[Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery]. / Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama.

BACKGROUND AND OBJECTIVE: Over 50% of patients still experience pain a year after mastectomy with or without lymphadenectomy. We aimed to determine the association between anesthetic technique, acute postoperative pain intensity, and the development of chronic postoperative pain. PATIENTS AND METHODS: Forty patients were randomly assigned to receive general anesthesia with or without a paravertebral nerve block for modified radical mastectomy. Postoperative pain was assessed on a visual analog scale at 60 minutes and 24 hours; the patients were also asked to respond to a telephone questionnaire on chronic pain 4 to 5 months later. RESULTS: No significant differences in acute pain were observed. Twenty-nine responded to the telephone questionnaire. Only 1 patient in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. Only 1 patient (6.7%) in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. In the group that received general anesthesia alone, 1 patient reported phantom breast pain and 6 patients had neuropathic pain, associated with phantom breast pain in 2 cases (incidence of chronic pain 50%; P = .01, Fischer exact test; relative risk, 7.5, 95% confidence interval, 1.0-53.5). The incidences of myofascial pain (neck muscle tightness) were similar in the 2 groups. CONCLUSIONS: Four to 5 months after mastectomy, fewer cases of chronic pain developed in the group operated under general anesthesia with a preincisional paravertebral block than in the group that received only general anesthesia, with postoperative morphine chloride for analgesia.

Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama / Chronic postoperative pain after general anesthesia with or without a singledose preincisional paravertebral nerve block in radical breast cancer surgery

Objetivo: En la cirugía del cáncer de mama, en más del 50% de las pacientes con mastectomía y/o linfadenectomía persiste el dolor en el primer año. Nuestro objetivo fue determinar la asociación entre la técnica anestésica, la intensidad del dolor agudo postquirúrgico y el desarrollo del dolor crónico postquirúrgico. Pacientes y métodos: Cuarenta pacientes fueron asignadas aleatoriamente a recibir anestesia general o anestesia general con bloqueo paravertebral para mastectomía radical modificada. Se midió el dolor mediante escala visual analógica a los 60 minutos, a las 24 horas y a los 4-5 meses se realizó encuesta de dolor crónico postquirúrgico. Resultados: No hubo diferencias significativas respecto al dolor agudo. Veintinueve pacientes contestaron a la encuesta telefónica. En el grupo del bloqueo paravertebral sólo hubo un caso de dolor neuropático y ninguno de miembro fantasma mientras que en el grupo de anestesia general hubo 7 casos de dolor neuropático asociados a 3 casos de miembro fantasma [6,7% frente a 50%; test exacto de Fischer, p = 0,01, con un RR de 7,5 (IC95% 1,0-53,5)]. Hubo dolor miofascial (contracturas en cuello) en ambos grupos sin diferencias significativas. Conclusiones: A los 4-5 meses de la cirugía la anestesia general con bloqueo paravertebral preincisional presenta menos casos de dolor crónico que sí se utiliza anestesia general y analgesia con cloruro mórfico(AU)

Background and objective: Over 50% of patients still experience pain a year after mastectomy with or without lymphadenectomy. We aimed to determine the association between anesthetic technique, acute postoperative pain intensity, and the development of chronic postoperative pain. Patients and methods: Forty patients were randomly assigned to receive general anesthesia with or without a paravertebral nerve block for modified radical mastectomy. Postoperative pain was assessed on a visual analog scale at 60 minutes and 24 hours; the patients were also asked to respond to a telephone questionnaire on chronic pain 4 to 5 months later. Results: No significant differences in acute pain were observed. Twenty-nine responded to the telephone questionnaire. Only 1 patient in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. Only 1 patient (6.7%) in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. In the group that received general anesthesia alone, 1 patient reported phantom breast pain and 6 patients had neuropathic pain, associated with phantom breast pain in 2 cases (incidence of chronic pain 50%; P = .01, Fischer exact test; relative risk, 7.5, 95% confidence interval, 1.0-53.5). The incidences of myofascial pain (neck muscle tightness) were similar in the 2 groups. Conclusions: Four to 5 months after mastectomy, fewer cases of chronic pain developed in the group operated under general anesthesia with a preincisional paravertebral block than in the group that received only general anesthesia, with postoperative morphine chloride for analgesia(AU)

Cefalea postpunción dural tras anestesia subaracnoidea en un programa de cirugía mayor ambulatoria / No disponible

Objetivo: Evaluar la incidencia de cefalea postpunción dural en pacientes sometidos a cirugía mayor ambulatoria bajo anestesia espinal intradural. Material y métodos: Estudio retrospectivo y descriptivo de9.992 pacientes intervenidos en un periodo de 9 años. Se cuantifican la relación de CPPD-tipo de aguja empleada, así como el consumo de agujas espinales por año de estudio. Se valoró por las consultas e ingresos al Servicio de Urgencias de los casos de CPPD según criterios de Jones. El método estadístico empleado fue la t de Student para las variables cuantitativas y la (..) (AU)

Objective: To evaluate the ratio of headaches after dural puncture (PDPH) in patients undergoing intradural spinal anaesthesia for ambulatory surgery. Material and methods: We undertook a retrospective and descriptive study of 9,992 patients over a period of 9 years. The relationship between PDPH and the type of needle used, as well as the consumption of spinal needles per year of study, were quantified. We evaluated the number of cases of PDPH through the consultations and admissions to the Emergency Service according to the Jones’ criteria. The statistical methods used were: Student’s t test for the quantitative variables and chi-squared test of frequencies for the qualitative variables. Results: The incidence of PDPH was 0.60%. The average age of PDPH appearance was 43.12 ± 15.62 years, with a predominance of the feminine sex (63,3%). The incidence of PDPH when using a 22-G Quincke type needle was superior, with statistically significant differences, with respect to the rest of needles. The PDPH was severe in 58% of the cases. The evolution of the migraine in most of the cases (91%) was benign with medical treatment. Conclusions: The progressive reduction in the number of days of hospitalization, accentuated, in the last years, with the new organizational models for surgical assistance has lead to the appearance, in primary medicine, of clinical problems usually found only in hospitalized patients. The PDPH is characterized bya front occipital headache that gets worse when in the upright position in surgical patients undergoing spinal anaesthesia, and is benign and self-limited when treated with conventional medication (AU)