Bloqueos nerviosos periféricos: una alternativa en cirugía mauor ambulatoria / Peripheral nerve blocks: an alternative technique in ambulatory surgery

Recientes investigaciones han puesto de manifiesto que los bloqueos nerviosos periféricos se asocian con mejores resultados que la anestesia general y que constituyen una práctica cada vez más frecuente en el ámbito de la cirugía ambulatoria. Nuestro objetivo es poner de manifiesto la situación actual de los bloqueos nerviosos periféricos en nuestra Unidad de Cirugía Mayor Ambulatoria y cómo ésta ha modificado la práctica habitual. MATERIAL Y MÉTODOS: Revisión retrospectiva de los bloqueos realizados en los dos últimos años, mediante el análisis de una hoja de bloqueos en la que se incluyen múltiples variables: datos del paciente, características del bloqueo, técnica de neuroestimulación y otras. RESULTADOS: Se realizaron 185 bloqueos en régimen de C.M.A., todos ellos en cirugía ortopédica y la mayoría en la extremidad inferior. El anestésico local empleado habitualmente fue mepivacaína. El bloqueo que se realizó con mayor frecuencia fue el bloqueo del nervio ciático en la fosa poplítea mediante abordaje latral. En la extremidad superior el abordaje del plexo braquial más frecuente fue a nivel axilar. Todos los pacientes fueron dados de alta a las 6 horas tras la realización de la técnica. DISCUSIÓN: En nuestra Unidad la práctica de bloqueos nerviosos periféricos en cirugía ambulatoria ortopédica está adquiriendo popularidad y en los últimos años se ha incrementado de manera muy importante. El empleo de bloqueos selectivos ajustados a las necesidades quirúrgicas con anestésico local de corta duración permiten una regresión temprana del bloqueo y el alta hospitalaria precoz (AU)

INTRODUCTION: Current investigations have demostrated that peripheral nerve block is associated with a superior outcome than general anestesia and it constitutes an useful and frequent technique in ambulatory surgery. The purpose of this manuscript is to show actual situation of peripheral nerve blocks in our Unit of Ambulatory Surgery and how it has modified our usual practice. MATERIAL AND METHODS: We made a prospective revision of peripheral nerve blocks used over the last two years. We analyzed a lot of variables onthe nerve block control sheet: patients´ data type of block, nerve stimulation technique and others. RESULTS: We registered 185 blocks in ambulatory surgery. All of them were for orthopaedic surgery and the majority in the lower limb. The local anesthetic most used was mepivacaine. Lateral popliteal block was the most frequent approach. Axillary block was the most frequent brachial plexus approach. All the patients were discharged six hours after the block. DISCUSSION: Today, peripheral nerve blocks are more popular than some years ago inour Unit for Ambulatory surgery. Selective peripheral nerve blocks, depending on the type and location of surgery, using a short acting local anesthetic allow an early discharge of patients (AU)

[Multivariate study of risk factors for arterial hypotension in pregnant patients at term undergoing Caesarean section under subarachnoid anesthesia]. / Estudio multivariable de factores de riesgo de hipotensión arterial en gestantes a término intervenidas de cesárea bajo anestesia subaracnoidea.

OBJECTIVES: The most common and potentially dangerous complication of spinal anesthesia for cesarean section is arterial hypotension. The aim of this study was to analyze maternal and gestational factors that might affect risk of arterial hypotension in full-term parturients undergoing cesarean section. MATERIAL AND METHOD: We enrolled full-term parturients scheduled for elective cesarean section under spinal anesthesia. Spinal puncture was performed at L2-L3 using an atraumatic Sprotte-type needle. We administered 12.5 mg of hyperbaric 0.5% bupivacaine and 12.5 micrograms of fentanyl. Arterial hypotension was defined as a decrease in systolic pressure of at least 20% or a decrease to a pressure below 100 mmHg. Multivariate analysis was performed to identify factors related to the presentation of hypotension appearing in the interval between spinal puncture and birth. RESULTS: The incidence of arterial hypotension was 33.3%. Statistical analysis revealed that integrity of the amniotic sac, parity and elective cesarean were significantly associated with a higher incidence of arterial hypotension (p < 0.03). CONCLUSIONS: Identifying risk for multiparous parturients with intact amniotic sacs scheduled for elective cesarean can be worthwhile if greater preventive measures are taken in such patients to reduce the incidence and intensity of arterial hypotension.

