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Int. j. morphol ; 41(3): 804-810, jun. 2023. ilus, tab
Article in English | LILACS | ID: biblio-1514282


SUMMARY: The preserved form of all components of the nerve fiber is a prerequisite for the proper conduction of the nerve impulse. various factors can change the shape of nerve fibers. In everyday practice, qualitative histological analysis is the gold standard for detecting changes in shape. Geometric morphometry is an innovative method that objectively enables the assessment of changes in nerve fibers' shape after local anesthetics action. A total of sixty sciatic nerves were used as material, which was intraneural injected with saline solution in the control group (n=30), and a solution of 1.33 % liposomal bupivacaine (n=30) in the test group. After the animals were sacrificed, nerve samples were taken and histological preparations were made. The preparations were first described and examined using a qualitative histological method, after which digital images were made. The images were entered into the MorphoJ program and processed using the method of geometric morphometry. Qualitative histological examination revealed no differences in nerve fibers after intraneurally applied physiological solution and liposomal bupivacaine. Using the method of geometric morphometry, a statistically significant change in the shape of axons was found after intraneurally applied saline solution and liposomal bupivacaine (p=0.0059). No significant differences in histological changes were found after the qualitative histological analysis of nerve fiber cross-section preparations. A statistically significant change in the shape of nerve fiber axons was observed after geometric morphometric analysis of digital images after intraneural application of saline and liposomal bupivacaine.

La forma conservada de todos los componentes de la fibra nerviosa es un requisito previo para la conducción correcta del impulso nervioso. Varios factores pueden cambiar la forma de las fibras nerviosas. En la práctica diaria, el análisis histológico cualitativo es el estándar de oro para detectar cambios de forma. La morfometría geométrica es un método innovador que permite evaluar objetivamente los cambios en la forma de las fibras nerviosas después de la acción de los anestésicos locales. Se utilizó como material un total de sesenta nervios ciáticos, que se inyectaron intraneuralmente con solución salina en el grupo control (n=30), y una solución de bupivacaína liposomal al 1,33 % (n=30) en el grupo de prueba. Después de sacrificados los animales, se tomaron muestras de nervios y se realizaron preparaciones histológicas. Primero se describieron y examinaron las preparaciones utilizando un método histológico cualitativo, después de lo cual se tomaron imágenes digitales. Las imágenes fueron ingresadas al programa MorphoJ y procesadas mediante el método de morfometría geométrica. El examen histológico cualitativo no reveló diferencias en las fibras nerviosas después de la aplicación intraneural de solución fisiológica y bupivacaína liposomal. Usando el método de morfometría geométrica, se encontró un cambio estadísticamente significativo en la forma de los axones después de la aplicación intraneural de solución salina y bupivacaína liposomal (p = 0,0059). No se encontraron diferencias significativas en los cambios histológicos después del análisis histológico cualitativo de las preparaciones de secciones transversales de fibras nerviosas. Se observó un cambio estadísticamente significativo en la forma de los axones de las fibras nerviosas después del análisis de morfometría geométrica de imágenes digitales después de la aplicación intraneural de solución salina y bupivacaína liposomal.

Animals , Rats , Bupivacaine/administration & dosage , Histological Techniques/methods , Anesthetics, Local/administration & dosage , Nerve Fibers/drug effects , Discriminant Analysis , Rats, Wistar , Principal Component Analysis , Saline Solution/administration & dosage , Injections , Liposomes/administration & dosage
Braz. J. Pharm. Sci. (Online) ; 58: e21310, 2022. graf
Article in English | LILACS | ID: biblio-1420508


Abstract In the hospital environment, postoperative pain is a common occurrence that impairs patient recovery and rehabilitation and lengthens hospitalization time. Racemic bupivacaine hydrochloride (CBV) and Novabupi® (NBV) (S (-) 75% R (+) 25% bupivacaine hydrochloride) are two examples of local anesthetics used in pain management, the latter being an alternative with less deleterious effects. In the present study, biodegradable implants were developed using Poly(L-lactide-co-glycolide) through a hot molding technique, evaluating their physicochemical properties and their in vitro drug release. Different proportions of drugs and polymer were tested, and the proportion of 25%:75% was the most stable for molding the implants. Thermal and spectrometric analyses were performed, and they revealed no unwanted chemical interactions between drugs and polymer. They also confirmed that heating and freeze-drying used for manufacturing did not interfere with stability. The in vitro release results revealed drugs sustained release, reaching 64% for NBV-PLGA and 52% for CBV-PLGA up to 30 days. The drug release mechanism was confirmed by microscopy, which involved pores formation and polymeric erosion, visualized in the first 72 h of the in vitro release test. These findings suggest that the developed implants are interesting alternatives to control postoperative pain efficiently.

Pain, Postoperative/classification , Bupivacaine/analysis , Absorbable Implants/classification , Anesthetics, Local/administration & dosage , In Vitro Techniques/methods , Pharmaceutical Preparations/analysis , Hospitals/classification
Arq. bras. oftalmol ; 84(2): 103-106, Mar,-Apr. 2021. tab
Article in English | LILACS | ID: biblio-1153118


ABSTRACT Purpose: To evaluate the relationship between the incidence of complications and functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia. Methods: We enrolled 22 functionally monocular patients (11 males and 11 females; group 1) and 19 age- and sex-matched controls (6 males and 13 females; group 2) in this prospective, interventional, cross-sectional, case control study. Demographics data, including age, sex, and educational background, were collected. Surgeries were performed by the same surgeon, and during surgery, the patients' vital signs (blood pressure and heart rate) and surgical events (duration, body movements, signs of increased vitreous cavity pressure, difficulty in performing capsulorhexis, and complications) were noted. Pre- and postoperative visual acuity was also analyzed. Results: The mean age of group 1 was 73.05 ± 13.31 years and of group 1 was 69.74 ± 16.81 years. There was no significant between-group difference in systolic and diastolic blood pressures. The average heart rate was similar in both groups, too. During surgery, the surgeon's perception of excessive eye, eyelid, or head movements in both groups was similar, in addition to signs of increased vitreous cavity pressure. Conclusion: It is safe to perform phacoemulsification under topical anesthesia in functionally monocular patients, who apparently behave similarly to binocular patients.(AU)

