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2.
Revista Digital de Postgrado ; 10(1): 262, abr. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147578

ABSTRACT

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)


The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Prostate/pathology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diclofenac/therapeutic use , Anesthetics, Local/therapeutic use , Lidocaine/therapeutic use , Nerve Block/methods , Placebos/therapeutic use , Prostate/diagnostic imaging , Administration, Rectal , Prospective Studies , Pain Management/methods , Image-Guided Biopsy , Anesthesia, Local
3.
Rev. colomb. anestesiol ; 49(1): e301, Jan.-Mar. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1149795

ABSTRACT

Abstract Complications in airway management remain a common cause of anesthesia-associated mortality. When a patient is considered with anticipated difficult airway, the management depends on several variables, however, at present, the standard of management continues to be the patient awake approach. In scenarios of acute upper airway obstruction, the only way to guarantee adequate ventilation is to obtain a translaryngeal or transtracheal access, for which, it is necessary to use local anesthesia and grade I / II sedation, avoiding loss of spontaneous ventilation. For this purpose, we propose ultrasound-guided superior laryngeal nerve block, in order to standardize an ultrasound landmark that is reproduceable, with a high success rate, which allows limiting complications related to regional anatomic techniques and thus facilitating the securing of the airway in these patients.


Resumen Las complicaciones en el manejo de la vía aérea siguen siendo una causa frecuente de mortalidad relacionada con anestesia. Cuando un paciente se considera con vía aérea difícil anticipada, el manejo depende de diversas variables, sin embargo, en la actualidad, el estándar de manejo sigue siendo el abordaje con paciente despierto. En escenarios de obstrucción aguda de la vía aérea superior, la única forma de garantizar una adecuada ventilación es obtener un acceso translaríngeo o transtraqueal, para lo cual, es necesario el uso de anestesia local y de sedación grado I/II evitando la pérdida de ventilación espontánea. Con este propósito, planteamos el bloqueo del nervio laríngeo superior guiado por ultrasonografía, con el fin de estandarizar una referencia ecográfica reproducible, con alto índice de éxito, la cual permita limitar complicaciones relacionadas con las técnicas regionales anatómicas y así facilitar el aseguramiento de la vía aérea en estos pacientes.


Subject(s)
Humans , Ultrasonography , Anesthesia, Local , Laryngeal Nerves , Nerve Block , Airway Obstruction , Anesthesiologists , Intubation
4.
Article in English | LILACS, BBO | ID: biblio-1143398

ABSTRACT

ABSTRACT Objective: To evaluate the effect of virtual reality (VR) on dental anxiety, pain, and behaviour at different time points among children undergoing dental treatment under local anaesthesia. Material and Methods: This randomised, two‐armed, within-subject, cross-over, placebo-controlled trial included 76 children. Eligible participants were treated in two dental visits using the following methods: with protective glasses only, without distraction (attention placebo-controlled - APC); and with the treatment condition (i.e., VR). Primary outcomes were dental anxiety and pain; secondary outcome was dental visit behaviour. Heart rate scores were recorded as an objective measure to evaluate dental anxiety and pain. Subjective measurements for each variable were also performed. Results: Significant reduction in dental pain and anxiety was observed in the VR group, according to the heart rate scores; however, no statistical differences were observed according to the self-reported measures. Decreased dental anxiety and pain were associated with the first visit sequence with VR. Dental pain and anxiety scores were lower during local anaesthesia in the VR group than in the APC group. Conclusion: Virtual reality significantly reduced pain and anxiety during local anaesthesia in children undergoing dental treatment; therefore, it may be recommended during dental treatment in school-age children.


Subject(s)
Humans , Male , Female , Child , Toothache/diagnosis , Child , Dental Anxiety , Behavior Observation Techniques , Virtual Reality , Turkey/epidemiology , Chi-Square Distribution , Analysis of Variance , Controlled Clinical Trials as Topic/methods , Anesthesia, Local
5.
Braz. oral res. (Online) ; 35: e26, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1153611

