Manejo del dolor posoperatorio en pacientes beneficiarios de una artroplastia total de rodilla: comparación de tres técnicas analgésica / Postoperative pail management in patients underfgoing total knee arthroplaty: comparison of three analgesic techniques

Introducción: La artroplastia total de rodilla (ATR) es un procedimiento quirúrgico muy doloroso en cirugía ortopédica, siendo muy difícil su tratamiento. El objetivo del presente estudio fue comparar 3 estrategias de analgesia post operatoria en el manejo del dolor post ATR. Pacientes y Método: se estudiaron 60 pacientes, divididos en 3 grupos. Grupo 1: Bloqueo iliofascial (BIFC), Grupo 2: Analgesia epidural continua (AEPIC) y Grupo 3: Morfina intratecal (MIT). Se evaluó el dolor post operatorio (DPO) en reposo y movimiento con escala visual análoga en las primeras 24 hrs., consumo de morfina endovenosa (MEV), incidencia de efectos adversos: prurito, náuseas y vómitos (NVPO), retención urinaria (RU). Al término del tratamiento se evaluó la satisfacción del paciente. Resultados: El DPO fue significativamente menor entre las 6 y 24 hrs. en los pacientes del Grupo 3 versus los de los Grupos 1 y 2 (p<0,01). El consumo de MEV fue menor en los pacientes del grupo 3 (p< 0,01). La incidencia de prurito post operatorio y RU fue significativamente mayor en el grupo 3 versus los grupos 1 y 2 (p< 0, 001 y p< 0,008). La hipotensión arterial fue mayor en los grupos 2 y 3 versus el grupo 1 (p< 0,05), siendo más frecuente la hipotensión moderada en el grupo 3 versus a los grupos 1 y 2 (p< 0.01). La calidad de la analgesia fue considerada superior en los pacientes del grupo 3. Conclusión: Las 3 técnicas analgésicas son útiles para el manejo del DPO de una ATR. La MIT presenta menor índice de dolor, mejor calidad de la analgesia percibida por el paciente, pero una mayor incidencia de efectos adversos en relación con el BIFC y AEPIC.

Introduction: Total knee arthroplasty (TKA) is a very painful surgical procedure in orthopedic surgery, making its treatmentvery difficult. The objective of the present study was to compare 3 postoperative analgesia strategies in the management of post TKA pain. Patients and Method: 60 patients, divided into 3 groups, were studied. Group 1: Iliofascial blockade (BIFC), Group 2: Continuous epidural analgesia (AEPIC) and Group 3: Intrathecal morphine (MIT). Postoperative pain (POD) at rest and movement was evaluated with a visual analog scale (EVA) in the first 24 hours, intravenous morphine consumption (VEM), incidence of adverse effects: pruritus, nausea and vomiting (PONV), urinary retention (UR). At the end of treatment, patient satisfaction was evaluated. Results: The DPO was significantly lower between 6 and 24 hours in the patients of Group 3 versus those of Groups 1 and 2 (p<0.01). MEV consumption was lower in patients of group 3 (p<0.01). The incidence of postoperative pruritus and UR was significantly higher in group 3 versus groups 1 and 2 (p<0.001 and p<0.008). Arterial hypotension was greater in groups 2 and 3 versus group 1 (p<0.05), with moderate hypotension being more frequent in group 3 versus groups 1 and 2 (p<0.01). The quality of analgesia was considered superior in patients in group 3. Conclusion: The three analgesic techniques are useful for managing the DPO of a TKA. MIT presents a lower pain index, better quality of analgesia perceived by the patient, but a higher incidence of adverse effects in relation to BIFC and AEPIC.

[Efficacy of the fascia iliaca compartment block vs continuous epidural infusion for analgesia following total knee replacement surgery]. / Utilidad del bloqueo iliofascial continuo versus la analgesia epidural continua para la analgesia postoperatoria en artroplastia total de rodilla.