RESUMO Objetivo: Avaliar a relação entre a incidência de complicações e reações emocionais durante a cirurgia de catarata sob anestesia tópica em pacientes funcionalmente monoculares. Métodos: Estudo prospectivo, transversal, caso-controle de vinte e dois pacientes monoculares e dezenove controles pareados por idade e sexo . Dados demográficos foram analisados: idade, sexo e escolaridade. As cirurgias foram realizadas pelo mesmo cirurgião e durante o procedimento os sinais vitais dos pacientes (como pressão arterial sistêmica e frequência cardíaca) e eventos cirúrgicos (duração da cirurgia, movimentos corporais, sinais de aumento da pressão vítrea, dificuldade de realização da capsulorrexis e complicações) foram coletados. A acuidade visual pré e pós foi analisada. A distribuição normal dos dados foi confirmada com o teste de Shapiro-Wilk. Os dados foram expressos como média ± DP e porcentagem. A comparação dos diferentes testes clínicos entre os grupos foi realizada utilizando Student's t-test e ANOVA com correção de Bonferroni. O qui-quadrado foi usado para comparar dados demográficos. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Este estudo incluiu vinte e dois olhos de 22 pacientes funcionalmente monoculares (6 homens e 13 mulheres) e dezenove olhos de 19 controles (11 homens e 11 mulheres). A média de idade foi de 73,05 ± 13,31 anos nos indivíduos monoculares e 69,74 ± 16,81 no controle. Considerando-se os sinais vitais não houve diferença significativa entre os grupos (p>0,05). Durante o procedimento, a percepção do cirurgião em relação aos movimentos excessivos de olho, pálpebra ou cabeça em ambos os grupos foi semelhante, assim como sinais de aumento da pressão vítrea (p=0,2 e p=0,1, respectivamente). Conclusão: Este estudo sugere que é seguro realizar a extração de catarata com anestesia tópica em pacientes funcionalmente monoculares. Esses pacientes aparentemente se comportam de maneira semelhante aos pacientes binoculares.(AU)

Humans , Male , Female , Visual Acuity , Phacoemulsification/psychology , Capsulorhexis/methods , Anesthetics, Local/administration & dosage , Vision, Monocular , Cross-Sectional Studies/instrumentation , Prospective Studies
Rev Chil Anest ; 50(4): 609-612, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1526325


Erector spinae plane block (ESP) is a regional anesthesia technique consisting of blocking the interfascial plane, where local anesthetic (LA) is injected at the site where the dorsal branch of the spinal nerve emerges. There are various publications on the application of the block (EPS) in the adult population, however there are few reports of the use of this block in pediatric surgery. We present the first case report of an infant under 9 months of age with the presence of a tumor in the anterior mediastinum, who underwent a resection through the 6th intercostal space, previous blockage of the erector spinae under ultrasound vision. The patient did not present adverse effects and was discharged on the fourth postoperative day.

El bloqueo del plano erector de la espina (ESP) es una técnica de anestesia regional consistente en bloquear el plano interfascial, donde se inyecta anestésico local (LA) en el sitio donde emerge la rama dorsal del nervio espinal. Existen diversas publicaciones sobre la aplicación del bloqueo (EPS) en población adulta, sin embargo, hay pocos reportes del uso de este bloqueo en cirugía pediátrica. Presentamos el primer reporte de caso de una lactante menor de 9 meses de edad con presencia de tumor en mediastino anterior, al cual se le hizo una resección a través del 6° espacio intercostal, previo bloqueo del erector de la espina bajo visión ecográfica. La paciente no presentó efectos adversos y fue dada de alta al cuarto día posoperatorio.

Humans , Female , Infant , Thoracotomy/methods , Paraspinal Muscles , Anesthetics, Local/administration & dosage , Nerve Block/methods , Mediastinal Neoplasms/surgery
Rev. chil. anest ; 50(3): 511-514, 2021.
Article in Spanish | LILACS | ID: biblio-1525730


Mastocytosis consists of a heterogeneous group of disorders characterized by an abnormal increase of mast cell in one or more organs or tissues. The degranulation of mast cells with subsequent clinical symptoms can be triggered by psychological, chemical or traumatic agents. The main challenge of these patients is to avoid these triggers in order to prevent an anaphylactic shock. We report a case of a patient diagnosed with cutaneous mastocytoses who underwent urgent appendicectomy. Their perioperative management involves a multidisciniplinary approach. We report the anaesthetic management in this disease.

Las mastocitosis son un grupo heterogéneo de enfermedades que se caracterizan por la proliferación de mastocitos y su posterior acumulación. La degranulación de los mastocitos puede desencadenarse por diferentes agentes como la cirugía, el estrés o los fármacos histaminoliberadores. El principal reto que plantea a un anestesiólogo un paciente con mastocitosis es la posibilidad de que se desencadene una reacción anafiláctica. Se describe el manejo anestésico de un paciente con mastocitosis cutánea. El desconocimiento de esta entidad puede suponer un aumento de la morbimortalidad de estos pacientes.

Humans , Female , Child , Mastocytosis, Cutaneous/surgery , Anaphylaxis/prevention & control , Anesthesia, Conduction/methods , Anesthetics, Local/administration & dosage
Rev. chil. anest ; 50(3): 498-501, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1525717


The case of a patient with clavicular middle third fractures is presented. The aim is explaining the ultrasound guided clavipectoral fascia plane block (CPB). This constitutes a novel technique and an alternative to traditional regional anesthesia of the brachial plexus. The purpose is to provide anesthesia, analgesia, and control over postoperative pain about the pathology mentioned. The technique was first described by L. Valdés in 2017.

Se presenta el caso de una paciente con fractura de tercio medio clavicular con el objetivo de explicar el bloqueo del plano de la fascia clavipectoral guiado por ultrasonido (CPB). Ésta constituye una técnica novedosa y una alternativa a los procedimientos tradicionales de anestesia regional del plexo braquial, con el propósito de brindar anestesia, analgesia y control del dolor posoperatorio sobre dicha patología. Esta técnica fue descrita por primera vez en el año 2017 por L. Valdés.

Humans , Female , Adolescent , Pain, Postoperative/therapy , Clavicle/injuries , Fractures, Bone/surgery , Fascia , Nerve Block/methods , Ultrasonography, Interventional , Fracture Fixation, Internal , Anesthetics, Local/administration & dosage
Rev. bras. anestesiol ; 70(6): 613-619, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155774


Abstract Background and objectives There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. Method Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░µg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. Results Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (p░<░0.05). Conclusion There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.

Resumo Justificativa e objetivos Não há consenso sobre qual é a técnica ideal para prover analgesia em reconstruções ligamentares de joelho. Objetivou‐se comparar a intensidade da dor pós‐operatória desses pacientes sob diferentes modalidades de analgesia. Método Ensaio clínico randomizado e controlado de pacientes submetidos à reconstrução do ligamento cruzado anterior com tendões flexores entre dezembro de 2013 e 2014. Todos os pacientes foram submetidos a raquianestesia e analgesia de resgate com tramadol. Compararam‐se os grupos C, M, R0,375 e R0,25; aos quais se ofertou apenas a técnica anteriormente descrita, morfina subaracnóidea (100 µg) ou bloqueio de nervo femoral com 25 mL de ropivacaína 0,375% e 0,25%, respectivamente. Avaliou‐se intensidade da dor em 6, 12 e 24 horas, idade, sexo, analgesia de resgate, reações adversas e satisfação. Resultados Entre os 83 pacientes elegíveis, observou‐se predomínio do sexo masculino (85,7%) entre 28 e 31 anos. O Grupo C solicitou mais opioide (27,3%) do que os demais grupos, sem significância quando comparados. Não houve diferenças significativas na intensidade da dor em 6, 12 e 24 horas. Houve maior incidência de retenção urinária no Grupo M (23,8%) do que no R0,375 (0%) e de bloqueio motor prolongado do quadríceps no Grupo R0,375 (30%) do que nos Grupos M e C (0%), com significância estatística (p< 0,05). Conclusão Não houve diferença na intensidade da dor pós‐operatória nos pacientes submetidos à reconstrução de ligamento cruzado anterior com tendões flexores sob as modalidades analgésicas avaliadas, apesar do predomínio de retenção urinária no Grupo M e bloqueio motor no Grupo R0,375.

