Túnel carpiano con anestesia local versus WALANT / Carpal tunnel with local anesthesia versus WALANT

Objetivo: Las cirugías con WALANT han ganado gran popularidad hoy en día. La ventaja principal que ofrece esta técnica es la de prescindir del torniquete y así eliminar las molestias que este genera. Nuestra hipótesis es que la descompresión del túnel carpiano con anestesia local y manguito neumático, realizada por un cirujano experimentado, en un tiempo quirúrgico corto, permite obtener similares resultados que con la cirugía con WALANT. materiales y métodos:Se diseñó un estudio de cohortes prospectivo comparativo clínico. Se incluyeron 23 pacientes (30 manos) con síndrome del túnel carpiano. Se asignó a los pacientes en forma aleatorizada, a 2 grupos: grupo 1, operados con anestesia local y grupo 2, operados con WALANT. Se realizó un análisis estadístico. Resultados:Todas las variables mostraron diferencias estadísticamente significativas respecto a los valores preoperatorios para los dos grupos. Respecto a la relación entre los dos grupos, los resultados funcionales de dolor y grado de satisfacción posoperatorios no mostraron diferencias con significancia estadística. Conclusiones: En nuestro estudio, la descompresión del túnel carpiano con anestesia local y torniquete y la realizada con WALANT arrojaron similares resultados. En cirujanos con experiencia posiblemente la anestesia local con torniquete sea suficiente para realizar el procedimiento, y así evitar las bajas, pero complejas complicaciones de la epinefrina. Nivel de Evidencia: II

Objective: Surgeries with the WALANT technique have recently become popular. The main advantage of this technique is that it avoids using the tourniquet and eliminates the discomfort it generates. We hypothesize that carpal tunnel decompression with local anesthesia and a pneumatic tourniquet, performed by an experienced surgeon in a short surgical time, allows us to obtain similar outcomes to the WALANT technique surgery. Materials and methods: We designed a prospective clinical comparative cohort study. We included twenty-three patients (30 hands) with carpal tunnel syndrome. Two groups of patients were randomized. Group 1 consisted of patients operated on with local anesthesia, and Group 2 included those operated on with the WALANT technique. We carried out a statistical analysis. Results: All the variables showed statistically significant differences concerning the preoperative values for the two groups. Regarding the relationship between those two groups, the functional outcomes of pain and degree of postoperative satisfaction did not show statistically significant differences. Conclusions: In our study, carpal tunnel decompression performed with local anesthesia with a tourniquet and those achieved with the WALANT technique had similar outcomes. In the hands of experienced surgeons, local anesthesia with a tourniquet may be sufficient to perform the procedure, thus avoiding the few but complex complications of epinephrine. Level of Evidence: II

Avaliação da termoablação com endolaser da veia safena parva com anestesia local / Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia

Resumo Contexto Na insuficiência venosa crônica (IVC), a veia safena parva (VSP) é afetada em 15% dos casos. A cirurgia convencional é a técnica padrão para o tratamento da insuficiência da VSP, sendo a lesão no nervo sural uma complicação bastante temida. O tratamento de termoablação com endolaser tende a ser um método cirúrgico que diminui complicações da terapia cirúrgica da IVC. Objetivos Avaliar os pacientes com IVC submetidos à terapia por endolaser da VSP ao menos 30 dias após o procedimento. Métodos Foram analisados 54 membros inferiores de 46 pacientes submetidos à terapia por endolaser 1470 nm, sob anestesia local, para o tratamento da IVC em um hospital terciário. Os pacientes foram avaliados no período pré-operatório, intraoperatório e pós-operatório de 30 dias, através da clínica, exame físico e achados ecográficos. Resultados Nos 54 membros inferiores submetidos ao tratamento, comparando-se o período pré-operatório e o 30º dia pós-operatório, houve diferença significativa (p < 0,003) na redução do diâmetro da VSP tratada (6,37 mm pré-operatório e 5,15 mm no 30º dia pós-operatório) (IC95% 4,58-5,72) e na melhora do escore de gravidade clínica venosa (VCSS) (média de 8,02 pré-operatório e 6,11 no 30º dia pós-operatório) (IC95% 5,01-7,21) (p < 0,02). Complicações pós-operatórias, como parestesia e flebite, estiveram presentes e foram diagnosticadas em cinco e três pacientes, respectivamente, sem significar alteração na qualidade de vida e nas atividades de rotina. Conclusões A técnica de termoablação com laser da VSP mostrou-se segura e eficaz na redução dos sintomas clínicos e na melhora da qualidade de vida.

Abstract Background The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. Objectives To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. Methods We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. Results In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01—7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. Conclusions Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.

Pre-emptive low-dose ketamine with local anesthesia reduces postoperative morbidity after third molar surgery: a systematic review and meta-analysis / Ketamina en dosis bajas con anestesia local reduce la morbilidad postoperatoria de la cirugía del tercer molar: revisión sistemática y metanálisis

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.

Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142, p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control.

