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1.
Int J Dermatol ; 58(8): 982-986, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31099425

RESUMO

On July 25, 2017, we conducted an extensive database tracking to identify all studies published from January 1990 to July 2017. Screening updates were performed until December 2017. RESULTS: There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. CONCLUSION: The mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.


Assuntos
Hiperidrose/terapia , Plexo Lombossacral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Soluções Esclerosantes/administração & dosagem , Simpatectomia/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , , Humanos , Hiperidrose/diagnóstico , Hiperidrose/psicologia , Plexo Lombossacral/efeitos dos fármacos , Masculino , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Soluções Esclerosantes/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Simpatectomia/efeitos adversos , Resultado do Tratamento
2.
Rev. esp. anestesiol. reanim ; 66(4): 213-221, abr. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187462

RESUMO

El dolor lumbar o lumbalgia es uno de los principales problemas de salud pública de la sociedad actual. De entre las múltiples causas de la misma las articulaciones zigoapofisarias, también denominadas facetas o articulaciones vertebrales posteriores, son una causa importante, generalmente secundaria a artrosis. El diagnóstico de la causa de la lumbalgia suele ser en muchas ocasiones difícil, haciendo que el enfoque terapéutico del paciente no sea el óptimo. Los bloqueos diagnósticos constituyen una herramienta de suma importancia para establecer un tratamiento adecuado del paciente con lumbalgia, siempre y cuando sean realizados de manera precisa, con un volumen adecuado de anestésico local, con una imagen y proyección fluoroscópica idónea y el resultado sea interpretado de manera exacta. En el siguiente artículo revisaremos la importancia de los bloqueos diagnósticos, así como el modo en que deben ser realizados, para obtener la máxima información de los mismos y el mayor beneficio terapéutico


Low back pain is currently one of the main public health problems. Among the multiple causes, pain in the zygapophysial joints, also called facets or posterior vertebral joints, are an important cause, usually secondary to osteoarthritis. The source of low back pain is often difficult to find, making the therapeutic approach to the patient sub-optimal. Diagnostic blocks are a very important tool in establishing an adequate treatment for patients with low back pain, as long as they are performed accurately, with an adequate local anaesthetic volume, with a suitable image and fluoroscopic projection and its result are precisely interpreted. In this article a review is presented on the importance of diagnostic blocks, as well as how they should be performed in order to obtain the maximum information and the greatest therapeutic benefit


Assuntos
Humanos , Bloqueio Nervoso/métodos , Artropatia Neurogênica/diagnóstico , Dor Lombar/diagnóstico , Articulação Zigapofisária/anatomia & histologia , Terapia por Radiofrequência/métodos , Medição da Dor/métodos , Manejo da Dor/métodos , Plexo Lombossacral/efeitos dos fármacos
5.
Rev Esp Anestesiol Reanim ; 65(10): 589-592, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30001858

RESUMO

Erector spinae plane block (ESPB) as postoperative analgesia method has been successfully carried out in several surgical interventions. Postoperative pain treatment for cesarean section is considered one of the important challenges for anesthesiologists due to the risk of chronic pain development and even pospartum depression. Regional anesthesia techniques were effectively used to prevent the pain together with multimodal analgesia regimes in cesarean section. Formerly, successful erector spinae plane block was documented as postoperative analgesia treatment for cesarean section; however, no motor weakness was recorded as a side effect. In this case report, we present an unexpected motor weakness as a side effect of the erector spinae plane block after cesarean delivery operation in a 29 year old patient. To our knowledge, this is the first report of motor weakness related to the ESPB.


Assuntos
Analgesia Obstétrica/efeitos adversos , Transtornos Neurológicos da Marcha/etiologia , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Músculos Paraespinais/efeitos dos fármacos , Adulto , Bupivacaína/efeitos adversos , Bupivacaína/farmacocinética , Cesárea/efeitos adversos , Difusão , Feminino , Humanos , Leiomioma/cirurgia , Lidocaína/efeitos adversos , Lidocaína/farmacocinética , Plexo Lombossacral/efeitos dos fármacos , Plexo Lombossacral/fisiopatologia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais/inervação , Músculos Paraespinais/fisiopatologia , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Ultrassonografia de Intervenção , Neoplasias Uterinas/cirurgia
7.
J Clin Anesth ; 49: 26-29, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29860224

