Bloqueo de nervios esplácnicos para tratamiento del dolor abdominal crónico benigno. Reporte de caso con revisión temática / Splanchnic nerve block for the treatment of benign chronic abdominal pain. a case report and literature review

El dolor abdominal crónico de origen benigno puede ser incapacitante y disminuye significativamente la calidad de vida de algunos pacientes. Para su tratamiento es usual el uso crónico de opioides que se han asociado a originar otras fuentes de dolor, por lo que deberían sopesar tratamientos farmacológicos alternativos. Sin embargo, cuando estos no son efectivos, insuficientes u ocasionan efectos adversos intolerables, el manejo intervencionista del dolor debería considerarse. En este campo la inhibición de los nervios esplácnicos que es una técnica que puede ser empleada para el control del dolor oncológico, podría jugar un papel importante a pesar de que aún no cuenta con evidencia sólida de su aplicabilidad en tratar el dolor crónico de origen benigno. Hasta donde sabemos, en el Ecuador es la primera vez que se realiza este procedimiento y el presente informe sugiere que puede ofrecer buenos resultados, incluso después de terminado el efecto de los fármacos utilizados

Chronic abdominal pain of benign origin can be disabling and significantly reduces the quality of life of some patients. Common treatment includes the chronic use of opioids that have also been linked with causing different sources of pain, so alternative pharmacological treatments should be considered instead. However, when these are not effective, insufficient, or cause intolerable adverse effects, interventional pain management should be considered. In this field, the inhibition of splanchnic nerves, which is a technique that can be used to control cancer pain, could play an important role in the treatment of chronic pain of benign origin, despite the lack of solid evidence in its applicability. As far as we know, it is the first time that this procedure has been performed in Ecuador and this report suggests that it can offer positive results even after the effect of the drugs used has ended

[Incidence and risk factors associated with in-hospital neonatal sepsis]. / Sepsis neonatal intrahospitalaria. Incidencia y factores de riesgo.

BACKGROUND: inhospital neonatal sepsis (IHNS) is a clinical syndrome characterized by an inflammatory reaction with local or systemic signs of infection, accompanied by the causal agent in the first month of life. The objective was to know the incidence and risk factors associated with IHNS. METHODS: during 2006 and 2007 a total of 49 patients in the case group and 50 patients in the control group were included in the study. A serie of qualitative variables comparing the two groups to determine their association were analyzed. RESULTS: We found an incidence of IHNS in our hospital of 3.7 %. The most frequently observed risk factors were: birth weight between 1501-2500 g, in the hypotrophic group, the use of central vascular access, ranitidine, steroids, parenteral nutrition, endotracheal intubation, orogastric catheter, vesical catheter, and also the presence of cardiopathy or hyaline membrane disease (HDM). The mortality rate was 24.4 %. CONCLUSIONS: the incidence of IHNS was less than reported in the literature. The number of deaths associated with IHNS was low.