Evaluación de la respuesta sostenida en pacientes con dolor crónico de la pared abdominal tratados con infiltración de anestesia local / Evaluation of sustained responses to infiltration of local anesthetic in patients with chronic abdominal wall pain

Resumen Introducción: el dolor abdominal crónico es frecuente en consulta externa. El enfoque tradicional es investigar patologías viscerales. El 50 % de esos pacientes finalmente tiene dolor crónico de la pared abdominal (DCPA), generalmente secundario a atrapamiento del nervio cutáneo anterior. Esta entidad se identifica con el signo de Carnett. El tratamiento de elección es infiltrar con lidocaína los puntos dolorosos. Con una postinfiltración hay una mejoría significativa en el 85 %-90 % de los pacientes. Se desconoce la duración de la mejoría postinfiltración. El objetivo de este trabajo es determinar la respuesta sostenida en seguimientos a 1 y 2 años. Materiales y métodos: estudio de cohorte, retrospectivo, realizado en la unidad de gastroenterología de la Clínica Fundadores. Se incluyeron pacientes adultos mayores de 18 años que hubieran recibido tratamiento con inyección local con lidocaína al 2 % sin epinefrina y que hubieran respondido una encuesta telefónica para evaluar la intensidad del dolor en una escala análoga. Resultados: se identificaron 360 elegibles y, finalmente, atendieron la entrevista telefónica 324 pacientes (90 %). El 87 % era de sexo femenino. La edad promedio de la población era de 57 años. En la preinfiltración el dolor promedio era 8,7 puntos. En la postinfiltración los pacientes tuvieron una mejoría con una intensidad promedio de 2,38 (p < 0,05). En el 71 % de los pacientes la intensidad del dolor en el seguimiento hasta 2 años tuvo una intensidad promedio de 1,65 (p < 0,05), que representa una mejoría del 81 % en la intensidad (p = 0,001). La fibromialgia tuvo una asociación positiva con la mejoría sostenida del dolor (p = 0,008). Conclusiones: en los pacientes con DCPA, la infiltración de la pared con anestesia local produce una respuesta sostenida hasta 2 años después del tratamiento.

Abstract Introduction: Chronic abdominal pain is frequently encountered at outpatient clinics where the traditional approach is to investigate visceral pathologies. Fifty percent of these patients are finally found to have abdominal wall pain which is generally secondary to entrapment of the anterior cutaneous nerve. This entity is identified by Carnett's sign. The treatment of choice is to infiltrate the painful points with lidocaine following which there is significant improvement in 85% to 90% of these patients. The duration of post-infiltration improvement is unknown. The objective of this work is to determine sustained response in one and two-year follow-up examinations. Materials and Methods: This is a retrospective cohort study conducted in the gastroenterology unit of the Clínica Fundadores. We included adult patients over 18 years of age who had received local injection treatment with 2% lidocaine without epinephrine and who had answered a telephone survey to assess the intensity of pain on an analogous scale. Results: Of the 360 eligible patients identified, 324 patients (90%) were interviewed by telephone. The average age of those interviewed was 57 years, and 87% were women. The average pain level prior to infiltration was 8.7 points. Following infiltration, the average intensity was 2.38 points (p <0.05). In 71% of patients, average pain intensity at a two year follow-up examination was 1.65 points (p <0.05), an 81% improvement in intensity (p = 0.001). Fibromyalgia had a positive association with sustained improvement in pain (p = 0.008). Conclusions: Infiltration of the abdominal wall with a local anesthetic produces a sustained response for up to two years in patients with chronic abdominal wall pain.

Facial Nerve Intraoperative Monitoring in Otologic Surgeries under Sedation and Local Anesthesia - A Case Series and Literature Review

Abstract Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve moni- toring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysi- ological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.

Hernioplastia inguinal con anestesia local y bloqueo nervioso: experiencia en el hospital Dr. Francisco Antonio Rísquez / Inguinal hernioplastia with local anesthesia and nervous block: experience in the hospital Dr. Francisco Antonio Rísquez

La anestesia local es una opción válida para realizar procedimientos quirúrgicos de pequeña o mediana consideración. Permite la deambulación y el alta precoz. Objetivo: Evaluar los resultados del uso de anestesia local y bloqueo de los nervios ilioinguinal e iliohipogástrico, en pacientes a quienes se les realizó cura operatoria de hernia inguinal, en el Servicio de Cirugía del Hospital "Dr. Francisco Antonio Rísquez", en el periodo octubre 2017 - octubre 2018. Métodos: Estudio prospectivo, transversal que incluyó 23 pacientes que aceptaron se le realizara la hernioplastia con anestesia local. Resultados: Se realizaron 46 curas operatorias de hernia inguinal, y en 23 se realizó con anestesia local (50 %). Predominaron pacientes masculinos (87 %), con una distribución bimodal en relación a la edad (26,1 % entre 30 y 39 años y entre 70 a 79 años). La hernia inguinal derecha fue la más frecuente con el 40 % (10 casos). Todos los pacientes reportaron una puntuación de 0-1 en la escala visual análoga, tanto en el transoperatorio como en el posoperatorio. El 96% de los pacientes logró una deambulación precoz (antes de 4 horas) y todos toleraron la vía oral antes de las dos horas en el posoperatorio. No se observó ninguna complicación en el transoperatorio; hubo 1 recidiva. Conclusiones: La cura operatoria de hernia inguinal con anestesia local, resultó ser efectiva y bien tolerada por los pacientes, brindando un reintegro casi inmediato a sus actividades, lo que representa una disminución en los costos intrahospitalarios(AU)

