What do we know about the PENG block for hip surgery? A narrative review / ¿Qué conocemos del bloqueo PENG para cirugía de cadera? Una revisión narrativa

Abstract Postoperative pain management in hip surgery is classified as severe and its inadequate control leads to complications that increase patient morbidity and mortality. The PENG block is advocated as a safe, opioid-sparing analgesic technique, which provides an adequate level of analgesia. The purpose of this study is to analyze about the efficacy, safety and therapeutic appropriateness of the PENG block in hip surgery. To this end, a narrative review is conducted using various databases such as PubMed and the Cochrane library. In all of the studies analyzed, an adequate postoperative pain control was achieved using the PENG block, with reduction in pain assessment scales and opioid consumption in the first postoperative hours. Improved results were also seen as compared with other regional blocks. There were few adverse effects and none of them was classified as severe. The PENG block contributes with numerous advantages and few adverse effects for hip surgery. Further studies are needed on this block, whether alone or in combination with other regional techniques, so as to include it in analgesia protocols, developing a standardized approach and study the outcomes in more controlled settings.

Resumen El manejo del dolor posoperatorio en cirugía de cadera se cataloga como severo y su inadecuado control conduce a complicaciones que aumentan la morbimortalidad de los pacientes. El bloqueo PENG se postula como una técnica analgésica segura, ahorradora de opioides, que otorga un nivel analgésico adecuado. El objetivo de este estudio es analizar acerca de la eficacia, seguridad y el lugar terapéutico del bloqueo PENG en cirugía de cadera. Para ello, se hace una revisión narrativa utilizando distintas bases de datos como PubMed y la biblioteca Cochrane. En todos los estudios analizados se observó un adecuado control del dolor posoperatorio con el uso del bloqueo PENG, con reducción en las escalas de evaluación del dolor y en el consumo de opioides en las primeras horas del posoperatorio. También se evidenciaron mejores resultados en comparación con otros bloqueos regionales. Los efectos adversos fueron escasos, y ninguno se catalogó como grave. El bloqueo PENG aporta numerosas ventajas con escasos efectos adversos para cirugía de cadera. Es necesario continuar estudiando este bloqueo, solo o en combinación con otras técnicas regionales, e incluirlo en protocolos de analgesia, estandarizarlo y estudiar sus resultados en escenarios más controlados.

Regional analgesia and surgical site infections after colorectal surgery: a retrospective cohort analysis

Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.

Manejo de cefalea cervicogénica mediante bloqueo great occipital nerve (GON) ecoguiado en el área de urgencias. Reporte de un caso / Cervicogenic headache treated with great nerve occipital block

Cervicogenic headache can be confused with migraine headache, which conditions multiple admissions to emergency services, within the established treatments, the international headache society establishes the blockade of the greater occipital nerve (GON) with local anesthetics as necessary for the diagnosis of occipital neuralgia, with the introduction of ultrasound to perform invasive procedures, it has facilitated the performance of the technique, with excellent results, reducing stays in the emergency department and it is a technique that emergency physicians can perform.

La cefalea cervicogenica se puede confundir con cefalea migrañosa eso condiciona múltiples ingresos a los servicios de urgencias, dentro de los tratamientos establecidos, the internacional headache society establece el bloqueo del nervio occipital mayor (GON) con anestésico locales como necesario para el diagnóstico de neuralgia occipital, con la introducción del ultrasonido para realizar procedimientos invasivos ha facilitado la realización de la técnica, con excelentes resultados reduciendo las estancias en el servicio de urgencias y es una técnica que pueden realizar los médicos urgenciologos.

Papel de la analgesia regional en el dolor postoperatorio / Role of regional analgesia in postoperative pain

Resumen: La anestesia y la analgesia regional son consideradas herramientas que, desde sus primeras descripciones, han ganado terreno en el arsenal del anestesiólogo, se han convertido en parte integral del cuidado moderno perioperatorio. La historia de la anestesia regional y neuroaxial se ha caracterizado por la búsqueda de métodos más efectivos y seguros durante los procedimientos quirúrgicos. Con base en lo anterior, el advenimiento del ultrasonido en anestesia regional permite realizar procedimientos bajo la visualización 2D de tejidos blandos, vasos sanguíneos y nervios, además de referencias óseas, siempre en tiempo real, con la posibilidad de visualización directa de aguja o punzones, brindando seguridad y aumentando la tasa de éxito al visualizar la administración, comportamiento y distribución del anestésico local utilizado. En años recientes, nuevas técnicas analgésicas como el uso de bloqueos interfasciales o troncales guiados por ultrasonido han sido empleadas como parte de modalidades analgésicas durante el perioperatorio.

Abstract: Anesthesia and regional analgesia are considered tools that, since their first descriptions, have become an integral part of modern perioperative care. The history of regional and neuroaxial anesthesia has been characterized by the search for more effective and safe methods during surgical procedures. Based on the above, the advent of ultrasound in regional anesthesia allows performing procedures under 2D visualization of soft tissues, blood vessels and nerves, as well as bone references, always in real time, with the possibility of direct visualization of needle or punches, providing safety and increasing the success rate when visualizing the administration, behavior and distribution of the local anesthetic used. In recent years, new analgesic techniques, such as the use of interfascial or ultrasound-guided trunks, have been used as part of analgesic modalities during the perioperative period.

Intervencionismo guiado por ultrasonido en cirugía torácica y pared abdominal / Ultrasound-guided intervention in thoracic surgery and abdominal wall

Resumen: Cada vez es más frecuente el uso de la ecografía para identificar las capas interfasciales, el cual ha llevado al desarrollo de varias técnicas de inyección para la analgesia del tórax y la pared abdominal. Para la realización de este tipo de abordajes es importante tener el conocimiento y dominio del ultrasonido, de los bloqueos troncales, anestésicos locales y toxicidad. Estos bloqueos interfasciales se desarrollaron como alternativas al bloqueo epidural, paravertebral, intercostal e intrapleural torácico, principalmente para la analgesia perioperatoria. En esta revisión incluimos diferentes abordajes guiados por ultrasonido como son el bloqueo del plano del erector espinal (ESP), el bloqueo del serrato anterior, bloqueo PEC1 y PEC2, bloqueo BRILMA, bloqueo paravertebral, bloqueo del plano del transverso abdominal (TAP), bloqueo del cuadrado lumbar, bloqueo de la vaina de los rectos. Se incluyen enlaces con videos para poder revisar la técnica, indicaciones y dosis (visite http://www.painoutmexico.com para ver artículo completo y videos).

Abstract: The increasing use of ultrasound to identify the interfascial layers has led to the development of several injection techniques for analgesia of the thorax and abdominal wall. For this type of approach it is important to have knowledge of ultrasound, trunk blocks, local anesthetics and toxicity. These interfascial blocks were developed as alternatives to epidural, paravertebral, intercostal and intrapleural thoracic block, mainly for perioperative analgesia. In this review, we include different approaches guided by ultrasound such as: erector spinae plane block (ESP), anterior serratus block, PEC1 and PEC2 block, BRILMA block, paravertebral block, transverse abdominal plane block (TAP), quadratus lumbar block (QLB) and rectus sheath block. Links with videos are included to review the technique, indications and dosage (visit http://www.painoutmexico.com obtain full version and videos).