Síndrome hemofagocítico asociado a virus de Epstein-Barr. Descripción de un caso y tratamiento en la Unidad de Reanimación / Hemophagocytic syndrome associated with Epstein-Barr virus. Presentation of a case and treatment in the Resuscitation Unit

Exponemos el caso clínico de un paciente varón de 17 años que ingresa en la Unidad de Reanimación con el diagnóstico de síndrome hemofagocítico asociado a infección por el virus de Epstein-Barr con evolución desfavorable. El síndrome hemofagocítico es un síndrome de activación inmune patológica debido a una producción/modulación incontrolada de algunas citocinas. Su cuadro clínico se define según los criterios de consenso HLH-2004, no son patognomónicos, y muchas veces aparecen secuencialmente, por lo que su sospecha debe seguirse de tratamiento de soporte agresivo combinado precozmente con el tratamiento específico del factor desencadenante, ya que es la única forma de mejorar la supervivencia en pacientes con fallo orgánico múltiple por esta causa (AU)

We report the case of a 17 year old male patient, who was admitted to the Resuscitation Unit with the diagnosis of hemophagocytic syndrome, associated with infection by Epstein-Barr virus with unfavorable outcome. Hemophagocytic syndrome is a pathological immune activation syndrome due to the production/uncontrolled modulation of some cytokines. Its clinical signs and symptoms, defined by consensus criteria HLH-2004, are not pathognomonic, and often appear sequentially, thus suspicion should be followed by aggressive supportive therapy combined with early specific treatment of the triggering factor, as it is the only way to improve survival in patients with multiple organic failure as a result (AU)

[Hemophagocytic syndrome associated with Epstein-Barr virus. Presentation of a case and treatment in the Resuscitation Unit]. / Síndrome hemofagocítico asociado a virus de Epstein-Barr. Descripción de un caso y tratamiento en la Unidad de Reanimación.

We report the case of a 17 year old male patient, who was admitted to the Resuscitation Unit with the diagnosis of hemophagocytic syndrome, associated with infection by Epstein-Barr virus with unfavorable outcome. Hemophagocytic syndrome is a pathological immune activation syndrome due to the production/uncontrolled modulation of some cytokines. Its clinical signs and symptoms, defined by consensus criteria HLH-2004, are not pathognomonic, and often appear sequentially, thus suspicion should be followed by aggressive supportive therapy combined with early specific treatment of the triggering factor, as it is the only way to improve survival in patients with multiple organic failure as a result.

Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica / No disponible

Objetivos: Estudiar la incidencia de fallos y complicaciones neurológicas de la analgesia epidural en obstetricia, así como hacer un seguimiento y análisis de las mismas. Pacientes y método: Estudio observacional prospectivo de gestantes que recibieron analgesia epidural para el trabajo de parto en un hospital terciario durante 2009 y 2010. Se registraron los datos demográficos maternoinfantiles, del trabajo de parto y el tipo de parto así como las complicaciones que se produjeron tanto durante la realización de la técnica como durante el peri- y postparto. Se siguieron a todas las pacientes hasta su alta hospitalaria identificándose y tratándose las posibles complicaciones hasta su resolución. Resultados: Se incluyeron 438 gestantes. Se dividieron las complicaciones en 2 etapas: peripartum y postpartum. En el periparto se identificaron, de mayor a menor frecuencia, las siguientes complicaciones: analgesia lateralizada (16,4%), punción hemática (8,7%), parestesias (8,2%), técnica dificultosa (5,2%), analgesia ineficaz (2,7%), hipotensión arterial (2,5%) y bloqueo subdural (0,2%). En el postparto: lumbalgia (18,5%), retención urinaria (3,4%), cefalea postpunción dural (1,4%), neuropatías periféricas (0,9%) e hipoestesia prolongada (0,2%). Todas las complicaciones se resolvieron ad integrum con tratamiento conservador salvo un caso de cefalea que precisó la realización de un parche hemático. Conclusiones: La alta tasa de fallos de la analgesia epidural en obstetricia así como la posibilidad de complicaciones neurológicas pueden resolverse siguiendo unas normas de buena práctica que incluyen la aspiración previa a la inyección, la dosis test y la revisión periódica del catéter. Resulta imprescindible conocer dichas complicaciones para su evaluación y tratamiento precoz (AU)

