ABSTRACT
médicos anestesiologistas, a sedação é um item de conforto do paciente, e diversas vezes menosprezada. O centro cirúrgico apresenta estímulos que podem ser danosos aos pacientes enquanto submetidos a anestesia regional sem uma adequada sedação, e estes podem gerar repercussões leves, como medo de novas anestesias, ou mais graves, como traumas permanentes. Este estudo avaliou a prevalência de sensações desagradáveis (álgica, térmica, proprioceptiva e auditiva) em pacientes submetidos a anestesia regional associados ou não a sedação. Foi realizado um estudo transversal onde foram entrevistados 184 pacientes no pós-operatório imediato. Informações demográficas e sensitivas foram coletadas e a análise estatística realizada utilizando o programa SPSS® versão 17.0. Os dados foram descritos utilizando prevalência eaplicados os testes do qui-quadrado ou índice de correlação de Pearson, com p<0,05. O risco relativo em relação ao gênero e ao uso de opióide como parte da sedação foi estimado com intervalo de confiança de 95%. Estudo aprovado pelo Comitê de Ética em Pesquisa do Hospital Governador Celso Ramos. Dos 184 pacientes, 53% relataram algum estímulo sensitivo ou auditivo, 16.8% sentiram frio ou calor durante o procedimento, 20% sentiram algum tipo de dor na realização do bloqueio. Não foi observada diferença estatística com o uso de opióide. Pacientes do gênero feminino relataram com mais frequência dor/desconforto na realização do bloqueio em comparação com o gênero masculino, porém sem diferença estatística ( p= 0,057).
Many surgical procedures are performed under regional anesthesia, and the patient's understanding of the type of anesthesia that will be performed may become impaired. The surgical center presents other types of stimuli that may be harmful to patients while undergoing regional anesthesia without adequate sedation, and these may generate mild repercussions, such as fear of new anesthetics, or more serious, such as permanent trauma. This study evaluated the prevalence of unpleasant sensations (pain, thermal, proprioceptive and auditory) in patients submitted to regional anesthesia associated with sedation. A cross-sectional study was conducted in which 184 patients were interviewed in the immediate postoperative period. Demographic and sensory information was collected and statistical analysis performed using SPSS ® version 17.0. The data were described using prevalence and when possible applied chi-squareand Pearson correlation coefficient, with p <0.05. The relative risk for gender and opioid use was estimated with a 95% confidence interval. Study approved by the Comitê de Ética of Hospital Governador Celso Ramos. Of the 184 patients, 53% reported some sensory or auditory stimuli. 16.8% felt cold or hot during the procedure, 20% felt some type of pain in the blockade and reported it in the postoperative period. It was not observed statistic difference related to opioid use. Female patients reported more pain / discomfort in the blockade compared to males, but there was no statistical difference (p = 0.057).
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: A síndrome dolorosa complexa regional (SDCR) é uma síndrome dolorosa debilitante, com prevalência elevada em serviços de tratamento de dor. Apresenta diversas opções terapêuticas, sendo o bloqueio regional simpático uma das mais efetivas. O objetivo deste estudo foi relatar a intercorrência incomum do bloqueio de gânglio estrelado em paciente portadora de SDCR no membro superior direito. RELATO DO CASO: Paciente do sexo feminino, 49 anos, estado físico ASA I, admitida para tratamento de dor no ombro superior direito de forte intensidade, em queimação, associada a mudanças tróficas, após oito meses de traumatismo local. Diagnosticada com SDCR, indicou-se bloqueio simpático em gânglio estrelado. Após monitorização realizou-se bloqueio com bupivacaína a 0,5% (8 mL), evoluindo, após injeção em topografia de gânglio estrelado por abordagem paratraqueal, com parestesia de membros distal, ansiedade e taquidispneia importante. Imediatamente a paciente foi sedada e realizada intubação orotraqueal, permanecendo em observação por 135 minutos. Recuperada, foi levada para a sala de recuperação pós-anestésica (SRPA). Após três dias do procedimento, relatou redução de dor na escala visual analógica, de 10 para 3 pontos. CONCLUSÃO: Bloqueios regionais já demonstraram eficácia elevada no tratamento de quadros dolorosos vários, incluindo a SDCR. Este caso demonstrou que, apesar de serem incomuns, efeitos indesejáveis podem ocorrer, e o anestesiologista deve estar preparado para o suporte adequado do paciente nessas situações. O conhecimento adequado da anatomia e da técnica anestésica reduz a ocorrência desses efeitos.
BACKGROUND AND OBJECTIVES: Complex regional painful syndrome (CRPS) is a debilitating painful syndrome, with high prevalence in pain management centers. CRPS has several therapeutic options being regional sympathetic block one of the most effective. This study aimed at reporting an uncommon intercurrence of stellate ganglion block in patient with right upper limb CRPS. CASE REPORT: Female patient, 49 years old, physical status ASA I, admitted for management of severe right shoulder burning pain, associated to trophic changes eight months after local trauma. Diagnosis was CRPS and sympathetic stellate ganglion block was indicated. After monitoring, blockade was induced with 0.5% (8 mL) bupivacaine, evolving, after injection in stellate ganglion topography by paratracheal route, with distal limbs paresthesia, anxiety and severe tachydyspnea. Patient was immediately sedated and intubated, remaining in observation for 135 minutes, being then transferred to the post-anesthetic recovery unit (PACU). Three day after procedure, patient reported pain decrease from 10 to 3 according to the visual analog scale. CONCLUSION: Regional blocks are highly effective to manage different pain conditions, including CRPS. This case has shown that, although being uncommon, there might be undesirable effects and the anesthesiologist has to be prepared to adequately support patients in such situations. Adequate understanding of anatomy and of the anesthetic technique decreases the incidence of such effects.
