Bloqueo del músculo erector de la espina como rescate analgésico para control de dolor agudo postoperatorio en fractura de escápula: reporte de caso / Erector spinae plane block as an analgesic rescue to acute control postoperative pain in scapula fracture: case report

Resumen: Introducción: el bloqueo en el plano del músculo erector de la espina (ESPB, por sus siglas en inglés) es un procedimiento seguro, en teoría menos exigente que las técnicas convencionales de anestesia regional torácica. Se utiliza para el tratamiento del dolor agudo y crónico. En la revisión de la literatura, no se encontraron informes de su uso como una técnica única en el dolor agudo de fractura de escápula. Presentación de caso: se reporta un caso clínico de ESPB como técnica experimental para el control del dolor postoperatorio agudo en fracturas de la escápula con aplicación a nivel T2. Se llevó a cabo postoperatorio con disminución de dolor después de 10 minutos de realizado, con una calificación de cero en la escala análoga del dolor. En este caso el ESPB fue realizado en el postoperatorio inmediato, con lo que se logró una disminución total del dolor a los 10 minutos, con posterior control de dolor a las 36 horas. Conclusión: este caso muestra la efectividad de ESPB como técnica experimental para control de dolor postoperatorio en fractura de escápula.

Abstract: Introduction: the erector spine plane block (ESPB) is a safe procedure, technically is less demanding than conventional thoracic regional anesthesia techniques. It is used for the treatment of acute and chronic pain. In the literature review, no reports of its use as a single technique in the acute pain of scapula fracture were found. Case presentation: ESPB is reported in a case as an experimental technique for controlling acute postoperative pain in scapula fractures with an application at the T2 level. It was performed postoperatively with a decrease in pain after 10 minutes and a score of zero on the analog pain scale. In this case, the ESPB was performed in the immediate postoperative period, achieving a total decrease in pain at 10 minutes, with subsequent pain control at 36 hours. Conclusion: this case shows the effectiveness of ESPB as an experimental technique for postoperative pain control in scapula fractures.

Anatomic barriers to paraspinal blocks: a cadaver case series

Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.

Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study

Abstract Background: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. Methods: Forty-one ASA III-IV patients who underwent SIFIB + PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. Results: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p < 0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p < 0.001) and during movement (p < 0.001 for the 1st and 3rd hours, and p = 0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p = 0.01). Conclusion: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Endoscopic ultrasound-guided celiac plexus neurolysis in pancreatic cancer-associated pain: different technical approaches in three challenging cases

Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancerassociated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.

El cáncer de páncreas se puede presentar con dolor abdominal intenso, siendo necesario el uso de analgésicos a largo plazo en muchos de los pacientes. Sin embargo, estos medicamentos pueden tener efectos adversos que finalmente reducen la calidad de vida de los pacientes. La neurólisis del plexo celíaco guiada por ecoendoscopia es un procedimiento que controla el dolor asociado a este tipo de neoplasia y consiste en inyectar un agente neurolítico en o alrededor del plexo celíaco. Presentamos tres casos en los cuales se realizan diferentes técnicas de abordaje terapéutico.

Evaluation of the efficacy of peripheral nerve block alone in episodic and chronic migraine patients / Avaliação da eficácia do bloqueio isolado do nervo periférico em pacientes com enxaquecas episódicas e crônicas

Abstract Background Peripheral nerve block (PNB) is usually performed in patients with migraine who are resistant to treatment with medications. Objective To compare the efficacy of PNB alone and PNB combined with prophylactic medications in migraine patients. Method The data on migraine patients who underwent PNB in our clinic between November 2019 and January 2022 were retrospectively reviewed. Blocks of the greater occipital nerve (GON), lesser occipital nerve (LON) and supraorbital nerve (SON) were performed upon admission and in the second week. Results The study included 116 patients. While 21 out of 39 episodic migraine (EM) patients continued to use prophylactic medications, 18 were followed up with PNB alone. While 49 out of 77 chronic migraine (CM) patients continued to use prophylactic medications, 28 were followed up with PNB alone. Comparison of the admission and second-month data of the patients who only underwent PNB and those who continued the drug treatment together with PNB in both the EM and the CM group showed that the number of days with pain, number of analgesics taken and scores on the Visual Analog Scale (VAS) and the Migraine Disability Assessment (MIDAS) were significantly reduced in both groups (p < 0.01). Comparison of the second-month data of the patients followed up with PNB alone and those followed up with PNB together with prophylactic medications showed that there was no significant difference between the EM and CM patients (p > 0.05). Conclusion Bilateral GON, LON and SON block with lidocaine injection seems to be an effective treatment on its own, without the need for prophylactic medications, in both EM and CM patients during a two-month follow-up.

