[Efficacy of a continuous interscalene block vs intra-articular analgesia for postoperative pain in arthroscopic acromioplasty]. / Eficacia del bloqueo interescalénico continuo en comparación a la analgesia intra-articular para el tratamiento del dolor postoperatorio en acromioplastias artroscópicas.

OBJECTIVE: To compare the utility of intra-articular analgesia (IA) to that of a continuous interscalene block (CIB) by evaluating the quality of postoperative analgesia, a satisfaction index, and the incidence of complications. PATIENTS AND METHOD: A randomized controlled trial enrolling patients classified as ASA 1 or 2. The IA group received 25 mL of ropivacaine 0.2% plus 2 mg of morphine. The CIB group received a 7-mL/h infusion of bupivacaine 0.0625% plus 1 microg/mL of sufentanil. Postoperative pain was expressed on a visual analog scale (VAS) at 2, 4, 6, 12, 24, and 48 hours. Intravenous morphine was used as a rescue analgesic. Morphine use, incidence of adverse effects, and level of patient satisfaction after 48 hours were recorded. RESULTS: Twenty-three patients were randomized to the IA group and 24 to the CIB group. There were no between-group differences in patient characteristics. VAS scores and morphine use were similar in the 2 groups in the first 12 hours but were lower in the CIB group at 24 and 48 hours. The level of patient satisfaction was higher in the CIB group. There was a higher incidence of nausea and/or vomiting in the IA group at 24 and 48 hours. CONCLUSIONS: Postoperative pain in the first 12 hours after shoulder surgery can be adequately managed with either IA or CIB. CIB is more effective than IA between 12 and 48 hours after surgery.

Eficacia del bloqueo interescalénico continuo en comparación a laanalgesia intra-articular para el tratamiento del dolor postoperatorioen acromioplastias artroscópicas / Efficacy of a continuous interscalene block vs intra-articular analgesia for postoperative pain in arthroscopic acromioplasty

OBJETIVO: Comparar la utilidad entre la analgesiaintra-articular (AI) y el bloqueo interescalénico continuo(BIEC), evaluando la calidad de la analgesia postoperatoria,índice de satisfacción e incidencia de complicaciones.PACIENTES Y MÉTODO: Estudio prospectivo controladoen pacientes ASA I-II, Grupo 1(AI): ropivacaína 0,2%25 mL + morfina 2 mg; Grupo 2 (BIEC): bupivacaína0,0625% + sufentanil 1 μg/mL, con un débito de 7 mL/h.El dolor postquirúrgico se registró a las 2, 4, 6, 12, 24 y48 horas mediante Escala Visual Análoga (EVA). Se usómorfina endovenosa como analgésico de rescate. Seregistró el consumo de morfina, la incidencia de efectosadversos y el grado de satisfacción experimentados porlos pacientes a las 48 h.RESULTADOS: Se incluyeron 23 pacientes en el Grupo1, y 24 en el Grupo 2. No hubo diferencias en los parámetrosdemográficos de ambos grupos. El EVA y el consumode morfina en las primeras 12 h fueron similares.A las 24 y 48 h fue menor en el Grupo BIEC en comparacióncon el Grupo AI. El grado de satisfacción experimentadopor los pacientes fue superior en el GrupoBIEC. Hubo mayor incidencia de náuseas y/o vómitos enel Grupo AI a las 24 y 48 h.CONCLUSIONES: El manejo del dolor postoperatoriomediante las técnicas de AI y BIEC es adecuado para lascirugías del hombro en las primeras 12 h. El BIEC sedemuestra más efectivo que la AI después de las 12 yhasta las 48 h postoperatorias (AU)