RESUMO

STUDY OBJECTIVE: This randomized controlled single blinded clinical trial compared the fascia iliaca block (FIB) and the lumbar plexus block (LPB) in patients with moderate to severe pain following hip arthroscopic surgery. DESIGN: Single blinded randomized trial. SETTING: Postoperative recovery area, postoperative days 0 and 1. PATIENTS: Fifty patients undergoing hip arthroscopy were approached in the Post Anesthesia Care Unit (PACU) if they had moderate to severe pain (defined as > or equal 4/10 on the numeric rating scale). Twenty-five patients were allocated to the FIB and twenty-five patients to the LPB. INTERVENTIONS: Fascia iliaca block or lumbar plexus block. MEASUREMENTS: A blinded observer recorded pain scores just prior to the block, 15 min following the block (primary endpoint), and then every 15 min for 2 h (or until the patient was discharged). Total PACU time and opioid use were recorded. Pain scores and analgesic use on postoperative day (POD) 0, and POD 1 were recorded. At 24 h post block the Quality of Recovery 9 questionnaire was administered. RESULTS: The mean pre-block pain scores were comparable between the two groups (P = 0.689). There was no difference in mean post block pain scores between the two groups at 15 min (P = 0.054). In the PACU patients who underwent a LPB consumed less opioids compared to FIB patients (P = 0.02), however no differences were noted between the two groups in PACU length of stay, or POD 0 or 1 opioid use. CONCLUSION: A fascia iliaca block is not inferior to a lumbar plexus block in reducing PACU pain scores in patients with moderate to severe pain following hip arthroscopic surgery and is a viable option to help manage postoperative pain following hip arthroscopic surgery.


Assuntos
Analgesia/métodos , Artroplastia de Quadril/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Adulto , Fáscia/inervação , Feminino , Quadril/inervação , Humanos , Plexo Lombossacral/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia
8.
Eur J Anaesthesiol ; 35(3): 224-230, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29135692

RESUMO

BACKGROUND: Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE: We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN: A randomised, observer-blinded, equivalence trial. SETTING: Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS: A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION: In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 µg ml and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES: We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min. RESULTS: Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, -4.8; 95% confidence interval, -8.1 to -1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION: Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION: www.clinicaltrials in the (Study ID: TCTR20160427003).


Assuntos
Bloqueio Nervoso Autônomo/métodos , Neuroestimuladores Implantáveis , Plexo Lombossacral/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso Autônomo/tendências , Feminino , Humanos , Neuroestimuladores Implantáveis/tendências , Plexo Lombossacral/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Método Simples-Cego , Ultrassonografia de Intervenção/tendências
9.
J Clin Anesth ; 44: 91-96, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29161549

RESUMO

STUDY OBJECTIVE: The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. DESIGN: Randomized controlled clinical trial. SETTING: Operating rooms of university hospital of Erzurum, Turkey. PATIENTS: One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. INTERVENTIONS: Patients assigned to two groups for ultrasound guided caudal block (Group U, n=68) or conventional caudal block (Group C, n=66). Caudal solution was prepared as 0.125% levobupivacaine plus 10mcg/kg morphine (total volume: 0.5ml/kg), and was administered to both groups. MEASUREMENTS: The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. MAIN RESULTS: The block performing time and the success rate of block were similar between Group U and Group C (109.96±49.73s vs 103.17±45.12s, and 97% vs 93%, respectively p>0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p=0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p=0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p<0.05). CONCLUSIONS: Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.


Assuntos
Anestesia Caudal/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Sacro/diagnóstico por imagem , Ultrassonografia de Intervenção , Variação Anatômica , Anestesia Caudal/métodos , Anestésicos Locais/administração & dosagem , Criança , Pré-Escolar , Circuncisão Masculina/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/métodos , Plexo Lombossacral/efeitos dos fármacos , Masculino , Fimose/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Sacro/anatomia & histologia , Resultado do Tratamento
10.
Am J Physiol Gastrointest Liver Physiol ; 314(3): G341-G348, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29167116