Local anesthesia is an option to perform surgical procedures of small or medium account. It allows the ambulation, and early discharge. Objective: To evaluate the results of the use of local anesthesia and nerve block ilioinguinal and iliohypogastric, in patients who underwent surgical cure of inguinal hernia, surgery of the Hospital "Dr. Francisco Antonio Rísquez" service, in the October 2017 period - October 2018. Methods: Prospective, cross-sectional study involving 23 patients who accepted it will be the hernioplasty under local anesthesia. Results: 46 surgical cure of inguinal hernia were performed, and in 23 was held with local anesthesia (50%). Dominated male patients (87%), with a bimodal distribution in relation to the age (26.1% between 30 and 39 years and between 70 to 79 years). Right inguinal hernia was the most frequent with 40% (10 cases). All patients reported a score of 0-1 in the Visual analog escale, both in the intraoperative and postoperative. 96% of patients achieved early ambulation (within 4 hours) and all tolerated the mouth before the two hours in the postoperative. There were no complications in the intraoperative; there was 1 recurrence. Conclusions: e surgical cure of inguinal hernia under local anesthesia, proved to be effective and well tolerated by the patients, providing a return almost immediately to their activities, which represents a decrease in hospital costs(AU)

Characterization of post-surgical critical patients with infections associated with healthcare after prolonged perfusion of remifentanil

SUMMARY INTRODUCTION Healthcare associated infections (HAI) are the most frequent complication of hospitalized patients. The aim of this study was to describe the clinical and epidemiological characteristics of critically ill post-surgical patients with a diagnosis of healthcare associated infections, after a pattern of sedoanalgesia of at least 4 days. METHODS All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology where sedation was based as analgesic the opioid remifentanil for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Data analysis was performed using the statistical package Stata version 7.0. RESULTS The patients admitted to the Post-Surgical Critical Care Unit (PCU) during study were 1789 and the population eligible was comprised of 102 patients. 56.86% of patients suffered IACS. The most frequent IACS was pneumonia associated with mechanical ventilation (30.96 per 1000 days of mechanical ventilation), Pseudomonas aeruginosa being the most frequently isolated germ. The germs with the greatest involvement in multiple drug resistance (MDROs) were enterobacteria, mainly Klebsiella pneumoniae resistant to extended-spectrum beta-lactamases (ESBL). CONCLUSIONS Pneumonia associated with mechanical ventilation is the most prevalent HAI and Pseudomonas aeruginosa is the main etiological agent. The groups of antibiotics most frequently used were cephalosporin and aminoglycosides. It is necessary to implement the prevention strategies of the different HAI, since most of them are avoidable.

RESUMO INTRODUCCIÓN Las infecciones asociadas a cuidados de salud (IACS) constituyen la complicación más frecuente de los pacientes hospitalizados. El objetivo de este estudio es describir las características clínicas y epidemiológicas de los pacientes críticos postquirúrgicos con diagnóstico de infección asociada a cuidados de salud, tras una pauta de sedoanalegia de al menos 4 días. MÉTODOS Se seleccionaron de manera consecutiva todos los pacientes mayores de 18 años con un ingreso en la Unidad de Reanimación Postquirúrgica (URP) superior a 4 días. La población de estudio fue aquella afectada por patología quirúrgica de cualquier origen donde la sedación se basó en cualquier hipnótico y como analgésico el opioide remifentanilo durante al menos 96 horas en perfusión continua. Se excluyeron los pacientes que fallecieron durante su ingreso en la unidad y aquellos pacientes con analgesia combinada (bloqueos periféricos o neuroaxiales). El análisis de los datos se realizó con paquete estadístico Stata versión 7.0. RESULTADOS El número de pacientes que ingresaron en la URP durante el periodo de estudio fueron de 1789. Tras aplicar los criterios de inclusión y exclusión, la población elegible quedó constituida por 102 pacientes. Un 56,86% de pacientes padecieron IACS. La IACS más frecuente fue la neumonía asociada a ventilación mecánica (30,96 por 1000 días de ventilación mecánica) siendo Pseudomona aeruginosa el germen más frecuentemente aislado. Los gérmenes con mayor implicación en las multirresistencias (MDROs) fueron las enterobacterias, principalmente Klebsiella pneumoniae resistente a betalactamasas de espectro extendido (BLEE). CONCLUSIONES La neumonía asociada a ventilación mecánica es la IACS más prevalente y Pseudomona aeruginosa es el principal agente etiológico. Los grupos de antibióticos más frecuentemente empleados fueron cefalosporinas y aminoglucósidos. Es necesario implementar las estrategias de prevención de las distintas IACS, ya que la mayoría de ellas son evitables.