Estudio multivariable de factores de riesgo de hipotensión arterial en gestantes a término intervenidas de cesárea bajo anestesia subaracnoidea / Multivariate study of risk factors for hypotension during full-term delivery by cesarean section under spinal anesthesia

Objetivos. La complicación más frecuente, y potencialmente peligrosa, de la anestesia subaracnoidea en la cesárea es la hipotensión arterial. El objetivo del estudio es analizar los factores maternos y de la gestación que pueden determinar el riesgo de hipotensión arterial en mujeres gestantes a término que finalizan su embarazo mediante intervención cesárea. Material y método. Se incluyeron aquellas gestantes a término programadas para cesárea que se realizaron bajo anestesia subaracnoidea. La punción dural se practicó en L2-L3 con aguja atraumática tipo Sprotte y se administraron conjuntamente 12,5 mg de bupivacaína hiperbárica al 0,5 por ciento y 12,5 µg de fentanilo, definiendo como hipotensión arterial al descenso de la TAS igual o superior al 20 por ciento, o un valor inferior a 100 mmHg. Se realizó un análisis discriminante multivariable para determinar los factores relacionados con la presentación de hipotensión arterial en el tiempo transcurrido entre la punción subaracnoidea y el nacimiento del feto. Resultados. La incidencia de hipotensión arterial fue del 33,3 por ciento. El análisis estadístico determinó de forma significativa que la integridad de la bolsa amniótica, la paridad y el carácter electivo de la cesárea se asociaron con la mayor incidencia de hipotensión arterial (p < 0,03).Conclusiones. La identificación como grupo de riesgo de las mujeres multíparas con bolsa amniótica íntegra y programadas para cesárea electiva puede conllevar un beneficio si se intensifican en estas pacientes las medidas preventivas que disminuyen la incidencia e intensidad de la hipotensión arterial (AU)

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[Satisfaction with locoregional anesthesia in women who had undergone cesarean section]. / Satisfacción con la anestesia locorregional en mujeres intervenidas de cesárea.

OBJECTIVES: To compare satisfaction with local-regional and general anesthesia in women undergoing cesarean, the possible influence of time of evaluation and recall of the anesthesiologist. PATIENTS AND METHODS: Retrospective study performed in all women who delivered by cesarean in the 6 first months of 1997. The women were assigned to two groups according to type of anesthesia, local-regional or general. Their satisfaction with anesthesia was evaluated by questionnaire 48 to 72 hours after surgery and two weeks after release. Most items required discrete-point answers, including a satisfaction of a scale of 0 to 10. During the second interview we also evaluated satisfaction with the procedure and hospital in general, as well as recall of the anesthesiologist. Group homogeneity was based on demographic, sociocultural, obstetric and surgical variables. RESULTS: In a context of high satisfaction with anesthesia, 189 (76%) of the 247 women receiving local-regional anesthesia gave high evaluations to the anesthesia (8.90 +/- 1.5; mean: 10), compared with 58 (24%) of those receiving general anesthesia (8 +/- 2; mean 8.5) (p = 0.001). Both groups were homogeneous except for the distribution of emergencies, which occurred more often in those receiving general anesthesia (p < 0.001). Women who had received local-regional anesthesia expressed greater willingness to repeat or recommend the technique (p < 0.001). The highest score in this group was from women receiving intradural anesthesia along with fentanyl for local anesthesia, with significant differences only in comparison to epidural anesthesia. The differences in responses between the first and second interview were scarce. The hospital received a lower evaluation than did either anesthesia or surgery (p < 0.001). The anesthesiologist, who was less well recognized than the obstetrician was remembered better among women receiving local-regional anesthesia (p = 0.008). CONCLUSIONS: Local-regional anesthesia can improve levels of satisfaction over that of general anesthesia among women undergoing cesarean surgery, and contributes to maintaining recall of the anesthesiologist. These results may be related to the fact of being conscious during the birth of a child.