ABSTRACT

Abstract This randomized parallel-group control trial tested the efficacy of distraction using audiovisual eyeglasses (AVE) during dental procedures [NCT03902158]. Forty-four 6-9 year-old children with low/moderate anxiety and who needed restorative treatment or exodontia of the primary molars were randomly allocated into two groups: the AVE (experimental) and the conventional behavior management techniques (control) groups. Motion sensors were used to measure the participants' body movements. Dental visits were video recorded, and their pain levels and behavior were assessed using the Faces, Legs, Activity, Cry, and Consolability Behavioral Pain Assessment Scale and the Venham Behavioral Scale, respectively. Anxiety was assessed via heart rate measurements. After treatment, the children scored their pain using the Faces Pain Scale. Mann-Whitney U and chi-square tests were used to compare the groups. The mean score on the behavioral scale was 0.59 in the experimental group and 0.72 in the control group under local anesthesia (p = 0.73). During the procedure, the mean score was 0.41 in the experimental group and 1.32 in the control group (p = 0.07). The mean heart rate was similar in both groups (p = 0.47), but a significant increase during treatment was observed in the control group. There was no difference between the groups in terms of pain, behavior, and self-reported pain scores (p = 0.08). Children aged 6-7 who used the AVE had fewer wrist movements (435.6) than that of children in the control group (1170.4) (p = 0.04). The AVE achieved similar results to the basic behavior management techniques, with good acceptance by the children.


Subject(s)
Humans , Child , Eyeglasses , Anesthesia, Dental , Pain Measurement , Dental Care , Anesthesia, Local
6.
Article in English | LILACS, BBO | ID: biblio-1287482

ABSTRACT

ABSTRACT Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G).


Subject(s)
Humans , Male , Female , Adult , Pain , Pain Measurement/instrumentation , Dental Anxiety/psychology , Visual Analog Scale , Anesthesia, Local/instrumentation , Efficacy , Analysis of Variance , Data Interpretation, Statistical , Randomized Controlled Trial , Cooling/methods , India , Mouth , Needles
7.
Ann. afr. méd. (En ligne) ; 14(3): 4250-4255, 2021.
Article in French | AIM, AIM | ID: biblio-1292608

ABSTRACT

Contexte et objectif. Au Sénégal, la chirurgie de la varicocèle, occupe une place non négligeable dans la prise en charge de l'infertilité masculine. Cette chirurgie connait une utilisation de plus en plus fréquente de la voie inguinale ou même sous inguinale. Cette modification progressive des habitudes a été l'origine de l'étude de la faisabilité et de la sécurité de l'anesthésie locale dans notre pratique. Méthodes. Dans une série des cas, trente-cinq (35) patients ayant donné leur consentement ont été opérés sous anesthésie locale selon le même protocole par les médecins de l'équipe. Résultats. L'âge moyen des patients était de 32,5 ± 8 ans (18-54 ans). Le motif de consultation le plus fréquent était l'infertilité du couple (62,9 %). Vingt-deux patients avaient une varicocèle bilatérale et treize une varicocèle unilatérale. Tous nos patients étaient classés ASA I. La moyenne de la durée d'intervention était de 22 ± 9,48 min. La moyenne du degré de la douleur pendant l'opération était à 1,37/10 selon l'EVA chez les 35 patients. Aucun incident peropératoire lié à l'anesthésie ou à un problème technique chirurgical n'a été observé. Après la chirurgie, 94,3% ont déclaré avoir été satisfait du geste. Conclusion. La pratique de la chirurgie ambulatoire sous anesthésie locale de la varicocèle offre une part importante dans la prise en charge de cette affection


Context and objective. In Senegal, varicocele surgery occupies a significant place in the management of male infertility. This surgery is increasingly performed via the inguinal or even sub inguinal route. This gradual change in habits was the origin of the study of the feasibility and safety of local anesthesia in our practice. Methods. In a cross sectional study, thirty-five (35) patients who gave their consent underwent the surgery under local anesthesia according to a standardized protocol by the team's doctors. Results. The average age of the patients was 32.5 ± 8 years (18-54 years). The most frequent reason for consultation was infertility in the couple (62.9%). Twenty-two patients had bilateral varicocele and thirteen had unilateral varicocele. All our patients were classified as ASA I. The average duration of the operation was 22 ± 9.48 min. The average degree of pain during the operation was 1.37/10 according to the Visual analog Scale in the 35 patients. No intraoperative incident related to anesthesia or a surgical technical problem was observed. After surgery, 94.3% said they were satisfied. Conclusion. The practice of outpatient surgery under local anesthesia for varicocele occupies an important part in the management of this condition.


