Asunto(s)
Anestesia de Conducción/normas , Ultrasonografía Intervencional/normas , Anestesia de Conducción/métodos , Anestesiología/educación , Extremidades , Humanos , Higiene/normas , Bloqueo Nervioso , Seguridad del Paciente , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/métodosRESUMEN
OBJECTIVE: Nasogastric tube placement (NTP) is no more systematically recommended in patients scheduled for elective colorectal surgery but could be necessary in case of postoperative vomiting. The aim of this study was to determine independent risk factors for NTP after colorectal surgery. PATIENTS AND METHODS: We performed an observational study including 290 patients scheduled for elective colorectal surgery included in an enhanced recovery programme: immunonutrition, thoracic epidural analgesia, antiemetic prophylaxis, respiratory physiotherapy, absence of NT and drainage, forced mobilization and oral nutrition. The main outcome was the occurrence of vomiting requiring NTP. Univariate analysis included: age, sex, BMI, American Society of Anesthesiologist Physical Status Classification System (ASA), duration of surgery, epidural analgesia, and mobilization, intraoperative fluid, temperature, laparotomy, use of droperidol, parenteral nutrition, stoma, diabetes, hypertension or coronary disease, COPD, type of surgery. A logistic regression was performed to determine independent risk factors of NTP. RESULTS: Among the 290 patients included, 277 were analyzed. The incidence of NTP was 10.5% (95%CI [7.4-14.6%]). Univariate analysis documented BMI, low temperature in PACU (<35°C), ASA scores, duration of surgery and epidural analgesia, rectal and sigmoid resections, diabetes, transfusion, no use of droperidol, duration of mobilization, conversion to laparotomy. Three independent risk factors were associated with NTP: temperature in SSPI<35.5°C (OR: 14.49; IC95% [4.52-45.45], P<0.0001), BMI<21kg/m(2) (8.40; [1.99-35.71], P=0.0038) and lack of postoperative droperidol administration (3.37 [1.02-11.39], P=0.04). CONCLUSIONS: After colorectal surgery tolerance to rapid oral feeding is impaired by denutrition and postoperative hypothermia. The combined used of postoperative droperidol should also be considered to avoid postoperative NTP.
Asunto(s)
Colon/cirugía , Cirugía Colorrectal/métodos , Intubación Gastrointestinal/efectos adversos , Recto/cirugía , Anciano , Antieméticos/uso terapéutico , Índice de Masa Corporal , Temperatura Corporal , Droperidol/uso terapéutico , Ambulación Precoz , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Intubación Gastrointestinal/estadística & datos numéricos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Apoyo Nutricional , Cuidados Posoperatorios , Factores de Riesgo , Análisis de SupervivenciaAsunto(s)
Anestesia de Conducción/métodos , Medicina Basada en la Evidencia , Ultrasonografía Intervencional/métodos , Anestésicos Locales/administración & dosificación , Plexo Braquial/diagnóstico por imagen , Sedación Consciente , Estimulación Eléctrica , Humanos , Monitoreo Intraoperatorio , Bloqueo Nervioso/métodos , Nervios Periféricos/diagnóstico por imagen , Postura , Ultrasonografía Intervencional/instrumentaciónAsunto(s)
Anestesia de Conducción , Anestesia Local , Ultrasonografía , Humanos , Higiene , Bloqueo NerviosoRESUMEN
BACKGROUND: Transversus abdominis plane (TAP) block has been reported to provide effective analgesia after lower abdominal surgery, but there are few data comparing ilioinguinal/iliohypogastric nerve (IHN) block with ultrasound-guided TAP block in patients undergoing inguinal hernia repair. METHODS: Two hundred and seventy-three patients undergoing day-case open inguinal hernia repair with a mesh were randomly allocated to receive either ultrasound-guided TAP block or blind IHN block with levobupivacaine 0.5%, before surgery. Patients were monitored for visual analogue scale (VAS) scores at rest (in the post-anaesthesia care unit, and at 4 and 12 h) and at rest and during movement (at 24, 48 h, 3 and 6 months). Pain at 6 months was also assessed using the DN4 questionnaire for neuropathic pain. RESULTS: Median VAS pain scores at rest were lower in the ultrasound-guided TAP group at 4 h (11 vs 15, P=0.04), at 12 h (20 vs 30, P=0.0014), and at 24 h (29 vs 33, P=0.013). Pain after the first 24 h, at 3 and 6 months after surgery, and DN4 scores were similar in both groups (P=NS). The proportion of patients with VAS >40 mm on movement at 6 months was comparable {18.2% [95% CI (12.2-26.1%)] vs 22.4% (15.8-30.6%) in the TAP and IHN groups, respectively, P=0.8}. Postoperative morphine requirements were lower during the first 24 h in the TAP block group (P=0.03). CONCLUSIONS: Ultrasound-guided TAP block provided better pain control than 'blind' IHN block after inguinal hernia repair but did not prevent the occurrence of chronic pain.