Resumo Antecedentes O bloqueio de nervos periféricos (BNP) geralmente é realizado em pacientes com migrânea resistentes ao tratamento medicamentoso. Objetivo Comparar a eficácia do BNP isolado e do BNP combinado com medicamentos profiláticos em pacientes com enxaqueca. Método Os dados de pacientes com enxaqueca submetidos a BNP em nossa clínica entre novembro de 2019 e janeiro de 2022 foram revisados retrospectivamente. Bloqueios do nervo occipital maior (NOM), nervo occipital menor (NOM) e nervo supraorbital (NSO) foram realizados na admissão e na segunda semana. Resultados O estudo incluiu 116 pacientes. Enquanto 21 dos 39 pacientes com enxaqueca episódica (EE) continuaram a usar medicamentos profiláticos, 18 foram acompanhados apenas com BNP. Enquanto 49 dos 77 pacientes com enxaqueca crônica (EC) continuaram a usar medicamentos profiláticos, 28 foram acompanhados apenas com BNP. A comparação dos dados de admissão e do segundo mês dos pacientes que fizeram apenas BNP e daqueles que continuaram o tratamento medicamentoso junto com BNP, tanto no grupo EE quanto no grupo EC, mostrou que o número de dias com dor, o número de analgésicos tomados e os escores da Escala Visual Analógica (EVA) e da Avaliação da Incapacidade da Enxaqueca (AIE) foram significativamente reduzidos em ambos os grupos (p < 0,01). A comparação dos dados do segundo mês dos pacientes acompanhados apenas com BNP e aqueles acompanhados com BNP juntamente com medicações profiláticas mostrou que não houve diferença significativa entre os pacientes EE e EC (p > 0,05). Conclusão O bloqueio bilateral de NOM, NOM e NSO com injeção de lidocaína parece ser um tratamento eficaz por si só, sem a necessidade de medicamentos profiláticos, tanto em pacientes EE quanto com EC durante um seguimento de dois meses.

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius / Bloqueio supracondilar de nervo radial versus bloqueio de hematoma de fratura. Comparativo de sua eficácia em casos de fraturas do terço distal do rádio

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study / Bloqueio do grupo de nervos pericapsulares do quadril com e sem auxílio de ultrassonografia: Estudo cadavérico comparativo

Abstract Objective To evaluate the technical reproducibility of a block of the pericapsular nerve group (PENG) of the hip aided or not by ultrasound in cadavers. Materials and Methods The present is a randomized, descriptive, and comparative anatomical study on 40 hips from 2 cadaver groups. We compared the PENG block technique with the method with no ultrasound guidance. After injecting a methylene blue dye, we verified the dispersion and topographical staining of the anterior hip capsule through dissection. In addition, we evaluated the injection orifice in both techniques. Results In the comparative analysis of the techniques, there were no puncture failures, damage to noble structures in the orifice path, or differences in the results. Only 1 hip from each group (5%) presented inadequate dye dispersion within the anterior capsule, and in 95% of the cases submitted to either technique, there was adequate dye dispersion at the target region. Conclusion Hip PENG block with no ultrasound guidance is feasible, safe, effective, and highly reliable compared to its conventional counterpart. The present is a pioneer study that can help patients with hip pain from various causes in need of relief.

Resumo Objetivo Propor e avaliar a reprodutibilidade técnica do bloqueio do grupo de nervos pericapsulares (pericapsular nerve group, PENG, em inglês) do quadril sem o auxílio da ultrassonografia, em cadáveres, de forma comparativa à realização do bloqueio guiado pela ultrassonografia em outro grupo de cadáveres. Materiais e Métodos Estudo anatômico randomizado, descritivo e comparativo, realizado em 40 quadris divididos em 2 grupos amostrais de cadáveres. Fez-se uma comparação da técnica do bloqueio do PENG à técnica não guiada por ultrassonografia injetando-se corante azul de metileno, seguida de dissecção para verificação da dispersão e da coloração topográfica da cápsula anterior do quadril, além de avaliação do pertuito das injeções entre as técnicas. Resultados Na análise comparativa das técnicas, não houve falha na punção, lesão de estruturas nobres no pertuito, ou diferença nos resultados. Não houve adequada dispersão do corante pela cápsula anterior somente em 1 quadril de cada grupo (5%), e em 95% dos casos submetidos a qualquer uma das técnicas observou-se dispersão adequada do corante pela região alvo. Conclusão O bloqueio do PENG do quadril sem auxílio de ultrassonografia é factível, seguro, eficaz, e com alta confiabilidade quando comparado à sua realização guiada pelo aparelho de imagem. Este estudo é pioneiro, e pode ajudar muito os pacientes que têm dor no quadril por diversas causas e necessitam alívio.

