Comparación de 3 combinaciones de levobupivacaína al 0,5 por ciento y de mepivacaína al 1 por ciento en el bloqueo del nervio ciático poplíteo, en la cirugía ambulatoria del hallux valgus / Comparison of 3 combinations of 0.5 percent levobupivacaine and 1percent mepivacaine in popliteal sciatic block in hallux valgus outpatient surgery

Objetivo: Comparar 3 combinaciones de levobupivacaína 0,5% con mepivacaína 1% en bloqueo del ciático poplíteo con dosis única para cirugía del hallux valgus. Métodos: Estudio prospectivo, doble ciego, en pacientes programados para cirugía ambulatoria de hallux valgus con bloqueo del nervio ciático poplíteo guíado por ultrasonidos. Los pacientes se distribuyeron aleatoriamente en 3 grupos, según el volumen de cada uno de los anestésicos locales: G1, levobupivacaína 20 mL + mepivacaína 10 mL, G2, levobupivacaína 10 mL + mepivacaína 20 mL y G3, levobupivacaína 15 mL + mepivacaína 15 mL. Fueron evauados el tiempo de inicio, de reversión y el tiempo total del bloqueo de los nervios tibial y peroneo; control del dolor postoperatorio a las 12, 24, 72 h y al séptimo día del postoperatorio mediante escala visual analógica (EVA), escala descriptiva simple (EDS) y la calidad del descanso nocturno; complicaciones postoperatorias y satisfacción del paciente. Resultados: Se incluyó a 120 pacientes, 40 por grupo. Los grupos fueron homogéneos y ningún paciente precisó anestesia complementaria. El tiempo de latencia del bloqueo fue significativamente mayor en el G1 respecto a G2 y G3 (39,4 ± 14,7 min frente a 32,2 ± 16,5 y 33,2 ± 12 min). El tiempo de reversión del bloqueo sensitivo y motor fue significativamente mayor en G1 respecto a G2 y G3 (29,5 ± 9,3 h frente a 22,2 ± 8,2 y 24,8 ± 7,9 h). El nivel máximo de dolor se registró a las 24 h del postoperatorio y fue significativamente superior en el G2 respecto al G1. El descanso nocturno también fue peor la primera noche en el G2 respecto al G1. La satisfacción del paciente fue buena o muy buena y no se registraron complicaciones. Conclusiones: El tiempo de latencia del bloqueo y la eficacia anestésica fueron adecuados en los 3 grupos. La combinación de levobupivacaína 0,5% 20 ml y mepivacaína 1% 10 ml es una buena alternativa para una analgesia postoperatoria más duradera(AU)

Background: To compare 3 combinations of 0.5% levobupivacaine (L) and 1% mepivacaine (M) for popliteal block for hallux valgus surgery. Methods: Prospective, double blind study of 120 patients undergoing unilateral hallux valgus outpatient surgery with posterior popliteal block with ultrasound-guided single injection. Patients were randomly allocated into three groups: G1: 20 mL L + 10 mL M; G2: 10 mL L + 20 mL M; and G3: 15 mL L + 15 mL M. Recorded variables were: time of block, onset and reversal times for tibial and peroneal nerves block; postoperative pain until the 7th day by means of visual analogue scale (VAS), simple descriptive scale and the quality of nocturnal rest, complications, and patient satisfaction. ANOVA and chi2 were applied in the statistical analysis, with a P < 0.05 considered significant. Results: Groups were homogeneous for demographic and surgical characteristics. None of the patients required intraoperative complementary analgesia or anaesthesia. Block onset was significantly longer in G1 than in G2 and G3 (39.4 ± 14.7 versus 32.2 ± 16.5 and 33.2 ± 12 minutes). Recovery time from sensory and motor block was significantly longer in G1 than in G2 and G3 (29.5 ± 9.3 versus 22.2 ± 8.2 and 24.8 ± 7.9 hours). Postoperative pain level was below VAS 30 (1-100) in the three groups; none of the patients experienced severe pain. Maximum pain level appeared at 24 h postoperatively. Patient satisfaction was high and there were no complications. Conclusions: Block onset time and anaesthetic efficacy was adequate in the three groups. The combination of 20 mL levobupivacaine 0.5% with 10 mL mepivacaine 1% provide a good alternative for a lasting postoperative analgesia(AU)

