ABSTRACT
Abstract Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
Subject(s)
Humans , Acute Pain/etiology , Peripheral Nerve Injuries/etiology , Anesthesia, Conduction/adverse effects , Anesthesia, Epidural/adverse effects , Tertiary Healthcare , Retrospective Studies , Abscess/complications , Hematoma/etiology , HospitalsABSTRACT
Abstract Background and objectives: Total knee arthroplasty and total hip arthroplasty are associated with chronic pain development. Of the studies focusing on perioperative factors for chronic pain, few have focused on the differences that might arise from the anesthesia type performed during surgery. Methods: This was a prospective observational study performed between July 2014 and March 2015 with patients undergoing unilateral elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) for osteoarthritis. Data collection and pain evaluation questionnaires were performed in three different moments: preoperatively, 24 hours postoperatively and at 6 months after surgery. To characterize pain, Brief Pain Inventory (BPI) was used and SF-12v2 Health survey was used to further evaluate the sample's health status. Results: Forty and three patients were enrolled: 25.6% men and 74.4% women, 51,2% for total knee arthroplasty and48.8% for total hip arthroplasty, with a mean age of 68 years. Surgeries were performed in 25.6% of patients under general anesthesia, 55.8% under neuraxial anesthesia and 18.6% under combined anesthesia. Postoperatively, neuraxial anesthesia had a better pain control. Comparing pain evolution between anesthesia groups, neuraxial anesthesia was associated with a decrease in “worst”, “medium” and “now” pain at six months. Combined anesthesia was associated with a decrease of “medium” pain scores at six months. Of the three groups, only those in neuraxial group showed a decrease in level of pain interference in “walking ability”. TKA, “worst” pain preoperatively and general were predictors of pain development at six months. Conclusions: Patients with gonarthrosis and severe pain preoperatively may benefit from individualized pre- and intraoperative care, particularly preoperative analgesia and neuraxial anesthesia.
Resumo Justificativa e objetivos: A artroplastia total de joelho e a artroplastia total de quadril estão associadas ao desenvolvimento de dor crônica. Dentre os estudos que avaliam os fatores perioperatórios para a dor crônica, poucos abordam as diferenças que podem surgir do tipo de anestesia feita durante a cirurgia. Métodos: Estudo observacional, prospectivo, feito entre julho de 2014 e março 2015 com pacientes submetidos à ATJ unilateral eletiva ou ATQ para a osteoartrite. A coleta de dados e a avaliação da dor por meio de questionários foram feitas em três momentos distintos: no pré-operatório, em 24 horas de pós-operatório e aos seis meses após a cirurgia. O Inventário Breve da Dor (IBD) foi usado para caracterizar a dor o e o Questionário SF-12v2 foi usado para avaliar melhor o estado de saúde da amostra. Resultados: Foram inscritos 43 pacientes: 25,6% homens e 74,4% mulheres, 51,2% para ATJ e 48,8% ATQ, com média de 68 anos. A cirurgia foi feita em 25,6% dos pacientes sob anestesia geral, em 55,8% sob anestesia neuroaxial e em 18,6% sob anestesia combinada. No pós-operatório, a anestesia neuraxial apresentou melhor controle da dor. Na comparação da evolução da dor entre os grupos, a anestesia neuraxial foi associada a uma diminuição de “pior”, “médio” e “sem” dor em seis meses. A anestesia combinada foi associada a uma diminuição do escore “médio” de dor em seis meses. Dos três grupos, apenas aqueles no grupo neuraxial apresentaram uma diminuição do nível de interferência da dor na “capacidade de caminhar”. ATJ, “pior” dor no pré-operatório e anestesia geral foram preditivos de desenvolvimento de dor aos seis meses. Conclusões: Os pacientes com gonartrose e dor intensa no pré-operatório podem obter benefício de cuidados individualizados no pré e intraoperatório, particularmente de analgesia no pré-operatório e anestesia neuraxial.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pain, Postoperative/epidemiology , Elective Surgical Procedures/adverse effects , Orthopedic Procedures/adverse effects , Anesthesia , Pain Measurement , Prospective Studies , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Middle AgedABSTRACT
ABSTRACT In this case report we highlight the uniqueness of aphonia as, to the best of our knowledge, cases of aphonia related to interscalene brachial plexus block (IBPB) are not described in the literature. Although hoarseness is a common complication of IBPB, aphonia is not. Therefore, we think it is important to publicize the first case of aphonia after IBPB, which may have arisen only because of a recurrent laryngeal nerve chronic injury contralateral to the IBPB site.