Menor aerolización con bloqueo del nervio laríngeo superior comparado con lidocaína intravenosa a la extubación / Less aerolization with superior laryngeal nerve block compared to intravenous lidocaine at extubation

Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.

Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.

Adhesive Capsulitis' Patients Report Improvement in Functionality Trough International Classification of Functioning, Disability and Health Checklist and Dash After Suprascapular Nerve Blocks / Pacientes com capsulite adesiva relatam melhora da funcionalidade pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde e DASH após bloqueios do nervo supraescapular

Abstract Objective To evaluate the functionality in patients with adhesive capsulitis undergoing suprascapular nerve block (SSNB). Methods A before-and-after clinical prospective study in a single center was conducted with patients with secondary adhesive capsulitis treated with four nerve blocks based on anatomical limits. The sample was non-probabilistic, and it was obtained after a routine appointment at a specialized outpatient clinic. The instruments used for evaluation were the International Classification of Functioning, Disability and Health (ICF) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, which were applied at baseline (T0), one week after the fourth SSNB (T4), and three months after the first SSNB (T12). The paired t-test was used to compare the means of the ICF checklist items and DASH in the different: T0xT4;T4xT12;and T0xT12). The probability of rejecting the null hypothesis was 5%. Results The sample was composed of 25 individuals with a mean age of 58.16 years; 16 of them were female. The duration of the pain symptoms ranged from 2 to 16 months, with a mean of 5.92 months. The ICF checklist showed that all domains had already improved in T4 except for the environmental factors, which only improved at 03 months (p = 0.037). The patients reported improvements in shoulder function in T4, which increased more in T12, at the end of data collection (p = 0.019). Conclusion The SSNB technique is effective in patients with adhesive capsulitis after4 weeks of application, with improvements in individual's functionality lasting for 12 weeks.

Resumo Objetivo Avaliar a funcionalidade em pacientes com capsulite adesiva submetidos a bloqueio do nervo supraescapular (BNSE). Métodos Um estudo clínico prospectivo do tipo antes e depois foi realizado em um único centro com pacientes com capsulite adesiva secundária tratados com quatro bloqueios baseados em limites anatômicos. A amostra foi não probabilística, tendo sido obtida após consulta de rotina em ambulatório especializado. Os instrumentos utilizados para avaliação foram a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e o questionário de Disfunções do Braço, Ombro e Mão (DASH), que foram aplicados antes da intervenção (T0), uma semana após o quarto BNSE (T4),etrêsapósoprimeiroBNSE(T12).AsmédiasdositensdaCIFedoDASHnos diferentes tempos (T0 x T4; T4 x T12; e T0 x T12) foram comparadas por meio do teste t pareado. A probabilidade de rejeitar a hipótese nula foi de 5%. Resultados A amostra foi composta por 25 indivíduos com média de idade de 58,16 anos; 16 eram mulheres. A duração dos sintomas dolorosos variou de 2 a 16 meses, com média de 5,92 meses. A CIF mostrou que todos os domínios já haviam melhorado em T4 à exceção dos fatores ambientais, que só melhoraram aos 3 meses (p = 0,037). Os pacientes já relataram melhora na função do ombro em T4 emaisainda em T12,ao finaldacoletadedados (p = 0,019). Conclusão A técnica de BNSE é eficaz em pacientes com capsulite adesiva após 4 semanas de aplicação, com melhora da funcionalidade do indivíduo e sua manutenção até 12 semanas.

Transient median nerve palsy following ultrasound-guided subscapularis plane block: a case report

Abstract The subscapularis plane block is an effective approach to anesthetize axillary and upper subscapular nerves. There have been no reports regarding brachial plexus paralysis as a potential complication to date. Described here is a case of median nerve palsy following ultrasound-guided subscapularis plane block for awake frozen shoulder manipulation that was performed on a 52-year-old female diagnosed with adhesive capsulitis. The patient could not flex digits two and three, and ipsilateral inner palm numbness occurred shortly after the block commenced, with complete resolution in the next two hours. The local anesthetics spillage towards brachial plexus with possible partial paralysis should always be expected after subscapularis plane block.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Complicaciones de la técnica anestésica mandibular Spix en la clínica odontológica de la Universidad Andrés Bello / Incidence of complications of mandibular anesthetic Spix techniques in the Andrés Bello University dental clinic