Objectives: To determine the incidence of failures and neurological complications related to the epidural analgesia for labour and to analyze their evolution and pathogenesis. Patients and methods: Prospective and descriptive study in pregnant women who received an epidural analgesia for labour in a third level hospital over a 11-month period. The following data were registered: demographic mother and child information, labour, type of childbirth and complications during the procedure and during the peripartum and postpartum periods. All women were followed up to their hospitable discharge with an identification and treatment of the observed complications up to their resolution. Results: We enrolled 438 patients. Complications were separated in 2 phases: peripartum and postpartum. In the peripartum period were identified, from bigger than minor frequency, the following complications: unilateral analgesia (16,4%), hematic punction (8.7%), paresthesias (8.2%), difficult technique (5.2%), ineffective analgesia (2.7%), hypotension (2.5%) and subdural block (0.2%). In the postpartum period: lumbar pain (18.5%), urinary retention (3.4%), post-dural puncture headache (1.4%), peripheral neurophaty (0.9%) and prolonged hypoesthesia (0.2%). All complications were resolved ad integrum by a conservative treatment except one patient who needed an epidural blood patching because of a refractory headache. Conclusions: The high frequency of failure of the epidural analgesia in obstetrics as well as the possibility of neurological complications can be solved following several norms of a good practice that include the previous aspiration to the injection, the test-dose and the continuous inspection of the catheter. It´s essential to know these complications for their evaluation and precocious treatment (AU)

Lesión de nervios periféricos en anestesia obstétrica: descripción de cuatro casos / No disponible

El abordaje neuroaxial es de elección para el control del dolor en obstetricia, pero no está exento de riesgos. Las neuropatías periféricas posparto pueden producirse por diferentes condiciones médicas, quirúrgicas y anestésicas, por lo que debemos tenerlas presentes para diagnosticarlas y tratarlas precozmente y así evitar que se atribuyan, por defecto, a la técnica anestésica. Presentamos cuatro casos que se diagnosticaron en el periodo periparto, 2 meralgias parestésicas, 1 neuropatía del femoral y 1 lumbociatalgia, de las cuales solo la lumbociatalgia pudo ser atribuida parcialmente a la técnica anestésica. Tras confirmar su diagnóstico se instauró tratamiento conservador que resolvió ad integrum, dentro de los primeros siete días, todas las neuropatías salvo la lumbociatalgia. La baja incidencia de neuropatías periféricas tras técnicas neuroaxiales en obstetricia puede ser superior a la que se diagnostica. Resulta imprescindible una buena anamnesis preanestésica y conocer los diferentes mecanismos fisiopatológicos que pueden desencadenar neuropatías periféricas (AU)

A neuroaxial approach is of choice for the management of pain in obstetrics but is not exempt of risks. Postpartum peripheral neuropathy may occur because of various medical, surgical, and anesthetic conditions, hence we should have them in mind in order to recognize them and treat them early enough to prevent their deffault attribution to the anesthetic technique. We report four cases diagnosed during the peripartum – 2 paresthetic meralgias, 1 femoral neuropathy, and 1 lumbosciatalgia, of which only the lumbosciatalgia could be partly attributed to the anesthetic technique. Once the diagnosis was confirmed a conservative therapy was initiated that solved ad integrum all neuropathies, except for the lumbosciatalgia episode, within seven days. The low incidence of peripheral neuropathy following neuroaxial techniques in obstetrics may be higher than diagnosed. Adequate history taking before anesthesia is crucial, as is an understanding of the various pathophysiological mechanisms that may trigger peripheral neuropathy (AU)

[Epidural analgesia in obstetrics: is there an effect on labor and delivery?]. / Analgesia epidural en obstetricia: cómo afecta al desarrollo y finalización del parto?

BACKGROUND AND OBJECTIVE: Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. PATIENTS AND METHODS: Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. RESULTS: Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P < .01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P < .001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P < .01) and of the expulsion phase (1.0 [0.6] hours vs 0.7 [0.6] hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3-3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9-1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge's first plane decreased risk 2.7-fold and 3.03-fold, respectively. CONCLUSIONS: Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery.

Analgesia epidural en obstetricia: ¿cómo afecta al desarrollo y finalización del parto? / Epidural analgesia in obstetrics: Is there an effect on labor and delivery?