[Comparison of 3 combinations of 0.5% levobupivacaine and 1% mepivacaine in popliteal sciatic block in hallux valgus outpatient surgery]. / Comparación de 3 combinaciones de levobupivacaína al 0,5% y de mepivacaína al 1% en el bloqueo del nervio ciático poplíteo, en la cirugía ambulatoria del hallux valgus.

BACKGROUND: To compare 3 combinations of 0.5% levobupivacaine (L) and 1% mepivacaine (M) for popliteal block for hallux valgus surgery. METHODS: Prospective, double blind study of 120 patients undergoing unilateral hallux valgus outpatient surgery with posterior popliteal block with ultrasound-guided single injection. Patients were randomly allocated into three groups: G1: 20mL L+10mL M; G2: 10mL L+20mL M; and G3: 15mL L+15mL M. Recorded variables were: time of block, onset and reversal times for tibial and peroneal nerves block; postoperative pain until the 7(th) day by means of visual analogue scale (VAS), simple descriptive scale and the quality of nocturnal rest, complications, and patient satisfaction. ANOVA and chi2 were applied in the statistical analysis, with a P<0.05 considered significant. RESULTS: Groups were homogeneous for demographic and surgical characteristics. None of the patients required intraoperative complementary analgesia or anaesthesia. Block onset was significantly longer in G1 than in G2 and G3 (39.4±14.7 versus 32.2±16.5 and 33.2±12minutes). Recovery time from sensory and motor block was significantly longer in G1 than in G2 and G3 (29.5±9.3 versus 22.2±8.2 and 24.8±7.9hours). Postoperative pain level was below VAS 30 (1-100) in the three groups; none of the patients experienced severe pain. Maximum pain level appeared at 24h postoperatively. Patient satisfaction was high and there were no complications. CONCLUSIONS: Block onset time and anaesthetic efficacy was adequate in the three groups. The combination of 20mL levobupivacaine 0.5% with 10mL mepivacaine 1% provide a good alternative for a lasting postoperative analgesia.

[Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy: anesthesia in 445 cases]. / Anestesia para simpatectomía torácica por videotoracoscopia en régimen ambulatorio o corta estancia: experiencia en 445 casos.

OBJECTIVE: To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. PATIENTS AND METHODS: The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. RESULTS: No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. CONCLUSION: The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.

Anestesia para simpatectomía torácica por videotoracoscopia en régimen ambulatorio o corta estancia: experiencia en 445 casos / Outpatient or short-stay videothoracoscopyassisted thoracic sympathectomy: anesthesia in 445 cases

OBJETIVOS: Demostrar que la inclusión de la simpatectomía bilateral por videotoracoscopia en régimen ambulatorio y corta estancia es un procedimiento seguro. PACIENTES Y MÉTODOS: Se analizaron retrospectivamente las historias clínicas de 445 pacientes intervenidos de simpatectomía torácica bilateral por videotoracoscopia con el mismo protocolo bajo régimen ambulatorio o de corta estancia. Se realizó anestesia intravenosa con tubo orotraqueal simple permitiendo periodos de apnea para la simpatectomía. Se instiló lidocaína al 2% por los drenajes torácicos que se retiraron en el postoperatorio inmediato. Se recogieron variables respiratorias intraoperatorias, el nivel de dolor y las complicaciones intraoperatorias y postoperatorias. Se compararon los datos de los pacientes operados en régimen de cirugía ambulatoria con los de corta estancia. RESULTADOS: No hubo diferencias entre los dos grupos en las variables demográficas y perioperatorias. El 3,6% de pacientes de la serie presentaron complicaciones respiratorias postoperatorias: 4 minitoracotomías de asistencia; un enfisema subcutáneo sin traducción radiológica; 9 neumotórax residuales de los que sólo dos requirieron drenaje pleural; un quilotórax y un hemotórax tardío. Excepto el hemotórax tardío, el resto de complicaciones se diagnosticaron y se tomó la decisión terapéutica en el postoperatorio inmediato. En el grupo de la cirugía ambulatoria los ingresos no planificados por negativa del paciente al alta fueron del 6,5%. CONCLUSIÓN: La baja incidencia de complicaciones, y sobre todo el hecho que se detecten en el postoperatorio inmediato permite realizar este procedimiento en régimen ambulatorio(AU)