Asunto(s)
Hernia Inguinal/cirugía , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Músculos Abdominales/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios , Anestesia General/métodos , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Bupivacaína/análogos & derivados , Humanos , Levobupivacaína , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: Postoperative renal dysfunction (PRD) is well-documented after cardiovascular surgery but there are only limited available data concerning major orthopedic surgery, although patients may have several risk factors prone to impair renal function. We designed an epidemiologic prospective study to assess the incidence of PRD after total hip arthroplasty (THA) and to determine risk factors. PATIENTS AND METHODS: Were included in the study 755 patients scheduled for THA in a single centre, over a 14 months period. Thirty-one demographic, clinical and biological parameters were collected for each patient. PRD was defined by a value of glomerular filtration, determined by the Cockroft and Gault formulaAsunto(s)
Lesión Renal Aguda/epidemiología
, Artroplastia de Reemplazo de Cadera
, Complicaciones Posoperatorias/epidemiología
, Factores de Edad
, Anciano
, Antiinflamatorios no Esteroideos/uso terapéutico
, Antihipertensivos/uso terapéutico
, Comorbilidad
, Creatinina/sangre
, Diabetes Mellitus/epidemiología
, Diuréticos/uso terapéutico
, Femenino
, Tasa de Filtración Glomerular
, Humanos
, Hipertensión/epidemiología
, Incidencia
, Masculino
, Persona de Mediana Edad
, Estudios Prospectivos
, Factores de Riesgo
, Urea/sangre
RESUMEN
A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. Postoperatively the patient received enoxaparin and then phenylindanedione for thromboprophylaxis. She was re-admitted 2 weeks after surgery because of a lower limb motor deficit and a left retroperitoneal haematoma requiring blood transfusion. Clinicians need to be aware of this potential complication of lumbar plexus block in patients receiving thrombphylaxis.
Asunto(s)
Hematoma/etiología , Plexo Lumbosacro , Bloqueo Nervioso/efectos adversos , Anciano , Artroplastia de Reemplazo de Cadera , Femenino , Fibrinolíticos/efectos adversos , Humanos , Dolor Postoperatorio/prevención & control , Espacio RetroperitonealRESUMEN
OBJECTIVE: To determine the effect of epidural analgesia (EA) on the duration of labour and the mode of delivery. DATA SOURCES: A Medline computerised literature research was conducted from 1989 to 2000 including all the prospective studies comparing EA and systemic analgesia during labour. DATA SYNTHESIS: EA prolongs the first and second stages of labour and increases the rate of instrumental delivery, without neonatal side effects. EA is not responsible for dystocia and caesarean section rate is not increased by this mode of analgesia. The effect of combined spinal-epidural analgesia is comparable to the one of EA on the length of labour and the mode of delivery. Ropivacaine does not appear to be different from bupivacaine in that setting. The benefit of ambulation remains controversial since it does not reduce the incidence of instrumental delivery, compared to conventional EA with similarly diluted local anaesthetic solutions. CONCLUSIONS: Pain relief provided by EA combined to modification of obstetric management (amniotomy, oxytocin) does not impair the rate of caesarean section and dystocia.
Asunto(s)
Analgesia Epidural , Analgesia Obstétrica , Adulto , Ensayos Clínicos como Asunto , Parto Obstétrico , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
Combined spinal-epidural anesthesia (CSE) is an effective technique with rapid onset of labor analgesia. We describe two cases of excessive cephalad spread of sensory blockade without motor blockade in two parturients in spontaneous labor with CSE. The patients received sufentanil 5 microg intrathecally with 1.25 mg bupivacaine. Spinal injection produced dyspnea and extension of sensory blockade to cervical or facial level without fetal consequences. We conclude that the risk of these side-effects previously described with the 10 microg dose persists for lower sufentanil spinal doses.
Asunto(s)
Anestesia Epidural , Anestesia Obstétrica , Esclerosis Múltiple , Complicaciones del Embarazo , Femenino , Humanos , EmbarazoRESUMEN
We report a case of total spinal anaesthesia which occurred after a lumbar plexus block using a posterior approach. After total hip arthroplasty under general anaesthesia, a lumbar plexus block was performed according to Winnie's landmarks at the L4 interspace using a nerve stimulator. Aspiration test for blood and spinal fluid were both negative, as well as a test dose of 3 mL lidocaine 2%-bupivacaine 0.5%. One minute after the injection of 27 mL of the same mixture, a complete anaesthetic block occurred with hypotension and loss of consciousness requiring intubation and controlled ventilation during 3h30, without sequelae. Lumbar plexus block using a posterior approach must be performed cautiously and a slow and fractionated injection of the full dose is recommended.