication consumption and patient satisfaction. CONCLUSIONS: We consider that the use of decompression of the major occipital nerve via suboccipital route can be taken as an alternative in patients with occipital neuralgia, with a high probability of obtaining an analgesic benefit and a low probability of presenting some adverse effect or complication


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neuralgia/terapia , Descompressão/métodos , Bupivacaína/administração & dosagem , Midazolam/administração & dosagem , Fentanila/administração & dosagem , Síndrome Pós-Laminectomia/complicações , Nervos Cranianos , Manejo da Dor/métodos , Anestesia Local/métodos , Resultado do Tratamento
16.
World Neurosurg ; 139: 488-494, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376381

RESUMO

BACKGROUND: Thoracic spinal stenosis (TSS), a common vertebral degenerative disease, is generally treated via surgical decompression. Percutaneous endoscopic thoracic decompression (PETD) under local anesthesia is considered a relatively safe, minimally invasive procedure. Few reports detail the success of endoscopic decompression for treatment of TSS caused by ossification of ligamentum flavum, the most common cause of TSS. This study investigated application of PETD for treatment of TSS caused by ossification of ligamentum flavum, ossification of posterior longitudinal ligament, or thoracic disc herniation. METHODS: From January 2017 to January 2019, 12 consecutive patients (6 men and 6 women) underwent PETD. TSS was caused by ossification of ligamentum flavum in 5 patients, thoracic disc herniation in 5 patients, and ossification of posterior longitudinal ligament in 2 patients. All cases were followed up for 1 year postoperatively. Preoperative and postoperative neurologic status was evaluated using the modified Japanese Orthopaedic Association score, and complications were documented. RESULTS: Average modified Japanese Orthopaedic Association score improved significantly from 6.25 ± 1.60 preoperatively to 9.75 ± 1.21 at final follow-up. Dural tear was observed in 1 case during the intervention, and 1 case had transient worsening of preoperative paralysis. Recovery at final follow-up was classified as excellent in 5 cases, good in 6 cases, and poor in 1 case. CONCLUSIONS: This retrospective analysis showed that PETD under local anesthesia may be a feasible alternative to treat TSS in elderly patients with other underlying complications for whom general anesthesia or major surgical trauma would be harmful.


Assuntos
Anestesia Local/métodos , Descompressão Cirúrgica/métodos , Neuroendoscopia/métodos , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
17.
Eur Rev Med Pharmacol Sci ; 24(9): 5162-5166, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32432781

RESUMO

OBJECTIVE: Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency. PATIENTS AND METHODS: In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. RESULTS: None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed. CONCLUSIONS: Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity.


Assuntos
Anestesia Local/métodos , Infecções por Coronavirus , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparotomia , Pandemias , Pneumonia Viral , Vigília , Idoso de 80 Anos ou mais , Anestesia Epidural/métodos , Raquianestesia/métodos , Betacoronavirus , Feminino , Humanos , Masculino , Duração da Cirurgia , Dor Pós-Operatória/terapia , Dor Processual/terapia
18.
J Fam Pract ; 69(4): 172-178, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32437482

RESUMO

Expertise in the delivery of effective local analgesia is critical to the success of in-office procedures. Here's how to optimize patient outcomes and satisfaction.


Assuntos
Anestesia Local/métodos , Anestesia Local/normas , Anestésicos Locais/administração & dosagem , Anestésicos Locais/normas , Manejo da Dor/métodos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto , Humanos
19.
Am Fam Physician ; 101(11): 669-679, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32463641

RESUMO

Family physicians use anesthesia to provide diagnostic and procedural analgesia for conditions such as neuropathies, fracture reduction, foreign body removals, and complex wound management. Local infiltration of anesthetics is commonly used in this setting because of the ease of use, safety, and effectiveness of the procedure. Nerve blocks are a specific regional anesthesia technique that blocks nerve function distal to the injection site. An understanding of the sensory distribution of the peripheral nervous system is essential in determining the safest and most effective nerve block for the procedure. There are various nerve block techniques, including landmark-guided and ultrasound-guided. Ultrasound guidance increases the effectiveness of the nerve block while decreasing complications when compared with other techniques. Depending on the required area of anesthesia for the procedure, various points throughout the lower extremity can be used to block the lateral femoral cutaneous, common peroneal, saphenous, tibial, deep peroneal, superficial peroneal, and sural nerves.


Assuntos
Extremidade Inferior/lesões , Bloqueio Nervoso/métodos , Anestesia Local/métodos , Humanos , Extremidade Inferior/anatomia & histologia , Extremidade Inferior/fisiopatologia , Manejo da Dor/métodos , Ultrassonografia/métodos
20.
Nat Commun ; 11(1): 2323, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32385252

RESUMO

An on-demand anesthetic that would only take effect when needed and where the intensity of anesthesia could be easily adjustable according to patients' needs would be highly desirable. Here, we design and synthesize a macromolecular prodrug (P407-CM-T) in which the local anesthetic tetracaine (T) is attached to the polymer poloxamer 407 (P407) via a photo-cleavable coumarin linkage (CM). P407-CM-T solution is an injectable liquid at room temperature and gels near body temperature. The macromolecular prodrug has no anesthetic effect itself unless irradiated with a low-power blue light emitting diode (LED), resulting in local anesthesia. By adjusting the intensity and duration of irradiation, the anesthetic effect can be modulated. Local anesthesia can be repeatedly triggered.


Assuntos
Anestésicos Locais/química , Anestesia Local/métodos , Animais , Sistemas de Liberação de Medicamentos , Humanos , Estrutura Molecular , Poloxâmero/química , Pró-Fármacos/química , Temperatura
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