Subject(s)
Humans , Female , Anesthesia, Spinal , Autonomic Nerve Block , PainABSTRACT
Sympathetic ganglion block (SGB) or intravenous regional block (IVRB) has been recommended for pain management in patients with complex regional pain syndrome type I (CRPS-I). Forty-five patients were initially selected but only 43 were accepted for the study. The present study evaluated the efficacy of IVRB produced by combining 70 mg lidocaine with 30 µg clonidine (14 patients, 1 male/13 females, age range: 27-50 years) versus SGB produced by the injection of 70 mg lidocaine alone (14 patients, 1 male/13 females, age range: 27-54 years) or combined with 30 µg clonidine (15 patients, 1 male/14 females, age range: 25-50 years) into the stellate ganglion for pain management in patients with upper extremity CRPS-I. Each procedure was repeated five times at 7-day intervals, and pain intensity and duration were measured using a visual analog scale immediately before each procedure. A progressive and significant reduction in pain scores and a significant increase in the duration of analgesia were observed in all groups following the first three blocks, but no further improvement was obtained following the last two blocks. Drowsiness, the most frequent side effect, and dry mouth occurred only in patients submitted to SGB with lidocaine combined with clonidine. The three methods were similar regarding changes in pain intensity and duration of analgesia. However, IVRB seems to be preferable to SGB due to its easier execution and lower risk of undesirable effects.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anesthesia, Intravenous/methods , Anesthetics, Local/administration & dosage , Autonomic Nerve Block/methods , Clonidine/administration & dosage , Lidocaine/administration & dosage , Reflex Sympathetic Dystrophy/drug therapy , Anesthetics, Local/adverse effects , Clonidine/adverse effects , Ganglia, Sympathetic , Lidocaine/adverse effects , Pain Measurement , Time Factors , Treatment OutcomeABSTRACT
@#ObjectiveTo determine the effectiveness of scalp nerve block for attenuating intraoperative hemodynamic stress, decreasing anesthetics and postoperative pain in neurosurgical patients.Methods60 adult patients undergoing frontotemporal craniotomies were randomly divided into three groups to receive scalp nerve block with normal saline as control in group A, 0.8% lidocaine combined with 0.13 % menthol in group B, and 1% ropivacaine in group C after intubation. Anesthesia was maintained with isoflurane. Mean arterial pressure (MAP) was controlled within-20%～+10% of the baseline with isoflurane (maximum limitation of isoflurane was 2 times of minimal alveolar air concentration) and intravenous nicardipine (0.5 mg bolus iv). Heart rate was controlled below 100 bpm with esmolol (50 mg bolus iv). Patient controlled analgesia (PCA) with tramadol was used for the postoperative analgesia. MAP, heart rate (HR) and end tidal isoflurane concentration were monitored during craniotomy. Visual analogous score (VAS) was observed after craniotomy.ResultsThe concentrations of end-tidal isoflurane in group A were significantly higher than that in group B and group C. MAP and HR in group A increased significantly than baseline values during operation, especially in skin incision, opening bone,while MAP and HR in group C did not increased significantly than baseline. VAS within 2 h postoperative in group B was significantly lower than that in group A (P<0.05).ConclusionThe scalp nerve block can effectively decrease intraoperative isoflurane concentration, attenuate hemodynamic responses and reduce postoperative pain.
ABSTRACT
There is no treatment either to prevent the development of complex regional pain syndromes (CRPS), or to adequately and specifically control established pain. Symptom-based analysis of pain is important for disease progress assessments and treatment outcomes. An intravenous regional block (IVRB) with local anesthetics can contribute to the management of CRPS. We observed that by the IVRB using ropivacaine, ketamine and clonidine, the patient with CRPS type I who was resistant to sympathetic ganglion block and medical treatment with gabapentin, carbamazepine and antidepressant, was relieved of neuropathic pain.
Subject(s)
Humans , Anesthetics, Local , Carbamazepine , Clonidine , Complex Regional Pain Syndromes , Ganglia, Sympathetic , Ketamine , NeuralgiaABSTRACT
BACKGROUND: Interruption of efferent sympathetic fibers is the mainstay of therapy in reflex sympathetic dystrophies(RSD) and be accomplished by temporary or permanent anesthetic blockade of sympathetic ganglia, surgical lesions of the sympathetic trunk, intravenous injecton of guanethidine or reserpine, or by systemic administration of adrenergic blocking drugs. In this study, the effects and the side effects of intravenous regional bretylium for the treatment of RSD were studied. METHODS: Seven patients have been administered with 2.0 mg/kg bretylium in 0.25% lidocaine with 100U of heparin three times weekly. A standard intravenous regional technique was used with 250~300 mmHg tourniquet pressure for 30 minutes. Blood pressure and pulse rate were monitored before injection, 1 minute and 5 minutes after injection, immediately before deflation of tourniquet, 1 minute, 5 minutes and 30 minutes after deflation of tourniquet. Pain and temperature evaluations were made before injection and at 1 week after every injection. RESULTS: The increase in skin temperature and decrease in pain score of the affected limb were noted after the use of bretylium in 5 patients out of 7 patients. These clinical effects probably resulted from bretylium,s ability to accumulate in adrenergic nerves and block norepinephrine release. One patient had hypotension immediately after tourniquet deflation. CONCLUSIONS: Intravenous regional bretylium provides significant pain relief for treatment of RSD.