Why do Women avoid Dental Visits During Pregnancy? A Cross- Sectional Survey in Al Madinah, Western Saudi Arabia

Objective: To investigate why women avoid dental visits during pregnancy and to explore the possible association between this attitude and relevant socio-demographic factors. Material and Methods: An online questionnaire was distributed to pregnant women during their routine visits to antenatal clinics in Al Madinah, Saudi Arabia. The questionnaire explored socio-demographic factors of age, education, employment status and nationality. It also explored misconceptions/ reasons for avoiding dental visits during pregnancy. Results: A total of 360 pregnant women participated, and their mean age was 30.08 years (range=18-52 years, SD=5.96). The most commonly cited misconception/reason for avoiding dental visits was "local anesthesia is not safe during pregnancy", followed by "transportation is difficult" and lastly, "dental treatment is not safe during pregnancy", (43.6%, 37.5%, 18.9%, respectively). Illiterate participants were statistically significantly associated with the misconception of "unsafe dental treatment during pregnancy" (p=0.002), whereas school-level and unemployed participants were statistically significantly associated with the misconception of "unsafe local anesthesia during pregnancy" (p=0.02, p=0.036 respectively). Conclusion: Pregnant women avoid dental visits mainly due to the misconception that local anesthesia is not safe during pregnancy. Difficult transportation seems to be another important deterrent in preventing pregnant women to visit dentists in this geographic area. Changing the misconceptions should be the starting point in addressing this public health problem and this should involve the three parties involved: pregnant women, oral healthcare providers and obstetric care providers.

Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo

Abstract Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

Resumo O vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima-se que possa afetar entre 1%-7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.

Reducción de fracturas nasales con anestesia local. Nuestra experiencia / Reduction of nasal fracture with local anesthesia. Our experience / Redução de fratura nasal com anestesia local. A nossa experiência

Introducción: las fracturas nasales son la consecuencia más frecuente de los traumatismos craneofaciales. Su tratamiento puede involucrar una reducción cerrada de huesos propios nasales que puede realizarse con anestesia local. El objetivo del presente trabajo es evaluar los resultados funcionales, estéticos y el dolor en la reducción cerrada de fracturas nasales. Material y método: Estudio prospectivo, randomizado, y descriptivo que evaluó la funcionalidad nasal antes y después de la reducción, en dolor del procedimiento, y sus resultados estéticos. Resultados: Se realizaron un total de 21 reducciones cerradas. El signo más habitual fue la crepitación en 14 pacientes, laterorrinia en 13, y 4 epistaxis. En cuanto a ventilación nasal previo a la reducción, el máximo puntaje en la escala Nasal Obstruction Symptoms Scale fue de 13 puntos, con un promedio de 4,8 puntos; y luego de realizar la reducción nasal el puntaje más alto fue de 7, con un promedio de 1,09 puntos. Estéticamente, luego de realizar la reducción nasal 8 pacientes notaron que su nariz estaba "mucho mejor", 9 pacientes notaron que su nariz estaba "mejor", y 4 pacientes indicaron que estaba igual. En cuanto a eficacia anestésica el menor puntaje fue de 0 referido por tres pacientes, el más alto fue de 10 en 2 pacientes; y el puntaje promedio referido fue de 3,5. Conclusiones: La reducción cerrada de fractura nasal es una técnica que es posible de realizar bajo anestesia local, obteniendo óptimos resultados estéticos y funcionales, y siendo bien tolerada por el paciente si la técnica se hace adecuadamente. Es necesario contar con la experiencia y los medios necesarios para realizarla.

Introduction: nasal fractures are the most frequent consequence of craniofacial trauma. Its treatment may involve a closed reduction of nasal bones that can be performed under local anesthesia. The objective of the present study is to evaluate the functional, aesthetic and pain outcomes in the closed reduction of nasal fractures. Material and method: Prospective, randomized, and descriptive study, evaluating nasal function before and after reduction, the pain of the procedure, and its aesthetic results. Results: A total of 21 nasal fracture reduction were made closed. The most common sign was crepitus in 14 patients, laterorrinia in 13, and 4 epistaxis. As for nasal ventilation prior to reduction, the maximum score in the Nasal Obstruction Symptoms Scale was 13 points, with an average of 4.8 points; and after performing the nasal reduction the highest score was 7, with an average of 1.09 points. Aesthetically, after making the nasal reduction 8 patients noticed that his nose was "much better", 9 patients noticed that his nose was "better", and 4 patients indicated that was “same as before”. As for anesthetic efficacy was the lowest score of 0 was reported by three patients, the highest was 10 in 2 patients; and referred the average score was 3.5. Conclusions: Closed reduction of nasal fracture is a technique that can perform under local anesthesia, obtaining optimal aesthetic and functional results, and being well tolerated by the patient if the technique is done properly. You must have the experience and resources needed to perform it.

Introdução: as fraturas nasais são a consequência mais frequente dos traumas craniofaciais. Seu tratamento pode envolver uma redução fechada de ossos próprios nasais, a qual pode ser realizada com anestesia local. O objectivo deste estudo foi avaliar o resultado funcional, estética e a dor na redução de fracturas fechadas nasais. Material e método: Estudo prospectivo, randomizado e descritivo que avaliou a funcionalidade nasal antes e depois da redução, a dor do procedimento e seus resultados estéticos. Resultados: Foram realizadas 21 reduções fechadas. O sinal mais comum foi a crepitação em 14 pacientes, laterorrinia em 13 e epistaxe em 4. No tocante à ventilação nasal antes da redução, o valor máximo na escala Nasal Obstruction Symptoms Scale foi 13 pontos, com uma média de 4,8 pontos; e, após a redução nasal, o valor mais alto foi 7, com uma média de 1,09 pontos. Esteticamente, após a redução nasal, 8 pacientes notaram que seu nariz estava "muito melhor"; 9 pacientes notaram que seu nariz estava "melhor" y 4 pacientes disseram que estava igual. A respeito da eficácia anestésica, o menor valor foi 0 segundo três pacientes, e o maior foi 10 em 2 pacientes. O valor médio comentado foi 3,5. Conclusões: A redução fechada de fratura nasal é uma técnica que pode ser realizada sob anestesia local, com ótimos resultados estéticos e funcionais. É bem tolerada pelo paciente se a técnica é realizada adequadamente. É preciso contar com a experiência e os meios necessários para realizá-la.

