[Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia]. / Eficacia del bloqueo de nervios intercostales con ropivacaína, en la analgesia de pacientes operados de colecistectomía abierta urgente bajo anestesia general.

INTRODUCTION: Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life. AIMS: To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management. MATERIAL AND METHODS: A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours. RESULTS: Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (p<0.0001). Visual Analog Scale for Pain results were similar in both groups. CONCLUSIONS: Intercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.

[Dystrophic osseus metaplasia on small bowell mesentery in a patient with multiple abdominal sugeries: a case report]. / Metaplasia ósea distrófica en el mesenterio de intestino delgado en un paciente con múltiples cirugías abdominales. Informe de un caso.

Heteropropic ossification was initially described by Riedel in 1883. This is a rare disease but well documented in gastrointestinal tract. Several mechanisms have been proposed to determine the etiology of this metaplasia. We present a 59 year old male that was treated in the National Institute of Medicine Sciences and Nutrition Salvador Zubirán in whom after various abdominal surgical procedures the presence of bowel osseous metaplasia was documented.

[Usefulness of chewing gum for the resolution of postoperative ileus in left colon resections]. / Utilidad de la goma de mascar para la resolución del íleo posoperatorio en resecciones de colon izquierdo.

BACKGROUND AND AIM: Disturbances in intestinal motility have been described since XIX century, with a not very well understood pathogenesis and few therapeutic approaches. Considering chewing as an important stimulus to promote intestinal motility we designed this study to assess the efficacy of chewing gum to improve the postoperative ileus, and the clinical relevance of this intervention. METHODS: Were included patients who underwent for elective left hemicolectomy during January 2007 to December 2008. The patients were randomly assigned to receive chewing gum or nothing during the post-surgery period. The main outcomes assessed were duration of postoperative ileus, and reduction in hospitalization days. RESULTS: During the period of the study were included 32 patients, were included mainly men (11 and 9 in treated and control patients, respectively). The first defecation after surgery procedure occurs at (44.2 ± 17.6 h) in the treated group and (55.5 ± 14.8 h) in the control group (p = 0.05). In the same way oral tolerance was achieved faster in the treated group (p= 0.05). The hospital stay duration was not different among treated and not treated patients. CONCLUSIONS: The use of chewing gum in patients after elective left hemicolectomy, reduce the duration of the postoperative ileus. However, this does not reduce the hospital stay duration.