RESUMO

Colorectal motility is regulated by two defecation centers located in the brain and spinal cord. In previous studies, we have shown that administration of serotonin (5-HT) in the lumbosacral spinal cord causes enhancement of colorectal motility. Because spinal 5-HT is derived from neurons of the medullary raphe nuclei, including the raphe magnus, raphe obscurus, and raphe pallidus, we examined whether stimulation of the medullary raphe nuclei enhances colorectal motility via the lumbosacral defecation center. Colorectal pressure was recorded with a balloon in vivo in anesthetized rats. Electrical stimulation of the medullary raphe nuclei failed to enhance colorectal motility. Because GABAergic neurons can be simultaneously activated by the raphe stimulation and released GABA masks accelerating actions of the raphe nuclei on the lumbosacral defecation center, a GABAA receptor antagonist was preinjected intrathecally to manifest excitatory responses. When spinal GABAA receptors were blocked by the antagonist, electrical stimulation of the medullary raphe nuclei increased colorectal contractions. This effect of the raphe nuclei was inhibited by intrathecal injection of 5-hydroxytryptamine type 2 (5-HT2) and type 3 (5-HT3) receptor antagonists. In addition, injection of a selective 5-HT reuptake inhibitor in the lumbosacral spinal cord augmented the raphe stimulation-induced enhancement of colorectal motility. Transection of the pelvic nerves, but not transection of the colonic nerves, prevented the effect of the raphe nuclei on colorectal motility. These results demonstrate that activation of the medullary raphe nuclei causes augmented contractions of the colorectum via 5-HT2 and 5-HT3 receptors in the lumbosacral defecation center. NEW & NOTEWORTHY We have shown that electrical stimulation of the medullary raphe nuclei causes augmented contractions of the colorectum via pelvic nerves in rats. The effect of the medullary raphe nuclei on colorectal motility is exerted through activation of 5-hydroxytryptamine type 2 and type 3 receptors in the lumbosacral defecation center. The descending serotoninergic raphespinal tract represents new potential therapeutic targets against colorectal dysmotility such as irritable bowel syndrome.


Assuntos
Colo/inervação , Defecação , Motilidade Gastrointestinal , Plexo Lombossacral/fisiologia , Bulbo/fisiologia , Núcleos da Rafe/fisiologia , Neurônios Serotoninérgicos/fisiologia , Animais , Defecação/efeitos dos fármacos , Estimulação Elétrica , Neurônios GABAérgicos/metabolismo , Neurônios GABAérgicos/fisiologia , Motilidade Gastrointestinal/efeitos dos fármacos , Injeções Espinhais , Plexo Lombossacral/efeitos dos fármacos , Plexo Lombossacral/metabolismo , Masculino , Bulbo/metabolismo , Inibição Neural , Pressão , Núcleos da Rafe/metabolismo , Ratos Sprague-Dawley , Receptores de GABA-A/metabolismo , Receptores 5-HT2 de Serotonina/metabolismo , Receptores 5-HT3 de Serotonina/metabolismo , Neurônios Serotoninérgicos/efeitos dos fármacos , Neurônios Serotoninérgicos/metabolismo , Serotonina/administração & dosagem , Serotonina/metabolismo
11.
Urologe A ; 56(12): 1532-1538, 2017 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-29043374

RESUMO

The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.


Assuntos
Bexiga Urinária Hiperativa/terapia , Terapia Comportamental , Toxinas Botulínicas Tipo A/uso terapêutico , Diagnóstico Diferencial , Terapia por Estimulação Elétrica , Feminino , Gabapentina/uso terapêutico , Humanos , Injeções Intramusculares , Plexo Lombossacral/efeitos dos fármacos , Masculino , Antagonistas Muscarínicos/uso terapêutico , Preferência do Paciente , Modalidades de Fisioterapia , Succinato de Solifenacina/uso terapêutico , Tadalafila/uso terapêutico , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/etiologia
14.
J Pain Palliat Care Pharmacother ; 31(2): 121-125, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28489477

RESUMO

Hip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.


Assuntos
Anestesia Geral , Artroscopia/métodos , Quadril/cirurgia , Plexo Lombossacral/efeitos dos fármacos , Bloqueio Nervoso , Manejo da Dor/métodos , Nervo Isquiático/efeitos dos fármacos , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
15.
Biomed Res Int ; 2017: 1873209, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28396863

RESUMO

Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; p = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228], p < 0.001 and 333 [254-439] versus 216 [176-294], p = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).


Assuntos
Anestésicos Locais , Plexo Lombossacral/efeitos dos fármacos , Imagem por Ressonância Magnética , Ultrassonografia de Intervenção/métodos , Adulto , Bloqueio do Plexo Braquial/métodos , Espaço Epidural/efeitos dos fármacos , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Plexo Lombossacral/fisiopatologia , Masculino , Bloqueio Nervoso/métodos
16.
Int Orthop ; 41(11): 2229-2235, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28396932