Medium-term results of mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS) procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI). Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A) without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI) cure rate in patients with mixed urinary incontinence (MUI), intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective) were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10) and from the local anesthesia. Visual analog scale (VAS) rating was low during and after the procedure (2.38 and 2.69 respectively). Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

Role of noninvasive ventilation in perioperative patients with neuromuscular disease: a clinical case / Papel da ventilação não invasiva no período perioperatório de doentes com patologia neuromuscular: caso clínico

The inclusion body myositis is an inflammatory myopathy that leads to chronic muscle inflammation associated with muscle weakness. It is characterized by a restrictive ventilatory syndrome requiring ventilatory support under non-invasive ventilation. The authors describe a clinical case and the anaesthetic management of a patient with inclusion body myopathy candidate for vertebroplasty, which highlights the importance of locoregional anaesthesia and of noninvasive ventilation and includes assisted cough techniques, maintained throughout the perioperative period.

A miosite por corpos de inclusão é uma miopatia inflamatória que cursa com inflamação crônica muscular associada à fraqueza muscular. Caracteriza-se por uma síndrome ventilatória restritiva com necessidade de suporte ventilatório sob ventilação não invasiva. Os autores descrevem caso clínico e respectivo manuseio anestésico de paciente com miopatia por corpos de inclusão proposta para vertebroplastia que realça a importância da anestesia locorregional e da ventilação não invasiva e inclui as técnicas de tosse assistida, mantidas durante todo o período perioperatório.

Estudio comparativo para el manejo del dolor en el reemplazo total de rodilla: infiltración tisular intraoperatoria versus bloqueo de nervios periféricos / Comparative study for pain management in total knee replacement: intraoperative tissue infiltracion versus peripheral nerve block

Introducción: El objetivo de este trabajo es comparar la infiltración intraoperatoria de los tejidos blandos periarticulares versus la utilización de bloqueos de los nervios periféricos (ciático y femoral) para el manejo del dolor posoperatorio de la artroplastia total de rodilla. Materiales y Métodos: Se evaluaron, en forma prospectiva, 60 pacientes tratados, que fueron divididos en dos grupos iguales: grupo A, con infiltración intraoperatoria y grupo B, con bloqueo de los nervios femoral y ciático antes de la cirugía. Resultados: El dolor fue significativamente menor en el grupo B (bloqueados) que en el grupo de control A (infiltrados) entre las 4 y las 8 horas poscirugía (p = 0,008). Al segundo y al tercer días de la cirugía, la curva de dolor se invirtió y fue estadísticamente menor en el grupo A (p = 0,009 y p = 0,023, respectivamente). Conclusiones: Al evaluar los resultados se observó que ambos métodos fueron eficaces para el tratamiento del dolor posquirúrgico e, incluso, para disminuir el consumo de opiáceos. Los bajos niveles de dolor y el menor uso de opiáceos en el posoperatorio inmediato dieron lugar a una mejor rehabilitación y a un mayor bienestar general para el paciente.

Background: The aim of this study is to compare intraoperative infiltration of periarticular soft tissues versus the use of peripheral nerve blocks (sciatic and femoral) for postoperative pain management in total knee arthroplasty. Methods: We prospectively evaluated 60 patients who were divided into two equal groups: group A, with intraoperative infiltration and group B, with femoral and sciatic nerve block before surgery. Results: Pain was significantly lower in group B (block) than in the control group A (infiltration) at 4 and 8 hours after surgery (p = 0.008). Two and three days after surgery, pain curve was inverted and it was statistically lower in group A (p = 0.009 and p = 0.023, respectively). Conclusions: Results showed that both methods were effective in the treatment of pain after surgery and even to reduce opiate use. Low levels of pain and less use of opioids in the immediate postoperative period led to a better rehabilitation and comfort of the patient.

Carotid endarterectomy in awake patients: safety, tolerability and results / Endarterectomia de carótida em pacientes acordados: segurança, tolerabilidade e resultados

Objective: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). Conclusion: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates. .