Subject(s)
Humans , Therapeutics , Varicocele , Anesthesia, Local , Senegal
8.
Article in Chinese | WPRIM | ID: wpr-921946

ABSTRACT

OBJECTIVE@#To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus.@*METHODS@#From September 2019 to December 2020, 48 patients with hallux valgus were treated surgically. According to different postoperative analgesia methods, the patients were divided into combined local infiltration group and intravenous analgesia pump group. There were 24 cases, in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old, with an average of (58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation, 20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once. There were 24 patients in intravenous analgesia pump group, including 3 males and 21 females;the age ranged from 23 to 81 years old, with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation, intravenous analgesia pump was used for analgesia. The basic flow was 2 ml / h;the self control dose was 0.5 ml;and the locking time was 15 min. Visual analogue scale (VAS) was recorded at 12, 24, 48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation. The occurrence of adverse drug reactions at 0 to 12 hours, 12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded.@*RESULTS@#All patients were followed up, and the duration ranged from 14 to 17 days, with a mean of (14.60±0.92) days. There was significantdifference in VAS at 12, 24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group(@*CONCLUSION@#Compared with intravenous analgesia pump group, ropivacaine combined with compound betamethasone can significantly reduce postoperative wound pain without increasing adverse drug reactions, and does not increase wound infection.


Subject(s)
Adult , Aged , Aged, 80 and over , Analgesia , Anesthesia, Local , Bunion , Feasibility Studies , Female , Hallux Valgus/surgery , Humans , Male , Middle Aged , Pain, Postoperative/drug therapy , Young Adult
9.
Article in Chinese | WPRIM | ID: wpr-877551

ABSTRACT

OBJECTIVE@#To compare the clinical therapeutic effect of fire needling stripping after local anesthesia, simple fire needling and liquid nitrogen cryotherapy on verruca vulgaris.@*METHODS@#A total of 900 patients with verruca vulgaris were randomized into a fire needling stripping group (300 cases, 2 cases dropped off), a fire needling group (300 cases, 4 cases dropped off) and a liquid nitrogen cryotherapy group (300 cases, 5 cases dropped off). After local anesthesia of compound lidocaine cream, fire needling therapy was adopted, and the necrotic tissue of verruca was stripped in the fire needling stripping group. Simple fire needling therapy was adopted in the fire needling group, without local anesthesia and stripping. Liquid nitrogen cryotherapy was adopted in the liquid nitrogen cryotherapy group. The treatment was given once a week, and totally 3 weeks were required in the 3 groups. The skin lesion scores of number, area, thickness, color, pruritus, isomorphism and the level of T lymphocyte (CD@*RESULTS@#Compared before treatment, the skin lesion scores were decreased (@*CONCLUSION@#Fire needling stripping after local anesthesia can effectively treat the verruca vulgaris, improve the skin lesion and immunity, its therapeutic effect is superior to simple fire needling and liquid nitrogen cryotherapy.


Subject(s)
Anesthesia, Local , Cryotherapy , Humans , Treatment Outcome , Vascular Surgical Procedures , Warts/therapy
10.
Rev. bras. oftalmol ; 79(6): 380-385, nov.-dez. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156161

ABSTRACT

Abstract Objective: To compare the use of 2 different local anesthetic solution (LAS) volumes of 1.5 mL and 3 mL in retrobulbar block in patients undergoing cataract surgery in terms of anesthesia, akinesia, and pain levels. Methods: 80 patients between 18-90 years old, ASA I-II-III, were included in the study. For retrobulbar anesthesia, 1.5 mL LAS was applied to one group (Group LV), and 3 mL LAS to the other group (Group HV). The patients' ocular and eyelid motion scores were evaluated and recorded in the first, third, fifth, and tenth minutes after the block, and at 30-minute intervals for 4 hours post-operatively. One day later, the first hour of analgesic need and the number of times they took analgesic agents were asked and recorded. In addition, side effects were questioned and recorded. Results: The 39 (48.75%) patients were male and 41 (51.25%) patients were female. The criteria determined in terms of ocular motor score after the retrobulbar block (ocular motor score≤4) were met in 92.5% of patients in Group LV in all patients in Group HV, and the time to fulfill the determined criteria in Group HV was found to be significantly lower compared to Group LV (p=0.004). The movements of the eye in all direction except the inward movement recovered in Group LV in a significantly shorter time than Group HV (p=0.004). There was no significant difference in pain levels and side effects between the groups (p=0.34). Conclusions: After 1.5 mL LAS administration in retrobulbar block, adequate akinesia was not achieved in about one tenth of patients, but no significant difference was found between 1.5 mL and 3 mL LAS volumes in analgesic efficacy and side effects.