Introducción: La analgesia epidural es el estándar de la analgesia obstétrica, pero se le atribuye una posible influencia en la dinámica del parto que puede provocar un aumento de los partos instrumentados y cesáreas. Nuestro objetivo fue valorar en una cohorte de pacientes obstétricas la finalización del parto en relación con el tipo de analgesia empleado. Pacientes y método: Estudio prospectivo de cohorte de gestantes a término divididas en 2 grupos. El grupo A recibió analgesia epidural y el grupo B no recibió analgesia epidural. Se compararon las variables demográficas materno-fetales, obstétricas y tipo de parto en cada grupo y se estudiaron la influencia de la analgesia epidural y las causas probables que provocaron partos distócicos. Resultados: Se incluyeron 602 pacientes: 462 en grupo A y 140 en grupo B. La analgesia epidural se relacionó con una mayor tasa de partos instrumentales pero no de cesáreas (p < 0,01), mayor necesidad de oxitócicos (30,7% en grupo A vs 0% en grupo B, p < 0,001) y una mayor duración de las fases del parto (fase de dilatación 6,4 ± 4,2 h en grupo A frente a 4,7 ± 3,5 h en grupo B y fase expulsivo 1,0 ± 0,6 h frente a 0,7 ± 0,6 h, p < 0,01), sin influir en la tasa de desgarros, episiotomías ni otras variables. La mayor duración del primer (OR 1,2 IC95% 1,1-1,3) y segundo estadios del parto (OR 2,3 IC95% 1,3-3,9) del trabajo de parto y la obesidad materna (OR: 1,1 IC95% 0,9-1,2) se relacionaron con aumento del riesgo de partos distócicos, mientras que la multiparidad e iniciar la analgesia epidural con una presentación en el I plano de Hodge o superior lo disminuyeron 2,7 y 3,03 veces respectivamente. Discusión: Pese a que clásicamente se ha relacionado la analgesia epidural con un aumento de partos distócicos, en nuestra cohorte dicha influencia es discutible. El posible incremento pareció deberse a factores obstétricos como mayor duración de los estadios del parto, mayor índice de masa corporal y la primiparidad(AU)

Background and objective: Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. Patients and methods: Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. Results: Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P<.01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P<.001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P<.01) and of the expulsion phase (1.0 [0.6] hours vs 0.7 [0.6] hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3-3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9-1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge’s first plane decreased risk 2.7-fold and 3.03-fold, respectively. Conclusions: Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery(AU)

Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas / Post-operative analgesia in hip surgery: a comparison of 3 techniques

Introducción. Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y la edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos. Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, el inicio de rehabilitación y los costes económicos en cada grupo. Pacientes y método. Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en tres grupos aleatorios: A: solo analgesia intravenosa; B: bloqueo iliofascial, y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y la satisfacción con la analgesia, el tiempo transcurrido hasta el inicio de la sedestación, el consumo total de analgésicos postoperatorios, los efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados. La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (escala visual analógica [EVA] media 2,14±1,24, satisfacción 3,75±0,8) que en los que solo recibieron analgesia intravenosa (EVA media 5,57±0,64, satisfacción 2,83±0,7) (p<0,001), con una duración superior a las 24h (p<0,01) y un menor consumo de analgésicos suplementarios y otros fármacos que en el grupo A, por lo que tuvieron menos reacciones adversas (p<0,01), iniciaron la rehabilitación más precozmente (31,2±5,01h frente a 44,62±7,9h) (p<0,001) y supusieron un menor coste económico farmacéutico (13,26±6,34€/paciente frente a 30,26±1,88€/paciente), no encontrándose complicaciones en la realización de los bloqueos. No se encontraron diferencias significativas entre la eficacia de ambos bloqueos, evolución de las EVA media, grado de satisfacción ni gasto económico entre los pacientes que recibieron algún tipo de bloqueo. Conclusiones. Los bloqueos realizados son una técnica efectiva, fácil y segura, que proporciona numerosas ventajas: analgesia postoperatoria prolongada, recuperación más rápida, menor coste y escasas complicaciones (AU)

