ABSTRACT
Antecedentes y objetivos: Las infiltraciones epidurales (IEE) constituyen una alternativa en el tratamiento del síndrome de radiculopatía lumbosacro (SRL). El objetivo de estudio es evaluar la eficacia de las IEE en la intensidad del dolor, mejora de la recuperación funcional y retorno a la actividad laboral. Material y métodos: Se realizó un estudio prospectivo en una cohorte de 100 pacientes consecutivos remitidos a la unidad del dolor por SRL de más de 3 meses de duración. Se analizó la eficacia de las inyecciones de corticoides y anestésicos locales por diferentes vías (interlaminar, caudal y transforaminal) a los 15 días, un mes y 3 meses de la infiltración, en cuanto a la intensidad del dolor mediante la escala analógica visual (EAV), evolución del grado de discapacidad y la reincorporación laboral. Resultados: Noventa y nueve pacientes se incluyeron en el estudio. El 46,5% fueron varones y el 53,5% mujeres. La edad media fue de 57,47±11,1 años. En la mayoría (58,6%) de los casos se optó por la vía caudal, seguida de la transforaminal (23,2%), e interlaminar (18,2%). Las IEE produjeron una reducción significativa del dolor en todos los periodos estudiados (EAV: 7,78±1,5 basal; 6,2±0,9 a los 15 días; 6,3±1,2 al mes; 6,15±1,3 a los 3 meses; p<0,05). La vía de acceso más eficaz fue la transforaminal. El 70% de los pacientes en situación de incapacidad laboral retornaron a su trabajo tras el tratamiento. Discusión y conclusiones: El tratamiento mediante las IEE redujo la intensidad del dolor por SRL, mejoró la situación funcional y la reincorporación a la actividad laboral.(AU)
Backgrund and objective: Epidural infiltrations are used for treatment of low back pain and sciatica. linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work. Methods: Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal). Results: Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47±11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48±1.5 basal; 6.2±0,9 at 15 days; 6.3±1.2 at one month; 6.15±1.3 at 3 months, P<.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections. Conclusions: Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.(AU)
Subject(s)
Humans , Male , Female , Anesthesia, Local/methods , Anesthesia, Epidural/methods , Radiculopathy/drug therapy , Pain Management , Back Pain/drug therapy , Intervertebral Disc Displacement/drug therapy , Neurosurgery , Prospective Studies , Cohort Studies , Pain/drug therapy , AnalgesiaABSTRACT
BACKGROUND AND OBJECTIVE: Epidural infiltrations are used for treatment of low back pain and sciatica. Linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work. METHODS: Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal). RESULTS: Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47 ± 11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48 ± 1.5 basal; 6.2 ± 0,9 at 15 days; 6.3 ± 1.2 at one month; 6.15 ± 1.3 at 3 months, p < 0.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections. CONCLUSIONS: Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.
Subject(s)
Low Back Pain , Radiculopathy , Sciatica , Male , Humans , Female , Middle Aged , Aged , Low Back Pain/drug therapy , Low Back Pain/etiology , Radiculopathy/drug therapy , Anesthetics, Local/therapeutic use , Treatment Outcome , Sciatica/drug therapy , Sciatica/etiology , Injections, EpiduralABSTRACT
La actual pandemia por coronavirus SARS-CoV-2 está planteando una serie de desafíos al modo en que ejercemos la actividad médica y quirúrgica. En concreto, dentro de la neurocirugía se ha visto que los abordajes endoscópicos endonasales suponen un elevado riesgo de contagio para el personal sanitario que interviene en la misma, por lo que, inicialmente, la recomendación fue evitar dichas cirugías. Dado que la pandemia se ha extendido en el tiempo y desconocemos cuándo se podrá controlar, se deben proponer nuevas soluciones para continuar con la realización de dichos abordajes de manera segura. Ante la falta de protocolos establecidos, planteamos el siguiente, en el que se establecen, de modo conciso, las medidas a tomar tanto en cirugía urgente como programada, además de la descripción de un nuevo dispositivo de protección-aspirado (Maskpirator) AU)
Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protecti (AU)n-aspiration device (Maskpirator) is described.
