Buprenorphine versus dexamethasone as perineural adjuvants in femoral and adductor canal nerve blocks for total knee arthroplasty: a randomized, non-inferiority clinical trial.

BACKGROUND: Optimal control of acute postoperative pain and prevention of chronic persistent pain in total knee arthroplasty (TKA) remain a challenge. METHODS: A randomized, non-inferiority clinical trial (385 patients) evaluated every hour immediate postoperative pain during 24 h, using a verbal rating 11-point scale for patient self-reporting of pain (VRS11). All patients received subarachnoid anesthesia and were randomly allocated in four groups: single shots femoral (FNB) or adductor canal blocks (ACB), both with dexamethasone (dex) and buprenorphine (bup). Patients received intravenous analgesia (metamizole magnesium, dexketoprofen) and rescue analgesia when needed: intravenous (paracetamol and morphine) and/or regional (femoral and sciatic nerve blocks). Demographics and adverse effects were also recorded. RESULTS: A 45.7% of patients had pain: bupACB 56.3%, bupFNB 50.0%, dexACB 40.6% and dexFNB 36.1% (P=0.022). Rescue analgesia was needed in 37.7% of patients (P=0.128). There were statistical differences in percentage of timepoints without pain (95.0±7.9%, P=0.014) and mean VRS11 (0.18±0.3, P=0.012) but no differences in distribution of intensity periods of pain. There were no significant differences in the need of rescue analgesia excepting the use of intravenous morphine (P=0.025). CONCLUSIONS: Buprenorphine is in the present trial inferior to dexamethasone by less than the established non-inferiority limit when used as perineural adjuvant in femoral nerve or adductor canal blocks in total knee arthroplasty analgesia. So, it could be considered an alternative in patients where dexamethasone is contraindicated, such as diabetics.

A randomized clinical trial comparing six techniques of postoperative analgesia for elective total hip arthroplasty under subarachnoid anesthesia with opioids.

BACKGROUND: Optimal control of acute postoperative pain and prevention of chronic persistent pain in total hip arthroplasty (THA) remain a challenge. The main hypothesis was that peripheral nerve blocks improve postoperative analgesia. METHODS: Immediate postoperative pain (24 hours) was evaluated every hour in 510 patients using a verbal rating 11-point scale for patient self-reporting of pain (VRS-11). All patients received subarachnoid anesthesia (SA) and were randomly allocated in six groups: SA with morphine 0.1 (SA0.1) or 0.2 mg (SA0.2), fascia iliaca compartment block with dexamethasone 4 mg + levobupivacaine 0.375% 20 (FICB20) or 30 mL (FICB30), lateral femoral cutaneous nerve block with levobupivacaine 0.25% 5 mL (LFCNB) and FICB20+LFCNB. Standardized analgesia included intravenous metamizole magnesium, dexketoprofen and rescue with paracetamol and morphine, and/or regional rescue (FICB, LFCNB, femoral and sciatic nerve blocks). RESULTS: About 37.5% of patients had at least one episode of pain, 31.3% of them needed rescue analgesia while the remaining 6.2% did not request analgesia. There were no significant differences between the groups in paracetamol, morphine and rescue nerve blocks requirements. There was pain only in 5.4% of the total PACU pain records: 3.1% mild pain, 1.7% moderate pain and 0.6% severe pain. CONCLUSIONS: combined with a multimodal analgesic approach, infra-inguinal FICB and LFCNB did not improve immediate postoperative analgesia for THA in our hospital. Other options and longer-term studies should be more extensively investigated to determine the role of peripheral blocks in postoperative pain treatment protocols.

Epidemiological Characteristics and Overall Burden of Accidental Injuries in Navarra, Spain: Epidemiology of Injuries in Children.

Injuries caused by accidents or violent situations in pediatric patients are a serious social problem where prevention plays a key role. The aim of this study was to describe the epidemiological situation of pediatric injuries in Spain. A prospective study of pediatric patients receiving care in the Emergency Service of the Complejo Hospitalario de Navarra due to for reasons of accidental injury was conducted. The study covered a period of 1 year and assessed a total of 16 variables. There were a total of 8,876 patients, of whom 56.4% were males. Traumatic injuries such as fractures and craniocerebral trauma were identified as the most frequent injuries, occurring as a result of injuries mainly in the home. In females, there was a decrease in the incidence of injuries related to age. There was a greater incidence at the end of the day, during the weekend, and in the months of March to October. The epidemiological profile of pediatric patients who met with accidents in Navarra, Spain, is described. The knowledge of the main areas and factors related to injuries allows us to improve preventive measures, which would contribute to better control in this region of Spain.

Differences in the treatment and evolution of acute coronary syndromes according to gender: what are the causes?