RESUMO

PURPOSE: Significant post-operative pain occurs after hip arthroplasty. In a prior study, lumbar plexus nerve blocks provided comparable analgaesia to lumbar epidurals; however, multimodal analgaesics were not used consistently. METHODS: This study assessed a randomly selected cohort of 48 patients undergoing primary hip arthroplasty who received a regional anaesthesia technique for post-operative pain. Twenty-four patients with lumbar epidurals and 24 with single-injection lumbar plexus nerve blocks were reviewed using electronic medical records. Post-operative opiate consumption was the primary endpoint. Secondary endpoints were participation in physical therapy, side effects, and time to discharge. Descriptive statistics were calculated to describe patients in the different groups. Opiate consumption was compared using linear mixed models. Multivariable models were examined for both primary and secondary endpoints. RESULTS: In comparison with patients receiving lumbar epidural catheters, patients with lumbar plexus blocks consumed less opiates post-operatively at 24-36 and 36-48 hours (P = 0.037 and 0.002, respectively); it did not differ at zero to 12 hours or 12-24 hours post-operatively. Patients with lumbar plexus blocks had earlier times to first ambulation (28.5 ± 3.29 vs 21.9 ± 1.76 h; P = 0.043). However, differences by block type were not observed for ambulation distance, level of assistance to ambulate or time of discharge orders. CONCLUSIONS: Following primary total hip arthroplasty, lumbar plexus nerve blocks provide effective post-operative analgaesia with decreased opiate consumption compared with lumbar epidural catheters. Lumbar plexus blocks also promote earlier post-operative ambulation and are compatible with post-operative prophylactic anticoagulants.


Assuntos
Analgesia Epidural/métodos , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Analgesia Epidural/efeitos adversos , Estudos de Coortes , Terapia Combinada/métodos , Deambulação Precoce/estatística & dados numéricos , Feminino , Humanos , Plexo Lombossacral/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos Retrospectivos
17.
Reg Anesth Pain Med ; 42(4): 446-450, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28277419

RESUMO

BACKGROUND AND OBJECTIVES: While benefits of regional anesthesia in total hip arthroplasty (THA) are well documented, data describing the incidence of complications related to the use of posterior lumbar plexus blockade for THA remain limited. Our primary aim was to evaluate the incidence of infectious, bleeding, and neurological complications related specifically to the use of continuous posterior lumbar plexus block for elective THA. METHODS: We reviewed the electronic medical records of all adult patients who underwent elective THA with continuous posterior lumbar plexus blockade between December 1, 2004, and April 30, 2015, using the Mayo Clinic Total Joint Registry. All complications were verified via manual chart review by 2 reviewers. Patient demographics, type of surgery, and complications were analyzed. RESULTS: A total of 9649 patients who underwent 11,395 THA procedures met the inclusion criteria. There were 8686 (76.2%) primary and 2709 (23.8%) revision THAs. There were no block-related infections (0.00%; 95% confidence interval [CI], 0.00%-0.03%) and only 1 block-related hematoma (0.01%; 95% CI, 0.00%-0.05%) in a patient with multiple risk factors for bleeding. There were 60 (0.53%; 95% CI, 0.40%-0.68%) perioperative nerve injuries. Forty-three were in the sciatic distribution (71.67%; incidence, 0.38%). Although there were no documented overt iatrogenic nerve injuries, the posterior lumbar plexus blockade could not be excluded as the potential cause in 9 cases (incidence, 0.08%) based on clinical distribution or electromyographic findings. CONCLUSIONS: In our large, single-center cohort study, we report no catheter-related infections, whereas catheter-related hemorrhagic and neurological complications also appear to be rare.


Assuntos
Artroplastia de Quadril/efeitos adversos , Plexo Lombossacral , Bloqueio Nervoso/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/tendências , Estudos de Coortes , Registros Eletrônicos de Saúde/tendências , Feminino , Humanos , Plexo Lombossacral/efeitos dos fármacos , Plexo Lombossacral/fisiologia , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/tendências , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos
18.
J Clin Anesth ; 37: 111-113, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28235496

RESUMO

A 56year-old woman underwent a lumbar plexus block for a revision of a left total hip arthroplasty. During the block procedure, the needle was advanced over the transverse process and isolated quadriceps twitches were elicited. After administering a test dose of 3ml of 1.5% lidocaine, the patient developed loss of sensation in the L3-4 dermatomal distribution that progressed caudally to involve both legs followed by inability to move the left leg. The patient shortly thereafter became hypotensive and sensory block spread cephalad and peaked at C7 bilaterally suggesting possible subdural spread of local anesthetic. The patient was resuscitated with normalization of blood pressure and eventually had full resolution of motor and sensory block. Subdural spread of local anesthetic is a potential complication of lumbar plexus block related perhaps to injection of local anesthetic near dural sleeves of nerve roots. The use of a test dose allows early recognition of subdural injection and may limit consequences of inadvertent subdural spread of local anesthetic.


