Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit.

INTRODUCTION: Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. OBJECTIVES: The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. MATERIALS AND METHODS: In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. RESULTS: A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). CONCLUSIONS: This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.

Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block. / Método de suma acumulada (CUSUM) para evaluar las curvas de aprendizaje del bloqueo femoral continuo guiado por ecografía.

BACKGROUND: Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. METHODS: We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. RESULTS: We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. CONCLUSIONS: The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum.

Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after total knee replacement. / Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla.

INTRODUCTION: Total knee replacement is usually a very painful procedure. A single-dose of femoral nerve block has been shown to provide similar analgesia to an epidural, with fewer side effects, but limited in time. OBJECTIVE: To compare the analgesia provided by dexamethasone used at perineural level in the femoral nerve block after total knee replacement with the one used at intravenous level, and with that of a control group. MATERIAL AND METHODS: A prospective, randomised, double-blind controlled trial was conducted on 81 patients randomly assigned to one of three groups: 1)IV dexamethasone (8mg); 2)perineural dexamethasone (8mg), and 3)placebo. All patients received 20ml of ropivacaine 0.5% for femoral nerve block. The primary outcome was the duration of the sensory-analgesic block of the femoral nerve block. The secondary outcomes included pain intensity measurements, patient satisfaction, and incidence of complications. RESULTS: Randomisation was effective. Analgesia duration was significantly higher (P<.0001) in the perineural dexamethasone group (mean 1152.2min, 95% confidence interval [95% CI]: 756.9-1547.6) in comparison with the control group (mean 186min, 95%CI: 81.2-292) and dexamethasone IV group (mean 159.4min, 95%CI: 109.8-209). Postoperative pain, complications and side effects were also lower in this group. CONCLUSIONS: Dexamethasone prolongs sensory block of single dose of femoral nerve block using ropivacaine. It also provides better analgesia and patient satisfaction, with fewer side effects.

Effectiveness and safety of continuous ultrasound-guided femoral nerve block versus epidural analgesia after total knee arthroplasty. / Eficacia y seguridad del bloqueo femoral continuo guiado con ecografía frente a la analgesia epidural en el postoperatorio de artroplastia total de rodilla.

OBJECTIVES: Total knee arthroplasty is associated with severe postoperative pain. The aim of this study was to compare continuous ultrasound-guided femoral nerve block with continuous epidural analgesia, both with low concentrations of local anaesthetic after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomised, unblinded study of 60 patients undergoing total knee replacement, randomised into two groups. A total of 30 patients received continuous epidural block, while the other 30 received continuous ultrasound-guided femoral nerve block, as well as using 0.125% levobupivacaine infusion in both groups. Differences in pain control, undesirable effects, and complications between the two techniques were assessed, as well as the need for opioid rescue and the level of satisfaction with the treatment received during the first 48hours after surgery. RESULTS: No differences were found in demographic and surgical variables. The quality of analgesia was similar in both groups, although in the first six hours after surgery, patients in the epidural group had less pain both at rest and with movement (P=.007 and P=.011). This difference was not observed at 24hours (P=.084 and P=.942). Pain control at rest in the femoral block group was better at 48hours after surgery than in the epidural group (P=.009). The mean consumption of morphine and level of satisfaction were similar. Epidural analgesia showed the highest rate of side effects (P=.003). CONCLUSIONS: Continuous ultrasound-guided femoral nerve block provides analgesia and morphine consumption similar to epidural analgesia, with the same level of satisfaction, but with a lower rate of side effects after total knee arthroplasty.

Eficacia del bloqueo femoral modificado en los pacientes con diagnóstico de fractura de cadera / Effectiveness of modified femoral block in patients with a diagnosis of hip fracture

