Myofascial pain syndrome in the oncologic patient: general considerations.

This article aims to make visible a common non-oncologic pain condition in cancer patients. Myofascial pain syndrome can generate an increase in the symptomatic burden of the oncologic patient, increase the demand for opioid medication, and decrease the quality of life. We consider that health professionals involved in the care of cancer patients in its different stages should be aware of it, diagnose it, and treat it early to avoid processes of pain chronification, peripheral tissue modification, and deterioration of the functional condition of patients with oncologic diseases.

Toxicidad por anestésicos locales: revisión de la literatura / Toxicity due to local anesthetic agents: literature review

Los anestésicos locales (AL) son medicamentos muy empleados en la práctica anestésica, con baja presentación de efectos adversos y, en el caso de toxicidad, una alta mortalidad. Actualmente las tasas de toxicidad sistémica han disminuido, del 0,2 % al 0,01 %, por el uso de medidas preventivas y desarrollo de medicamentos más seguros. Dado el riesgo de mortalidad latente, los estudios en humanos no son factibles, siendo la fuente de información disponible la extrapolación de estudios animales o reportes de caso. Las manifestaciones de toxicidad severa por AL, se dan principalmente con la administración intravascular más que por la absorción tisular; siendo así la bupivacaína el AL con mayor riesgo. Clínicamente se observa alteración del estado de conciencia y convulsiones tónico-clónicas seguidas de compromiso cardiovascular, dado por bloqueos de la conducción y colapso cardiovascular de difícil manejo. En cuanto al manejo, la prevención es la base de éste seguido de una técnica anestésica adecuada; rápido reconocimiento y diagnostico e inicio temprano de medidas de rescate según el ACLS y más recientemente el uso concomitante de emulsiones lipídicas al 20 %, soportado en reportes de caso con resucitación exitosa.

Local anesthetics (LA) are drugs widely used in the practice of anesthesia, with low incidence of adverse events; however, in case of toxicity, mortality is very high. Currently, the systemictoxicity rates have dropped from 0.2 % to 0.01 %, thanks to the use of preventive measures and to the development of safer drugs. Inview of the high risk of latent mortality, studies in humans are not feasible and hence the available sources of information are extrapolated animal studies or case reports. Severe LA toxicity manifestations occur mainlyas a result of intravascular administration rather than due to tissue absorption; hence, bupivacaine is the LA that exhibits the highest risk. Clinically there are awareness disorders and tonic-clonic seizures followed by cardiovascular involvement resulting from conduction blocks and difficult to manage cardiovascular collapse. With regards to management, prevention is the key, followed by an adequate anesthetic technique; rapid identification and diagnosis and early application of ACLS rescue measures.More recently, the concomitant use of 20 % lipid emulsions has been supported by successful resuscitation case reports.