Objetivo: Determinar la incidencia de complicaciones de la técnica anestésica Spix en procedimientos odontológicos a pacientes atendidos en la clínica de la Universidad Andrés Bello (UNAB). Material y Métodos: Se analizó a 37 pacientes que fueron atendidos por alumnos de cuarto y quinto año de la clínica odontológica, a los cuales se le realizó la técnica anestésica Spix para realizar el procedimiento odontológico. Se consignó mediante la observación la presencia de formación de hematomas intraorales en el sitio de punción, rotura de la aguja, cantidad de tubos de solución anestésica inyectados, presencia de dolor a la inyección de solución anestésico y la presencia o no de parálisis facial. Mediante la recolección de datos y posterior encuesta a los participantes se consignó la presencia de trismus al día siguiente de la atención y parestesia persistente al día siguiente de la atención. Resultados: De 37 pacientes estudiados que recibieron la técnica anestésica Spix, 6 presentaron hematoma intraoral (16,2%), ninguno reportó rotura de la aguja, 1 presentó parálisis facial (2,7%), 1 presentó parestesia persistente al día siguiente (2,7%), 12 presentaron trismus posterior a la inyección (32,4%). El rango de dolor reportado fue entre 1 y 4 según la escala EVA. Conclusión: Hay una baja incidencia de las complicaciones asociadas a la técnica anestésica Spix en la clínica odontológica de la UNAB, siendo el trismus la complicación más frecuente. Se necesita un mayor número de muestra para entender mejor esta realidad.

Objective: To determine the incidence of complications of the Spix anesthetic technique in the dental procedures of patients attended at the Andrés Bello University dental clinic. Material and Methods: 37 patients who were cared for by fourth- and fifth-year students from the dental clinic of the Andrés Bello University were analyzed, who underwent the Spix anesthetic technique to perform the dental procedure. The presence of intraoral hematoma formation at the puncture site, needle breakage, number of injected anesthesia tubes, presence of pain upon injection of anesthetic and the presence or not of facial paralysis were recorded. Through data collection and subsequent survey of the participants, the presence of trismus was recorded the day after care. Results. Of the 37 cases of patients studied who received the Spix anesthetic technique, 6 had intraoral hematoma (16.2%), no needle break was reported, 1 had facial paralysis (2.7%), 1 had persistent paresthesia at the next day (2.7%), 12 presented trismus after the injection (32.4%), the pain range was between 1 and 4 according to the VAS scale. Conclusion. There is a low incidence of complications associated with the Spix anesthetic technique in the Andrés Bello University dental clinic, trismus being the most frequent (32.4%). A larger sample number should be needed to better understand this reality.

The effectiveness of foraminal root block in relieving sciatic pain due to lumbar disc herniation / A eficácia do bloqueio radicular foraminal no alívio da dor ciática devido à hérnia discal lombar

ABSTRACT Objective: To evaluate the clinical profile, pain improvement, and the need for surgical interventions in patients undergoing transforaminal block with the use of corticosteroids and anesthetics. Methods: This is a prospective, randomized, double-blind study with 45 patients with unilateral radicular pain in their lower limbs and a single-segment lumbar disc herniation diagnosis. In the intervention group, transforaminal blocks with bupivacaine, dexamethasone, and clonidine were applied and in the control group, distilled water and bupivacaine. The Oswestry questionnaire was applied. Results: We included 24 female (53.4%) and 21 male patients (46.6%). Of those with an occupation, 85.71% (n = 30) were relieved from their duties due to their illness and 14.29% (n = 5) continued to work with limitations. Those who underwent transforaminal block with an injection of corticosteroids, clonidine, and anesthetics showed immediate relief. However, such effect failed to alleviate patients' symptoms after three weeks. We observed that 52% of patients showed varying degrees of improvement. The control group experienced mild pain relief after one week, which also failed to last after three weeks. Moreover, 50% of patients improved in varying degrees. Conclusion: Further studies with larger samples, new epidemiological data, and longer follow-ups are necessary to validate our hypotheses. Level of Evidence II, Prospective Study.