Introducción: La evidencia demuestra que un inadecuado alivio del dolor preoperatorio tiene consecuencias fisiológicas y psicológicas nocivas en los pacientes, aumenta la morbilidad y la mortalidad. Objetivo: Evaluar la eficacia del bloqueo femoral modificado en los pacientes con el diagnóstico de fractura de cadera. Método: Se realizó un estudio cuasiexperimental en el Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, en el periodo correspondiente de enero 2016 hasta enero 2018. Se constituyó el universo con 639 pacientes programados de urgencia y electivo con el diagnóstico de fractura de cadera, a través de un muestreo aleatorio simple de manera automática con el Statistical Package for the Social Sciences (SPSS) Versión 21 para Windows, error aceptable y nivel de confianza del 95 por ciento. Se conformó la muestra por 295 pacientes. Resultados: La mayor parte de los pacientes intervenidos por fractura de cadera están por encima de la quinta década de la vida. Se diagnosticó la fractura extracapsular en 174 pacientes, en la evaluación del dolor a través del Cuestionario de dolor de McGill se constata dolor terrible de 4 con intervalo de confianza (2,00912-6,23110) antes del bloqueo y analgesia después del bloqueo de 1 con intervalo de confianza (0,73102 - 1,48209). Conclusiones: El bloqueo femoral modificado proporcionó analgesia en la totalidad de los casos(AU)

Introduction: Evidence shows that inadequate control of preoperative pain has harmful physiological and psychological consequences in patients, and increases morbidity and mortality. Objective: To evaluate the efficacy of modified femoral block in patients with a diagnosis of hip fracture. Method: A quasi-experimental study was carried out at Manuel Ascunce Domenech University Hospital in Camagüey Province, from January 2016 to January 2018. The study population was made up of 639 emergency and elective surgical patients with the diagnosis of hip fracture of hip, through simple random sampling automatically with the Statistical Package for the Social Sciences (SPSS) Version 21 for Windows, acceptable error and 95% confidence level. The sample was made up of 295 patients. Results: Most of the patients operated on for hip fracture are above their fifth decade of life. Extracapsular fracture was diagnosed in 174 patients. Regarding pain evaluation through McGill's Pain Questionnaire, terrible pain of 4 was perceived, with confidence interval (2.00912-6.23110) before block; and also analgesia of 1 after blockage, with confidence interval (0.73102-1.48209). Conclusions: The modified femoral block provided analgesia in all cases(AU)

Artroscopía de rodilla bajo bloqueos de nervios femoral y ciático en paciente COVID-19 con artritis séptica. Reporte de caso / Knee arthroscopy under femoral and sciatic nerve blocks in a COVID-19 patient with septic arthritis. A case report

Since the start of the COVID-19 pandemic, several anesthetic societies have generated clinical recommendations for the perioperative management of these patients, including the Chilean Society of Anesthesiology. Among these recommendations, the advantages of regional anesthesia have been highlighted. In this article, we report and discuss the case of a 59-year-old patient with diabetes mellitus II, Chronic Arterial Hypertension, Gout, and Stage IV Chronic Renal Failure admitted with a multifocal septic condition characterized by suppurative collections including a large subcutaneous lumbar abscess recently drained. The patient evolved with left knee septic arthritis and was scheduled for arthroscopic irrigation and debridement. As per protocol a SARS-COV2 PCR was tested and resulted positive. It was decided to proceed to surgery under anesthetic ultrasound-guided femoral and sciatic nerve blocks using an adrenalized (2.5 ug/mL) solution of 0.33% Levobupivacaine- 0.66% Lidocaine (15 mL each). Fifteen minutes later, the knee was mobilized passively without pain. Surgery started after 30 minutes. The surgical and anesthetic conditions were described as adequate by the surgeon and the patient, respectively. The postoperative evolution was satisfactory without presenting respiratory symptoms and the patient was discharged 17 days after under oral antibiotic treatment.

Desde el comienzo de la pandemia de COviD-19, varias sociedades de anestesia han generado recomendaciones clínicas para el tratamiento perioperatorio de estos pacientes, incluida la Sociedad Chilena de Anestesiología. Entre estas recomendaciones, se han destacado las ventajas de la anestesia regional. En este artículo, reportamos y discutimos el caso de un paciente de 59 años con diabetes mellitus tipo 2, hipertensión arterial, gota e insuficiencia renal crónica en etapa IV, admitido por una sepsis multifocal caracterizada por colecciones supurativas que incluyen un gran absceso lumbar subcutáneo drenado recientemente. El paciente evolucionó con artritis séptica de rodilla requiriendo de una exploración y aseo artroscópico. Por protocolo perioperatorio COviD-19, se solicitó PCR para SARS-COv2 con un resultado positivo. Se decidió proceder a la cirugía bajo bloqueos anestésicos guiados por ultrasonido de nervios femoral y ciático utilizando una solución adrenalizada (2,5 ug/mL) de levobupivacaína al 0,33% lidocaína al 0,66% (15 mL en cada uno). Quince minutos después, la rodilla se movilizó pasivamente sin dolor. La cirugía se inició tras media hora empleando una ligera sedación con propofol. Las condiciones quirúrgicas y anestésicas fueron descritas como adecuadas por el cirujano y el paciente. Este último evolucionó favorablemente, sin síntomas respiratorios y fue dado de alta 17 días después con tratamiento antibiótico oral.

Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study / Bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo para analgesia após artroplastia total de joelho: estudo multicêntrico, randomizado e controlado / Bloqueo continuo del nervio femoral guiado por ultrasonido y estimulador de nervio para analgesia posterior a la artroplastia total de rodilla: estudio multicéntrico, aleatorizado y controlado

BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group); in 24 patients, epidural analgesia was done (PCEA group). The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score) during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition. .

JUSTIFICATIVA E OBJETIVOS: Analgesia pós-operatória é fundamental para o exercício funcional precoce logo após a artroplastia total de joelho. O objetivo foi investigar a eficácia clínica do bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo em analgesia após artroplastia total do joelho. MÉTODOS: Receberam analgesia pós-operatória, de outubro de 2012 a janeiro de 2013, 46 pacientes, estado físico ASA I-III, submetidos à artroplastia total de joelho. Em 22 pacientes, o bloqueio femoral contínuo foi guiado por ultrassom e estimulador de nervo para analgesia (grupo BFC); em 24 pacientes, analgesia foi administrada por via epidural (grupo ACP). Os efeitos analgésicos, efeitos colaterais, a recuperação articular e as complicações foram comparados entre os dois grupos. RESULTADOS: Às seis e 12 horas após a cirurgia, os escores de dor no joelho (escore EVA) durante os testes funcionais após exercício ativo e passivo foram significativamente menores no grupo BFC do que no grupo ACP. A quantidade usada de parecoxib nos pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. Quarenta e oito horas após a cirurgia, o grau de força muscular no grupo BFC foi significativamente maior e o tempo de atividade ambulatória foi menor do que no grupo ACP. A incidência de náusea e vômito em pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. CONCLUSÃO: O bloqueio femoral contínuo guiado por ultrassom e estimulador do nervo proporcionou melhor analgesia às seis e 12 horas, demonstrada por EVA-R e EVA-P. A quantidade de parecoxib também foi menor, a incidência de náusea e vômito diminuiu, a influência sobre a força muscular é comprometida e os pacientes podem fazer atividade ambulatorial sob essa condição. .

JUSTIFICACIÓN Y OBJETIVOS: La analgesia postoperatoria es fundamental para el ejercicio funcional precoz posteriormente a la artroplastia total de rodilla. El objetivo fue investigar la eficacia clínica del bloqueo continuo del nervio femoral guiado por ultrasonido y estimulador de nervio en analgesia después de la artroplastia total de la rodilla. MÉTODOS: Cuarenta y seis pacientes, con estado físico ASA I-III, sometidos a artroplastia total de rodilla recibieron analgesia postoperatoria de octubre de 2012 a enero de 2013. En 22 pacientes, el bloqueo femoral continuo fue guiado por ultrasonido y estimulador de nervio para analgesia (grupo BFC); en 24 pacientes, la analgesia fue administrada por vía epidural (grupo ACP). Los efectos analgésicos, efectos colaterales, recuperación articular y las complicaciones fueron comparados entre los 2 grupos. RESULTADOS: A las 6 y 12 h después de la operación, las puntuaciones de dolor en la rodilla (puntuación EVA) durante los test funcionales después del ejercicio activo y pasivo fueron significativamente menores en el grupo BFC que en el grupo ACP. La cantidad usada de parecoxib en los pacientes del grupo BFC fue significativamente menor en comparación con el grupo ACP. Cuarenta y ocho horas después de la operación, el grado de fuerza muscular en el grupo BFC fue significativamente mayor y el tiempo de actividad ambulatoria fue menor que en el grupo ACP. La incidencia de náuseas y vómitos en pacientes del grupo BFC fue significativamente menor en comparación con el grupo ACP. CONCLUSIÓN: El bloqueo femoral continuo guiado por ultrasonido y estimulador del nervio proporcionaron una mejor analgesia a las 6 y 12 horas, lo que quedó demostrado por EVA-R y EVA-P. La cantidad de parecoxib también fue menor, la incidencia de náuseas y vómito disminuyó, la influencia sobre la fuerza muscular está comprometida y los pacientes pueden realizar una actividad ambulatoria bajo esa condición. .