BACKGROUND AND OBJECTIVE: Total knee replacement causes moderate to severe postoperative pain. The aim of this trial was to compare postoperative analgesia from a fascia iliaca compartment block to continuous epidural analgesia following knee arthroplasty. PATIENTS AND METHODS: Clinical trial enrolling patients in American Society of Anesthesiologists (ASA) classes 1 to 3 randomized to 2 groups. One group received spinal anesthesia plus a fascia iliaca compartment block with 0.1% bupivacaine at a rate of 10 mL/h. The second group received combined spinal-epidural anesthesia plus epidural analgesia with 0.1% bupivacaine in continuous infusion at a rate of 8 mL/h. Postoperative pain on a visual analog scale (VAS) at rest and on movement was recorded every 3 hours for the first 24 hours. Use of intravenous morphine and the adverse events were also recorded. RESULTS: Forty patients (20 for each group) were enrolled. The distribution of age, weight, body mass index, sex, ASA class, duration of surgery, use of morphine, and the incidence of adverse effects were similar in the 2 groups. Postoperative VAS scores at rest and on movement were also similar. The incidence of arterial hypotension was higher in the epidural analgesia group. CONCLUSIONS: The fascia iliaca compartment block and continuous epidural infusion are similarly efficient in providing postoperative analgesia for patients after total knee replacement. The fascia iliaca compartment block is associated with a lower incidence of postoperative hemodynamic complications. Early, safe rehabilitation is facilitated by both analgesic techniques.

Utilidad del bloqueo iliofascial continuo versus la analgesia epidural continua para la analgesia postoperatoria en artroplastia total de rodilla / Efficacy of the fascia iliaca compartment block vs continuous epidural infusion for analgesia following total knee replacement surgery

Objetivo: La artroplastia total de rodilla induce dolor postoperatorio de moderado a severo. El objetivo de este ensayo clínico fue comparar la analgesia postoperatoria del bloqueo femoral iliofascial continuo frente a la analgesia epidural continua en pacientes sometidos a artroplastia total de rodilla. Pacientes y métodos: Ensayo clínico, prospectivo, aleatorizado, en pacientes ASA I a III, divididos en 2 grupos. Grupo 1: Anestesia subaracnoidea más bloqueo iliofascial con infusión continua de bupivacaína 0,1% a 10 ml/h. Grupo 2: Anestesia combinada subaracnoidea-epidural más analgesia epidural continua con bupivacaína 0,1% en infusión continua a 8 ml/h. Se registró dolor postoperatorio según la escala visual analógica, tanto en reposo (EVA estático) como en movimiento (EVA dinámico) cada 3 h durante 24 h; consumo de morfina endovenosa e incidencia de efectos adversos. Resultados: Fueron incluidos 40 pacientes, 20 por cada grupo. No hubo diferencias entre los grupos en relación a la edad, peso, índice de masa corporal, sexo, clase ASA, duración de la cirugía, consumo de morfina e incidencia de efectos adversos. El valor en la escala analógica visual en el postoperatorio, tanto estático como dinámico fue similar en ambos grupos de estudio. Hubo una mayor incidencia de hipotensión arterial en el grupo de analgesia epidural. Conclusión: Tanto el bloqueo iliofascial como la analgesia epidural continua proporcionan una analgesia eficiente y de similar calidad en pacientes sometidos a artroplastia de rodilla. El bloqueo iliofascial presenta menor incidencia de complicaciones hemodinámicas en el periodo postoperatorio. Ambas técnicas permiten una rehabilitación precoz y segura(AU)

Background and objective: Total knee replacement causes moderate to severe postoperative pain. The aim of this trial was to compare postoperative analgesia from a fascia iliaca compartment block to continuous epidural analgesia following knee arthroplasty. Patients and Methods: Clinical trial enrolling patients in American Society of Anesthesiologists (ASA) classes 1 to 3 randomized to 2 groups. One group received spinal anesthesia plus a fascia iliaca compartment block with 0.1% bupivacaine at a rate of 10 mL/h. The second group received combined spinal-epidural anesthesia plus epidural analgesia with 0.1% bupivacaine in continuous infusion at a rate of 8 mL/h. Postoperative pain on a visual analog scale (VAS) at rest and on movement was recorded every 3 hours for the first 24 hours. Use of intravenous morphine and the adverse events were also recorded. Results: Forty patients (20 for each group) were enrolled. The distribution of age, weight, body mass index, sex, ASA class, duration of surgery, use of morphine, and the incidence of adverse effects were similar in the 2 groups. Postoperative VAS scores at rest and on movement were also similar. The incidence of arterial hypotension was higher in the epidural analgesia group. Conclusions: The fascia iliaca compartment block and continuous epidural infusion are similarly efficient in providing postoperative analgesia for patients after total knee replacement. The fascia iliaca compartment block is associated with a lower incidence of postoperative hemodynamic complications. Early, safe rehabilitation is facilitated by both analgesic techniques(AU)