Resumo Objetivo: Comparar o uso de 2 volumes diferentes de solução anestésica local (LAS) de 1,5 mL e 3 mL no bloqueio retrobulbar em pacientes submetidos à cirurgia de catarata em termos de anestesia, acinesia e níveis de dor. Métodos: 80 pacientes entre 18 e 90 anos, ASA I-II-III, foram incluídos no estudo. Para anestesia retrobulbar, 1,5 mL de LAS foi aplicado em um grupo (Grupo LV) e 3 mL de LAS no outro grupo (Grupo HV). Os escores de movimento ocular e palpebral dos pacientes foram avaliados e registrados no primeiro, terceiro, quinto e décimo minutos após o bloqueio e em intervalos de 30 minutos por 4 horas no pós-operatório. Um dia depois, a primeira hora de necessidade de analgésico e o número de vezes que eles tomaram analgésicos foram solicitados e registrados. Além disso, os efeitos colaterais foram questionados e registrados. Resultados: 39 (48,75%) pacientes eram do sexo masculino e 41 (51,25%) do sexo feminino. Os critérios determinados em termos de escore motor ocular após o bloqueio retrobulbar (escore motor ocular≤4) foram atendidos em 92,5% dos pacientes do Grupo LV em todos os pacientes do Grupo HV, e foi encontrado o tempo para atender aos critérios determinados no Grupo HV ser significativamente menor em comparação ao grupo LV (p = 0,004). Os movimentos do olho em todas as direções, exceto o movimento interior, se recuperaram no Grupo LV em um tempo significativamente menor que o Grupo HV (p = 0,004). Não houve diferença significativa nos níveis de dor e efeitos colaterais entre os grupos (p = 0,34). Conclusões: Após administração de 1,5 mL de LAS no bloqueio retrobulbar, não foi alcançada acinesia adequada em cerca de um décimo dos pacientes, mas não foi encontrada diferença significativa entre os volumes de 1,5 mL e 3 mL de LAS na eficácia analgésica e efeitos colaterais.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pain , Cataract Extraction , Neuromuscular Blockade , Eye Movements , Anesthesia, Local , Anesthetics, Local , Comparative Study
11.
Rev. bras. anestesiol ; 70(5): 553-555, Sept.-Oct. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1143970

ABSTRACT

Abstract Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life-threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.


Resumo O cisto hidático na região cervical é uma condição extremamente rara que pode criar desafios para os anestesiologistas. O reconhecimento oportuno das vias aéreas difíceis e a preparação do plano de manejo são cruciais para evitar complicações com risco de vida, como danos cerebrais hipóxicos. Descrevemos um caso de difícil controle das vias aéreas em um paciente com cisto hidático cervical maciço. Utilizamos sedação com cetamina-propofol em baixa dose e spray de lidocaína para anestesia local orofaríngea. Relaxantes musculares não foram utilizados e a respiração espontânea foi mantida durante a intubação. O reconhecimento, a avaliação e o planejamento perioperatório são essenciais para o manejo difícil das vias aéreas em pacientes com cisto hidático cervical.


Subject(s)
Humans , Male , Adult , Airway Obstruction/parasitology , Echinococcosis/complications , Cervical Cord/parasitology , Propofol/administration & dosage , Echinococcosis/surgery , Airway Management , Intubation, Intratracheal , Ketamine/administration & dosage , Anesthesia, Local/adverse effects , Lidocaine/administration & dosage
12.
Arq. bras. med. vet. zootec. (Online) ; 72(5): 1639-1645, Sept.-Oct. 2020. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1131532