Dolor posoperatorio en pacientes sometidos a artroscopia de cadera con la técnica dentro-fuera en comparación con la técnica fuera-dentro / Douleur postopératoire chez les patients traités par la technique arthroscopique de dehors en dedans en comparaison avec la technique de dedans en dehors au niveau de la hanche / Postoperative pain in patients undergoing hip arthroscopy with inside-out technique compared with the outside-in technique

Objetivo: comparar el dolor posoperatorio en pacientes sometidos a artroscopia de cadera con la técnica dentro-fuera en comparación con la técnica fuera-dentro. Métodos: se realizó un estudio prospectivo en el que se comparó el dolor posoperatorio en un grupo de pacientes (n = 31) a los que se les realizó artroscopia de cadera mediante la técnica fuera-dentro, con los pacientes (n = 31) a los que se les realizó con la técnica dentro-fuera; ambos grupos de pacientes recibieron la misma analgesia multimodal. Los parámetros principales medidos fueron: la escala visual análoga en diferentes momentos hasta 24 horas después de la operación y la necesidad de opiáceos. Para las variables categóricas se realizó la comparación mediante Chi cuadrado, y para las variables cuantitativas mediante t Student o Mann-Whitney. Se calcularon el OR y el IC 95 por ciento. Para el análisis de los datos se utilizó el programa SPSS versión 21.0 y se consideró un error alfa de 5 por ciento. Resultados: la escala visual análoga posoperatoria fue menor en pacientes con la técnica de fuera-dentro después de 1 hora (diferencia media 1,9 IC 95 por ciento: 0,5 a 3,2, p = 0,01), después de 2 horas (diferencia media 1,29 IC 95 por ciento: 0,3 a 2,2, p = 0,01), y en el momento del alta (diferencia media 0,77 IC 95 por ciento: 0,16 a 1,18; p = 0,01). Sin embargo, 24 horas después del procedimiento, la diferencia no fue significativa (diferencia media 0,4 IC 95 por ciento: 0,02 a 0,84; p = 0,08). Las necesidades de opioides en el posoperatorio fueron significativamente menores en los pacientes con la técnica fuera-dentro ─6,5 por ciento vs. 41,9 por ciento─ (OR crudo 0,09 IC 95 porciento: 0,02 a 0,47; p = 0,004), incluso después de ajustar por edad, sexo y el IMC (OR ajustado 0,09 IC 95 por ciento: 0,016 hasta 0,51, p = 0,006). Conclusiones: los pacientes a los que se les realiza artroscopia de cadera con la técnica fuera-dentro tienen menos dolor posoperatorio y requerimientos de opioides que aquellos a los que se les realiza la técnica dentro-fuera(AU)

Objective: compare postoperative pain in patients undergoing hip arthroscopy with the inside-out technique compared to outside-in technique. Methods: a prospective study was conducted on postoperative pain in a group of patients (n = 31) who underwent hip arthroscopy by outside-in technique, which were compared with patients (n = 31) who received the inside-out technique. Both groups of patients received the same multimodal analgesia. The main parameters were measured: visual analogue scale at different times up to 24 hours after surgery and opioid need. Categorical variables were compared using Chi-square, and quantitative variables using Student t or Mann-Whitney. OR and CI 95 percent were calculated. SPSS version 21.0 was used for data analysis program and an alpha error of 5 percent was considered. Results: postoperative visual analogue scale was lower in patients with outside-in technique after 1 hour (mean difference 1.9, 95 percent CI 0.5 to 3.2, p = 0.01) after 2 hours (mean difference 1.29, 95 percent CI 0.3 to 2.2, p = 0.01) and at discharge (mean difference 0.77, 95 percent CI 0.16 to 1.18; p = 0.01). However, 24 hours after the procedure, the difference was not significant (mean difference 0.4, 95 percent CI 0.02 to 0.84; p = 0.08). Opioid requirements postoperatively were significantly lower in patients with the outside-in technique ─6,5 percent vs. 41.9 percent─ (crude OR 0.09 95 percnt CI 0.02 to 0.47; p = 0.004), even after adjusting age, sex and BMI (adjusted OR 0.09, 95 percent CI: 0.016 to 0.51, p = 0.006). Conclusions: Patients who underwent hip arthroscopy with outside-in technique have less postoperative pain and opioid requirements that those who undergo the inside-out technique(AU)