Humans , Male , Female , Adult , Pain, Postoperative/drug therapy , Femoral Nerve , Anterior Cruciate Ligament Reconstruction , Analgesics, Opioid/administration & dosage , Anesthesia, Spinal/methods , Morphine/administration & dosage , Nerve Block/methods , Time Factors , Tramadol/administration & dosage , Pain Measurement , Urinary Retention/chemically induced , Quadriceps Muscle/drug effects , Acute Pain/drug therapy , Ropivacaine/administration & dosage , Analgesia/methods , Anesthetics, Local/administration & dosage
Rev. bras. anestesiol ; 70(5): 561-564, Sept.-Oct. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1143959


Abstract Background and objectives The Sphenopalatine Ganglion Block (SGB) is an effective, low-risk treatment option for Postdural Puncture Headache (PDPH) refractory to conservative management. Case report This report presents four complex cases of patients with headache related to low cerebrospinal fluid pressure. Three of them were successfully treated with the application of local anesthetic topical drops through the nasal cavity. Conclusion The novel approach described in this report has minimal risks of discomfort or injury to the nasal mucosa. It is quick to apply and can be administered by the patient himself.

Resumo Justificativa e objetivos: O Bloqueio do Gânglio Esfenopalatino (BGEP) é opção de tratamento efetivo associado a baixo risco para Cefaleia Pós-Punção Dural (CPPD) refratária às medidas conservadoras. Relato de caso: Este relato apresenta quatro pacientes com alta complexidade que apresentaram cefaleia relacionada à baixa pressão do líquido cefaloraquidiano. Três pacientes foram tratados com sucesso pela instilação de gotas de anestésico local tópico na cavidade nasal. Conclusões: A nova abordagem descrita neste relato apresenta riscos mínimos de desconforto ou lesão à mucosa nasal. A aplicação é rápida e pode ser administrada pelo próprio paciente.

Humans , Male , Female , Adult , Post-Dural Puncture Headache/therapy , Sphenopalatine Ganglion Block/methods , Anesthetics, Local/administration & dosage , Administration, Intranasal , Self Administration , Treatment Outcome , Middle Aged , Nasal Mucosa/metabolism
Rev. bras. anestesiol ; 70(5): 457-463, Sept.-Oct. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1143967


Abstract Background: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. Methods: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. Results: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49−5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0−0.97]), history of motion sickness (2.5 [1.27−5.25]), significant nausea during the first trimester (0.3 [0.16−0.64]), intraoperative nausea and vomiting (8.2 [3.67−20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01−4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. Conclusions: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.

Resumo Introdução: Os fatores de risco para náusea e vômitos pós-operatórios (NVPO) ainda não foram definidos para pacientes de obstetrícia. Neste estudo, nosso objetivo foi identificar potenciais fatores de risco para NVPO após parto cesariano realizado sob raquianestesia. Método: Uma coorte de pacientes submetidas a cesariana sob raquianestesia foi usada para investigar potenciais fatores de risco para NVPO. Os melhores fatores de risco numéricos foram dicotomizados por meio do método qui-quadrado. Uma rede casual de independência condicional (método de associação adicional) foi usada para selecionar os melhores preditores de NVPO. Resultados: Das 260 pacientes iniciais, 250 completaram o estudo. A razão de chances para NVPO foi estatisticamente significante para menor idade materna (< 25 anos: 2,9 [1,49−5,96]), dose mais baixa de bupivacaina raquidiana (< 13 mg, inf [2,4-inf]), dose mais baixa de morfina raquidiana (< 80 mg, 0,03 [0−0,97]), histórico de enjoo de movimento (2,5 [1,27−5,25]), náuseas importantes durante o primeiro trimestre (0,3 [0,16−0,64]), náusea e vômitos intraoperatórios (8,2 [3,67−20,47]) e menor idade gestacional (< 38 semanas, 2,0 [1,01−4,08]). A rede causal selecionou ausência de náuseas significativas durante o primeiro trimestre gestacional, náusea intraoperatória e idade gestacional < 38 semanas como os principais fatores de risco diretos para NVPO. Conclusões: Náusea intraoperatória e idade materna < 25 anos foram os principais fatores de risco para NVPO após cesariana sob raquianestesia. A ausência de náusea autorreferida durante o primeiro trimestre foi um fator protetor para náusea e vômitos após cesariana.

Humans , Female , Pregnancy , Adult , Young Adult , Cesarean Section/methods , Postoperative Nausea and Vomiting/epidemiology , Anesthesia, Spinal/methods , Prognosis , Bupivacaine/administration & dosage , Cesarean Section/adverse effects , Prospective Studies , Risk Factors , Cohort Studies , Maternal Age , Postoperative Nausea and Vomiting/etiology , Anesthesia, Spinal/adverse effects , Anesthetics, Local/administration & dosage , Morphine/administration & dosage
Rev. bras. anestesiol ; 70(5): 556-560, Sept.-Oct. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1143960


Abstract Background: The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. Case report: A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. Conclusion: The use of a regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.

Resumo Introdução: O papel da tireoplastia tipo I (TPI) está bem estabelecido no tratamento de insuficiência glótica após a paralisia das pregas vocais, mas o manejo anestésico ideal para a TPI ainda é controverso. Descrevemos uma nova técnica anestésica para a TPI usando o Bloqueio do Plexo Cervical (BPC) superficial e o BPC intermediário associados, em presença de analgo-sedação leve e intermitente. Relato de caso: Paciente de 51 anos de idade com paralisia da prega vocal esquerda e apneia obstrutiva do sono foi agendada para TPI. BPC intermediário guiado por ultrassom foi realizado usando acesso posterior, e 15 mL de ropivacaína a 0,5% foram injetados no espaço cervical posterior entre o músculo esternocleidomastoideo e a fáscia prevertebral. A seguir, para o BPC superficial, 10 mL de ropivacaína a 0,5% foram injetados na região subcutânea adjacente à borda posterior do músculo esternocleidomastoideo, sem transfixar a fáscia de revestimento. Analgo-sedação intermitente com infusão alvo-controlada de remifentanil (alvo de 0,5 ng.mL-1) foi usada para facilitar a inserção da prótese e a laringoscopia com fibra ótica. A técnica ofereceu via aérea segura durante a anestesia, boa condição para o cirurgião, possibilidade de monitorar a voz, além de ótimo conforto à paciente. Conclusões: O uso de anestesia regional é uma técnica promissora para o cuidado anestésico durante a TPI, especialmente em pacientes com via aérea comprometida.

Humans , Female , Vocal Cord Paralysis/surgery , Laryngoplasty/methods , Cervical Plexus Block/methods , Ultrasonography, Interventional , Ropivacaine/administration & dosage , Anesthetics, Local/administration & dosage , Middle Aged
Rev. bras. anestesiol ; 70(4): 357-363, July-Aug. 2020. tab
Article in English, Portuguese | LILACS | ID: biblio-1137204


Abstract Study objective: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. Design: In vitro prospective study. Setting: University Clinical Microbiology Laboratory. Measurements: In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37 °C. Main results: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). Conclusions: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.