Objetivo: Analisar os resultados de 125 endarterectomias carotídeas, realizadas sob anestesia loco-regional com uso seletivo de shunt e remendo de pericárdio bovino. Métodos: Cento e dezessete pacientes com estenose na artéria carótida interna ≥ 70% ao ecoDoppler colorido + arteriografia ou angiorressonância magnética foram submetidos a 125 endarterectomias carotídeas. As medidas de proteção farmacológica intraoperatória incluíam a administração endovenosa de alfentanil e dexametazona. Clopidogrel, aspirina e estatinas eram utilizadas em todos os casos. Setenta e sete pacientes eram do sexo masculino (65,8%). A idade média foi de 70,8 anos, variando de 48 a 88 anos. A operação foi indicada por estenose sintomática em 69 artérias (55,2%), e por estenose assintomática em 56 artérias (44,8%). Resultados: O shunt de carótida foi necessário em 3 casos (2,4%) devido a sintomas de isquemia cerebral após a colocação do clampe carotídeo durante o ato cirúrgico, e os três pacientes tiveram boa evolução. Remendo de pericárdio bovino foi utilizado em 71 artérias ≤ 6 mm de diâmetro (56,8%). A mortalidade perioperatória foi de 0,8%: um paciente faleceu devido a infarto agudo do miocárdio. Dois pacientes (1,6%) tiveram infartos cerebrais isquêmicos ipsilaterais menores com boa recuperação, e 2 pacientes (1,6%) tiveram infartos do miocárdio não-fatais com boa recuperação. O tempo médio de seguimento foi de 32 meses. No pós-operatório tardio, houve reestenose significativa em apenas três artérias (2,4%). Conclusão: A endarterectomia carotídea no paciente acordado é uma técnica segura, sendo realizada com baixas taxas de morbimortalidade. .

Ethanol sclerotherapy of head and neck venous malformations / Escleroterapia com etanol em malformações venosas da cabeça e pescoço

Objective This retrospective study evaluated the results of sclerotherapy with low doses of ethanol for treatment of head and neck venous malformations. Methods We treated 51 patients, 37 females. Median age was 23 years. Patients were treated with percutaneous intralesional injection of alcohol every two weeks and followed up prospectively for a median period of 18 months. Most lesions affected the face and cosmetic disfigurement was the most frequent complaint. Results We performed a median of 7 sessions of sclerotherapy. Complete resolution or improvement was observed in 48 patients presented. Five cases of small skin ulceration, two cases of hyperpigmentation and two of paresthesia were documented; all of them were treated conservatively. Conclusion Percutaneous sclerotherapy with low doses of ethanol is a safe and effective treatment modality for venous malformations affecting the head and neck. .

Objetivo Estudo retrospectivo que analisou os resultados da escleroterapia, com doses baixas de etanol, realizada sob anestesia local para tratamento de malformações venosas na cabeça e pescoço. Métodos Foram tratados 51 pacientes, sendo 37 do gênero feminino. A mediana de idade foi de 23 anos. Os pacientes foram tratados com injeções alcoólicas nas lesões, por via percutânea, em sessões quinzenais, e acompanhados prospectivamente por um período mediano de 18 meses. A maioria das lesões acometia a face e a queixa principal mais frequente foi deformidade estética. Resultados Foram realizadas, em média, sete sessões de escleroterapia. Resolução completa ou melhora foi observada em 48 pacientes. Cinco pacientes apresentaram pequena úlcera cutânea, dois hiperpigmentação e dois parestesia, sendo todos tratados conservadoramente. Conclusão A escleroterapia percutânea com doses baixas de etanol é um método seguro e eficaz para tratar malformações venosas na cabeça e pescoço. .

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation / Avaliação da satisfação dos pacientes submetidos à facectomia por facoemulsificação realizada com anestesia tópica associada à lidocaína na câmara anterior combinada com sedação

PURPOSE: Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. METHODS: Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery. RESULTS: A total of 106 patients were enroled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. CONCLUSIONS: Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.

OBJETIVO: Acinesia ocular, uso de anticoagulantes e cooperação do paciente são fatores envolvidos na escolha da anestesia para cirurgia de catarata por facoemulsificação. A satisfação com anestesia tópica associada à sedação consciente neste procedimento foi pouco descrita no Brasil. Sedação consciente permite que o paciente sedado mantenha a capacidade de deambular e de responder ao chamado de voz. Avaliar a satisfação, dor e alterações hemodinâmicas perioperatórias de pacientes submetidos à facoemulsificação sob sedação consciente por anestesia tópica com injeção de lidocaína na câmara anterior. MÉTODOS: Estudo de coorte prospectivo, não controlado de pacientes operados pela mesma equipe em um período de 70 dias. Realizada sedação com 3 mg de midazolam, anestesia tópica com cloridrato de proximetacaína 0,5% e lidocaína gel 2%, associada à injeção de lidocaína 2% na câmara anterior. Registrados parâmetros vitais intraoperatórios, escala de satisfação com a anestesia de Iowa (ISAS) e a Escala Analógica Visual da Dor (EVA) em diferentes períodos do pós-operatório. RESULTADOS: Foram avaliados 106 pacientes (73,6% do sexo feminino), com idade média de 65,9 anos. O tempo cirúrgico médio foi de 11,2 minutos. Não houve diferença estatisticamente significante entre as variáveis hemodinâmicas nos momentos estudados. Ao final da operação, a média de escores na escala ISAS foi de 2,67 e 8 horas após foi de 2,99, apresentando aumento significativo (p<0,0001). Não houve relato de qualquer dor transoperatória em 68,9% dos casos, e 98,10% dos pacientes negaram dor pós-operatória. CONCLUSÕES: Em cirurgia de facectomia por facoemulsificação realizada sob sedação consciente associada à anestesia tópica com injeção de lidocaína 2% na câmara anterior, obtêm-se níveis adequados de satisfação com a anestesia, estabilidade de variáveis hemodinâmicas durante o procedimento e adequado controle da dor.