OBJECTIVE: To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. PATIENTS AND METHODS: The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or shortstay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. RESULTS: No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. CONCLUSION: The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis(AU)

[Ultrasound-guided single dose injection of 0.5% levobupivacaine or 0.5% ropivacaine for a popliteal fossa nerve block in unilateral hallux valgus surgery]. / Levobupivacaína 0.5% frente a ropivacaína 0.5% en el bloqueo poplíteo con dosis única de anestésico local por abordaje posterior dirigido por ecografía para cirugía de hallux valgus unilateral.

OBJECTIVE: To compare the perioperative analgesic efficacy of 0.5% levobupivacaine and 0.5% ropivacaine injected in a single dose to block the tibial and peroneal nerves for surgery using a posterior (popliteal fossa) approach. MATERIAL AND METHODS: Prospective randomized trial in patients undergoing hallux valgus surgery; anesthesia was provided by blocking nerves in the popliteal fossa with either 0.5% levobupivacaine or 0.5% ropivacaine. Variables studied were times until anesthetic block onset and reversal, need for additional sedation or peripheral block anesthetic, course of postoperative pain at 12, 24 and 48 hours and at 7 days, nighttime rest, need for additional analgesia, and patient satisfaction. RESULTS: Forty-six patients were enrolled. Times until onset of the sensory and motor blocks were similar in the 2 groups. For 57.1% of the patients, the sensory and motor block lasted 24 hours after surgery, with no between-group differences. The levobupivacaine group had less pain at rest 24 hours after surgery (mean [SD] visual analog scale score of 0.16 [0375] vs. 1.17 [1.88] in the ropivacaine group; P < .05). No patient reported severe pain or required additional analgesics. None were readmitted. More than 80% rested well at night. No between-group differences were observed. CONCLUSIONS: The use of a single dose of either levobupivacaine or ropivacaine to provide anesthesia for a popliteal approach to hallux valgus surgery is effective for controlling postoperative pain.

Levobupivacaína 0.5 % frente a ropivacaína 0.5 % en el bloqueo poplíteo con dosis única de anestésico local por abordaje posterior dirigido por ecografía para cirugía de hallux valgus unilateral / Ultrasound-guided single dose injection of 0.5% levobupivacaine or 0.5% ropivacaine for a popliteal fossa nerve block in unilateral hallux valgus surgery