Resumo Objetivo: O objetivo do presente estudo foi comparar os efeitos antimicrobianos da bupivacaína e citrato de fentanil e revelar o impacto no potencial do efeito antimicrobiano no caso de uso combinado. Desenho: Estudo prospectivo in vitro. Local: Laboratório de Microbiologia Clínica da Universidade. Medidas: Em nosso estudo, os efeitos antimicrobianos in vitro do citrato de fentanil na concentração de 0,05 mg.mL-1 - Grupo F e da bupivacaína na concentração de 5 mg.mL-1 - Grupo B foram testados em culturas de Staphylococcus aureus ATCC 29213 (do inglês American Type Culture Collection 29213), Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 e Candida albicans ATCC 10231. As culturas de S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 e Escherichia coli ATCC 25922 foram semeadas em placas de ágar Mueller Hinton (Oxoid, Reino Unido), e a cultura de Candida albicans ATCC 10231 foi realizada em placa de ágar Sabouraud dextrose (Oxoid, Reino Unido) durante 18-24 horas a 37 °C. Principais resultados: Com relação ao diâmetro da zona de inibição, os valores de S. aureus ATCC 29213, P. aeruginosa ATCC 27853 e C. albicans ATCC10231 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo F do que no Grupo B (p < 0,001). Os valores do diâmetro da zona de inibição das culturas de E. coli ATCC 25922 e K. pneumomiae ATCC 13883 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo B do que no Grupo F (p < 0,001, E. coli na 12ª hora p = 0,005) Conclusões: A preferência atual e frequente pela adição de fentanil aos Anestésicos Locais (AL) para a realização de anestesia regional se deve sobretudo à possibilidade de redução da dose do anestésico local, a melhora na qualidade da analgesia e a satisfação do paciente. No entanto, ao considerar estudos em que o fentanil antagonizou o efeito antimicrobiano dos AL, pode-se pensar que esse fato contribua para aumento de complicação infecciosa. O citrato de fentanil usado em nosso estudo, contendo ácido clorídrico e hidróxido de sódio como agentes conservantes, ampliou o espectro de efeitos antimicrobianos dos AL, não teve efeito antagônico e demonstrou efeito antimicrobiano sinérgico contra a E. coli. Acreditamos que a adição de fentanil aos anestésicos locais traria importante contribuição na prevenção das crescentes complicações por infecção da anestesia regional.

Bupivacaine/pharmacology , Fentanyl/pharmacology , Anesthetics, Local/pharmacology , Anti-Infective Agents/pharmacology , Sodium Hydroxide/pharmacology , Bupivacaine/administration & dosage , Microbial Sensitivity Tests , Fentanyl/administration & dosage , Prospective Studies , Drug Synergism , Hydrochloric Acid/pharmacology , Anesthetics, Local/administration & dosage , Anti-Infective Agents/administration & dosage
Rev. bras. anestesiol ; 70(4): 443-447, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137201


Abstract Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours and 3.35 from 24-48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.

Resumo Justificativa: Existem várias abordagens para a realização do Bloqueio do Quadrado Lombar (BQL) guiado por ultrassom. Diversas abordagens são descritas para a realização do BQL: paramediana lateral, posterior, anterior ou transmuscular e subcostal, todas com o objetivo de obter a máxima dispersão da solução injetada, usando-se alto volume e baixa concentração de anestésico local. Relato de caso: Nesta nova abordagem, a sonda de ultrassom curvilínea foi usada com o paciente em decúbito dorsal. A sonda foi posicionada longitudinalmente na linha axilar média para visualizar o Músculo Quadrado Lombar (MQL) no plano coronal. A agulha foi introduzida na direção cranial-caudal, e foram inseridos cateteres na Fáscia Toracolombar Anterior (FTLA) até uma distância de 4-5 cm, em 24 pacientes a serem submetidos à correção de fratura do acetábulo pela via anterior. O bisel da agulha e a dispersão do Anestésico Local (AL) eram visíveis em todos os pacientes. Os 24 pacientes, com exceção de quatro, apresentaram excelente analgesia perioperatória, baseando-se na estabilidade hemodinâmica e nos escores EVA de 2-3/10 nas primeiras 48 horas. Todos os pacientes receberam 1 g de paracetamol intravenoso a cada 8 horas. O escore EVA no período pós-operatório foi de 2-3/10, em 20 dos 24 pacientes. No período pós-operatório, quatro pacientes apresentaram queixa de dor persistente, necessitando de bolus de fentanil por via intravenosa e analgesia multimodal. O escore médio da EVA no pós-operatório foi 2,87 entre 0-12 horas; 3,14 entre 12-24 horas e 3,35 entre 24-48 horas pós-operatórias. Não houve complicações relacionadas ao bloqueio em nenhum paciente. Conclusão: A abordagem supina axilar média coronal para BQL anterior é eficaz e viável para BQL, e pode ser realizada com os pacientes em decúbito dorsal.

Humans , Male , Female , Pain, Postoperative/prevention & control , Anesthetics, Local/administration & dosage , Nerve Block/methods , Time Factors , Supine Position , Abdominal Muscles , Ultrasonography, Interventional , Acetabulum/surgery , Acetabulum/injuries , Acetaminophen/administration & dosage , Middle Aged , Nerve Block/adverse effects
Rev. bras. anestesiol ; 70(4): 434-439, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137195


Abstract Background and objectives When planning the management of a predicted difficult airway, it is important to determine which strategy will be followed. Video laryngoscopy is a major option in scenarios with factors suggesting difficult airway access. It is also indicated in rescue situations, when there is tracheal intubation failure with direct laryngoscopy. The objective of the present report was to show the efficacy of using the video laryngoscope as the first device for a patient with a large tumor that occupied almost the entire anterior portion of the oral cavity. Case report An 85 year-old male patient, 162 cm, 70 kg, ASA Physical Status II, Mallampati IV classification, was scheduled for resection of an angiosarcoma located in the right maxillary sinus that invaded much of the hard palate and the upper portion of the oropharynx. He was conscious and oriented, with normal blood pressure, heart and respiratory rates and, despite the large tumor in the oral cavity, he showed no signs of respiratory failure or airway obstruction. After intravenous cannulation and monitoring, sedation was performed with 1 mg of intravenous midazolam, and a nasal cannula was placed to provide oxygen, with a flow of 2 L min−1. Then, the target-controlled infusion of remifentanil with an effect site concentration of 2 ng mL−1 was initiated, according to Minto's pharmacokinetic model. Ventilation was maintained spontaneously during airway handling. A trans-cricothyroid block was performed, with 8 mL of 1% lidocaine solution injected into the tracheal lumen. Slight bleeding did not prevent the use of an optical method for performing tracheal intubation. The entire oral cavity was sprayed with 1% lidocaine. The McGraph video laryngoscope with the difficult intubation blade was used, and an armored tube with a guide wire inside was used for tracheal intubation, performed on the first attempt with appropriate glottis visualization. Conclusion The video laryngoscope occupies a prominent position in cases in which access to the airway is difficult. In the present case it was useful. It can be used as first choice or as a rescue technique. The video laryngoscope is an appropriate alternative and should be available for facing the ever-challenging difficult airway patient.