RESUMO Objetivo: Avaliar o perfil clínico, a melhora da dor e a necessidade de intervenções cirúrgicas em pacientes submetidos ao bloqueio transforaminal com uso de corticosteroides e anestésicos. Métodos: Estudo prospectivo, randomizado e duplo-cego realizado com 45 pacientes com dor radicular unilateral em membros inferiores e diagnóstico de hérnia discal lombar em um único segmento. No grupo intervenção, os bloqueios transforaminais foram feitos com bupivacaína, dexametasona e clonidina; no controle, água destilada e bupivacaína. Foi aplicado questionário de Oswestry. Resultados: A amostra foi composta de 24 mulheres (53,4%) e 21 homens (46,6%). Dos pacientes com ocupação, 85,71% (n = 30) estavam afastados de suas funções devido à doença e 14,29% (n = 5) continuavam a trabalhar com limitações. Os que foram submetidos ao bloqueio transforaminal com injeção de corticoide, clonidina e anestésico apresentaram alívio imediato. Após três semanas, contudo, o efeito não perdurou de forma tão satisfatória, e 52% dos pacientes apresentaram melhora em graus variados. No grupo controle, houve discreto alívio álgico após uma semana, que não perdurou de forma satisfatória após três semanas, com 50% dos pacientes evoluindo para melhora em graus variados. Conclusão: Mais estudos com espaço amostral maior, novos dados epidemiológicos e seguimento mais prolongado são necessários para validar as hipóteses aventadas. Nível de Evidência II, Estudo Prospectivo.

The effectiveness and safety of cranial nerve block in migraine: a critical review / A eficácia e segurança do bloqueio de nervos cranianos na enxaqueca: uma revisão crítica

Cranial nerve blocks (CNBs) have been used for the acute and preventive treatment of a variety of headaches, including migraine. The effectiveness of CNBs in migraine is usually observed beyond the duration of the nerve block, possibly due to central pain modulation. The most used target is the greater occipital nerve. Other commonly targeted nerves are the lesser occipital nerve and various branches of the trigeminal nerve, including the supratrochlear, supraorbital, and auriculotemporal nerves. CNBs are generally safe and well-tolerated procedures that can be performed in either emergency or outpatient settings. There is currently no guideline standardizing CNBs in migraine. In clinical practice, as well as the few published studies, the results are encouraging, justifying further studies in the area. In the present study we critically review the literature about the safety and efficacy of CNBs in the treatment of migraine attacks and in the preventive treatment of migraine.

Bloqueios de nervos cranianos (BNCs) têm sido usados ​​para o tratamento agudo e preventivo de uma variedade de dores de cabeça, incluindo enxaqueca. A eficácia dos BNC na enxaqueca é geralmente observada além da duração do bloqueio nervoso, possivelmente devido à modulação central da dor. O alvo mais utilizado é o nervo occipital maior. Outros nervos comumente alvo são o nervo occipital menor e vários ramos do nervo trigêmeo, incluindo os nervos supratroclear, supraorbital e auriculotemporal. Os CNBs são geralmente procedimentos seguros e bem tolerados que podem ser realizados em ambientes de emergência ou ambulatoriais. Atualmente não há nenhuma diretriz padronizando BNCs na enxaqueca. Na prática clínica, assim como nos poucos estudos publicados, os resultados são animadores, justificando novos estudos na área. No presente estudo revisamos criticamente a literatura sobre a segurança e eficácia dos BNC no tratamento de crises de enxaqueca e no tratamento preventivo da enxaqueca.

A Comparison between Inferior Alveolar Nerve Block and Crestal Anesthesia in Children Undergoing Dental Extraction Procedure

ABSTRACT Objective: To evaluate the efficacy of crestal anesthesia compared to the inferior alveolar nerve block (IANB) in 6-9-year-old children undergoing tooth extraction. Material and Methods: This case-control study was conducted on 70 children who needed bilateral mandibular primary molar extractions. The Faces Pain Scale was used to determine the efficacy of the anesthetic technique. Demographic data, onset time of anesthesia, duration of anesthesia, and blood pressure were also recorded. The data were analyzed using SPSS 25 and analytical tests: t-test, chi-squared test, and one-way ANOVA. The level of significance was set at p<0.05. Results: The efficacy of the IANB was significantly higher than the crestal anesthesia (p<0.05). The duration of IANB anesthesia was significantly more than the crestal anesthesia (p<0.05). The two anesthetic techniques showed no significant differences in pediatric blood pressure as a determinant of the pain evoked in children during the injection (p>0.05). Conclusion: Crestal anesthesia proved an effective method to extract primary molars. However, further studies are necessary to confirm this.