OBJECTIVE: To compare the utility of intra-articularanalgesia (IA) to that of a continuous interscalene block(CIB) by evaluating the quality of postoperativeanalgesia, a satisfaction index, and the incidence ofcomplications.PATIENTS AND METHOD: A randomized controlled trialenrolling patients classified as ASA 1 or 2. The IA groupreceived 25 mL of ropivacaine 0.2% plus 2 mg ofmorphine. The CIB group received a 7-mL/h infusion ofbupivacaine 0.0625% plus 1 μg/mL of sufentanil.Postoperative pain was expressed on a visual analogscale (VAS) at 2, 4, 6, 12, 24, and 48 hours. Intravenousmorphine was used as a rescue analgesic. Morphine use,incidence of adverse effects, and level of patientsatisfaction after 48 hours were recorded.RESULTS: Twenty-three patients were randomized tothe IA group and 24 to the CIB group. There were nobetween-group differences in patient characteristics.VAS scores and morphine use were similar in the 2groups in the first 12 hours but were lower in the CIBgroup at 24 and 48 hours. The level of patientsatisfaction was higher in the CIB group. There was ahigher incidence of nausea and/or vomiting in the IAgroup at 24 and 48 hours.CONCLUSIONS: Postoperative pain in the first 12 hoursafter shoulder surgery can be adequately managed witheither IA or CIB. CIB is more effective than IA between12 and 48 hours after surgery (AU)

[Intrathecal fentanyl reduces the dose of propofol required for sedation during spinal anesthesia]. / Fentanilo intradural disminuye los requerimientos de propofol utilizado para sedación durante la anestesia espinal.

OBJECTIVES: To assess the effects of 2 dosages of intrathecal fentanyl on the requirement for propofol infused intravenously for the sedation of patients under spinal anesthesia. MATERIAL AND METHODS: We conducted a prospective controlled clinical trial enrolling patients in ASA physical status class 1 randomly assigned to 3 groups. Group 1 received 12.5 mg of 0.75% hyperbaric bupivacaine; group 2, 12.5 mg of bupivacaine plus 15 microg of fentanyl; group 3, 12.5 mg of bupivacaine plus 25 microg of fentanyl. After initiation of spinal anesthesia, monitoring of the bispectral (BIS) index (BIS XP A-2000) was begun, and sedation was maintained with a propofol infusion through a target-controlled infusion device (Orchestra Base Primea) for an initial effect-site concentration of 2.5 microg mL(-1), which was adjusted to maintain the BIS index between 60 and 75. We recorded BIS indices, noninvasive blood pressure, electrocardiogram, oxygen saturation, nasal end-tidal carbon dioxide pressure, mean infusion dose of propofol, total infusion dose of propofol, time until awakening, propofol consumption, and adverse effects. RESULTS: Seventy-five patients (25 in each group) were enrolled. Patient characteristics and BIS indices were similar in all groups. Propofol doses were significantly lower and times until awakening were significantly shorter in groups 2 and 3 than in group 1 (P < .01). The incidences of pruritus were significantly higher in groups 2 and 3. CONCLUSIONS: Adding 15 or 25 microg of fentanyl to hyperbaric bupivacaine lowers the dose of intravenous propofol required for sedation of patients under spinal anesthesia.

Fentanilo intradural disminuye los requerimientos de propofol utilizado para sedación durante la anestesia espinal / Intrathecal fentanyl reduces the dose of propofol required for sedation during spinal anesthesia