Objectif: le but de ce travail est de comparer la douleur postopératoire chez des patients opérés par la technique arthroscopique de dedans en dehors avec la technique de dehors en dedans au niveau de la hanche. Méthodes: une étude prospective a été réalisée afin de comparer la douleur postopératoire dans un groupe de patients traités par la technique arthroscopique de dehors en dedans (n = 31) et dans un groupe de patients traités par la technique arthroscopique de dedans en dehors (n = 31) au niveau de la hanche. Tous les deux groupes ont reçu une analgésie multimodale. On a fondamentalement évalué des paramètres tels que l'échelle visuelle analogique (EVA) en différents moments, même 24 heures après l'opération, et le besoin d'opiacés. Pour les variables catégoriques, on a utilisé le test de Chi carré, et pour les variables quantitatives le test du t de Student ou de Mann-Whitney. On a également calculé l'OR et l'IC 95 pourcent. Pour l'analyse des données, on a utilisé le logiciel SPSS v21.0, et une erreur alpha de 5 pourcent a été considérée. Résultats: la valeur EVA en postopératoire a été inférieure chez les patients opérés par la technique de dehors en dedans après 1 h (différence moyenne 1.9 IC 95 pourcent : 0.5 à 3.2, p = 0.01), après 2 h (différence moyenne 1.29 IC 95 pourcent : 0.3 à 2.2, p = 0.01), et à la sortie de l'hôpital (différence moyenne 0,77 IC 95 pourcent : 0.16 à 1.18 ; p = 0.01). Par contre, la différence n'a pas été significative (différence moyenne 0.4 IC 95 pourcent : 0.02 à 0.84 ; p = 0.08) 24 h après le geste opératoire. Le besoin d'opiacés en postopératoire a été significativement inférieur chez les patients traités par la technique de dehors en dedans ─6.5 pourcent vs. 41.9 pourcent─ (OR cru 0.09 IC 95 pourcent : 0.02 à 0.47 ; p = 0.004), même après l'ajustement par âge, sexe et IMC (OR ajusté 0.09 IC 95 pourcent : 0.016 jusqu'à 0.51, p = 0.006). Conclusions: on conclut que les patients traités par la technique arthroscopique de dehors en dedans souffrent moins de douleur postopératoire et n'ont pas besoin d'opiacés que ceux qui ont été traités par la technique arthroscopique de dedans en dehors. Mots clés: arthroscopie de hanche, technique arthroscopique de dehors en dedans, technique arthroscopique de dedans en dehors, blocage fémoral, blocage ilio-facial, analgésie multimodale, douleur postopératoire(AU)

Bloqueos de nervio periférico para el dolor posoperatorio de artroscopia de cadera / Peripheral nerve block for the postoperative pain relief after arthroscopy of the hip

