Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis. A retrospective study.

BACKGROUND: Studies of spinal anesthesia in children are limited to a reduced group of high-risk patients and it remains relatively underused compared with general anesthesia in this age group in most institutions. In our experience, spinal anesthesia appears to be a good alternative to general anesthesia during pyloromyotomy in neonates and infants. AIMS: The purpose of this study was to retrospectively evaluate respiratory morbidity of spinal anesthesia compared to general anesthesia in infants undergoing pyloromyotomy. METHODS: The University Hospital of Salamanca used spinal or general anesthesia on infants undergoing pyloromyotomy between 2003 and 2017. The primary outcome assessed was the prevalence of apnea. The second one was the prevalence of oxygen saturation below 95%. An analysis was performed using t test or Mann-Whitney U test for continuous variables, and Chi-square for categorical variables. Logistic regression was done to account for differences in demographic and clinical covariates. RESULTS: The study sample consisted of 68 infants and neonates undergoing pyloromyotomy (48 with spinal anesthesia and 20 with general anesthesia). There was a significant difference in apneic episodes after surgery between general (number/percentage = 5/20, 25%) and spinal (number/percentage = 0/48, 0%) groups. Absolute risk reduction is 25% (CI 95%: 6%-44%), P < .001. CONCLUSION: Spinal anesthesia in neonates with hypertrophic pyloric stenosis undergoing pyloromyotomy was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter.

Comparison of the Analgesic Efficacy between Levobupivacaine 0.25% and Ropivacaine 0.375% for PENG (Pericapsular Nerve Group) Block in the Context of Hip Fracture Surgery of Elderly Patients: A Single-Center, Randomized, and Controlled Clinical Trial.

Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed. Patients were randomized to receive ultrasound-guided PENG blocks using 20 mL of either 0.25% levobupivacaine or 0.375% ropivacaine (both of which are equipotent concentrations). The primary endpoint was to compare the analgesic duration (time to first rescue) and analgesic quality (pain scores using the VAS, PAINAD, and AlgoPlus scales) between the groups. Secondary endpoints included comparing the onset time, describing the need for and type of rescue analgesics, and possible associated adverse effects. There were no statistically significant differences in analgesic duration between levobupivacaine (median 861.0, IQR 960) and ropivacaine (median 1205.0, IQR 1379; p = 0.069). Likewise, the quality of analgesia and onset time were comparable among the groups. A small number of patients required opioids as rescue analgesics (4.6%). The possible associated adverse effects included postoperative infection (11.1%) and delirium (2.8%).

Influence of comorbidities not associated with fibromyalgia on neuropathic pain in patients with psoriatic arthritis: relationship with clinical parameters.

Objective: Neuropathic pain (NP) may influence disease activity assessment in patients with psoriatic arthritis, this relationship being traditionally based on the presence of concomitant fibromyalgia. We analyzed the influence of other comorbidities on NP and the relationship between pain and various clinical parameters. Methods: A cross-sectional study was conducted in patients diagnosed with psoriatic arthritis, excluding patients with a previous diagnosis of fibromyalgia, depression, anxiety, diabetes and/or dyslipidemia under treatment. NP was identified using the painDETECT questionnaire (score > 18). Obesity and related clinical parameters, anxious and depressive symptoms, sleep quality and fatigue were assessed as comorbidities. Disease activity was measured using the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) in peripheral involvement, the ASDAS-PCR in axial involvement, functioning and disease impact were measured using the Health Assessment Questionnaire-Disability Index and 12-item Psoriatic Arthritis Impact of Disease questionnaire, respectively. Results: Overall, 246 patients were included (136 men; 55%). The mean age was 53.4 ± 11.0 years. Forty-two patients had NP (17.1%). Patients with NP had higher leptin levels (OR: 1.03, 95% CI: 1.007-1.056; p < 0.01) and poor sleep quality (OR: 1.20, 95% CI: 1.09-1.297; p < 0.001). Patients with NP also had greater fatigue NRS (6.2 ± 2.2 vs. 2.4 ± 0.19, p < 0.001). Patients with NP had higher cDAPSA score (17.3 ± 5.4 vs. 8.9 ± 6.5, p < 0.001), poorer functioning (1.1 ± 0.5 vs. 0.4 ± 0.5, p < 0.001) and greater disease impact (6.1 ± 1.7 vs. 2.6 ± 1.9, p < 0.001). Conclusion: NP was correlated with sleep quality and serum leptin and may be associated with worse disease activity, functioning and disease impact.

30-day mortality after hip fracture surgery: Influence of postoperative factors.

PURPOSE: The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. METHODS: Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. RESULTS: A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371-4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025-1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039-1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/µl, OR = 1.842[1.063-3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316-4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415-4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263-31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947-12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909-27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894-6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206-35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). CONCLUSION: We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.

The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study.

PURPOSE: To analyze the associations of oral anticoagulant and antiplatelet treatments in older patients requiring surgical treatment for hip fracture with mortality, length of stay, waiting time to surgery and postsurgical immediate complications. METHODS: A prospective observational study, including surgically treated hip fracture patients aged 65 years and older. We analyzed admission status variables, and time to surgery, length of stay and immediate surgical and medical complications. We recorded a 2-year survival follow-up. RESULTS: Of the 237 patients studied, 32.5% received antiplatelet treatment and 17.7% received oral anticoagulant treatment. The overall 2-year mortality was 29.1%. The 2-year mortality rate reached the 33.8% for antiplatelet-treated patients (n.s.) and 45.2% for oral anticoagulated patients (p = 0.011). The length of stay increased significantly associated with the oral anticoagulant or high-dose antiplatelet treatment (p < 0.001). The same happened for the time to surgery (p < 0.001), but no delay was observed for patients with low-dose antiplatelet treatment. Oral anticoagulated and antiplatelet-treated patients had a higher Charlson comorbidity index (p = 0.004, p = 0.019) and ASA score (p = 0.006, p = 0.011). Those treatments were also associated with a higher rate of some immediate postsurgical medical complications. We found a relationship between low hemoglobin at admission and high-dose antiplatelet treatment (p = 0.044). CONCLUSIONS: Hip fracture patients following previous oral anticoagulant treatment have a higher 2-year mortality rate. The oral anticoagulant or high-dose antiplatelet treatments are significantly associated with an increase in the length of stay, related to time to surgery, but we could not demonstrate an effect on early mortality.

Ankylosing spondylitis without axial progression: analysis of associated factors.

OBJECTIVE: To evaluate clinical factors associated with the absence of radiographic progression in patients with spondylitis. METHODS: The cross-sectional study included 672 patients. All patients presented a disease evolution of more than 15 years. Patients were classified as with radiographic spinal involvement versus without radiographic spinal involvement. We included clinical variables potentially related to null radiological progression. RESULTS: Seventy-five patients had no radiographic involvement. These patients were predominantly female, had a lower erythrocyte sedimentation rate (ESR), and a lower C-reactive protein level. Multivariate analysis showed an association with the female sex and low ESR. CONCLUSION: Clinical factors associated with this lack of progression were female sex and low ESR.