[Efficacy of a continuous interscalene block vs intra-articular analgesia for postoperative pain in arthroscopic acromioplasty]. / Eficacia del bloqueo interescalénico continuo en comparación a la analgesia intra-articular para el tratamiento del dolor postoperatorio en acromioplastias artroscópicas.

OBJECTIVE: To compare the utility of intra-articular analgesia (IA) to that of a continuous interscalene block (CIB) by evaluating the quality of postoperative analgesia, a satisfaction index, and the incidence of complications. PATIENTS AND METHOD: A randomized controlled trial enrolling patients classified as ASA 1 or 2. The IA group received 25 mL of ropivacaine 0.2% plus 2 mg of morphine. The CIB group received a 7-mL/h infusion of bupivacaine 0.0625% plus 1 microg/mL of sufentanil. Postoperative pain was expressed on a visual analog scale (VAS) at 2, 4, 6, 12, 24, and 48 hours. Intravenous morphine was used as a rescue analgesic. Morphine use, incidence of adverse effects, and level of patient satisfaction after 48 hours were recorded. RESULTS: Twenty-three patients were randomized to the IA group and 24 to the CIB group. There were no between-group differences in patient characteristics. VAS scores and morphine use were similar in the 2 groups in the first 12 hours but were lower in the CIB group at 24 and 48 hours. The level of patient satisfaction was higher in the CIB group. There was a higher incidence of nausea and/or vomiting in the IA group at 24 and 48 hours. CONCLUSIONS: Postoperative pain in the first 12 hours after shoulder surgery can be adequately managed with either IA or CIB. CIB is more effective than IA between 12 and 48 hours after surgery.

Eficacia del bloqueo interescalénico continuo en comparación a laanalgesia intra-articular para el tratamiento del dolor postoperatorioen acromioplastias artroscópicas / Efficacy of a continuous interscalene block vs intra-articular analgesia for postoperative pain in arthroscopic acromioplasty

OBJETIVO: Comparar la utilidad entre la analgesiaintra-articular (AI) y el bloqueo interescalénico continuo(BIEC), evaluando la calidad de la analgesia postoperatoria,índice de satisfacción e incidencia de complicaciones.PACIENTES Y MÉTODO: Estudio prospectivo controladoen pacientes ASA I-II, Grupo 1(AI): ropivacaína 0,2%25 mL + morfina 2 mg; Grupo 2 (BIEC): bupivacaína0,0625% + sufentanil 1 μg/mL, con un débito de 7 mL/h.El dolor postquirúrgico se registró a las 2, 4, 6, 12, 24 y48 horas mediante Escala Visual Análoga (EVA). Se usómorfina endovenosa como analgésico de rescate. Seregistró el consumo de morfina, la incidencia de efectosadversos y el grado de satisfacción experimentados porlos pacientes a las 48 h.RESULTADOS: Se incluyeron 23 pacientes en el Grupo1, y 24 en el Grupo 2. No hubo diferencias en los parámetrosdemográficos de ambos grupos. El EVA y el consumode morfina en las primeras 12 h fueron similares.A las 24 y 48 h fue menor en el Grupo BIEC en comparacióncon el Grupo AI. El grado de satisfacción experimentadopor los pacientes fue superior en el GrupoBIEC. Hubo mayor incidencia de náuseas y/o vómitos enel Grupo AI a las 24 y 48 h.CONCLUSIONES: El manejo del dolor postoperatoriomediante las técnicas de AI y BIEC es adecuado para lascirugías del hombro en las primeras 12 h. El BIEC sedemuestra más efectivo que la AI después de las 12 yhasta las 48 h postoperatorias (AU)

