[Evaluation of 2 invasive techniques for treating myofascial pain]. / Evaluación de dos técnicas invasivas en el tratamiento del dolor miofascial.

OBJECTIVE: To assess the efficacy of 2 invasive techniques for treating myofascial pain: trigger point acupuncture and 1% lidocaine infiltration of trigger points. MATERIAL AND METHODS: Patients who met the inclusion criteria were randomized to 2 groups for evaluation at our pain clinic over a period of 7 months. Each patient had 4 treatment sessions. Response was evaluated on a visual analog scale (VAS) and by means of the Lattinen test. RESULTS: Twenty-one patients were enrolled. Eleven underwent acupuncture and 10 received lidocaine infiltrations. When post-treatment pain was assessed, the mean (SD) VAS scores fell from 5.50 (2.08) to 2.45 (2.05) in the acupuncture group and from 4.8 (2.03) to 2.2 (1.91) in the lidocaine group. Lattinen test scores also fell, from 10.63 (2.69) to 8.54 (3.14) in the acupuncture group and from 10.9 (1.59) to 8.60 (2.63) in the lidocaine group. There were no statistically significant differences between the 2 treatment groups. CONCLUSION: Both acupuncture and lidocaine infiltration of trigger points were effective in reducing pain intensity after treatment and in improving quality of life. One method could not be shown to be better than the other for treating myofascial pain.

Ultrasound-guided transversalis fascia plane block versus anterior transversus abdominis plane block in outpatient inguinal hernia repair. / Bloqueo de la fascia transversalis versus bloqueo plano transverso del abdomen anterior ecoguiados en cirugía ambulatoria de hernia inguinal.

INTRODUCTION: The aim of the study was to assess the effectiveness of ultrasound-guided transversalis fascia plane block (TFP) compared to anterior transversus abdominis plane block (TAP-A) for post-operative analgesia in outpatient unilateral inguinal hernia repair. MATERIALS AND METHODS: Retrospective observational study conducted on ASA I-II patients. Two groups (TAP-A and TFP), which were given 30ml of 0.25% levobupivacaine prior to surgical incision. The primary endpoint was the post-operative pain evaluated by verbal numerical scale (VRN at rest and movement) at 10, 30, 60, 90min, coinciding with ambulation, and 24hours by telephone. An evaluation was also made of the sensory block level reached prior to surgery, the need for additional analgesia, side effects, ease of performing the technique, and the level of satisfaction of patients with the anaesthetic-analgesic technique. RESULTS: A total of 61 patients were included, 30 patients in the TAP-A group and 31 in the TFP group. The analgesic efficacy obtained in both groups was similar, although some higher values were found in the VNR on moving in the TAP-A group, reaching statistical difference at 10minutes (P=.014) and 30minutes (P=.013) post-operatively. A higher level of sensory block was achieved in the TFP group than in the TAP-A group (P<.01). There were no significant differences in additional analgesia requirements, and the cumulative dose of morphine was similar in both groups in the post-operative period. There were no differences in side effects or complications. The technical ease of the block was similar in both groups and the level of satisfaction of patients very high. CONCLUSIONS: Both blocks with a multimodal approach achieve good post-operative analgesia of inguinal hernia repair, are easy to perform and have few complications. TFP achieves the highest sensory level, but there are no differences in the requirements for additional analgesia.

Total intravenous anesthesia for aortic aneurysm replacement surgery in a patient with limb-girdle dystrophy.

We report the anesthetic management with total intravenous anesthesia of a 61-year-old male diagnosed with limb-girdle muscular dystrophy admitted for replacement of ascending aorta due to an aortic aneurysm. Limb-girdle muscular dystrophy belongs to a genetically heterogeneous group of muscular dystrophies involving shoulder and hip girdles. Although the risk of malignant hyperthermia does not seem to be increased in these patients compared with the general population, the exposure to inhaled anesthetics and succinylcholine should probably be avoided because these patients have a predisposition to hyperkalemia and rhabdomyolysis. We chose to use total intravenous anesthesia with propofol, remifentanil and muscle relaxants to reduce oxygen consumption, and later to reduce the doses of propofol and remifentanil. The combination of a carefully planned anesthetic strategy, anesthetic depth, and neuromuscular blockade monitoring is explained.

Black esophagus (acute esophageal necrosis) after spinal anesthesia.

Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.