Resumo Justificativa e objetivos No planejamento da abordagem a uma via aérea difícil prevista, é importante determinar qual será a estratégia a ser seguida. A videolaringoscopia é uma ótima opção em situações em que existam fatores indicadores de dificuldade de acesso à via aérea. Também é indicada em situações de resgate, quando houve insucesso na tentativa de intubação com a laringoscopia direta. O objetivo deste relato é mostrar a eficácia da utilização do videolaringoscópio como primeiro dispositivo diante de paciente com grande tumor que ocupava quase a totalidade da porção anterior da cavidade oral. Relato do caso Paciente com 85 anos, sexo masculino, 162 cm, 70 kg, estado físico ASA II, classificação de Mallampati IV, foi escalado para a ressecção de um angiossarcoma localizado no seio maxilar direito que invadia grande parte do palato duro e da porção superior da orofaringe. Apresentava-se lúcido, consciente e orientado, com valores de pressão arterial, frequência cardíaca e respiratória normais e, apesar do grande tumor na cavidade oral, não apresentava qualquer sinal de insuficiência respiratória ou de obstrução das vias aéreas. Após venóclise, foi feita monitorização e sedação com 1 mg de midazolam, por via venosa, e colocado cateter nasal para administração de oxigênio, com fluxo de 2 L.min-1. Em seguida, foi iniciada a infusão alvo-controlada de remifentanil com concentração efeito de 2 ng.mL-1 segundo o modelo farmacocinético de Minto. A ventilação foi mantida em espontânea durante a manipulação da via aérea. Foi realizado bloqueio transcricotireóideo, sendo injetados 8 mL de solução de lidocaína a 1% na luz traqueal. Um pequeno sangramento não impediu que um método óptico fosse utilizado para realizar a intubação traqueal. Toda a cavidade oral recebeu o spray de lidocaína tópica a 1%. Foi utilizado o videolaringoscópio McGraph com a lâmina de intubação difícil, e um tubo aramado com fio guia no seu interior, foi utilizado para a intubação traqueal, que foi realizada na primeira tentativa, com boa visualização da glote. Conclusão O videolaringoscópio ocupa uma posição de destaque nos casos em que o acesso à via aérea é difícil. No presente caso, a sua utilização foi útil. Ele pode ser utilizado como primeira opção ou como técnica de resgate. Nas condições sempre preocupantes diante de um paciente com via aérea difícil, o videolaringoscópio deve estar disponível, constituindo-se uma boa opção.

Humans , Male , Aged, 80 and over , Mouth Neoplasms/surgery , Intubation, Intratracheal/methods , Laryngoscopy/methods , Hemangiosarcoma/surgery , Video Recording , Laryngoscopes , Remifentanil/administration & dosage , Anesthetics, Local/administration & dosage , Laryngoscopy/instrumentation , Lidocaine/administration & dosage
Rev. bras. anestesiol ; 70(4): 333-342, July-Aug. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137205


Abstract Background and objectives: PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. Methods: This was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 - 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05). Results: In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 - 5.56; mean 95% CI), 3.75 (3.13 - 4.37), 3.79 (2.93 - 4.64), and 2.29 (1.56 - 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 - 5.60), 4.00 (3.50 - 4.49), 3.93 (3.12 - 4.73), and 2.29 (1.56 - 3.01), respectively. Conclusions: PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.

Resumo Justificativa e objetivos: O bloqueio PECS I foi descrito pela primeira vez para cirurgia envolvendo os músculos peitorais. Nenhum estudo clínico randomizado foi realizado em procedimentos envolvendo diretamente os músculos peitorais, como a mamoplastia de aumento submuscular. Nossa hipótese foi de que o bloqueio PECS I diminuiria a dor pós-operatória nessa população. Método: Realizamos estudo randomizado, duplo-cego, controlado por placebo em mulheres submetidas à mamoplastia de aumento submuscular. Realizamos o bloqueio PECS I com 0,4 de solução salina a 0,9% de um lado e bupivacaína (0,25%) do outro lado, sendo cada paciente seu próprio controle. Os escores da Escala de Avaliação Numérica (EAN) de dor (0 - 10) foram obtidos em repouso e durante movimento. O desfecho primário foi o escore de dor em repouso 30 minutos após a chegada à SRPA. Para detectar uma diferença clinicamente significante de 50% na redução da dor, 14 voluntárias foram incluídas (poder de 90% e alfa < 0,05). Resultados: Na SRPA, três pacientes não apresentaram diferença na dor entre os lados, cinco relataram menos dor no lado do placebo e seis, menos dor no lado da bupivacaína. No grupo bupivacaína, os escores de dor em repouso aos 5, 30 e 60 minutos e 24 horas foram 4,89 (4,23 - 5,56; IC médio 95%), 3,75 (3,13 - 4,37), 3,79 (2,93 - 4,64) e 2,29 (1,56 - 3,01), respectivamente, enquanto no grupo placebo foram 4,96 (4,32 - 5,60), 4,00 (3,50 - 4,49), 3,93 (3,12 - 4,73) e 2,29 (1,56 - 3,01), respectivamente. Conclusões: O bloqueio PECS I em pacientes submetidas a mamoplastia de aumento não oferece melhor alívio da dor do que o placebo. Portanto, as indicações para bloqueio de PECS I na cirurgia de aumento de mama devem ser reconsideradas.

Humans , Female , Adult , Pain, Postoperative/prevention & control , Bupivacaine/administration & dosage , Breast Implantation/methods , Nerve Block/methods , Pain Measurement , Double-Blind Method , Anesthetics, Local/administration & dosage
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 376-382, May-June 2020. graf
Article in English | LILACS | ID: biblio-1132586


Abstract Introduction: Packing of the nasal cavity has traditionally been used for postoperative bleeding control and decreasing synechia formation in patients undergoing nasal surgeries. Although absorbable nasal packing has been gaining popularity in the recent years, nonabsorbable nasal packing is still often used in nasal surgeries in various parts of the world. It is known to be associated with pain and discomfort especially upon and during removal, and previous reviews have only evaluated the effects of local anesthetic infiltration of nasal packing in septal surgeries. Objective: To evaluate the effect of infiltrating nasal packing with local anesthetics in postoperative pain and anxiety following sinonasal surgeries Materials and methods: We searched the PubMed and Embase databases from their earliest record to April 27, 2019, randomized controlled trials and prospective controlled trials for review, and included only randomized controlled trials for data analysis. We included studies using topical anesthetics-infiltrated nasal packing following sinonasal surgeries and evaluated the effectiveness compared to placebo packing in pain reduction during postoperative follow up, as well as the effectiveness in anxiety reduction. Results: Among 15 studies included for review, 9 studies involving 765 participants contributed to the meta-analysis. In terms of pain reduction, our analysis showed significant standard mean differences regarding effectiveness at postoperative 1, 12, 24 h interval for all surgical groups combined, in the sinus surgery group, as well as during nasal packing removal. There was no consistent evidence to support the effectiveness in anxiety reduction. Conclusions: Our study supports anesthetics infiltration of nasal packing as an effective method in managing pain in patients with nasal packing after sinonasal surgeries. However, the level of evidence is low. More high-quality randomized controlled trials are needed to establish its effectiveness in reducing anxiety. We believe this review is of great clinical significance due to the vast patient population undergoing sinonasal surgeries. Postoperative local hemorrhage remains the greatest concern for ear nose and throat surgeons due to the rich vasculature of the nose and sinuses. Sinonasal packing provides structural support and serves as an important measure for hemostasis and synechia formation. Although absorbable packing has been gaining popularity in the recent years, nonabsorable packing materials are still used in many countries due to lower cost. Infiltration of nasal packing with local anesthetic provides a solution to the discomfort, nasal pressure and nasal pain experienced commonly by the patients as evidenced by our analysis.