Influência da anestesia geral e bloqueio peribulbar em trabeculectomias: comparação visual e pressórica / Peribulbar blockage and general anesthesia influency in trabeculectomies: visual and pressure effects

OBJETIVO: Avaliar os resultados de trabeculectomias (TRECs) com anestesia geral e bloqueio peribulbar, visando definir de forma indireta a influência das técnicas anestésicas no resultado da cirurgia. MÉTODOS: Foram analisados os prontuários de 25 pacientes com glaucoma não controlado submetidos à trabeculectomia (TREC), sendo 11 com anestesia geral e 14 com anestesia peribulbar. Foram incluídos somente pacientes pseudofácicos com glaucoma e sem outras patologias oculares como retinopatia diabética ou doença macular relacionada a idade. A acuidade visual (AV), pressão intraocultar (PIO), número de medicações utilizadas, além de dados demográficos foram coletados retrospectivamente com 7, 30, 6 meses e 1 ano de pós-operatório. RESULTADOS: Ambos os grupos foram semelhantes nos quesitos demográficos, onde não houve diferença estatisticamente significante entre idade, sexo e raça. Não foram encontradas diferenças significativas nas variáveis estudadas em todas as avaliações, com significância estatística (p<0,05). CONCLUSÃO: Não encontramos diferenças entre os resultados de TRECs com anestesia geral e com bloqueio peribulbar, porém mais estudos com um número maior de pacientes são necessários para comprovar este achado.

OBJECTIVE: To evaluate trabeculetomies results with peribulbar anesthesia and general anesthesia and to watch the influence by this two techniques in the surgery result. METHODS: It was analyzed charts of 25 patients with uncontrolled glaucoma that undergone trabeculectomy, 11 patients had general anesthesia and 14 with peribulbar anesthesia. It was included in this study pseudophakic patients with glaucoma. We excluded other ocular patologies such as diabetic retinopathy and macular degeneration. Visual acuity, intraocular pressure, number of medications and demographic data were collected. The data were analyzed in 7 days, 30 days, 6 months and 1 year after surgery. RESULTS: Both groups were similar in demographic data, with no statically significance among age, sex and race. We didn't find significant differences in the variables studied in all evaluations, with statisctically significance (p<0.05). CONCLUSION: There was no statistically difference between patients submitted to surgery with general anesthesia or peribulbar anesthesia. We need a larger group of patients to comprove it.

Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia) are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender). The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334). The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79) in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51) in the second - 69.27% difference between them (p<0.001). The mean costs according to gender analysis were R$ 50.32 and R$ 66.69 (p=0.263) in the spinal anesthesia group versus R$ 222.52 and R$ 158.10 (p=0.221) in the combined anesthesia group, respectively. The direct costs of anesthesia-related materials were significantly lower in patients submitted to hemorrhoidectomy using spinal anesthesia. No difference was observed between the genders in each group analyzed. (AU)

Não há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local) são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero). A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334). O custo médio do procedimento anestésico no primeiro grupo foi de R$ 58,50 (R$ 36,48 - R$ 85,79), no segundo foi de R$ 190,31 (R$ 98,16 - R$ 358,51). A diferença das médias foi de 69,27%, com significância estatística (p<0,001). A média dos custos dos gêneros masculino e feminino no grupo da raquianestesia foi de R$ 50,32 e R$ 66,69 (p=0,263) e no grupo da anestesia combinada foi de R$ 222,52 e R$ 158,10 (p=0,221), respectivamente. Os custos diretos médios dos materiais anestésicos dos pacientes submetidos a hemorroidectomias foram significativamente menores no grupo da raquianestesia. Não houve significância estatística na diferença entre os gêneros em cada grupo. (AU)

Cirugía de la hernia inguinal en la tercera edad: ambulatoria y con hospitalización corta / Inguinal hernia surgery in third age patients: ambulatory and with a short hospitalization

INTRODUCCIÓN. La cirugía de la enfermedad herniaria de la pared abdominal, y en especial de la hernia inguinofemoral, ha sufrido un incremento pero en realidad su prevalencia se desconoce. El objetivo de este estudio fue valorar el resultado del tratamiento quirúrgico de la hernia de la región inguinofemoral en los pacientes de la tercera edad atendidos en el Hospital General Docente Dr Enrique Cabrera. MÉTODOS. Se realizó un estudio en 1 093 pacientes de la tercera edad operados de hernia inguinofemoral entre enero de 1999 y diciembre del 2008, en el Hospital General Docente Dr Enrique Cabrera. En todos los casos se ofreció al paciente la alternativa de ser operado de forma ambulatoria o con corta estadía. También se incluyeron los pacientes operados de urgencia. De entre los pacientes operados de forma electiva se excluyeron los que padecían enfermedades asociadas, cardiopulmonares o tromboembólicas de tipo ASA-III (clasificación de la American Society of Anesthesiologists). RESULTADOS. La mayor incidencia de la hernia inguinal se encontró en las edades de 60-69 años (59,3 por ciento). La hernia inguinal derecha, indirecta, apareció con mayor frecuencia. La técnica quirúrgica anatómica de Desarda fue la más aplicada en la hernia inguinal, y la técnica protésica de Lichtenstein, con el 32 por ciento, le siguió en frecuencia. Hubo un total de 20 recidivas (1,8 por ciento). Se aplicó anestesia local en el 75,4 por ciento de los pacientes, de forma ambulatoria en el 76,4 por ciento. El total de complicaciones fue de 78 (7,1 por ciento). CONCLUSIONES. El tratamiento quirúrgico de las hernias inguinofemorales, de forma ambulatoria o con corta hospitalización, es un procedimiento adecuado en pacientes de la tercera edad, ya que aumenta la comodidad de los pacientes, disminuye el riesgo de infección hospitalaria, reduce las listas de espera y los costos hospitalarios(AU)