Introduction. The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives. Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods. A prospective study of 90 patients undergoing hip surgery. Patients were randomised to receive intravenous analgesia only, fascia iliaca compartment block or blockade of the obturator and femoral cutaneous nerves. In each group we recorded visual analogue scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. Results. Analgesia and level of patient satisfaction were significantly more effective in patients with nerve blocks than in those who received only intravenous analgesia (mean [SD] VAS scores, 2.14 [1.24], mean [SD] satisfaction scores 3.75 [0.8] and mean [SD] VAS scores, 5.57 [0.64], mean [SD] satisfaction scores 2.83 [0.7], respectively) (p<0.001). Patients with nerve blocks also had a pain-free period of more than 24h (p<0.01), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (p<0.01), started rehabilitation earlier (31.2 [5.01] hours vs. 44.62 [7.9] hours) (p<0.001), generated less expenditure (€13.26 [€6.34]/patient vs. €30.26 [€1.88]/patient), with no complications in the blocking techniques. No significant differences were found between the efficacy of both blocks, VAS scores, level of satisfaction or cost between the patients who received a block. Conclusions. The nerve blocks were effective, easy to perform, and safe. They afforded numerous advantages: extended period of postoperative analgesia, fast recovery, lower costs, and no complications (AU)

Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas / Post-surgical analgesia in hip surgery: a comparison of three techniques

Introducción. Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos. Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, inicio de rehabilitación y costes económicos en cada grupo. Pacientes y método. Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en 3 grupos aleatorios: A: solo analgesia intravenosa, B: bloqueo iliofascial y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y satisfacción analgésica, tiempo transcurrido hasta el inicio de la sedestación, necesidad de analgésicos postoperatorios, efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados. La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (EVA medio 2,14±1,24, satisfacción 3,75±0,8) que en los que solo recibieron analgesia intravenosa (EVA medio 5,57±0,64, satisfacción 2,83±0,7) (p<0,001), con una duración superior a las 24h (p<0,01) y un menor consumo de analgésicos suplementarios y otros fármacos que en el grupo A, por lo que tuvieron menos reacciones adversas (p<0,01), iniciaron la rehabilitación más precozmente (31,2±5,01h vs 44,62±7,9h) (p<0,001) y supusieron un menor coste económico farmacéutico (13,26±6,34€/paciente vs 30,26±1,88€/paciente) no encontrándose complicaciones en la realización de los bloqueos. No se encontraron diferencias significativas entre la eficacia de ambos bloqueos, evolución de los EVAs medio, grado de satisfacción ni gasto económico entre los pacientes que recibieron algún tipo de bloqueo...(AU)

Introduction. The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives. Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods. Prospective study of 90 patients undergoing hip surgery. Patients were randomised to receive intravenous analgesia only, fascia iliaca compartment block or blockade of the obturator and femoral cutaneous nerves. In each group, we recorded visual analogue scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. Results. Analgesia and level of patient satisfaction were significantly more effective in patients with nerve blocks than in those who received intravenous analgesia only (mean [SD] VAS scores, 2.14 [1.24], mean [SD] satisfaction scores 3.75 [0.8] and mean [SD] VAS scores, 5.57[0.64], mean [SD] satisfaction scores 2.83[0.7], respectively) (p<0.001). Patients with nerve blocks also had a pain-free period of more than 24h (p<0.01), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (p<0.01), started rehabilitation earlier (31.2 [5.01]h vs 44.62 [7.9]h) (p<0.001), generated less expenditure (€13.26 [€6.34]/patient vs €30.26 [€1.88]/patient), with no complications in the blockade techniques. No significant differences were found between the efficacy of both blockades, VAS scores, level of satisfaction, or the cost between the patients who received a blockade...(AU)

Descripción de un caso de síndrome de hipoventilación-apnea alveolar central adquirido / No disponible

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Eficacia del bloqueo de los nervios obturador y femorocutáneo para analgesia postoperatoria en cirugía de cadera / Efficacy of obturator and femoral cutaneous nerve blocks for postoperative analgesia in hip surgery