Introducción: el tratamiento del dolor posoperatorio de la artroscopia de cadera es un reto y no se conocen estudios relacionados con su tratamiento basado en bloqueos regionales. Objetivo: Determinar el comportamiento del dolor posoperatorio y la satisfacción de los pacientes tratados por artroscopia de cadera con bloqueo femoral, bloqueo del plexo lumbar o infiltración intraarticular. Métodos: Se revisaron prospectivamente todos los registros anestésicos de 61 pacientes que requirieron artroscopia de cadera bajo anestesia general utilizando bloqueo femoral con 0,3 mL/kg de levobupivacaína al 0,375 %, bloqueo del plexo lumbar con 0,4 mL/kg de levobupivacaína al 0,375 % o infiltración intraarticular con 20 mL de bupivacaína al 0,5 %. Se revisaron los datos de dolor posoperatorio evaluados con escala visual análoga a los 15, 30, 60 y 120 minutos y a las 24 horas; la satisfacción del paciente en el momento del alta hospitalaria y a las 24 horas, el bloqueo motor y sensitivo y la necesidad de morfina en el posoperatorio. Resultados: El grupo tratado con infiltración intraarticular presentó los niveles de dolor más altos en casi todos los momentos evaluados. Comparado con el bloqueo del plexo lumbar, más pacientes del grupo bloqueo femoral presentaron niveles mayores de dolor en casi todos los momentos. De los pacientes del grupo tratado con infiltración intraarticular 55 % recibieron morfina en algún momento del posoperatorio, así como 28,5 % del grupo bloqueo femoral y 15 % del grupo bloqueo del plexo lumbar. El nivel de satisfacción de los pacientes fue alto y similar en los tres grupos. Conclusión: La analgesia posoperatoria para artroscopia de cadera fue mejor con bloqueo del plexo lumbar comparado con el bloqueo femoral o la infiltración intraarticular.

Background: The treatment of postoperative pain after arthroscopy of the hip is a challenge and there are no known studies related to its treatment which have been based on regional block. Objectives:To determine the behaviour of postoperative pain and the satisfaction of the patients who have been treated with arthroscopy of the hip with femoral block, lumbar plexus block or intra-articular infiltration. Methods:All the anaesthetic records of 61 patients that required arthroscopy of the hip under general anaesthesia using femoral block with 0,3 mL/kg of Levobupivacaine 0,375 %, lumbar plexus block with 0,4 mL/kg of Levobupivacaine 0,375 % or intra-articular infiltration with 20 mL of Bupivacaine 0,5 % were checked. The data about postoperative pain which had been assessed with visual analogous scale at the 15, 30, 60 and 120 minutes and at the 24 hours, the satisfaction of the patients at the moment of the discharge from hospital at the 24 hours, the sensitive and motor block and the need to use Morphine in the postoperative phase were also checked. Results:The group of patients that were treated with intra-articular infiltration presented the highest levels of pain in almost all evaluated moments. As compared with the lumbar plexus block, more patients that underwent femoral block presented higher levels of pain in almost all moments. Out of the patients in the group that was treated with intra-articular infiltration, the 55 % received Morphine at any postoperative moment as well as the 28,5 % treated with femoral block and the 15 % who underwent lumbar plexus block. The level of patients´ satisfaction was high and similar in the three groups. Conclusions:Postoperative analgesia for arthroscopy of the hip was better with lumbar plexus block as compared with femoral block or intra-articular infiltration.

Estudo comparativo do bloqueio combinado femoral-isquiático, por punção em sítio único, com anestesia subaracnóidea para cirurgia unilateral do membro inferior / Comparative study between combined sciatic-femoral nerve block, via a single skin injection, and spinal block anesthesia for unilateral surgery of the lower limb / Estudio comparativo del bloqueo combinado femoral-isquiático por punción en sitio único, con anestesia subaracnoidea para cirugías unilateral del miembro inferior

JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar vantagens em pacientes ambulatoriais. O objetivo deste trabalho foi comparar a raquianestesia unilateral com o bloqueio combinado femoral-isquiático em cirurgias ortopédicas unilaterais e ambulatoriais. MÉTODO: Sessenta pacientes foram aleatoriamente separados em dois grupos para receber 6 mg de bupivacaína hiperbárica ou hipobárica (grupo RQ) em decúbito lateral esquerdo ou 800 mg de lidocaína 1,6 por cento com epinefrina nos nervos femoral e isquiático (grupo CFI) em decúbito dorsal. O bloqueio dos nervos foi realizado com agulha de 150 mm conectada a um neuroestimulador e inserida no ponto médio entre as duas abordagens clássicas, sendo injetados 15 mL no nervo femoral e 35 mL no nervo isquiático. Avaliados o tempo para realização dos bloqueios e sua duração. Vinte minutos após, os pacientes foram avaliados em relação aos bloqueios sensitivo e motor. RESULTADOS: O tempo para a realização da raquianestesia foi significativamente menor do que o bloqueio combinado femoral-isquiático. O bloqueio unilateral foi obtido em 90 por cento dos pacientes no grupo RQ e 100 por cento no grupo CFI. O tempo para recuperação do bloqueio sensitivo e motor foi significativamente maior no grupo CFI. Não houve bradicardia ou hipotensão. CONCLUSÕES: Este estudo conclui que é tecnicamente fácil realizar bloqueio anterior combinado femoral-isquiático e pode ser uma alternativa para o bloqueio unilateral do membro inferior. A raquianestesia unilateral com baixas doses de bupivacaína resultou em menor tempo para realização, menor número de tentativas e recuperação mais precoce do bloqueio combinado femoral-isquiático, porém com mesma efetividade.