Subject(s)
Humans , Coronavirus Infections , Pneumonia, Viral , Pandemics , Security Measures , Transanal Endoscopic Surgery/standardsABSTRACT
Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.
Subject(s)
COVID-19 , Natural Orifice Endoscopic Surgery/methods , Neurosurgical Procedures/methods , SARS-CoV-2 , COVID-19/complications , COVID-19/transmission , Humans , Natural Orifice Endoscopic Surgery/adverse effects , Natural Orifice Endoscopic Surgery/standards , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/standards , PandemicsABSTRACT
Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.
Subject(s)
COVID-19 , Endoscopy/methods , Humans , Pandemics/prevention & control , SARS-CoV-2 , Skull Base/surgeryABSTRACT
Abstract Introduction: Amiodarone has become one of the main antiarrhythmic drugs. However, it may cause a wide variety of adverse effects, sometimes severe. Amiodarone-induced thyroid dysfunction is one of the best known problems, resulting in either thyrotoxicosis or hypothyroidism. Case presentation: A patient who, after 2 years of using amiodarone for the control of atrial fibrillation, developed thyrotoxicosis, refractory to conventional medical treatment. To optimize the patient's clinical condition before total thyroidectomy, embolization of thyroid arteries was performed. Conclusion: Embolization of the thyroid arteries as bridge therapy to thyroidectomy is an uncommon alternative in patients with amiodarone-induced hyperthiroidism. However, this treatment was useful to improve our patient's symptoms and to optimize the anesthetic/surgical procedure.
Resumen Introducción: La amiodarona se ha convertido en uno de los principales fármacos empleados en el manejo de las arritmias cardiacas. Sin embargo, puede llegar a presentar una amplia variedad de efectos adversos, en ocasiones graves. La alteración de la función tiroidea es uno de sus problemas más conocidos, que puede causar tanto hipertiroidismo como hipotiroidismo. Presentación del caso: Se presenta el caso de un paciente que, después de recibir durante dos años amiodarona para el control de una fibrilación auricular, desarrolló una tirotoxicosis refractaria al tratamiento médico clásico, por lo que se decidió realizar una embolización de las arterias tiroideas previa a tiroidectomía total, para lograr una optimización preoperatoria de su situación clínica. Conclusión: La embolización de las arterias tiroideas como terapia puente a la tiroidectomía es una alternativa poco empleada en pacientes con hipertiroidismo, más aun si es debido a la administración de amiodarona, con escasos datos publicados en la literatura. En nuestro caso fue de utilidad para mejorar la sintomatología del paciente y optimizar el procedimiento anestésico-quirúrgico.
Subject(s)
Humans , Male , Middle Aged , Arteries , Thyroidectomy , Thyrotoxicosis , Amiodarone , Arrhythmias, Cardiac , Atrial Fibrillation , Surgical Procedures, Operative , Thyroid Gland , Pharmaceutical Preparations , Anesthetics , Anti-Arrhythmia AgentsABSTRACT
INTRODUCTION: Open thoracotomy is one of the surgical procedures that is still very painful in the postoperative period, which, in this type of surgery can have on respiratory function and subsequent recovery of the patient. PATIENTS AND METHOD: The aim of the study is to assess continuous paravertebral thoracic block as an analgesic technique in thoracotomy. A total of 139 patients undergoing pulmonary resection surgery by posterolateral thoracotomy received postoperative analgesia using a 1.5% lidocaine infusion (7-10 ml/h) through a thoracic paravertebral catheter for at least 48 h. Pain intensity measured on the visual analogue scale (VAS) both at rest (passive VAS) and during stimulated cough (active VAS) was recorded at time of discharge from the Recovery Unit, and on the second, third and fourth day post-surgery. Postoperative complications and the need for analgesic rescue were studied. RESULTS: On discharge from recovery, 98.6% of the patients had mild pain (passive VAS <3), 1.4% had moderate pain (passive VAS 4-6) and none with severe pain (EVA >6); on the 2nd day post-surgery, 97.9% had mild pain, and 1.2% moderate pain; on the third day 98.6% had mild pain and 0.7% moderate pain; and on the 4th day 100% had mild pain. There were no complications arising from the analgesic technique. CONCLUSIONS: Continuous thoracic paravertebral analgesia is effective and safe in controlling post-thoracotomy pain.