Resumo Introdução: O tamponamento da cavidade nasal tem sido usado tradicionalmente para controle do sangramento pós-operatório e diminuição da formação de sinéquia em pacientes submetidos a cirurgias nasais. Embora o tamponamento nasal absorvível tenha ganhado popularidade nos últimos anos, o tampão nasal não absorvível ainda é frequentemente usado em várias partes do mundo. Sabe-se que o tamponamento está associado a dor e desconforto, especialmente na sua remoção, e revisões anteriores avaliaram apenas os efeitos do tampão com anestésico local em cirurgias do septo nasal. Objetivo: Avaliar o efeito do tamponamento nasal infiltrado com anestésicos locais na dor e ansiedade pós-operatórias após cirurgias nasosinusais. Material e métodos: Para a revisão, pesquisamos nos bancos de dados PubMed e Embase desde o registro mais antigo até 27 de abril de 2019, incluímos ensaios clínicos controlados e randomizados, a ensaios clínicos prospectivos controlados e apenas ensaios clínicos controlados e randomizados para análise de dados. Incluímos estudos que usaram tamponamento nasal infiltrado com anestésicos tópicos após cirurgias nasosinusais e avaliamos a eficácia em comparação com o tamponamento com placebo na redução da dor durante o acompanhamento pós-operatório, bem como os efeitos na redução da ansiedade. Resultados: Entre os 15 estudos incluídos, 9, que envolveram 765 participantes, contribuíram para a metanálise. Em termos de redução da dor, nossa análise mostrou diferenças médias padrão significantes em relação à eficácia no pós-operatório nos intervalos de 1, 12, 24 horas para todos os grupos cirúrgicos combinados, no grupo da cirurgia sinusal e durante a remoção do tamponamento nasal. Não houve evidências consistentes para apoiar a eficácia na redução da ansiedade. Conclusões: Nosso estudo apoia o uso de tamponamentos nasais infiltrados com anestésicos locais como um método eficaz no tratamento da dor em pacientes após cirurgias nasosinusais. No entanto, o nível de evidência é baixo. São necessários mais ensaios clínicos randomizados de alta qualidade para estabelecer sua eficácia na redução da ansiedade. Acreditamos que esta revisão seja de grande significado clínico devido à vasta população submetida a cirurgias nasosinusais. A hemorragia local pós-operatória continua a ser a maior preocupação para os cirurgiões otorrinolaringológicos devido à rica vasculatura do nariz e seios nasais. O tamponamento nasosinusal fornece suporte estrutural e serve como uma medida importante para a hemostasia e formação de sinéquias. Embora o tamponamento absorvível tenha ganhado popularidade nos últimos anos, os materiais de tamponamento não absorvíveis ainda são usados em muitos países devido ao menor custo. A infiltração do tamponamento nasal com anestésicos locais fornece uma solução para desconforto, pressão e dor nasal comumente referida pelos pacientes, como evidenciado por nossa análise.

Humans , Anxiety/psychology , Pain, Postoperative/prevention & control , Paranasal Sinuses/surgery , Postoperative Hemorrhage/prevention & control , Nasal Surgical Procedures/methods , Anesthetics, Local/administration & dosage , Pain, Postoperative/psychology , Bandages , Clinical Trials as Topic , Postoperative Hemorrhage/psychology
Rev. chil. anest ; 49(5): 742-746, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1512265


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

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

Humans , Male , Middle Aged , Arthroscopy/methods , Arthritis, Infectious/surgery , COVID-19/complications , Anesthetics, Local/administration & dosage , Nerve Block/methods , Sciatic Nerve/drug effects , Arthritis, Infectious/complications , Arthritis, Infectious/diagnostic imaging , Femoral Nerve/drug effects , Knee Joint
Rev. chil. anest ; 49(6): 882-888, 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1512275


OBJECTIVE: The objective of this study was to know the current reality of Uruguayan anesthesiologists in terms of the frequency of peripheral nerve blocks, which is the most used neurolocation method, the most frequent blockages and which has been the main source of training in this zone. METHODS: After the approval of the institutional ethics committee, it sent a survey through the SurveyMonkey® server to all the anesthesiologists partners of the Uruguayan Society of Anesthesiology whose design was based on the completion in 2016 by Corvetto et al., modifying it and using only the questions referred to peripheral regional blocks to make the data comparable. Data is processed anonymously. RESULTS: The survey was sent to 404 anesthesiologists, responding to the same 201 participants (49.8%), of these 66.2% performed peripheral nerve blocks, interscalenic (40.9%), femoral (46%), axillary and ankle (6.6%) respectively. The most used neurolocation technique is ultrasound either as a single technique (45.1%) or combined with neurostimulation (34.5%). The primary source of training is self-training (42.7%) followed by residency programs (31.7%) and workshops (19.5%). CONCLUSIONS: There is an improvement in our environment regarding the use of peripheral nerve blocks by anesthesiologists with a growing use of ultrasound as the main method of neurolocation.

OBJETIVO: Conocer la realidad actual de los anestesiólogos uruguayos en cuanto a la realización de bloqueos nerviosos periféricos, método de neurolocalización más utilizado, bloqueos más frecuentes y cuál ha sido la principal fuente de formación en esta área. MÉTODO: Tras la aprobación del comité de ética institucional, se envió una encuesta a través del servidor SurveyMonkey® a todos los anestesiólogos socios de la Sociedad Uruguaya de Anestesiología cuyo diseño se basó en la realizada en 2016 por Corvetto y cols, modificando la misma y utilizando sólo las preguntas referidas a los bloqueos regionales periféricos para hacer los datos comparables. Los datos se procesaron de forma anónima. RESULTADOS: La encuesta fue enviada a 404 anestesiólogos, respondiendo la misma 201 participantes (49,8%), de estos 66,2% afirmó realizar bloqueos de nervio periférico, dentro de estos: interescalénico (40,9%), femoral (46%), axilar y tobillo (6,6%) respectivamente. La técnica de neurolocalizacion más utilizada es el ultrasonido ya sea como técnica única (45,1%) o combinada con neuroestimulación (34,5%). La fuente primaria de formación es la autoformación (42,7%) seguido de los programas de residencia (31,7%) y los workshops (19,5%). CONCLUSIONES: Existe una mejora en nuestro medio respecto al uso de los bloqueos nerviosos periféricos por parte de los anestesiólogos con una creciente utilización del ultrasonido como principal método de neurolocalización.