OBJETIVOS: Tratar el dolor postoperatorio de fracturade cadera es imperativo para iniciar una rehabilitaciónprecoz y para disminuir la morbimortalidad. Dada la pluripatologíay edad de los pacientes, la analgesia locorregionalpuede ser eficaz para tratarlo. Los objetivos planteadosfueron valorar la eficacia analgésica del bloqueo delos nervios obturador y femorocutáneo frente a analgesiaintravenosa total, así como registrar el grado de satisfacción,las complicaciones, inicio de rehabilitación y costeseconómicos en cada grupo.PACIENTES Y MÉTODO: Estudio prospectivo en 75pacientes sometidos a cirugía de fractura de cadera. Sedividieron en 3 grupos distribuidos aleatoriamente, grupoA, recibió sólo analgesia intravenosa; grupo B, recibiódoble bloqueo, y grupo C recibió bloqueo del nervioobturador. Se investigó el grado de dolor y satisfaccióncon la analgesia postoperatoria, el tiempo transcurridohasta el inicio de la rehabilitación, necesidad de analgésicospostoperatorios, efectos secundarios y los costeseconómicos farmacéuticos en cada grupo.RESULTADOS: La eficacia analgésica fue significativamentemayor en los pacientes con bloqueos nerviosos(EVA medio 2,6±1,4) que en los que recibieron sólo analgesiaintravenosa (5,6±0,7), mostrando además un periodolibre de dolor de más de 24 horas (p<0,001), un menorconsumo de analgésicos suplementarios y otros fármacos,menos reacciones adversas (p<0,01), un inicio de la rehabilitaciónmás precoz (32,6±5,4h frente a 45,7±8,2h), unmenor coste económico (2,6±1,5 frente a 7,0±0,4 €/paciente)y una ausencia total de complicaciones de las técnicas.CONCLUSIONES: Los bloqueos realizados son una técnicaefectiva, fácil y segura que proporciona numerosasventajas: analgesia postoperatoria prolongada, recuperaciónmás rápida, menor coste y escasas complicaciones(AU)

OBJECTIVES: The treatment of pain after surgery torepair a hip fracture is essential for an early start ofrehabilitation and for reducing morbidity and mortality.Given that patients are elderly and have multiplemedical conditions, local-regional analgesia can be aneffective approach. Our aim was to compare the efficacyof obturator and femoral cutaneous nerve blocks andtotal intravenous analgesia in terms of level of patientsatisfaction, complications, start of rehabilitation, andcost.PATIENTS AND METHODS: Prospective study of 75patients undergoing surgery to repair hip fractures.Patients were randomized to receive intravenousanalgesia only, blockade of both nerves, or blockade ofonly the obturator nerve. In each group we recordedvisual analog scale (VAS) pain scores, satisfaction withpostoperative analgesia, time elapsed until start ofrehabilitation, need for postoperative analgesics, sideeffects, and the cost of drugs.RESULTS: Analgesia was significantly more effective inpatients with nerve blocks than in those who receivedonly intravenous analgesia (mean [SD] VAS scores, 2.6[1.4] and 5.6 [0.7], respectively). Patients with nerveblocks also had a pain-free period of more than 24 hours(P<.001), needed fewer doses of supplementaryanalgesics or other drugs, had fewer side effects (P<.01),started rehabilitation earlier (32.6 [5.4] hours vs 45.7[8.2] hours), generated less expenditure (€2.6[€1.5]/patient vs €7.0 [€0.4]/patient). The testedtechniques had no complications.CONCLUSIONS: The nerve blocks were effective, easy toperform, and safe. They afforded numerous advantages:extended period of postoperative analgesia, fastrecovery, lower costs, and no complications(AU)

[Efficacy of obturator and femoral cutaneous nerve blocks for postoperative analgesia in hip surgery]. / Eficacia del bloqueo de los nervios obturador y femorocutáneo para analgesia postoperatoria en cirugía de cadera.

OBJECTIVES: The treatment of pain after surgery to repair a hip fracture is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Our aim was to compare the efficacy of obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation, and cost. PATIENTS AND METHODS: Prospective study of 75 patients undergoing surgery to repair hip fractures. Patients were randomized to receive intravenous analgesia only, blockade of both nerves, or blockade of only the obturator nerve. In each group we recorded visual analog scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. RESULTS: Analgesia was significantly more effective in patients with nerve blocks than in those who received only intravenous analgesia (mean [SD] VAS scores, 2.6 [1.4] and 5.6 [0.7], respectively). Patients with nerve blocks also had a pain-free period of more than 24 hours (P < .001), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (P < .01), started rehabilitation earlier (32.6 [5.4] hours vs 45.7 [8.2] hours), generated less expenditure (2.6 Euros [1.5 Euros]/patient vs 7.0 Euros [0.4 Euros]/patient). The tested techniques had no complications. CONCLUSIONS: The nerve blocks were effective, easy to perform, and safe. They afforded numerous advantages: extended period of postoperative analgesia, fast recovery, lower costs, and no complications.

Trombosis de seno cavernosopostraumática / Posttraumatic cavernous sinus thrombosis

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