Anesthetic block of the intertransverse septum, a prospective observational study / Bloqueio anestésico do septo intertransverso, estudo prospectivo observacional / Bloqueo anestésico del septo intertransverso, estudio prospectivo observacional

ABSTRACT Objective: To evaluate the influence of intertransverse septal anesthetic block (BASIT) on postoperative pain in lumbar spine surgery. Methods: The study was carried out prospectively and observationally. Were included 105 patients who underwent posterior lumbar spine surgery, divided into two groups: 35 patients in the experimental group, who received BASIT at the end of the procedure, and 70 patients in the control group, without BASIT. Patients were assessed for low back pain (visual pain scale), opioid consumption on the 1st postoperative day, complications related to the procedure, and length of stay after surgery. Results: The sample consisted of 46 men and 59 women, with a mean age of 57.7 years (21 to 90 years). Mean postoperative pain in the experimental group was 1.88, and in the control group 2.11 (p<0.05). There was a trend towards less morphine use in the experimental group with p = 0.053. There was a statistical difference in morphine consumption between patients who did not previously use opioids and those who already used them (p 0.04). There was no difference between the groups regarding length of stay. Conclusion: Anesthetic blockade of the intertransverse septum reduced the consumption of opioids and the levels of low back pain after surgery (p<0.05), with no statistical difference in length of hospital stay or complications related to the technique. Level of Evidence II; Clinical Prospective Study.

RESUMO: Objetivo: Avaliar a influência do bloqueio anestésico do septo intertransverso (BASIT) sobre a dor pós-operatória em cirurgia de coluna lombar. Metodologia: O estudo foi realizado de modo prospectivo e observacional. Foram incluídos no estudo 105 pacientes submetidos à cirurgia da coluna lombar por via posterior e divididos em dois grupos: 35 pacientes no grupo experimental, que recebeu o BASIT ao final do procedimento e 70 pacientes no grupo controle, sem o BASIT. Os pacientes foram avaliados quanto à dor lombar (escala visual de dor), consumo de opioide no 1º dia pós-operatório, complicações referentes ao procedimento e tempo de internamento após a cirurgia. Resultados: A amostra consistiu em 46 homens e 59 mulheres, com média de idade de 57,7 anos (21 a 90 anos). A média de dor pós-operatória do grupo experimento foi 1,88 e no grupo controle 2,11 (p<0,05). Houve uma tendência a menor uso de morfina no grupo experimento com p = 0,053. Houve diferença estatística no consumo de morfina entre os pacientes que não utilizavam opioides previamente quanto comparados aos que já faziam uso (p 0,04). Não houve diferença entre os grupos quanto ao tempo de internamento nem eventos adversos relacionados à técnica. Conclusão: O bloqueio anestésico do septo intertransverso reduziu o consumo de opioides e os níveis de dor lombar após cirurgia (p<0,05), não havendo diferença estatística no tempo de internamento, nem intercorrências relacionadas a técnica. Nível de Evidência II; Estudo Prospectivo Clínico.

RESUMEN: Objetivo: Evaluar la influencia del bloqueo anestésico del septo intertransverso (BASIT) sobre el dolor posoperatorio en cirugía de columna lumbar. Método: El estudio se realizó de forma prospectiva observacional. Fueron incluidos en el estudio 105 pacientes sometidos a cirugía de columna lumbar posterior y se dividieron en dos grupos: 35 pacientes en el grupo experimental, recibieron BASIT al final del procedimiento, y 70 pacientes en el grupo control, sin BASIT. Los pacientes fueron evaluados por dolor lumbar (escala visual de dolor), consumo de opioides en el primer día postoperatorio, complicaciones relacionadas con el procedimiento y tiempo de estancia hospitalaria después de la cirugía. Resultado: La muestra consistió en 46 hombres y 59 mujeres, con una edad media de 57,7 años (21 a 90 años). El dolor postoperatorio medio en el grupo experimental fue de 1,88 y en el grupo control de 2,11 (p<0,05). Hubo una tendencia hacia un menor uso de morfina en el grupo experimental con p = 0,053. Hubo una diferencia estadística en el consumo de morfina entre los pacientes que no usaban previamente opioides en comparación con los que ya los usaban (p 0,04). No hubo diferencia entre los grupos con respecto a la duración de la estancia. Conclusión: El bloqueo anestésico del septo intertransverso redujo el consumo de opioides y los niveles de dolor lumbar posoperatorio (p<0,05), sin diferencia estadística en la estancia hospitalaria ni en las complicaciones relacionadas con la técnica. Nivel de Evidencia II; Estudio Clínico Prospectivo.