ABSTRACT

Objetivou-se avaliar os efeitos fisiológicos e sobre o consumo do propofol, relativos à anestesia epidural com levobupivacaína isolada ou associada a diferentes doses de tramadol. Para tal, 18 cadelas foram pré-tratadas com acepromazina, utilizando-se propofol para indução e manutenção anestésicas. Conforme o protocolo epidural instituído, formaram-se três grupos (n=6) tratados com levobupivacaína isolada (1,5mg/kg) (GL) ou acrescida de 2mg/kg (GLT2) ou 4mg/kg (GLT4) de tramadol, respectivamente. As fêmeas foram submetidas à mastectomia e à ovário-histerectomia (OH), registrando-se as variáveis fisiológicas nos períodos pré (TB e T0) e transanestésicos (T10 a T70), bem como a taxa mínima de propofol necessária. Houve redução da FC para o GL e o GLT4 em relação ao GLT2 (T30 a T70), detectando-se, no GL, redução da PAS e da PAD em relação ao TB. Maiores taxas de infusão do propofol foram necessárias para o GL (0,70±0,12mg/kg/min) em relação ao GLT2 (0,50±0,19mg/kg/min) e ao GLT4 (0,50±0,19mg/kg/min). Conclui-se que o tramadol potencializou o propofol, ao ofertar analgesia, independentemente da dose administrada. Todos os protocolos testados foram seguros e eficazes em cadelas submetidas à mastectomia e à OH.(AU)


The aim of this study was to evaluate the physiological and on propofol-sparing effects related to epidural anesthesia with levobupivacaine alone or combined with different doses of tramadol. For this purpose, 18 female dogs were pretreated with acepromazine, using propofol for induction and maintenance of anesthesia. Based on a previously established epidural (L7-S1) protocol, three groups (n=6) were treated with either levobupivacaine alone (1.5mg.k-1) (GL) or in association with to 2mg.kg-1 (GLT2) or 4mg.kg-1 (GLT4) of tramadol, respectively. These dogs were all undergoing mastectomy and ovariohysterectomy (OH). The physiological data were registered in the pre (TB and T0) and trans-anesthetic periods (T10 - T70), as well as the consumption of propofol. There was a reduction in the HR for GL and GLT4 in relation to GLT2 (T30 - T70) and reductions in SAP and DAP in relation to TB in the GL group. Higher continuous infusion rate of propofol were required for GL (0.70±0.12mg.kg-1.min-1) relative to GLT2 (0.50±0.19mg.kg-1.min-1) and GLT4 (0.50±0.19mg.kg-1.min-1). It was concluded that tramadol potentiated propofol, offering analgesia independently of its administered dose. All protocols tested were safe and effective in female dogs undergoing mastectomy and OH.(AU)


Subject(s)
Animals , Female , Dogs , Tramadol/analysis , Propofol/analysis , Levobupivacaine/analysis , Ovariectomy/veterinary , Anesthesia, Local/veterinary , Mastectomy/veterinary
13.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(3): 246-253, ago. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1352327

ABSTRACT

Presentamos a un paciente que sufrió una amputación traumática de la falange distal del 5to dedo de su mano izquierda, y fue tratado mediante un reimplante sin anastomosis venosa. En el mismo acto quirúrgico, se le realizó una artrodesis definitiva con clavijas. La cirugía se efectuó con anestesia troncular del dedo, por lo cual no se requirió de un anestesista ni fue necesario un tiempo adecuado de ayuno. Debido a la localización distal de la amputación y a la ausencia de una vena dorsal viable para ser anastomosada, se optó por un drenaje venoso controlado mediante la extracción de la placa ungueal, el frotado del lecho ungueal y la colocación periódica (cada 3 h, por 7 días) de una gasa impregnada con heparina. Además, el paciente fue anticoagulado con enoxaparina 40 mg y ácido acetilsalicílico cada 24 h, por 21 días. El reimplante fue exitoso. Nivel de Evidencia: IV


We present a patient who experienced a traumatic amputation of his left fifth finger distal phalanx, and was treated using replantation without venous anastomosis. The same surgical procedure also included a final arthrodesis with Kirschner wires. Surgery was performed with digital block anesthesia, which did not require the presence of an anesthesiologist nor fasting. The distal level of the amputation and the lack of viable options for dorsal vein anastomosis motivated our decision for venous drainage controlled by nail-plate removal, nail-bed scrubbing and periodic (every 3 hours during 7 days) dressing with heparin-impregnated gauze. In addition, the patient received anticoagulant therapy with aspirin and enoxaparin 40 mg every 24 hours for 21 days. The replantation procedure was a success. Level of Evidence: IV


Subject(s)
Adult , Replantation , Finger Injuries/surgery , Amputation, Traumatic , Anesthesia, Local
14.
J. oral res. (Impresa) ; 9(4): 259-270, ago. 31, 2020. ilus, tab
Article in English | LILACS | ID: biblio-1179044

ABSTRACT

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.


Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142, p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control.


Subject(s)
Humans , Pain, Postoperative/drug therapy , Postoperative Complications/therapy , Ketamine/administration & dosage , Anesthesia, Local , Pain , Morbidity , Molar, Third/surgery
15.
Rev. colomb. gastroenterol ; 35(2): 159-165, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126303

ABSTRACT

Resumen Introducción: el dolor abdominal crónico es frecuente en consulta externa. El enfoque tradicional es investigar patologías viscerales. El 50 % de esos pacientes finalmente tiene dolor crónico de la pared abdominal (DCPA), generalmente secundario a atrapamiento del nervio cutáneo anterior. Esta entidad se identifica con el signo de Carnett. El tratamiento de elección es infiltrar con lidocaína los puntos dolorosos. Con una postinfiltración hay una mejoría significativa en el 85 %-90 % de los pacientes. Se desconoce la duración de la mejoría postinfiltración. El objetivo de este trabajo es determinar la respuesta sostenida en seguimientos a 1 y 2 años. Materiales y métodos: estudio de cohorte, retrospectivo, realizado en la unidad de gastroenterología de la Clínica Fundadores. Se incluyeron pacientes adultos mayores de 18 años que hubieran recibido tratamiento con inyección local con lidocaína al 2 % sin epinefrina y que hubieran respondido una encuesta telefónica para evaluar la intensidad del dolor en una escala análoga. Resultados: se identificaron 360 elegibles y, finalmente, atendieron la entrevista telefónica 324 pacientes (90 %). El 87 % era de sexo femenino. La edad promedio de la población era de 57 años. En la preinfiltración el dolor promedio era 8,7 puntos. En la postinfiltración los pacientes tuvieron una mejoría con una intensidad promedio de 2,38 (p < 0,05). En el 71 % de los pacientes la intensidad del dolor en el seguimiento hasta 2 años tuvo una intensidad promedio de 1,65 (p < 0,05), que representa una mejoría del 81 % en la intensidad (p = 0,001). La fibromialgia tuvo una asociación positiva con la mejoría sostenida del dolor (p = 0,008). Conclusiones: en los pacientes con DCPA, la infiltración de la pared con anestesia local produce una respuesta sostenida hasta 2 años después del tratamiento.


Abstract Introduction: Chronic abdominal pain is frequently encountered at outpatient clinics where the traditional approach is to investigate visceral pathologies. Fifty percent of these patients are finally found to have abdominal wall pain which is generally secondary to entrapment of the anterior cutaneous nerve. This entity is identified by Carnett's sign. The treatment of choice is to infiltrate the painful points with lidocaine following which there is significant improvement in 85% to 90% of these patients. The duration of post-infiltration improvement is unknown. The objective of this work is to determine sustained response in one and two-year follow-up examinations. Materials and Methods: This is a retrospective cohort study conducted in the gastroenterology unit of the Clínica Fundadores. We included adult patients over 18 years of age who had received local injection treatment with 2% lidocaine without epinephrine and who had answered a telephone survey to assess the intensity of pain on an analogous scale. Results: Of the 360 eligible patients identified, 324 patients (90%) were interviewed by telephone. The average age of those interviewed was 57 years, and 87% were women. The average pain level prior to infiltration was 8.7 points. Following infiltration, the average intensity was 2.38 points (p <0.05). In 71% of patients, average pain intensity at a two year follow-up examination was 1.65 points (p <0.05), an 81% improvement in intensity (p = 0.001). Fibromyalgia had a positive association with sustained improvement in pain (p = 0.008). Conclusions: Infiltration of the abdominal wall with a local anesthetic produces a sustained response for up to two years in patients with chronic abdominal wall pain.


Subject(s)
Humans , Male , Female , Middle Aged , Infiltration-Percolation , Surveys and Questionnaires , Cohort Studies , Abdominal Wall , Chronic Pain , Anesthesia, Local , Patients , Therapeutics
16.
Rev. bras. anestesiol ; 70(2): 159-164, Mar.-Apr. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137165

ABSTRACT

Abstract Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the post-operative period and provides safety to patients and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.