OBJETIVOS: Comparar la eficacia analgésica perioperatoriade levobupivacaína 0,5% frente a ropivacaína0,5% en el bloqueo con punción única de los nerviostibial y peroneo por abordaje poplíteo.MATERIAL Y MÉTODOS: Estudio prospectivo, randomizadoen pacientes sometidos a cirugía de hallux valgus. Bloqueoen el hueco poplíteo con levobupivacaína 0,5% o ropivacaína0,5%. Se estudiaron tiempo de inicio y reversióndel bloqueo anestésico, necesidad de sedación adicional orefuerzo anestésico periférico, evolución del dolor postoperatoriotras la cirugía y a las 12 h, 24 h, 48 h y 7º día postoperatorio,valoración del descanso nocturno, necesidadde analgesia adicional y satisfacción del paciente.RESULTADOS: Se incluyeron 46 pacientes. El tiempo deinstauración de bloqueo sensitivo y motor fue similar enambos grupos. En el 57,1% de los pacientes la recuperacióndel bloqueo motor y sensitivo se produjo durantelas 24 primeras horas de postoperatorio, sin diferenciasentre los grupos. Se constató menor grado de dolor postoperatorioen reposo a las 24 horas de la intervención enel grupo de levobupivacaína (EVA medio 0,16 ± 0,375)frente al grupo de ropivacaína (EVA medio 1,17 ± 1,88),p<0,05. Ningún paciente acusó dolor severo ni precisóanalgesia suplementaria, no se produjo ningún reingreso,más del 80% de los pacientes presentaron buen descansonocturno, sin diferencias entre ambos grupos.CONCLUSIONES: La utilización de levobupivacaína oropivacaína en dosis única por abordaje poplíteo es altamenteeficaz para el control del dolor postoperatorio dela cirugía por hallux valgus(AU)

OBJETIVE: To compare the perioperative analgesicefficacy of 0.5% levobupivacaine and 0.5% ropivacaineinjected in a single dose to block the tibial and peronealnerves for surgery using a posterior (popliteal fossa)approach.MATERIAL AND METHODS: Prospective randomizedtrial in patients undergoing hallux valgus surgery;anesthesia was provided by blocking nerves in thepopliteal fossa with either 0.5% levobupivacaine or0.5% ropivacaine. Variables studied were times untilanesthetic block onset and reversal, need for additionalsedation or peripheral block anesthetic, course ofpostoperative pain at 12, 24 and 48 hours and at 7 days,nighttime rest, need for additional analgesia, and patientsatisfaction.RESULTS: Forty-six patients were enrolled. Times untilonset of the sensory and motor blocks were similar in the2 groups. For 57.1% of the patients, the sensory andmotor block lasted 24 hours after surgery, with nobetween-group differences. The levobupivacaine grouphad less pain at rest 24 hours after surgery (mean [SD]visual analog scale score of 0.16 [0.375] vs 1.17 [1.88] inthe ropivacaine group; P<.05). No patient reportedsevere pain or required additional analgesics. None werereadmitted. More than 80% rested well at night. Nobetween-group differences were observed.CONCLUSIONS: The use of a single dose of eitherlevobupivacaine or ropivacaine to provide anesthesia fora popliteal approach to hallux valgus surgery is effectivefor controlling postoperative pain(AU)

[Continuous epidural perfusion with meperidine on demand for the treatment of postoperative pain]. / Perfusión continua más demanda de meperidina por vía peridural en el tratamiento del dolor postoperatorio.

OBJECTIVE: To determine whether epidural administration of meperidine through a system affording patient-controlled analgesia (PCA) is appropriate for postoperative pain. PATIENTS AND METHODS: A prospective double-blind study of 30 patients undergoing high abdominal surgery randomly into two groups. After surgery with the same type of general anesthesia for both groups, group A received epidural meperidine through a PCA pump (initial boluses of 50 mg + infusion of 10 mg/h with additional doses of 25 mg upon patient demand and closure time of 90 min). Control group B received 0.9% saline serum through an epidural PCA system with identical perfusion characteristics. All patients had access to additional analgesia with subcutaneous meperidine (1 mg/kg weight). RESULTS: There was a wide interindividual variation in meperidine consumption in group A, with a mean total dose of 301.4 +/- 73 mg in 24 hours and no patient requiring additional subcutaneous meperidine. Subcutaneous meperidine required in group B reached 273 +/- 65.8 mg in 24 hours, with no significant differences between groups A and B for total dose given. No side effects inherent to the technique were found. Sufficient control of pain was achieved for all patients receiving epidural meperidine. CONCLUSIONS: Epidurally administered PCA with meperidine affords better pain relief with greater patient satisfaction than the same amount of drug given subcutaneously in successive doses upon patient request.