Tratamiento anestésico mediante bloqueo del plexo braquial costoclavicular con analgesia controlada por el paciente en Pediatría: caso clínico / Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in Pediatrics: A case report

El bloqueo del plexo braquial costoclavicular (CBPB) ha venido recibiendo atención creciente como técnica eficaz en la cirugía de la parte superior del brazo realizada sin parálisis frénica. Sin embargo, se carece de estudios en niños. Se realizó CBPB a una niña de 10 años sometida a osteotomía radial y ulnar programada, debido a exostosis múltiples cartilaginosos y elongación ulnar. Se realizó CBPB con administración de un bolo de 10ml de levobupivacaína al 0,25%, sustituyéndose secuencialmente el catéter en el espacio costoclavicular derecho. Tras la cirugía, se inició infusión continua de 2ml/h de levobupivacaína al 0,17% a través de catéter, junto con analgesia controlada por el paciente (PCA) de 3ml de levobupivacaína al 0,17% con bloqueo de 60 min. La paciente se quejó de dolor de nivel 5/10 de la escala numérica (NRS) transcurridas 2h de la cirugía, que mejoró inmediatamente tras la administración del bolo. Por lo demás, la analgesia inducida por CBPB fue efectiva (NRS ≤ 2). El CBPB con PCA puede aportar una analgesia adecuada en casos pediátricos.(AU)

Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in pediatrics: a case report Abstract The costoclavicular brachial plexus block (CBPB) has been receiving increasing attention as an effective technique for upper arm surgery conducted without phrenic paralysis. However, studies in children are lacking. CBPB was applied to a 10 year-old girl undergoing scheduled radial and ulnar osteotomy due to multiple cartilaginous exostoses and ulnar lengthening. CBPB was performed with a bolo administration of 10 mL of 0.25% levobupivacaine, and the catheter was sequentially replaced in the right costoclavicular space. After surgery, a continuous infusion of 0.17% levobupivacaine through a catheter was initiated at 2 mL/h, along with patient-controlled analgesia (PCA) of 3 mL 0.17% levobupivacaine with a 60-minute lock out. The patient complained of 5/10 pain on the numerical rating scale (NRS) 2 hours after surgery, which improved immediately after bolus administration. The analgesia induced by CBPB was otherwise effective (NRS ≤ 2). CBPB with PCA may provide adequate analgesia in pediatric cases.(AU)

Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in Pediatrics: A case report.

The costoclavicular brachial plexus block (CBPB) has been receiving increasing attention as an effective technique for upper arm surgery conducted without phrenic paralysis. However, studies in children are lacking. CBPB was applied to a 10 year-old girl undergoing scheduled radial and ulnar osteotomy due to multiple cartilaginous exostoses and ulnar lengthening. CBPB was performed with a bolus administration of 10 mL of 0.25% levobupivacaine, and the catheter was sequentially replaced in the right costoclavicular space. After surgery, a continuous infusion of 0.17% levobupivacaine through a catheter was initiated at 2 mL/h, along with patient-controlled analgesia (PCA) of 3 mL 0.17% levobupivacaine with a 60-min lock out. The patient complained of 5/10 pain on the numerical rating scale (NRS) 2 h after surgery, which improved immediately after bolus administration. The analgesia induced by CBPB was otherwise effective (NRS ≤ 2). CBPB with PCA may provide adequate analgesia in paediatric cases.

Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in Pediatrics: A case report. / Tratamiento anestésico mediante bloqueo del plexo braquial costoclavicular con analgesia controlada por el paciente en Pediatría: caso clínico.

Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in pediatrics: a case report Abstract The costoclavicular brachial plexus block (CBPB) has been receiving increasing attention as an effective technique for upper arm surgery conducted without phrenic paralysis. However, studies in children are lacking. CBPB was applied to a 10 year-old girl undergoing scheduled radial and ulnar osteotomy due to multiple cartilaginous exostoses and ulnar lengthening. CBPB was performed with a bolo administration of 10 mL of 0.25% levobupivacaine, and the catheter was sequentially replaced in the right costoclavicular space. After surgery, a continuous infusion of 0.17% levobupivacaine through a catheter was initiated at 2 mL/h, along with patient-controlled analgesia (PCA) of 3 mL 0.17% levobupivacaine with a 60-minute lock out. The patient complained of 5/10 pain on the numerical rating scale (NRS) 2 hours after surgery, which improved immediately after bolus administration. The analgesia induced by CBPB was otherwise effective (NRS ≤ 2). CBPB with PCA may provide adequate analgesia in pediatric cases.