OBJECTIVE: To compare the utility of intra-articularanalgesia (IA) to that of a continuous interscalene block(CIB) by evaluating the quality of postoperativeanalgesia, a satisfaction index, and the incidence ofcomplications.PATIENTS AND METHOD: A randomized controlled trialenrolling patients classified as ASA 1 or 2. The IA groupreceived 25 mL of ropivacaine 0.2% plus 2 mg ofmorphine. The CIB group received a 7-mL/h infusion ofbupivacaine 0.0625% plus 1 μg/mL of sufentanil.Postoperative pain was expressed on a visual analogscale (VAS) at 2, 4, 6, 12, 24, and 48 hours. Intravenousmorphine was used as a rescue analgesic. Morphine use,incidence of adverse effects, and level of patientsatisfaction after 48 hours were recorded.RESULTS: Twenty-three patients were randomized tothe IA group and 24 to the CIB group. There were nobetween-group differences in patient characteristics.VAS scores and morphine use were similar in the 2groups in the first 12 hours but were lower in the CIBgroup at 24 and 48 hours. The level of patientsatisfaction was higher in the CIB group. There was ahigher incidence of nausea and/or vomiting in the IAgroup at 24 and 48 hours.CONCLUSIONS: Postoperative pain in the first 12 hoursafter shoulder surgery can be adequately managed witheither IA or CIB. CIB is more effective than IA between12 and 48 hours after surgery (AU)

[Intrathecal but not systemic sufentanil reduces the consumption of propofol for bispectral index-guided sedation]. / La administración de sufentanil intratecal pero no la sistémica reduce el consumo de propofol para sedación guiada mediante índice bi-espectral.

OBJECTIVE: The addition of opioids to local anesthetics in spinal anesthesia modulates some aspects of anesthesia and analgesia. We evaluate the effect of adding different doses of intrathecal and subcutaneous sufentanil on propofol requirements for sedation during spinal anesthesia. MATERIAL AND METHODS: Prospective clinical trial randomizing patients undergoing knee arthroscopy to 4 groups. Group 1 received 12.5 mg of 0.75% hyperbaric bupivacaine (HBB); Group 2, 12.5 mg of HBB plus 2.5 microg of intrathecal sufentanil; Group 3, 12.5 mg of HBB plus 5 microg of intrathecal sufentanil; and Group 4, 12.5 mg of HBB plus 5 microg of subcutaneous sufentanil. When spinal anesthesia had been induced, a bispectral index (BIS) monitor was connected and baseline values were recorded for each patient. Sedation was then initiated with propofol at a dose of 2.5 microg/ml, using an effect-site target-controlled infusion system to maintain a BIS value between 60 and 75. BIS, vital signs, total propofol dose (TPD), mean infusion dose (MID), and awakening time were recorded. RESULTS: One hundred patients were included in the study. MID and TPD were lower in Groups 2 and 3 than in Groups 1 and 4 (P = .009). Consumption of propofol was 35.23% less in Group 2 and 37.50% less in Group 3 than in Group 1 (P = .001). CONCLUSIONS: The addition of 2.5 microg or 5 microg of intrathecal sufentanil to HBB reduces MID, TPD, and consumption of propofol in patients undergoing spinal anesthesia; the addition of 5 microg of subcutaneous sufentanil does not produce this effect.

La administración de sufentanil intratecal pero no la sistémicareduce el consumo de propofol para sedación guiada medianteíndice bi-espectral / Intrathecal but not systemic sufentanil reduces the consumption of propofol for bispectral index-guided sedation

OBJETIVO: La adición de opioides a los anestésicos localesen anestesia espinal (AE) modula algunos aspectos dela anestesia y la analgesia. Evaluamos la adición de dosdosis distintas de sufentanilo (S) intratecal (IT), y vía subcutánea(SC), sobre los requerimientos de propofol (P)para sedación durante AE.MATERIAL Y MÉTODO: Ensayo clínico, prospectivo, aleatorizadoen pacientes intervenidos de artroscopia de rodilla,distribuidos en 4 grupos: Grupo 1: Bupivacaína hiperbárica0,75% (BHB), 12,5 mg; Grupo 2: BHB 12,5 mg +2,5 μg S IT; Grupo 3: BHB 12,5 mg + 5 μg S IT y Grupo4: BHB 12,5 mg + 5 μg S SC. Realizada la AE, se instalómonitor de Índice Biespectral (BIS XP), registrándose losvalores basales en cada paciente. Luego, se inició sedacióncon propofol TCI sitio-efecto con dosis de 2,5 μg/ml, paramantener BIS entre 60-75. Se registró BIS, signos vitales,dosis total utilizada (DTP), dosis promedio de infusión(DPI) y el tiempo de despertar.RESULTADOS: En los 100 pacientes estudiados, las DPI yel DTP fueron menores en los Grupos 2 y 3 versus los Grupos1 y 4 (p = 0,009). Los consumos de P fueron menores35,23% (G 2) y 37,50% (G 3), comparados con G 1 (p =0,001).CONCLUSIONES: La adición de 2,5 ó 5 μg de S IT a laBHB, pero no la adición de 5 μg S SC, reduce las dosis promediode infusión, dosis total utilizada y el consumo de Pen pacientes bajo AE (AU)