Resumo Desde o início da pandemia de COVID-19, muitas questões surgiram referentes à segurança do manejo anestésico de pacientes acometidos pela doença. A anestesia regional, seja esta periférica ou neuroaxial, é alternativa segura no manejo do paciente COVID-19, desde que o emprego de modalidades que minimizam o comprometimento da função pulmonar seja escolhido. A adoção dessa técnica anestésica minimiza os efeitos adversos no pós-operatório e oferece segurança para o paciente e equipe, desde que sejam respeitados os cuidados com proteção individual e de contágio interpessoal. Respeito às contraindicações e emprego criterioso das técnicas e normas de segurança são fundamentais. Este manuscrito tem por objetivo revisar as evidências disponíveis sobre anestesia regional em pacientes com COVID-19 e oferecer recomendações práticas para sua realização segura e eficiente.


Subject(s)
Humans , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Anesthesia, Conduction/methods , Anesthesia, Local/methods , Pneumonia, Viral/transmission , Postoperative Period , Coronavirus Infections/transmission , Pandemics , COVID-19 , Anesthesia, Conduction/adverse effects , Anesthesia, Local/adverse effects
17.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 11-17, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090557

ABSTRACT

Abstract Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve moni- toring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysi- ological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Otologic Surgical Procedures/methods , Monitoring, Intraoperative/methods , Facial Nerve/physiology , Anesthesia, Local , Treatment Outcome , Electric Stimulation , Electromyography
18.
Rev. bras. ortop ; 55(1): 95-99, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1092669

ABSTRACT

Abstract Objective To assess how shoulder specialists have used infiltration in their daily practice. Methods A survey study in which shoulder and elbow specialists answered a questionnaire on the use of infiltration in painful shoulders. Results Most of the doctors (45.9%) have > 10 years of experience in the area and have carried out up to 10 infiltrations in the last 12 months. The main indications for glenohumeral and subacromial infiltration are glenohumeral arthrosis and rotator cuff tendinopathy, respectively. The most used portals are the posterior (52.2%) for glenohumeral infiltration and the lateral (57.5%) for subacromial infiltration. The majority of the doctors (752%) infiltrate in an outpatient setting without imaging methods, and the most commonly used drug is the combination of corticoid and anesthetic. The main contraindication cited is the presence of diabetes, and the most common complication is pain after infiltration. Conclusion Subacromial infiltrations are indicated especially for the treatment of rotator cuff tendinopathies and bursitis, performed by the lateral portal, in an outpatient setting, with low index of long-term complications. Glenohumeral infiltrations are indicated especially for glenohumeral arthrosis, with a combination of a corticoid and anesthetic, performed mostly in an outpatient setting.


Resumo Objetivo Avaliar como especialistas de ombro têm utilizado a infiltração na sua prática diária. Métodos Estudo tipo survey interseccional em tempo único, no qual especialistas em ombro e cotovelo responderam a um questionário sobre o uso de infiltrações no ombro doloroso. Resultados A maior parte (45,9%) dos entrevistados possui experiência > 10 anos na área e realizaram até 10 infiltrações nos últimos 12 meses. As principais indicações para infiltração glenoumeral e subacromial são artrose glenoumeral e tendinopatia do manguito rotador, respectivamente. Os portais mais utilizados são o posterior (52,2%) para infiltração glenoumeral e o lateral (57,5%) na subacromial. A maioria (75,2%) dos entrevistados realiza a infiltração ambulatorialmente sem auxílio de métodos de imagem, e a droga mais utilizada é a combinação de corticoide e anestésico. A principal contraindicação citada é a presença de diabetes, e a complicação mais comum é a dor após a infiltração. Conclusão Infiltrações subacromiais são indicadas especialmente para tratamento de tendinopatias do manguito e bursites, realizadas pelo portal lateral, em ambiente ambulatorial, com baixo índice de complicações em longo prazo. As infiltrações glenoumerais são indicadas especialmente para artrose glenoumeral, com combinação de corticoide e anestésico, realizadas, em sua maioria, ambulatorialmente.