Subject(s)
Analgesia/methods , Nerve Block/methods , Pain, Postoperative/therapy , Thoracotomy , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Introducción: La toracotomía abierta es uno de los procedimientos quirúrgicos con postoperatorio más doloroso, hecho que en este tipo de cirugía puede repercutir sobre la función respiratoria y posterior recuperación del paciente. Paciente y método: El propósito del estudio es evaluar el bloqueo paravertebral contínuo torácico como técnica analgésica en la toracotomía. Ciento treinta y nueve pacientes sometidos a cirugía de resección pulmonar mediante toracotomía posterolateral recibieron analgesia postoperatopria mediante infusión de lidocaína al 1,5% (710ml/h) a través de un catéter paravertebral torácico y durante un mínimo de 48h. La intensidad del dolor mediante la escala analógica visual (EVA) tanto en reposo (EVA pasivo) como durante la tos incentivada (EVA activo), fue registrada al alta de la unidad de reanimación, al segundo, tercer y cuarto día postoperatorio. Se estudiaron las complicaciones postoperatorias y la necesidad de analgesia de rescate. Resultados: Al alta de reanimación un 98,6% de los pacientes presentaron un dolor leve (EVA pasivo <3 un 1 4 dolor moderado eva pasivo ndash 6 y 0 severo 6); en el 2.° día postoperatorio un 97,9% tuvieron un dolor leve, y un 1,2% dolor moderado; en el 3.er día un 98,6% un dolor leve y un 0,7% dolor moderado; y al 4° día un 100% presentaron dolor leve. No se encontraron complicaciones derivadas de la técnica analgésica. Conclusiones: La analgesia paravertebral torácica contínua es efectiva y segura en el control del dolor postoracotomía (AU)
Introduction: Open thoracotomy is one of the surgical procedures that is still very painful in the postoperative period, which, in this type of surgery can have on respiratory function and subsequent recovery of the patient. Patients and method: The aim of the study is to assess continuous paravertebral thoracic block as an analgesic technique in thoracotomy. A total of 139 patients undergoing pulmonary resection surgery by posterolateral thoracotomy received postoperative analgesia using a 1.5% lidocaine infusion (710ml/h) through a thoracic paravertebral catheter for at least 48h. Pain intensity measured on the visual analogue scale (VAS) both at rest (passive VAS) and during stimulated cough (active VAS) was recorded at time of discharge from the Recovery Unit, and on the second, third and fourth day post-surgery. Postoperative complications and the need for analgesic rescue were studied. Results: On discharge from recovery, 98.6% of the patients had mild pain (passive VAS <3 1 4 had moderate pain passive vas ndash 6 and none with severe eva 6); on the 2nd day post-surgery, 97.9% had mild pain, and 1.2% moderate pain; on the third day 98.6% had mild pain and 0.7% moderate pain; and on the 4th day 100% had mild pain. There were no complications arising from the analgesic technique. Conclusions: Continuous thoracic paravertebral analgesia is effective and safe in controlling post-thoracotomy pain (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Analgesia/methods , Nerve Block/methods , Pain, Postoperative/therapy , Thoracotomy , Prospective StudiesSubject(s)
Lung Transplantation , Reperfusion , Electrocardiography , Hemodynamics/physiology , HumansABSTRACT
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