Accuracy of Hip Pericapsular Nerve Block (PENG) without Ultrasound Aid in Patients with Hip Pain / Acurácia do bloqueio dos nervos pericapsulares (PENG) do quadril sem auxílio de ultrassonografia em pacientes com dor no quadril

Abstract Objective To describe and evaluate the accuracy of the pericapsular nerve group (PENG) block technique with no ultrasound guidance. Method Series of 40 infiltrations in patients with hip pain undergoing outpatient follow-up in the hip surgery group or admitted to the emergency room from a hospital in São Paulo, SP, Brazil. The hip PENG technique was guided by palpable anatomical pelvic structures, with no ultrasound orientation for needle positioning, using the equipment only to check the correct location after an unguided puncture. Results In the 40 hips infiltrated from 35 patients with a mean age of 59.2 years, the success rate was 85%. Among the mispositioned cases, 71.4% occurred in the first 13 applications and 28.6% in the subsequent 27 applications. In all patients, the neurovascular bundle was in the medial third of the pen-made demarcation. Even in cases with a failed needle location, the distance from the neurovascular bundle was safe. A single adverse effect occurred, with spontaneous improvement of the femoral nerve apraxia within two days. Conclusion Unguided PENG block is a viable technique for a physician knowledgeable about its application in services with no ultrasound availability.

Resumo Objetivo Descrever e avaliar a acurácia da técnica do bloqueio PENG realizado sem auxílio de ultrassonografia. Método Série de 40 infiltrações em pacientes com dor no quadril, em acompanhamento ambulatorial no grupo de cirurgia do quadril ou admitidos no pronto atendimento de um hospital na cidade de São Paulo. Utilizada a técnica de bloqueio nervoso pericapsular do quadril (PENG) guiado por estruturas anatômicas palpáveis da pelve e sem auxílio de ultrassonografia no posicionamento da agulha, usando o aparelho apenas para conferência da localização correta após punção não guiada. Resultados Nos 40 quadris infiltrados em 35 pacientes com idade média de 59,2 anos, obtivemos um índice de acerto de 85%. Dos casos mal posicionados 71,4% ocorreram nas primeiras 13 aplicações e 28,6% nas 27 aplicações subsequentes. Em todos os pacientes o feixe neurovascular estava situado no terço medial da marcação realizada à caneta e mesmo nos casos em que houve falha da localização da agulha havia distância segura ao feixe neurovascular. Obtivemos apenas 1 caso de efeito adverso, onde ocorreu apraxia do nervo femoral com melhora espontânea em 2 dias. Conclusão O bloqueio PENG não guiado é uma técnica viável e pode ser realizada por um médico que já possui conhecimento na aplicação, em serviços onde não haja disponibilidade do aparelho de ultrassonografia.

Effect of right stellate ganglion block-serratus anterior plane block combined with general anesthesia in thoracoscopic radical resection of lung cancer / 中国医师杂志

Objective:To investigate the effect of right stellate ganglion block (RSGB)-serratus anterior plane block (SAPB) combined with general anesthesia in thoracoscopic radical resection of lung cancer.Methods:A total of 90 patients who planned to undergo thoracoscopic radical resection of lung cancer in Xiangya Changde Hospital from March 2020 to September 2021 were prospectively selected and divided into 3 groups by random number table method: general anesthesia group (G group), (SAPB)+ general anesthesia group (SG group), RSGB+ SAPB+ general anesthesia group (RSG group), 30 cases in each group. The SG group received SAPB on the operative side before general anesthesia, and the RSG group received RSGB+ SAPB on the operative side before general anesthesia. After the blocking effect was determined, all patients were given general anesthesia in the same scheme according to their weight, and patients were given patient-controlled intravenous analgesia (PCIA) after surgery. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia (T 0), before intubation (T 1), 1 min after intubation (T 2), 5 min after intubation (T 3), at extubation (T 4) and 5 min after extubation (T 5). The intraoperative dosage of remifentanil, incidence of nausea and vomiting (PONV) within 24 hours after surgery, number of additional PCIA within 24 hours, the Visual Analogue Scale (VAS) of static and dynamic pain, the Bruggrmann Comfort Scale (BCS) and Richard Campbell Sleep Questionnaire (RSCQ) 24 hours after surgery were recorded. Results:Compared with T 0, the MAP and HR in 3 groups were increased 1 min after intubation (T 2) and at extubation (T 4), but the increases in RSG group were significantly less than those in G and SG groups (all P<0.05). The remifentanil dosage, PONV incidence and PCIA supplemental times in SG and RSG groups were less than those in G group, and the BCS score and RSCQ score were higher than those in G group (all P<0.05); the BCS score and RSCQ score in RSG group were higher than those in SG group (all P<0.05). Conclusions:RSGB+ SAPB combined with general anesthesia in thoracoscopic radical resection of lung cancer has little circulation fluctuation, good postoperative analgesia effect, less adverse reactions and high comfort level.