RESUMO Relativamente a este relato de caso destacamos a sua singularidade, uma vez que não se encontram descritos na literatura, tanto ou quanto os autores puderam investigar, casos de afonia após uma anestesia combinada com bloqueio do plexo braquial via interescalénica (BPBI). Embora a rouquidão seja uma complicação frequente do BPBI, a afonia não o é. Desse modo, pensamos ser importante dar a conhecer o primeiro caso de afonia após o BPBI, que na opinião dos autores surgiu apenas por causa de uma lesão crônica do nervo laríngeo recorrente contralateral ao local do BPBI.
Subject(s)
Humans , Female , Postoperative Complications/etiology , Shoulder Joint/surgery , Aphonia/ethnology , Brachial Plexus Block/adverse effects , Arthroscopy , Anesthesia, General , Middle AgedABSTRACT
Esta pesquisa se insere no contexto da formação de recursos humanos para a saúde que, na busca de melhor preparação dos profissionais para atuar no modelo do Sistema Único de Saúde, incentiva mudanças nos cursos de graduação de saúde das universidades brasileiras. Visando caracterizar a formação em saúde da PUC Minas, unidade São Gabriel, a luz das diretrizes curriculares e a partir do tripé ensino, pesquisa e extensão, mapeamos os cenários de aprendizagem em saúde existentes entre os anos de 2006 e 2008, período anterior a entrada do curso para o Programa Nacional de Reorientação da Formação Profissional da Saúde (Pró-Saúde). Para tal mapeamento, utilizou-se a análise documental do projeto político-pedagógico do curso, relatórios e outros documentos sobre estágios supervisionados, pesquisa, extensão e monografia, além da produção dos docentes. Os campos da saúde e da saúde pública, bem como a abordagem interdisciplinar estão presentes na proposta do curso. Observa-se no período estudado a presença diversificada de cenários de aprendizagem e de temáticas em saúde, mesmo que alguns desses estejam pouco integrados ou ainda dispersos na formação e na articulação entre ensino, pesquisa e extensão. A configuração dos cenários de aprendizagem reafirma a proposta de reorientar a formação em saúde defendida pelo programa, principalmente na atuação multiprofissional e na abordagem interdisciplinar, ainda pouco presentes nos cenários de aprendizagem analisados. Explorando fontes documentais, compreendemos uma dada realidade de formação em saúde que ultrapassa as prescrições curriculares, e apresenta o currículo como possibilidade de construção de sujeitos.
This research is part of the discussion on the formation of health human resources for health, in an attempt to find well-prepared professionals to act in the Brazilian Health System (Unified Health System SUS), encouraging changes in the undergraduate health courses of Brazilian universities. In order to characterize the health training of a private university of Minas Gerais (PUC Minas), regarding the national curriculum guidelines and the tripod of university education, we mapped the learning scenarios in health between 2006 and 2008, prior to the entering of the course to the National Program for the Reorientation of Vocational Training of Health (Pró-Saúde). For doing such work, we used documentary analysis of the political and pedagogic project of the course, reports and other documents on supervised internships, research, extension programs and articles, besides the production of the professors. The fields of health and public health, as well as an interdisciplinary approach are present in the course guidelines. It was observed in the studied period the varied presence of learning scenarios and health themes, even if they can be poorly integrated or dispersed in the training process and in the articulation of teaching/ learning, research and extension. The configuration of learning scenarios reaffirms the proposal to reorient the health education defended by the program, especially in multiprofessional actions and in the interdisciplinary approach, still present in some of the analyzed learning scenarios. Exploring documentary sources, it was possible to understand the given reality of health education that goes beyond the curriculum requirements, and presents the curriculum as a possibility for the construction of subjects.