[Preoperative erythropoietin as blood conservation technique for elderly patients in elective orthopedic surgery]. / Eritropoyetina preoperatoria como estrategia de ahorro de sangre en cirugía ortopédica mayor en pacientes de edad avanzada.

BACKGROUND AND OBJECTIVE: Preoperative anemia is a major risk factor for perioperative transfusion in orthopedic surgery and aging is associated with an increased risk for developing anemia. The aim of this study was to compare the efficacy and safety of preoperative epoetin alfa in patients older and younger than 65 years in orthopedic surgery. PATIENTS AHD METHOD: This study involved 75 patients scheduled for total joint arthroplasty who had an hemoglobin level between 100 and 130 g/l. Patients were assigned to receive weekly doses of subcutaneous epoetin alfa (40000 IU) on days -21, -14, -7, -1 before surgery. We tabulated age, weight, gender, baseline analytic parameters, perioperative evolution of the mean hemoglobin level, transfusion, side effects and complications. RESULTS: Fifty-four patients were included in group A (> or = 65 years) and 21 in group B (< 65 years). The two study groups did not differ in terms of demographic characteristics and baseline analysis but differed in age and associated diseases. The preoperative increase in mean hemoglobin level (20 and 18 g/l) and transfusion rate (15% and 14.3%) were similar in both groups. There were no complications associated with the use of epoetin alfa. CONCLUSIONS: Preoperative epoetin alfa administration seems to be as effective and safe in patients younger as in those older than 65 years.

Eritropoyetina preoperatoria como estrategia de ahorro de sangre en cirugía ortopédica mayor en pacientes de edad avanzada / Preoperative erythropoietin as blood conservation technique for elderly patients in elective orthopedic surgery

FUNDAMENTO Y OBJETIVO: La anemia preoperatoria es el principal factor de riesgo de transfusión perioperatoria en cirugía ortopédica mayor. La prevalencia de la anemia aumenta considerablemente con la edad. Nuestro objetivo fue comparar la eficacia y seguridad de la epoetina alfa preoperatoria en pacientes de edad superior o inferior a 65 años en cirugía ortopédica mayor.PACIENTES Y MÉTODO: Se incluyó en el estudio a 75 pacientes intervenidos de artroplastia de cadera o rodilla con hemoglobina basal entre 100 y 130 g/l que recibieron una dosis semanal subcutánea de epoetina alfa (40.000 IU) los días -21, -14, -7 y el día previo a la cirugía. Estudiamos la edad, el peso, el sexo, los antecedentes patológicos, los parámetros hematológicos, la evolución perioperatoria de la hemoglobina, la dosis de epoetina recibida, la transfusión de hemoderivados y las complicaciones.RESULTADOS: En el grupo A (65 o más años) se incluyó a 54 pacientes y 21 en el grupo B (menores de 65 años). Ambos grupos fueron comparables excepto en edad y antecedentes patológicos. El incremento de hemoglobina preoperatoria (20 y 18 g/l, respectivamente) y el índice transfusional (15 y 14,3 por ciento) fueron similares. No hubo complicaciones atribuibles a la epoetina alfa.CONCLUSIONES: La administración preoperatoria de epoetina alfa parece ser igual de eficaz y segura en pacientes de edad superior o inferior a 65 años (AU)

Retroperitoneal abscess after neurolytic celiac plexus block from the anterior approach.

BACKGROUND AND OBJECTIVES: The anterior approach for celiac plexus block has the potential risks of infection, hemorrhage, and fistula formation. We report a case of a patient who developed a retroperitoneal abscess with the formation of a vascular-enteric fistula after a neurolytic celiac plexus block from the anterior approach. CASE REPORT: A 60-year-old female with a history of pain secondary to chronic idiopathic calcifying pancreatitis (VAS 7-8) underwent a subtotal resection of the head of the pancreas with an end-to-side pancreatojejunostomy using a Roux-en-Y loop. Pain continued secondary to chronic pancreatitis. Because of intolerance (vomiting and constipation) of morphine and transdermal fentanyl over a 2-month period, it was decided to perform a neurolytic celiac plexus block using the anterior approach with ultrasound guidance. The patient's pain was completely relieved, enabling withdrawal of oral analgesics. Pain reappeared after 2 years, and the same technique was repeated. Ten days later, she was admitted with diabetic ketoacidosis and lower gastrointestinal bleeding. Computed tomography showed a left paravertebral retroperitoneal abscess; arteriography suggested a fistula between the mesenteric vein and the jejunum. Urgent surgery was undertaken, revealing a leak of the pancreatojejunostomy and a large abscess around the celiac plexus. A distal pancreatectomy and partial resection of the Roux-en-Y loop was performed. The patient was discharged 1 month later in good clinical condition. Because of recurrent pain, she has required repeated neurolytic celiac plexus blocks via a posterior approach without complications. CONCLUSION: The posterior approach for neurolytic celiac plexus block should be considered in particular in patients with previous pancreatic surgery.