AIMS AND OBJECTIVES: The objectives of this study were to analyse the differences in the treatment and the evolution of acute coronary syndromes according to the gender of the patient and to determine the likely causes of these differences. BACKGROUND: Epidemiological studies confirm the differences in the course and treatment of acute coronary syndromes according to factors such as gender and age. The factors associated with the observed gender-based differences are not known. DESIGN AND METHODS: This prospective study was conducted on 596 patients treated in the Hospital Emergency Service of the Hospital Complex of Navarra, Spain, from 1 January 2012 to April 2013 with acute coronary syndromes. A bivariate and logistic analysis has been made by adjusting the age and severity of process to know the differences by gender. RESULTS: A total of 71·8% (n = 428) were men, and the remaining 28·2% (168) were women. The mean age of the men was 66·4 ± 12·7 years, and the mean age of the women was 72·5 ± 13·9 years. We found that antiplatelet drugs (68·4 vs. 22·7%), blockers (70 vs. 25·4%), ACE inhibitors (56·2 vs. 15·6%), fibrinolysis (17·2 vs. 4·5%, p = 0·025) and primary angioplasty (AP) (38·7 vs. 16·3%, p = 0·008) were less frequently administered to women compared with men. We observed an additional delay in the demand for health care in women with acute coronary syndromes compared with men. CONCLUSIONS: There is an association between treatment differences and gender. The delay in the request of health care in women is observed to be the largest correlating factor, in addition to voluntary discharge in women affected by acute coronary syndromes. RELEVANCE TO CLINICAL PRACTICE: Delays in seeking medical care or voluntary discharge are likely factors related to worse outcomes in women. These factors should be explored, and the results should be made available to the public, particularly to women.

Percepción y actuación de los pacientes con patología coronaria aguda en la fase prehospitalaria / Perception and action by patients with Acute Coronary Failure in the prehospital phase

El estudio de desigualdad de género en el ámbito sanitario muestra la existencia de diferencias en la actuación profesional según sexo en las patologías coronarias. OBJETIVOS: este trabajo pretende conocer la percepción y actuación de los pacientes con patología coronaria aguda e identificar los factores relacionados con la demora en la solicitud de asistencia sanitaria. MÉTODO: estudio descriptivo, analítico y transversal con pacientes diagnosticados de patología coronaria aguda (IAM o angina inestable)hospitalizados en las unidades de cardiología y/o en la unidad coronaria del Complejo Hospitalario de Navarra (CHN), entre el 1 de enero y el 1 de julio de 2012. Muestreo no probalístico, excluidos los pacientes con más de 48 horas de ingreso y aquellos cuyo episodio coronario era de repetición. Recogida de información mediante un cuestionario de 13ítems sobre la percepción del estado general de salud previo, cambios del estado emocional, existencia de cargas familiares, tiempo transcurrido desde la apariación de síntomas y la solicitud de ayuda, causas del retraso y autopercepción del conocimiento de la patologia coronaria. RESULTADOS: se realizaron 113 encuestas, de las cuales un 71,7% fueron hombres, cuya edad media fue de 67 años y de 72 años en las mujeres(p= 0,041). La media de minutos transcurridos hasta solicitar asistencia fue de 138 en los hombres y 238 en las mujeres (p= 0,001).También se hallaron diferencias significativas en la percepción del estado de salud, la gravedad del proceso, la carga familiar, el grado de actividad en el momento del episodio, el reconocimiento de la gravedad y la autopercepción del conocimiento. CONCLUSIONES: hallamos un mayor retraso en la demanda de atención sanitaria en las mujeres, así como diferencias psicosociales relacionadas con esta actuación

The study on gender inequality within the healthcare setting shows the current differences in professional activity on cardiac conditions according to gender. OBJECTIVES: this article intends to understand the perception and action of patients with Acute Coronary Failure, and to identify those factors associated with the delay in requesting medical care. METHOD: descriptive, analytical and transversal study with patients diagnosed with Acute Coronary Failure (AMI or unstable angina), admitted to the Cardiology Unit and/or the Coronary Unit of the Complejo Hospitalario de Navarra (CHN), between January, 1st and July, 1st,2012. Non-probabilistic sample, excluding patients with over 48 hours since admission, and those with a repeated coronary episode. Information was collected through a 13-item questionnaire about the perception of their previous health status, changes in emotional state, presence of family obligations, period of time since symptom initiation and until help was requested, causes for this delay, and self-perception of knowledge about the coronary condition. RESULTS: 113 questionnaires were completed, out of which 71.7% were completed by male patients. The mean age was 67 years in men and 72years in women (p = 0.041). The average minutes elapsed until help was requested was 138 in men and 238 in women (p= 0.001). There were also significant differences in the perception of health status, severity of the condition, family obligations, level of activity at the time of the episode, acknowledgement of severity, and self-perception of knowledge. CONCLUSIONS: we found a higher delay in the demand for medical care in women, as well as psychosocial differences associated with this action