OBJECTIVE: The addition of opioids to local anesthetics inspinal anesthesia modulates some aspects of anesthesia andanalgesia. We evaluate the effect of adding different doses ofintrathecal and subcutaneous sufentanil on propofolrequirements for sedation during spinal anesthesia.MATERIAL AND METHODS: Prospective clinical trialrandomizing patients undergoing knee arthroscopy to 4groups. Group 1 received 12.5 mg of 0.75% hyperbaricbupivacaine (HBB); Group 2, 12.5 mg of HBB plus 2.5 μgof intrathecal sufentanil; Group 3, 12.5 mg of HBB plus 5μg of intrathecal sufentanil; and Group 4, 12.5 mg of HBBplus 5 μg of subcutaneous sufentanil. When spinalanesthesia had been induced, a bispectral index (BIS)monitor was connected and baseline values were recordedfor each patient. Sedation was then initiated with propofolat a dose of 2.5 μg/ml, using an effect-site target-controlledinfusion system to maintain a BIS value between 60 and 75.BIS, vital signs, total propofol dose (TPD), mean infusiondose (MID), and awakening time were recorded.RESULTS: One hundred patients were included in thestudy. MID and TPD were lower in Groups 2 and 3 thanin Groups 1 and 4 (P = .009). Consumption of propofolwas 35.23% less in Group 2 and 37.50% less in Group 3than in Group 1 (P = .001).CONCLUSIONS: The addition of 2.5 μg or 5 μg ofintrathecal sufentanil to HBB reduces MID, TPD, andconsumption of propofol in patients undergoing spinalanesthesia; the addition of 5 μg of subcutaneous sufentanildoes not produce this effect (AU)

[Continuous interscalene block for analgesia following shoulder rotator cuff repair: evaluation of 2 bupivacaine concentrations applied with the same infusion technique]. / Analgesia postoperatoria en la reparación del manguito de los rotadores del hombro mediante bloqueo interescalénico continuo. Evaluación de dos concentraciones de bupivacaína en un mismo modo de administración.

OBJECTIVE: To evaluate postoperative analgesia and patient satisfaction with the continuous interscalene block using 2 bupivacaine concentrations in combination with sufentanil for patients undergoing shoulder rotator cuff repair surgery. MATERIAL AND METHODS: Prospective trial in 43 patients randomized to 2 groups. Group 1 received 0.125% bupivacaine plus 1 microg mL(-1) of sufentanil in continuous infusion at a rate of 7 mL h(-1). Group 2 received an infusion of 0.0625% bupivacaine plus 1 microg mL(-1) of sufentanil at the same rate. Pain was assessed on a visual analog scale (VAS) 2, 4, 6, 12, 24, and 48 hours after surgery. Intravenous ketoprofen and morphine were used to provide rescue analgesia. Morphine and bupivacaine consumption, degree of satisfaction, and the incidence of adverse effects were recorded. RESULTS: Forty-three patients (21 in group 1 and 22 in group 2) were enrolled. Postoperative VAS scores, morphine consumption, and satisfaction were similar in the 2 groups. Bupivacaine consumption was lower in group 2 (P<.005). CONCLUSIONS: Both the tested bupivacaine concentrations for the continuous interscalene block provided similar levels of analgesia after shoulder rotator cuff repair surgery. Reducing the bupivacaine concentration to 0.625% decreased the consumption of local anesthetic without diminishing the quality of analgesia.