Subject(s)
Humans , Male , Female , Osteoarthritis , Outpatients , Pain , Shoulder , Bursitis , Surveys and Questionnaires , Tendinopathy , Anesthesia, Local
19.
Article in English | LILACS, BBO | ID: biblio-1101291

ABSTRACT

Abstract Objective: To analyze the clinical and histological condition of Chlorella vulgaris ointment extract smearing on wound healing. Material and Methods: The sample consisted of 9 pigs by making 4 incisions on the pig's right ear measuring 2cm x 1cm and applying Chlorella vulgaris ointment in 3 concentrations namely 5%, 10%, 15% and without ointment application as the control group. Furthermore, the observation of the clinical condition of wounds divided into 4 time periods (day 1, 3, 7 and 14). After completing clinical observations based on time period, the skin of the pig's ear was taken by cutting in the area that had been made injured. Skin tissue extraction carried out under inhalation and local anesthesia. The tissue pieces are then processed in the anatomical pathology laboratory to become 36 slide preparations. The clinical trial assessment was done using parameters of wound moisture, color of wound and scab wound. Whereas for histological examination was done by looking at the number of fibroblast cells in the CX31 light microscope with 40x magnification. ANOVA and Kruskal Wallis tests were used. Results: In the clinical observation conditions there were significant differences between the treatment group and the control group as well as the number of fibroblast cells there were significant differences between the 3 concentrations of Chlorella vulgaris extract ointment and the per time period control group. Conclusion: Chlorella vulgaris extract ointment containing 15% extract gives the best results in accelerating the wound healing process in the pig's ear seen from wound healing and increased number of fibroblast cells.


Subject(s)
Animals , Wound Healing , Wounds and Injuries , Chlorella vulgaris , Fibroblasts , Anesthesia, Local , Swine , Analysis of Variance , Models, Animal , Indonesia
20.
Rev. cientif. cienc. med ; 23(1): 38-43, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1126277

ABSTRACT

INTRODUCCION: en el postoperatorio de anestesia obstétrica, los temblores representan el 54%. Por lo cual, se pretende evitarlo en la sala de recuperación, usando medicamentos que regulen los temblores como ketamina y meperidina. OBJETIVOS: determinar la eficacia de la ketamina y meperidina para prevención de temblores en pacientes sometidas a cesárea bajo anestesia regional. METODOS: se realizó un ensayo clínico, simple ciego, aleatorizado y controlado. En el Hospital Obrero N° 2, Ingresaron en el estudio 40 pacientes cumpliendo criterios de inclusión, 20 pacientes por grupo. Las dosis usadas en el grupo Ketamina de 0.25 mg/kg y grupo meperidina de 0.1 mg/Kg. Se usó la escala de Crossley para determinar temblores, medición de temperatura periférica y efectos secundarios maternos y fetales. Para análisis estadístico se usó Chi x2 de Pearson. RESULTADOS: la edad media del estudio es 29,77±3,35 años; Tiempo quirúrgico media de 50 ± 8,8 minutos;Temperatura en quirófano más frecuente se encontraba entre 22° a 23° C; La temperatura periférica se encontró entre 36.6°C a 37.5 °C; en el grupo de meperidina se presentó más nauseas. No existen efectos secundarios en neonatos. CONCLUSIONES: Los temblores redujeron en los pacientes que recibieron ketamina mientras que en los que recibieron meperidina presentaron más nauseas como efecto secundario.


INTRODUCTION: The presence of shiviring in obstetric anesthesia in the postoperative period is up to 54%. Therefore, it is intended to avoid in the recovery room, using medications that regulate shiviring such as ketamine and meperidine. OBJECTIVES: to determine the efficacy of ketamine and meperidine for the prevention of shivering in patients undergoing cesarean section under regional anesthesia. METHODS: a single-blind, randomized, controlled clinical trial was conducted. In Hospital Obrero N ° 2, 40 patients enrolled in the study meeting inclusion criteria, 20 patients per group.The doses used in the Ketamine group of 0.25 mg / kg and meperidine group of 0.1 mg / Kg. The Crossley scale was used to determine shivering, peripheral temperature measurement and maternal and fetal side effects. For statistical analysis, Chi x2 from Pearson was used. RESULTS: the average age of the study is 29.77 ± 3.35 years; Average surgical time of 50 ± 8.8 minutes;Temperature in the most frequent operating room was between 22 ° to 23 ° C;The peripheral temperature was between 36.6 ºC to 37.5 ºC; in the meperidine group there was more nausea; No neonatal side effects. CONCLUSIONS: patients who received ketamine is better at preventing tremors while patients who received meperidine had more nausea as a side effect.


Subject(s)
Ketamine , Cesarean Section , Anesthesia, Local , Obstetrics
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