INTRODUCTION. The surgery of hernial disease of abdominal wall and especially of the inguinofemoral hernia has increase but in fact its prevalence is unknown. The objective of present study was to assess the result of surgical treatment of the inguinofemoral region hernia in third-age patients seen in the Dr Enrique Cabrera Teaching General Hospital. METHODS. A study was conducted in 1 093 third-age patients operated on of inguinofemoral hernia from January, 1999 to December, 2008 in the above mentioned hospital. In all cases patients had the alternative to be operated on in ambulatory way or with a short hospital stay. Also, were included the patients operated on as an urgency. From the patients operated on in an elective way were excluded those suffering of associated, cardiopulmonary or thromboembolic ASA-III type diseases (classification of the American Society of Anesthesiology). RESULTS. The great incidence of the inguinal hernia was found in ages from 60-69 years (59,3 percent). The indirect right inguinal hernia was the more frequent. The Desarda's anatomical surgical technique was the more applied one in the inguinal hernia and the Lichtenstein's prosthetic technique with the 32 percent was the following in frequency. There were 20 relapses (1.8 percent). Local anesthesia was applied in the 75,4 percent of patients, in ambulatory way in the 76,4 percent. The total of complications was of 78 (7,1 percent). CONCLUSIONS. The surgical treatment of inguinofemoral hernias, ambulatory or with a short hospital stay is a suitable procedure in third-age patients since to increase the comfort of patients, to decrease the hospital infection risk, to reduce the waiting lists and the hospital costs(AU)

Influência da solução anestésica na percepção de dor após cirurgia periodontal: um estudo piloto / Infuence of anesthetic solution on pain perception after periodontal surgery: a pilot study

As características farmacológicas de agentes anestésicos locais estão entre os diversos fatores que podem infuenciar a percepção de dor pós-operatória. O objetivo deste estudo piloto foi avaliar a infuência de dois agentes anestésicos na percepção de dor pós-operatória após cirurgia a retalho para raspagem e alisamento radicular (RAR). Neste ensaio clínico randomizado, paralelo, duplo-cego, foram realizadas 12 cirurgias para RAR em pacientes com doença periodontal que apresentassem sinais clínicos de infamação após terapia periodontal básica em pelo menos um sextante. Os pacientes foram aleatoriamente alocados em um dos seguintes grupos: G1- mepivacaína 2% com norepinefrina 1:100.000; G2- lidocaína 2% com epinefrina 1:100.000. A intensidade da dor foi avaliada por meio de escala visual analógica (EVA) e escala numérica de 101 pontos (NRS-101), durante oito horas após a cirurgia. Os resultados demonstraram que a intensidade de dor pós-operatória foi estatisticamente inferior no grupo G2 em determinados períodos após a cirurgia, conforme indicam as respectivas medianas (Md). No período de uma hora: Md G1: 2,5; G2:18; p = 0,01; de duas horas: Md G1:2; G2:28,5; p = 0,009; de três horas: Md G1:6; G2:28; p = 0,01. Desta forma, os dados deste estudo piloto indicam que a utilização de mepivacaína 2% com norepinefrina 1:100.000 promove maior controle da dor no período pós-operatório imediato que a lidocaína 2% com epinefrina 1:100.000, após cirurgia de RAR a retalho.

Pharmacologic characteristics of local anesthetics agents are among several features that may infuence postoperative pain intensity. The aim of this study was to evaluate the infuence of two anesthetic agents on postoperative pain perception after open fap debridement surgeries. For this parallel-group, double-masked, placebo-controlled randomized clinical trial, 12 surgeries for open fap debridement were performed on patients who presented periodontal disease with clinical signs of infammation after nonsurgical treatment on at least one sextant. Patients were allocated in one of the following groups: G1- 2% mepivacaine with 1:100.000 norepinephrine; G2- 2% lidocaine with 1:100.000 epinephrine. Pain intensity was assessed using visual analog scale (VAS) and 101-point numerical rate scale (NRS-101) during the frst 8 hours after surgery. The results demonstrated that postoperative pain intensity was statistically lower in G2 at 1 (Median (Md) G1:2.5; G2:18; p = 0.01), 2 (Md G1:2; G2:28.5; p = 0.009) and 3 (Md G1:6; G2:28; p = 0.01) hours-period after surgery. Therefore, data from this pilot study indicate that 2% mepivacaine with 1:100.000 norepinephrine might promote more pain control at immediate postoperative period than does 2% lidocaine with 1:100.000 epinephrine after open fap debridement surgery.