Humans , Male , Female , Peripheral Nerves , Anesthetics/administration & dosage , Nerve Block/statistics & numerical data , Uruguay , Surveys and Questionnaires , Ultrasonography, Interventional , Anesthetics, Local/administration & dosage , Nerve Block/methods
Rev. chil. anest ; 49(1): 125-132, 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1510350


INTRODUCTION: The commonly used concentrations of local anesthetics (LA) for femoral nerve block (FNB) cause a significant decrease in the quadriceps strength (QS), limiting physiotherapy and determining a risk factor for patient's falls. The use of more dilute solutions could determine the preservation of motor function without impairing analgesia. METHODS: Five patients scheduled for total knee arthroplasty (TKA) received a preoperative FNB with 20 mL of bupivacaine in decreasing concentrations (0.0875%, 0.075%, 0.0625%, 0.050%, 0.0375%). Sensory block to cold in the anterior knee region, QS, surface electromyography (SEMG) of vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) plus were recorded before and 30 minutes after the blockage. Posteriorly, the clinical data of 20 patients who underwent TKA and received a continuous femoral nerve block (CFNB) with bupivacaine in the most dilute concentration that granted sensory blockade and significantly preserved the QS in the previous analysis were retrospectively analyzed. Postoperative pain at 24 and 48 hours, morphine consumption at 24 hours, the ability to successfully perform physiotherapy on the first postoperative day (POD) and reports of falls were rescued from the patients' files. Finally, seventy-five patients that underwent TKA during 2018 who received a CFNB with a similar dilution, but using levobupivacaine, were also retrospectively analyzed. Postoperative pain, need for advanced rescue analgesia, ability to perform physiotherapy, CFNB related complications and reports of patients falls during the first 72 hours post-surgery were obtained. RESULTS: Biomechanical study: of the 5 concentrations analyzed, either 0.050% or 0.0375% bupivacaine were adequate producing sensory block and preserving 94% and 100% of the basal QS, respectively. With both concentrations, the SEMG showed a similar range of activation with respect to baseline values. Bupivacaine case series: Twenty patients undergoing TKA received a 5-8 mL/hr infusion of 0.037% bupivacaine. The average consumption of morphine at 24 hours was 3.9 (3.6) mg. The median [IQR] of dynamic postoperative pain at 24 and 48 hours was 3 [1-4] and 3 [2-5]. All patients had adequate active joint ranges at 24 hours and physiotherapy was not limited by significant motor block. No falls were reported during the stay. Levobupivacaine case series: seventy-five patients undergoing TKA received a 5-8 mL/hr infusion of 0.037% levobupivacaine. The median [IQR] of at rest (R) and dynamic (D) postoperative pain at 24, 48 and 72 hours were R24: 0 [0-3]; D24: 3 [1-5]; R48: 0 [0-2]; D48: 3 [1.5-5]; R72: 0 [0-1]; D72: 3 [1-4]. 21% of patients required adding a PCA mode to the CFNB and a 7% a morphine PCA. On POD 1, 4% of patients were not able to adequately perform rehabilitation. On POD 2 and 3, all patients had adequate active joint ranges and physiotherapy was not limited by significant motor block. There were also no falls during hospitalization. CONCLUSIONS: The use of diluted solutions of bupivacaine and levobupivacaine for CFNB may represent a good alternative for TKA postoperative analgesia while avoiding significant quadriceps paresis. Additional studies are necessary to determine the ideal concentration and administration regimen to then compare with other quadriceps sparing analgesic alternatives.

INTRODUCCIÓN: Las concentraciones habituales de anestésicos locales (AL) utilizadas para el bloqueo del nervio femoral (BNF) provocan una disminución significativa de la fuerza del cuádriceps (FC), limitando la fisioterapia y constituyendo un factor de riesgo de caídas de pacientes. El uso de soluciones más diluidas podría determinar preservación de la función motora sin perjudicar la analgesia. MÉTODOS: Cinco pacientes programados para artroplastía total de rodilla (ATR) recibieron un BNF preoperatorio con 20 mL de bupivacaína en concentraciones decrecientes (0,0875%, 0,075%, 0,0625%, 0,050%, 0,0375%). Se registró la FC, electromiografía de superficie (EMGS) de vasto lateral (VL), vasto medial (VM) y recto femoral (RF) y el bloqueo sensitivo al frío antes y 30 minutos después del bloqueo. Posteriormente, se analizó retrospectivamente 20 casos sometidos a ATR que recibieron un bloqueo continuo del nervio femoral (BCNF) con bupivacaína en la concentración más diluida que otorgó bloqueo sensitivo y preservó significativamente la fuerza basal del cuádriceps durante el análisis anterior. El dolor postoperatorio a las 24 y 48 horas, el consumo de morfina las primeras 24 horas, la capacidad de realizar con éxito la fisioterapia el primer día postoperatorio (DPO) y reporte de caídas fueron rescatados de los expedientes. Por último, también se analizó retrospectivamente un grupo de 75 pacientes sometidos a ATR durante el 2018 y que recibieron un BCNF con una dilución similar, pero de levobupivacaína. Se obtuvieron datos de dolor, requerimientos de rescate analgésico, capacidad de realizar rehabilitación, complicaciones del BCNF y reporte de caídas durante las primeras 72 horas postoperatorias. RESULTADOS: Estudio biomecánico: de las 5 concentraciones analizadas, tanto bupivacaína 0,05% como 0,0375% produjeron adecuado bloqueo sensorial preservando el 94% y el 100% de la FC, respectivamente. Con ambas concentraciones la EMGS mostró similar rango de activación respecto a valores basales. Serie de casos con bupivacaína: veinte pacientes sometidos a ATR recibieron una infusión de bupivacaína 0,037% a 5-8 mL/h. El consumo promedio de morfina a las 24 horas fue 3,9 (3,6) mg. La mediana [RIC] del dolor dinámico postoperatorio a las 24 y 48 horas fue 3 [1-4] y 3 [2-5]. Todos los pacientes tuvieron rangos articulares activos adecuados a las 24 horas y la fisioterapia no fue limitada por bloqueo motor significativo. No se registraron caídas durante la hospitalización. Serie de casos levobupivacaína: setenta y cinco pacientes sometidos a ATR recibieron una infusión de levobupivacaína 0,037% a 5-8 mL/h. La mediana [RIC] de dolor postoperatorio en reposo (R) y dinámico (D) a las 24, 48 y 72 horas fue R24: 0 [0-3]; D24: 3 [1-5]; R48: 0 [0-2]; D48: 3 [1.5-5]; R72: 0 [0-1]; D72: 3 [1-4]. Un 21% requirió agregar modo PCA al BCNF y 7% una PCA de morfina. En DPO 1, un 4% de pacientes no pudo realizar adecuadamente la rehabilitación. En DPO 2 y 3 todos los pacientes tuvieron rangos articulares activos adecuados y fisioterapia no fue limitada por bloqueo motor significativo. Tampoco se registraron caídas durante la hospitalización. CONCLUSIONES: El uso de soluciones diluidas de bupivacaína y levobupivacaína en BCNF podría representar una buena opción para analgesia postoperatoria en ATR evitando la paresia significativa del cuádriceps. Estudios adicionales son necesarios para determinar la concentración y régimen de administración ideal para luego comparar con otras alternativas analgésicas preservantes del cuádriceps.