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia has advantages when used in outpatient basis. The objective of the present study was to compare unilateral spinal anesthesia with combined sciatic-femoral nerve block in unilateral orthopedic surgeries in outpatients. METHODS: Sixty patients were randomly divided into two groups of 30 patients to receive 6 mg of hyperbaric or hypobaric bupivacaine (RQ group) in left lateral decubitus, or 800 mg of 1.6 percent lidocaine with epinephrine on sciatic and femoral nerves (CFI group) in dorsal decubitus. A 150-mm needle connected to a neurostimulator, inserted in the middle point between both classical approaches, was used for the nerve block, with the injection of 15 mL on the femoral nerve and 35 mL on the sciatic nerve. The time for the blockades and their duration were evaluated. After twenty minutes, patients were evaluated regarding the sensorial and motor blockades. RESULTS: Time for performance of spinal anesthesia was substantially lower than for combined sciatic-femoral nerve block. Unilateral blockade was achieved in 90 percent of the patients in the RQ group, and 100 percent in the CFI group. Bradycardia or hypotension was not observed. CONCLUSIONS: This study concluded that combined sciatic-femoral nerve block is technically easy to perform and it can be an alternative for unilateral blockade of the lower limbs. Unilateral spinal anesthesia with low doses of bupivacaine resulted in shorter time to perform it, lower number of attempts, and earlier recovery than combined sciatic-femoral nerve block, but with the same efficacy.

JUSTIFICATIVA Y OBJETIVOS: La raquianestesia unilateral puede presentar ventajas en pacientes ambulatoriales. El objetivo de este trabajo fue comparar la raquianestesia unilateral con el bloqueo combinado femoral-isquiático en cirugías ortopédicas unilaterales y ambulatoriales. MÉTODO: Sesenta pacientes fueron separados aleatoriamente en dos grupos de 30 para recibir 6 mg de bupivacaína hiperbárica o hipobárica (grupo RQ), en decúbito lateral izquierdo u 800 mg de lidocaína 1,6 por ciento con epinefrina en los nervios femoral e isquiático (grupo CFI), en decúbito dorsal. El bloqueo de los nervios fue realizado con una aguja de 150 mm conectada a un neuroestimulador e insertada en el punto medio entre las dos incisiones clásicas. Se inyectaron 15 mL en el nervio femoral y 35 mL en el nervio isquiático. Fue mensurado el tiempo para la realización de los bloqueos y su duración. Veinte minutos después, los pacientes fueron evaluados con relación a los bloqueos sensitivo y motor. RESULTADOS: El tiempo para la realización de la raquianestesia fue significativamente menor que el bloqueo combinado femoral-isquiático. El bloqueo unilateral se obtuvo en un 90 por ciento de los pacientes en el grupo RQ y en un 100 por ciento en el grupo CFI. El tiempo para la recuperación del bloqueo sensitivo y motor fue significativamente mayor en el grupo CFI. No hubo bradicardia o hipotensión. CONCLUSIONES: Por medio de este estudio, se llega a la conclusión de que es técnicamente fácil realizar el bloqueo anterior combinado femoral-isquiático y de que ese puede ser una alternativa para el bloqueo unilateral del miembro inferior. La raquianestesia unilateral con bajas dosis de bupivacaína, mostró un menor tiempo para la realización, un menor número de intentos y una recuperación más rápida del bloqueo combinado femoral-isquiático. Sin embargo, la efectividad fue la misma.