OBJETIVOS: Evaluar los efectos de dos dosis de fentanilo(F) intradural sobre los requerimientos de propofol(P) en perfusión endovenosa como sedación en pacientesintervenidos bajo anestesia raquídea (AR).MATERIAL Y MÉTODO: Ensayo clínico, prospectivo,controlado en pacientes con estado físico ASA I, distribuidosaleatoriamente en 3 grupos: Grupo 1: Bupivacaína0,75% hiperbara (BHB), 12,5 mg; Grupo 2: BHB12,5 mg + 15 μg F; Grupo 3: BHB 12,5 mg + 25 μg F.Tras la AR, se instaló monitor BIS XP® A-2000 paramedición de índice biespectral (BIS), y se inició sedacióncon una perfusión de propofol TCI (Base PrimeaOrchestra®) con dosis iniciales de 2,5 μg mL–1 a sitioefecto,las cuales fueron modificadas para mantener unBIS entre 60 y 75. Se registraron los valores de BIS,ECG, PANI, SatO2, EtCO2 nasal, dosis promedio deinfusión de propofol (DPI), dosis total utilizada de propofol(DTP), tiempo de despertar (TDD), consumo depropofol (CP) y efectos adversos.RESULTADOS: Se incluyeron 75 pacientes (25 en cadagrupo). Los datos biológicos, signos vitales y valores deBIS fueron similares en todos los grupos. Las dosis depropofol utilizadas así como el tiempo de despertar fueronsignificativamente menores en los Grupos 2 y 3 encomparación al Grupo 1 (p<0,01). La incidencia deprurito fue significativamente mayor en los Grupos 2 y3.CONCLUSIONES: La adición de 15 ó 25 μg de fentaniloa la bupivacaína hiperbara disminuye las dosis de perfusiónendovenosa de propofol utilizadas para sedaciónen pacientes bajo anestesia raquídea

OBJECTIVES: To assess the effects of 2 dosages of intrathecal fentanyl on the requirement for propofol infused intravenously for the sedation of patients under spinal anesthesia. MATERIAL AND METHODS: We conducted a prospective controlled clinical trial enrolling patients in ASA physical status class 1 randomly assigned to 3 groups. Group 1 received 12.5 mg of 0.75% hyperbaric bupivacaine; group 2, 12.5 mg of bupivacaine plus 15 μg of fentanyl; group 3, 12.5 mg of bupivacaine plus 25 μg of fentanyl. After initiation of spinal anesthesia, monitoring of the bispectral (BIS) index (BIS XPA-2000) was begun, and sedation was maintained with a propofol infusion through a targetcontrolled infusion device (Orchestra Base Primea) for an initial effect-site concentration of 2.5 μg mL–1, which was adjusted to maintain the BIS index between 60 and 75. We recorded BIS indices, noninvasive blood pressure, electrocardiogram, oxygen saturation, nasal end-tidal carbon dioxide pressure, mean infusion dose of propofol, total infusion dose of propofol, time until awakening, propofol consumption, and adverse effects. RESULTS: Seventy-five patients (25 in each group) were enrolled. Patient characteristics and BIS indices were similar in all groups. Propofol doses were significantly lower and times until awakening were significantly shorter in groups 2 and 3 than in group 1 (P < .01). The incidences of pruritus were significantly higher in groups 2 and 3. CONCLUSIONS: Adding 15 or 25 μg of fentanyl to hyperbaric bupivacaine lowers the dose of intravenous propofol required for sedation of patients under spinal anesthesia

Bloqueo femoral para analgesia postoperatoria en reconstrucción de ligamento cruzado anterior de rodilla. Comparación de dos concentraciones de bupivacaína asociada a clonidina en 3 modos de administración / Femoral nerve block for postoperative analgesia after anterior cruciate ligament reconstruction: comparison of 2 concentrations of bupivacaine with clonidine in 3 modes of administration