The potential for the development of liver metastasis from alpha-fetoprotein-producing human gastric carcinomas in nude mice.

The potential for liver metastasis in addition to the transplantability and doubling time of alpha-fetoprotein(AFP)-producing and non-AFP-producing human gastric carcinomas were studied in nude mice. The potential for liver metastasis was analyzed histopathologically from intrasplenic injections of tumor cell suspensions prepared from subcutaneous tumors. Tumor fragments prepared aseptically from 15 AFP-producing and 140 non-AFP-producing gastric cancers were subcutaneously transplanted into nude mice with transplantability rates of 80% (12/15 cases) and 50% (70/140 cases), respectively. The mean tumor doubling times in the first generation were 10.6 days for AFP-producing and 13.2 days for non-AFP-producing gastric carcinomas. Serially transplantable tumor lines in nude mice were established from six AFP-producing and 10 non-AFP-producing carcinomas. When tumor cell suspensions prepared from the subcutaneous tumors were injected into spleens, all six AFP-producing carcinomas (two poorly differentiated and four tubular adenocarcinomas) but only four out of the 10 non-AFP-producing carcinomas (two poorly differentiated adenocarcinomas, one mucinous carcinoma and one papillary adenocarcinoma) demonstrated a potential for liver metastasis. The results indicate AFP-producing gastric carcinomas to possess a higher potential for liver metastasis than do non-AFP-producing carcinomas, a distinguishing feature which thus reflects a poor prognosis.

[Effect of concomitant use of anticancer drugs and a Ca2+ antagonist, on human gastric cancer transplanted into nude mice].

We examined the effect of concomitant use of anticancer drugs such as Carmofur or 5-FU and Nicardipine, a Ca2+ antagonist, on human gastric cancer transplanted into nude mice, and obtained the following results: 1. Combined administration of Carmofur or 5-FU together with Nicardipine caused potentiation of an antitumor effect. 2. After Carmofur was used together with Nicardipine, the FU level in the tumor tissue was significantly elevated. In conclusion, it was found that in the combined use of Carmofur or 5-FU together with Nicardipine, a Ca2+ antagonist, caused a higher level of the FU in tumor tissue and potentiation of an antitumor effect on human gastric cancer transplanted into nude mice.

Enhanced liver metastatic potential of alpha-fetoprotein-producing human gastric carcinoma after carbon tetrachloride-induced liver damage in nude mice.

The liver metastatic potential of alpha-fetoprotein (AFP)-producing human gastric carcinoma (NSC-3) was examined in male, BALB/c, nude mice. Metastatic nodules in the liver were produced by intrasplenic (IS) injection of tumor cell suspension prepared by trypsinization from subcutaneous NSC-3 tumor. The serum AFP level increased exponentially after IS injection along with the growth of metastatic nodules in the liver, and a positive correlation was observed between the estimated weight of metastatic nodules and serum AFP level. To investigate the effect of liver damage by carbon tetrachloride (CCl4) on the metastatic potential of NSC-3 cells injected intrasplenically, the mice were divided into 4 groups: Group 1 received IS injection of 1 x 10(6) of NSC-3 cells without CCl4 treatment; Groups 2, 3 and 4 received IS injection 7 days, 2 days and 1 day after CCl4 treatment, respectively. All mice were killed 64 days after IS injection. The incidence of liver metastasis was 80% in Group 1, but 100% in Groups 2, 3 and 4. The mean numbers of metastatic nodules per liver were 4.2 in Group 1, 16.8 in Group 2, 18.0 in Group 3 and 44.5 in Group 4. Significant differences in the mean numbers of metastatic nodules were observed between Group 4 and the other groups. It was clearly demonstrated that the metastatic potential of AFP-producing human gastric carcinoma cells (NSC-3) is enhanced in the situation prevailing after liver parenchymal cells are damaged by CCl4.