Radiculopatía lumbosacra severa tras un parto con analgesia epidural / No disponible

No disponible

Bloqueo continuo del plexo braquial vía supraclavicular en recidiva ósea por adenocarcinoma de mama / No disponible

Objetivo: se expone la utilidad de técnicas intervencionistas sencillas en casos de dolor oncológico rebelde a tratamiento convencional o con intolerancia a ellos. Material y métodos: implantación de catéter braquial en la vaina perineurovascular por vía supraclavicular de Kulenkampff con tunelización a región pectoral, y perfusión de anestésicos locales en recidiva de carcinoma de mama. Se obtiene una disminución del dolor en un 70% del EVA mediante una perfusión de anestésicos locales (ropivacaína 0,2%) con una bomba de infusión elastomérica, y reducción de la medicación vía oral al primer escalón de la OMS. Resultados: importante mejora de la calidad de vida y del estado anímico de la enferma. Conclusiones: el dolor oncológico en ocasiones puede resultar rebelde al tratamiento convencional. Pueden ser necesarios procedimientos terapéuticos más complejos (cuarto escalón de la OMS). Su realización de forma temprana, proporciona una mejor calidad de vida que un tratamiento farmacológico convencional poco efectivo (AU)

Objective: to discuss these simple interventionist techniques useful for cancer pain refractory to conventional treatment or treatment intolerance. Material and methods: brachial catheter implantation in the perineuro-vascular sheath via the supraclavicular Kulenkampff route with tunelization to pectoral region, and local anaesthetic perfusion in breast cancer relapse. A 70% pain reduction on a VAS scale with a local anaesthetic (0.2% ropivacaine) using an elastomeric infusion pump, and oral medication reduction. Results: important improvement of the patient's quality of life and psychic status. Conclusions: oncologic pain may sometimes be refractory to conventional treatment. Other therapeutic procedures (fourth WHO step) may be needed. Its early accomplishment provides better quality of life than when compared to ineffective conventional drug therapy (AU)

Avulsión del plexo braquial traumático no controlado con remifentalino. Papel de la analgesia epidural cervical / Avulsión del plexo braquial traumático no controlado con remifentalino. Papel de la analgesia epidural cervical

Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8) de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con exito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6). El dolor es controlado en fase crónica (escala visual analógica 2) con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol)

We presented you a patient who suffered a left brachial plexus avulsion with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8). High-dose remifentanil infusion was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6) epidural catheter. At discharge pain remained controlled (visual analogue scale 2) with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol)

[Intracranial hypotension syndrome treated with an epidural blood patch]. / Síndrome de hipotensión intracraneal espontánea tratada con parche hemático epidural.

A 41-year-old woman was admitted to the internal medicine department to assess incapacitating postural headache. Clinical findings suggested the need for computed tomography and nuclear magnetic resonance scanning of the head, which led to a diagnosis of spontaneous intracranial hypotension syndrome. Later, isotopic cysternography and nuclear magnetic resonance imaging of the spine were used unsuccessfully to try to locate the cerebrospinal fluid leak that caused the syndrome. When conservative treatment proved ineffective, the pain clinic was called in to perform an epidural blood patch procedure. The patch led to an improvement in symptoms and the syndrome resolved completely after a second lumbar blood patch was used.

Síndrome de hipotensión intracraneal espontánea tratada con parche hemático epidural / Intracranial hypotension syndrome treated with an epidural blood patch

Paciente mujer de 41 años que ingresó en el servicio de Medicina Interna para estudio de cefalea postural invalidante. Ante los hallazgos clínicos se le realizó una tomografía axial computerizada y resonancia magnética nuclear craneales llegando al diagnóstico de síndrome de hipotensión intracraneal espontáneo. Posteriormente se intentó localizar el punto de fuga de líquido cefalorraquídeo causante del síndrome mediante cisternografía isotópica y resonancia magnética nuclear de columna sin éxito. El tratamiento conservador resultó ineficaz y se solicitó la colaboración de la unidad de dolor para la realización de un parche hemático epidural. La aplicación de un parche epidural a nivel dorsal mejoró los síntomas, que se resolvieron definitivamente tras un segundo parche a nivel lumbar

A 41-year-old woman was admitted to the internal medicine department to assess incapacitating postural headache. Clinical findings suggested the need for computed tomography and nuclear magnetic resonance scanning of the head, which led to a diagnosis of spontaneous intracranial hypotension syndrome. Later, isotopic cysternography and nuclear magnetic resonance imaging of the spine were used unsuccessfully to try to locate the cerebrospinal fluid leak that caused the syndrome. When conservative treatment proved ineffective, the pain clinic was called in to perform an epidural blood patch procedure. The patch led to an improvement symptoms and the syndrome resolved completely after a second lumbar blood patch was used

Factors determining analgesic and sedative drug requirements during extracorporeal shock wave lithotripsy.

PURPOSE: The aim of this study was to determine what factors influence the analgesic and sedative requirements during extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A retrospective study was carried out on 2,103 lithotripsy treatments performed over a 7-year period using an electromagnetic lithotriptor. Treatment with analgesics and anxiolytic drugs administered during ESWL was evaluated, and two new variables to determine the analgesic and sedative requirements were defined. A multivariant analysis model was established to determine which variables are related to or could predict the analgesic and/or sedative drug requirements. RESULTS: The most frequently used sedative drug was potassium chlorazepate which was used in 2,059 patients at a mean total dose of 25.6 mg. Pethidine was used in 2, 006 patients at a mean total dose of 56.3 mg, and fentanyl in 995 patients at a dose of 93.3 microg. In 52.4% of patients analgesic requirements were low, and in 76.6% sedative requirements were low. In 21.1% of patients analgesic drug requirements were high, and in 1. 8% of patients sedative drug requirements were high. The multivariant analysis showed that those requiring most analgesics were, the younger patients (p = 0.003), those who received a higher number of shock waves (p < 0.001) and those who needed more sedation (p < 0.001). Those who received the greatest amount of sedatives were women (p = 0.0026); younger patients (p < 0.001); those treated with higher voltages (p = 0.032), and patients with the highest analgesic requirements (p < 0.001). CONCLUSIONS: Predicting the analgesic drug requirements prior to ESWL is very difficult. The present study shows that young age, a greater discharge of shock waves and a high sedative drug requirement are factors clearly related to greater analgesic drug requirements. Higher sedative drug requirements are needed by women, younger patients, those receiving high discharge voltages and those with higher analgesic requirements.