Assuntos
Anestesia Epidural/efeitos adversos , Anestésicos Locais/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Lidocaína/efeitos adversos , Plexo Lombossacral/efeitos dos fármacos , Bloqueio Nervoso/efeitos adversos , Anestesia Epidural/métodos , Anestésicos Locais/administração & dosagem , Antieméticos/uso terapêutico , Efedrina/uso terapêutico , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipotensão/induzido quimicamente , Hipotensão/tratamento farmacológico , Injeções Epidurais/efeitos adversos , Lidocaína/administração & dosagem , Pessoa de Meia-Idade , Monitorização Intraoperatória , Náusea/induzido quimicamente , Náusea/tratamento farmacológico , Agulhas , Bloqueio Nervoso/métodos , Dor Pós-Operatória , Taxa Respiratória/efeitos dos fármacos , Espaço Subdural , Vasoconstritores/uso terapêutico
19.
J Clin Anesth ; 37: 17-20, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28235517

RESUMO

Epidural catheter migration is a well-known cause of failed anesthesia and complications. One of the factors that affect catheter movement is when patients change their position after skin fixation. We report a case of an epidural catheter placed without evidence of intravascular or subdural insertion that produced an insufficient block. A 36-year-old woman presented for ankle surgery under epidural anesthesia. Epidural block was conducted at the L3-4 intervertebral space with a catheter threaded 3 cm into the epidural space with the patient in a back flexion and lateral position. The total volume of injected anesthetic was 28 mL, including a 3-mL test dose. The final anesthesia level was L1. The planned operation was completed without a pneumatic tourniquet. A postoperative C-arm fluoroscopic image revealed that 1 side hole of the catheter had moved out of the epidural space. We think that a positional change after catheter fixation was the reason for catheter outmigration leading to insufficient analgesia, which was incompatible with the amount of local anesthetic injected.


Assuntos
Anestesia Epidural/efeitos adversos , Anestésicos Locais/administração & dosagem , Cateterismo/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Adulto , Fraturas do Tornozelo/cirurgia , Meios de Contraste/administração & dosagem , Feminino , Fluoroscopia , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Vértebras Lombares , Plexo Lombossacral/efeitos dos fármacos , Movimento , Decúbito Dorsal
20.
Br J Anaesth ; 118(3): 430-438, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28203808

RESUMO

Background: The currently best-established ultrasound-guided lumbar plexus block (LPB) techniques use a paravertebral location of the probe, such as the lumbar ultrasound trident (LUT). However, paravertebral ultrasound scanning can provide inadequate sonographic visibility of the lumbar plexus in some patients. The ultrasound-guided shamrock LPB technique allows real-time sonographic viewing of the lumbar plexus, various anatomical landmarks, advancement of the needle, and spread of local anaesthetic injectate in most patients. We aimed to compare block procedure outcomes, effectiveness, and safety of the shamrock vs LUT. Methods: Twenty healthy men underwent ultrasound-guided shamrock and LUT LPBs (2% lidocaine­adrenaline 20 ml, with 1 ml diluted contrast added) in a blinded randomized crossover study. The primary outcome was block procedure time. Secondary outcomes were procedural discomfort, number of needle insertions, injectate spread assessed with magnetic resonance imaging, sensorimotor effects, and lidocaine pharmacokinetics. Results: The shamrock LPB procedure was faster than LUT (238 [sd 74] vs 334 [156] s; P=0.009), more comfortable {numeric rating scale 0­10: 3 [interquartile range (IQR) 2­4] vs 4 [3­6]; P=0.03}, and required fewer needle insertions (2 [IQR 1­3] vs 6 [2­12]; P=0.003). Perineural injectate spread seen with magnetic resonance imaging was similar between the groups and consistent with motor and sensory mapping. Zero/20 (0%) and 1/19 (5%) subjects had epidural spread after shamrock and LUT (P=1.00), respectively. The lidocaine pharmacokinetics were similar between the groups. Conclusions: Shamrock was faster, more comfortable, and equally effective compared with LUT. Clinical trial registration: NCT02255591


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Plexo Lombossacral/efeitos dos fármacos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Estudos Cross-Over , Humanos , Plexo Lombossacral/diagnóstico por imagem , Masculino , Valores de Referência , Método Simples-Cego , Fatores de Tempo , Adulto Jovem
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