Humans , Male , Female , Middle Aged , Aged , Bupivacaine/administration & dosage , Arthroplasty, Replacement, Knee , Quadriceps Muscle/physiology , Muscle Strength/physiology , Anesthetics, Local/administration & dosage , Nerve Block/methods , Biomechanical Phenomena , Quadriceps Muscle/drug effects , Muscle Strength/drug effects , Femoral Nerve , Levobupivacaine/administration & dosage
Rev. chil. anest ; 49(4): 514-520, 2020. tab
Article in Spanish | LILACS | ID: biblio-1511710


OBJECTIVES:Transmuscular quadratus lumborum block (TQLB) is a novel regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. The present study evaluated its efficacy on pain intensity and analgesic consumption in children undergoing low abdominal surgery. METHODS: The study included forty patients, aged 1 to 6 years, scheduled for low abdominal surgery (hernia repair or orchiopexy) under general anaesthesia. They were enrolled in two groups: TQLB block plus systemic analgesia (group 1; n = 20) wound infiltration done by the surgeon plus systemic analgesia (Group 2; n = 20). All blocks were performed by the same anesthesiologist under general anaesthesia before surgery. Both groups received the same systemic analgesia protocol. Analgesic consumption (ibuprofen) within the first 24 postoperative hours, pain intensity scores (FLACC scale) at 60 minutes, 2, 6 and 24 hours after surgery, time in which the first analgesia was required, satisfaction levels of the parents (0-10), adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered. RESULTS: We found differences between both groups in ibuprofen consumption (80 mg 185 mg; p < 0.05) and pain scores (FLACC) within the first 24 postoperative hours at each interval (p < 0.05 for every point in time analyzed). Time in which the first analgesia was required was longer for the TQLB group (18 10 hours; p < 0.05). Satisfaction levels of the parents were also higher in the first group (p < 0.05). Adverse events related to medication and time to hospital discharge showed similar results. Further investigation comparing the TQLB with different approaches of QLB or conventional TAP block could be interesting and is required in a near future.

INTRODUCCIÓN: El bloqueo del cuadrado lumbar transmuscular (TQL) es una técnica de anestesia regional ecoguiada que demostró ser efectiva en cirugía abdominal abierta y laparoscópica como parte de un esquema multimodal de analgesia postoperatoria. La presente investigación evaluó su eficacia en cirugía de hernia inguinal y testículo no descendido en población pediátrica (de 1-6 años de edad). MATERIALES Y MÉTODOS: El estudio fue diseñado como un ensayo clínico controlado, aleatorizado en 2 ramas: grupo protocolo bloqueo TQL (Grupo 1; n = 20) grupo protocolo infiltración local por cirujano (Grupo 2; n = 20), simple ciego que incluyó a 40 pacientes pediátricos sometidos a una cirugía de hernia inguinal u orquidopexia unilateral. Todos los bloqueos fueron realizados bajo anestesia general antes del inicio de procedimiento quirúrgico. Ambos grupos recibieron el mismo esquema de analgesia endovenosa y oral postoperatoria. Consumo de analgésicos durante las primeras 24 horas (mg de ibuprofeno), intensidad de dolor con escala FLACC a tiempo 1, 2, 6 y 24 horas postoperatorias, tiempo transcurrido a la primera administración de ibuprofeno, escala de satisfacción parental (0-10) e incidencia de náuseas y vómitos fueron evaluados y registrados. Se consideró como significativa una p < 0,05. RESULTADOS: El consumo promedio de ibuprofeno en las primeras 24 horas fue de 80 mg para el grupo bloqueo TQL y de 185 mg para el segundo grupo, diferencia estadísticamente significativa (p < 0,05). El tiempo transcurrido a la primera administración de ibuprofeno fue mayor en el grupo TQL (18 10 horas), p < 0,05. Las escalas de dolor por FLACC a los 60 y 120 minutos y a las 6 y 24 horas. postcirugía fueron menores comparadas con el grupo de infiltración local por el cirujano (p < 0,05 en cada punto de análisis). Las escalas de satisfacción parental mostraron puntajes más elevados para el grupo que recibió el bloqueo TQL (p < 0,05). No se hallaron diferencias significativas en la incidencia de episodios de náuseas y/o vómitos en las primeras 24 horas. postoperatorias (p > 0,2). No se reportaron complicaciones asociadas al bloqueo. CONCLUSIONES: Este estudio muestra que el bloqueo TQL aporta beneficios adicionales respecto al plan de analgesia estándar empleado en cirugía de hernia inguinal unilateral u orquidopexia, disminuyendo el requerimiento de analgésicos y la intensidad de dolor en las primeras 24 horas postoperatorias, así como también incrementando la satisfacción de los cuidadores respecto al estado postoperatorio del niño. Sería interesante llevar a cabo nuevas investigaciones comparando esta técnica con otros abordajes del bloqueo de cuadrado lumbar y con el cuestionado bloqueo TAP convencional.

Humans , Infant , Child, Preschool , Child , Surgical Procedures, Operative/methods , Ultrasonography/methods , Anesthesia, Conduction/methods , Anesthetics, Local/administration & dosage , Nerve Block/methods , Pain, Postoperative/drug therapy , Postoperative Period , Time Factors , Pain Measurement , Single-Blind Method , Ibuprofen/therapeutic use , Treatment Outcome , Patient Satisfaction , Abdominal Muscles/drug effects , Orchiopexy , Hernia, Inguinal
Rev. chil. anest ; 49(1): 183-186, 2020.
Article in Spanish | LILACS | ID: biblio-1510447


Local anesthetics are drugs widely used to perform peripheral nerve blocks. Signs and symptoms of toxicity may vary from mild to severe, including neuro and cardiotoxicity, with seizures and cardiac arrest. We present the case of an 85-year-old patient in total left knee replacement plan due to tibial saucer fracture, where systemic toxicity was observed by local anesthetics (LAST) after performing a femoral nerve block guided by neurostimulation and ultrasound with a solution of 20 ml of 0.525% ropivacaine + 0.6% lidocaine. As a positive data, the patient presented severe hypoalbuminemia

Los anestésicos locales son fármacos ampliamente utilizados para realizar bloqueos nerviosos periféricos. Los signos y síntomas de toxicidad pueden variar de leves a severos, incluidas la neuro y cardiotoxicidad, con convulsiones y paro cardíaco. Presentamos el caso de una paciente de 85 años de edad en plan de reemplazo total de rodilla izquierda debido a fractura de platillo tibial, donde se observó toxicidad sistémica por anestésicos locales (LAST por su sigla en inglés) después de realizar un bloqueo del nervio femoral guiado por neuroestimulación y ultrasonido con una solución de 20 ml de ropivacaína al 0,525% + lidocaína al 0,6%. Su único antecedente médico era presentar hipoalbuminemia severa.

Humans , Female , Aged, 80 and over , Hypoalbuminemia/complications , Anesthetics, Local/adverse effects , Anesthetics, Local/administration & dosage , Nerve Block/adverse effects