INTRODUCCIÓN: El bloqueo femoral continuo (BFC) seutiliza en la analgesia postoperatoria ortopédica.OBJETIVO: Evaluar la utilidad del BFC, comparandodos concentraciones de bupivacaína asociada a clonidina,en 3 esquemas de administración.MAT E R I A L Y MÉ TO D O: Estudio randomizado enpacientes ASA I-II divididos en seis grupos. En los 3grupos numéricos se usó bupivacaína 0,125% + clonidina.Los 3 grupos alfa-numéricos usaron bupivacaína0,0625% + clonidina. Grupo 1 y 1A: 10 mL h–1 en Infusióncontinua (IC); Grupo 2 y 2A: 5 mL h–1 IC + 2,5 mLc/30 min en sistema controlado por el paciente (PCRA);Grupo 3 y 3A : 5 mL c/30 min en PCRA. Se registróe n t re las 2 y 48 horas dolor postquirúrgico medianteEVA, consumo de bupivacaína y de morfina.RESULTADOS: Se incluyeron 105 pacientes: Grupo 1 (n =17), Grupo 1A(n = 18), Grupo 2 (n = 18), Grupo 2A(n = 17),Grupo 3 (n = 17), Grupo 3A (n = 18). No hubo diferenciasentre los datos demográficos, EVApostoperatorio y consumode morfina entre las 2 y 48 horas entre los seis grupos.CO N C L U S I O N E S: El BFC es útil para el manejo deldolor postoperatorio en la reconstrucción de ligamentocruzado anterior de rodilla. Un débito de 5 mL h–1 en ICo en bolos PCRA asegura excelente analgesia postoperatoria.Concentraciones de bupivacaína 0,0625% disminuyeel consumo de anestésicos locales, sin detrimentoen la calidad de la analgesia

BACKGROUND: The continuous femoral nerve block isused for postoperative orthopedic analgesia.OBJECTIVE: To evaluate 2 concentrations of bupivacainewith clonidine in 3 methods of administration forperforming a continuous femoral nerve block.MATERIAL AND METHODS: Randomized controlled trialin ASA 1-2 patients in 6 groups. In groups 1, 2, and 3, thecombination used was 0.125% bupivacaine plus clonidine.In groups 1a, 2a, and 3a, the combination was 0.0625%bupivacaine plus clonidine. Methods of administrationwere as follows: groups 1 and 1a, 10 mL·h–1 in continuousinfusion; groups 2 and 2a, 5 mL·h–1 in continuous infusionplus 2.5 mL e v e ry 30 minutes through a patient-controlledanalgesia (PCA) system; groups 3 and 3a, 5 mL e v e ry 30minutes in a PCA system. Pain on a visual analog scale(VAS) and amounts of bupivacaine and morphine usedwere recorded 2 and 48 hours after surgery.RESULTS: A total of 105 patients were enrolled: 17 ingroup 1, 18 in group 1a, 18 in group 2, 17 in group 2a,17 in group 3, and 18 in group 3a. No significant differencesbetween any of the 6 groups were observed forpatient characteristics, postoperative VAS scores, ormorphine use.CONCLUSIONS: A continuous femoral nerve block isuseful for managing pain after anterior cruciate ligamentsurgery. The application of 5 mL·h–1 in continuousinfusion or in PCA system bolus doses provides excellentpostoperative analgesia. Use of 0.0625% bupivacained e c reases overall consumption of analgesic and is notdetrimental to quality of analgesia

Adición de bicarbonato de sodio y/o clonidina a la mepivacaína. Influencia sobre las características del bloqueo de plexo braquial por vía axilar / Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics

INTRODUCCIÓN: El bloqueo del plexo braquial (BPB)por vía axilar es un procedimiento anestésico habitual.La adición de variados fármacos coadyuvantes se hamostrado efectiva en la mejoría de los resultados conesta técnica. Este estudio evalúa la incorporación debicarbonato de sodio y/o clonidina al BPB con mepivacaína.MATERIAL Y MÉTODO: Se realizó un estudio controladorandomizado de 60 pacientes, entre 18 y 70 años, ASA 1a 3 estables, que recibieron anestesia con técnica deBPB. Se dividieron en 4 grupos de 15 pacientes: GrupoI (control) recibió 40 mL de mepivacaína (MEP) 1% conadrenalina (A) + 5 mL de suero fisiológico (SF); el GrupoII, 40 mL MEP 1% con A + 4 mL NaHCO3 + 1 mLSF; el Grupo III, 40 mL MEP 1% con A + 150 µg clonidina+ 4 mL SF y el Grupo IV, 40 mL MEP 1% con A +4 mL NaHCO3 + 150 µg de clonidina.RESULTADOS: El tiempo de instalación del BPB fue significativamentemenor en los grupos II y IV. La duracióndel BPB fue mayor en el grupo III, la analgesia obtenidaen el grupo 3 fue significativamente mayor.CONCLUSIONES: La adición de bicarbonato de sodio ala mepivacaína disminuye el tiempo de latencia del BPBpor vía axilar, la incorporación de clonidina prolonga laduración de la anestesia y analgesia, la adición conjuntade bicarbonato de sodio y clonidina reduce el tiempo delatencia pero no incrementa la duración de la anestesiay analgesia