Effects of general anesthesia combined with serratus anterior plane block on quality of life and postoperative pain in patients undergoing breast cancer surgery / 中国医师杂志

Objective:To observe the effect of general anesthesia combined with serratus anterior plane block (SAPB) on the quality of life and postoperative pain of patients undergoing breast cancer surgery.Methods:The clinical data of 80 patients with breast cancer undergoing elective modified radical mastectomy admitted to the Affiliated Hospital of Guilin Medical College from January 2020 to March 2021 were retrospectively analyzed. According to different anesthesia methods, they were divided into control group and observation group, with 40 cases in each group. The control group received simple general anesthesia, while the observation group received general anesthesia combined with SAPB. The degree of postoperative pain in the two groups at 3, 6, 12 and 24 h after surgery was evaluated with the Numerical Rating Scale (NRS) score, and the postoperative recovery at 24 h after surgery and quality of life at 3 h and 6 months after surgery were evaluated with the Quality of Recovery-40 (QoR-40) score and the Short Form of Health Survey (SF-36). The serum levels of pain related cytokines[neuropeptide Y (NPY), prostaglandin E2 (PGE2), and 5-hydroxytryptamine (5-HT) ] in the two groups were compared. The complications of the two groups were recorded.Results:The NRS score in the observation group at 6 h and 12 h after operation were lower than those in the control group (all P<0.05). The QoR-40 score at 24 h after operation and SF-36 score at 6 months after operation in the observation group were higher than those in the control group (all P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). The NPY, PGE2 and 5-HT levels of patients in the observation group were lower than those in the control group at 24 h after operation (all P<0.05). Conclusions:The use of general anesthesia combined with SAPB in modified radical mastectomy for breast cancer can alleviate postoperative pain and improve long-term quality of life, which may be related to the reduction of pain related cytokine secretion.

Application of transversus abdominis plane block combined with sevoflurane in laparoscopic cholecystectomy for patients with coronary heart disease / 中国医师杂志

Objective:To investigate the application value of ultrasound guided transversus abdominis plane block (TAP) combined with sevoflurane inhalation general anesthesia in patients with coronary heart disease undergoing laparoscopic cholecystectomy.Methods:A total of 90 patients with coronary heart disease who received laparoscopic cholecystectomy in the Third Hospital of Changsha from April 2021 to December 2021 were selected. The patients were randomly divided into observation group (47 cases) and control group (43 cases). The observation group was given ultrasound guided TAP combined with sevoflurane inhalation general anesthesia; The control group was given conventional general anesthesia. The heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO 2) of the two groups were observed before anesthesia (T 1), at the time of skin resection (T 2), at the time of gallbladder separation (T 3) and at the time of skin suture (T 4). The recovery time, operation time, anesthesia time and postoperative Visual Analogue Scale(VAS) score at 2, 6, 12 and 24 h were recorded. The levels of serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), myocardial troponin (cTnI), superoxide dismutase (SOD) and malondialdehyde (MDA) before and after operation were detected, and the incidence of adverse cardiovascular events in the two groups were observed. Results:The MAP and HR in T 2, T 3 and T 4 were higher than those in T 1 in the control group (all P<0.05); The MAP and HR at T 2, T 3 and T 4 in the observation group were significantly lower than those in the control group (all P<0.05); There was no significant difference in operation time and anesthesia time between the observation group and the control group (all P>0.05); The recovery time of observation group was significantly earlier than that of control group ( P<0.05). The CK, CK-MB and cTnI in the observation group were significantly lower than those in the control group at 24 h after surgery (all P<0.05). There was no significant difference in SOD and MDA between the observation group and the control group at 24 h after surgery (all P<0.05). The VAS score of the observation group were lower than those of the control group at 2 h, 6h, 12 h and 24 h after surgery (all P<0.05). There was no significant difference in the incidence of postoperative adverse cardiovascular events between the two groups ( P>0.05). Conclusions:TAP combined with sevoflurane inhalation general anesthesia has good application value in laparoscopic cholecystectomy in elderly patients, which can improve the anesthesia effect and the quality of recovery, and significantly reduce the myocardial injury of patients.