BACKGROUND AND OBJECTIVE: The axillary brachialplexus block is a frequently performed anesthetic technique.Adding a variety of coadjuvant drugs has beenshown to improve results. This study evaluated the additionof sodium bicarbonate (NaHCO3) and/or clonidineto mepivacaine for performing the block.MATERIAL AND METHODS: Sixty patients between 18and 70 years old, ASA 1-3 in stable condition receivedaxillary brachial plexus blocks in a randomized controlledstudy. Four groups of 15 patients each were formed:group I (control group) received 40 mL of 1% mepivacainewith adrenaline plus 5 mL of saline; group II, 40mL of 1% mepivacaine with adrenaline plus 4 mL ofNaHCO3 and 1 mL of saline; group III, 40 mL of 1%mepivacaine with 150 µg of clonidine plus 4mL of saline;and group IV, 40 mL of 1% mepivacaine with adrenalineplus 4 mL of NaHCO3 and 150 µg of clonidine.RESULTS: The onset time was significantly shorter ingroups 2 and 4. The duration of the block was longer ingroup 3 and the analgesic effect was significantlybetter.CONCLUSIONS: Adding NaHCO3 to mepivacaine shortensthe time of onset of an axillary brachial plexus block.Including clonidine prolongs the duration of anesthesiaand analgesia. The addition of both NaHCO3 and clonidineshortens time to onset but does not prolong durationof anesthesia or analgesia

[Femoral nerve block for postoperative analgesia after anterior cruciate ligament reconstruction: comparison of 2 concentrations of bupivacaine with clonidine in 3 modes of administration]. / Bloqueo femoral para analgesia postoperatoria en reconstrucción de ligamento cruzado anterior de rodilla. comparación de dos concentraciones de bupivacaína asociada a clonidina en 3 modos de administración.

BACKGROUND: The continuous femoral nerve block is used for postoperative orthopedic analgesia. OBJECTIVE: To evaluate 2 concentrations of bupivacaine with clonidine in 3 methods of administration for performing a continuous femoral nerve block. MATERIAL AND METHODS: Randomized controlled trial in ASA 1-2 patients in 6 groups. In groups 1, 2, and 3, the combination used was 0.125% bupivacaine plus clonidine. In groups la, 2a, and 3a, the combination was 0.0625% bupivacaine plus clonidine. Methods of administration were as follows: groups 1 and la, 10 mL x h(-1) in continuous infusion; groups 2 and 2a, 5 mL h x (-1) in continuous infusion plus 2.5 mL every 30 minutes through a patient-controlled analgesia (PCA) system; groups 3 and 3a, 5 mL every 30 minutes in a PCA system. Pain on a visual analog scale (VAS) and amounts of bupivacaine and morphine used were recorded 2 and 48 hours after surgery. RESULTS: A total of 105 patients were enrolled: 17 in group 1, 18 in group la, 18 in group 2, 17 in group 2a, 17 in group 3, and 18 in group 3a. No significant differences between any of the 6 groups were observed for patient characteristics, postoperative VAS scores, or morphine use. CONCLUSIONS: A continuous femoral nerve block is useful for managing pain after anterior cruciate ligament surgery. The application of 5 mL x h(-1) in continuous infusion or in PCA system bolus doses provides excellent postoperative analgesia. Use of 0.0625% bupivacaine decreases overall consumption of analgesic and is not detrimental to quality of analgesia.