[Intrathecal fentanyl reduces the dose of propofol required for sedation during spinal anesthesia]. / Fentanilo intradural disminuye los requerimientos de propofol utilizado para sedación durante la anestesia espinal.

OBJECTIVES: To assess the effects of 2 dosages of intrathecal fentanyl on the requirement for propofol infused intravenously for the sedation of patients under spinal anesthesia. MATERIAL AND METHODS: We conducted a prospective controlled clinical trial enrolling patients in ASA physical status class 1 randomly assigned to 3 groups. Group 1 received 12.5 mg of 0.75% hyperbaric bupivacaine; group 2, 12.5 mg of bupivacaine plus 15 microg of fentanyl; group 3, 12.5 mg of bupivacaine plus 25 microg of fentanyl. After initiation of spinal anesthesia, monitoring of the bispectral (BIS) index (BIS XP A-2000) was begun, and sedation was maintained with a propofol infusion through a target-controlled infusion device (Orchestra Base Primea) for an initial effect-site concentration of 2.5 microg mL(-1), which was adjusted to maintain the BIS index between 60 and 75. We recorded BIS indices, noninvasive blood pressure, electrocardiogram, oxygen saturation, nasal end-tidal carbon dioxide pressure, mean infusion dose of propofol, total infusion dose of propofol, time until awakening, propofol consumption, and adverse effects. RESULTS: Seventy-five patients (25 in each group) were enrolled. Patient characteristics and BIS indices were similar in all groups. Propofol doses were significantly lower and times until awakening were significantly shorter in groups 2 and 3 than in group 1 (P < .01). The incidences of pruritus were significantly higher in groups 2 and 3. CONCLUSIONS: Adding 15 or 25 microg of fentanyl to hyperbaric bupivacaine lowers the dose of intravenous propofol required for sedation of patients under spinal anesthesia.

Influencia de la inhalación de óxido nitroso en las dosis de propofol y tiopental para la inducción anestésica. Estudio mediante potenciales evocados auditivos / Influence of inhaled nitrous oxide on the induction doses of propofol and thiopental assessed by auditory evoked potentials

OBJETIVO: Evaluar la influencia del óxido nitroso 50% sobre las dosis inductoras de propofol y tiopentalmediante el índice de potenciales evocados auditivosAAI. Evaluar el tiempo de inducción.PACIENTES Y MÉTODO: Estudio clínico, prospectivo yaleatorio en pacientes ASA I-II, divididos en cuatro grupos,según uso de propofol (P) Grupo P 1: O2 100%;Grupo P 2: N2O/O2 50%, o tiopental (T) Grupo T 1: O2100%; grupo T 2: N2O/O2 50%. Se instaló equipo deAAI. Se administró propofol (1%) o tiopental (2,5%) enperfusión endovenosa continua a 120 mL h–1, hasta obtenerun AAI < 40 (hipnosis clínica) y AAI < 20 (hipnosisquirúrgica). Se registraron signos vitales, las dosisinductoras para AAI de 40 y 20 y el tiempo de inducción.RESULTADOS: Se incluyeron 160 pacientes con índicede masa corporal < 30. Los datos biológicos y signosvitales fueron similares en los cuatro grupos de 40pacientes cada uno. Las dosis inductoras de tiopental ypropofol así como los tiempos de inducción fueron significativamentemenores en los grupos en los que se utilizóN2O/O2 50% en comparación con los grupos con O2100%, en la obtención tanto de AAI 20 como AAI 40(p < 0,01). No hubo complicaciones en la totalidad de lospacientes.CONCLUSIONES: Las dosis de tiopental y propofol, y eltiempo de inducción son reducidos por la inhalación deN2O/O2 50%. El uso del índice AAI facilita la administracióntitulada de estos fármacos durante la inducción anestésica (AU)

OBJECTIVES: To assess the influence of 50% nitrous oxide (N2O) on the induction doses of propofol and thiopental by means of the auditory evoked potentials index (AAI). To evaluate the time to induction of anesthesia. PATIENTS AND METHOD: This was a prospective controlled trial in ASA 1-2 patients randomized to 4 groups for administration of propofol in 100% oxygen (group P1), propofol in a mixture of 50% N2O and 50% oxygen (group P2), thiopental in 100% oxygen (group T1) or thiopental in a 50% N2O and 50% oxygen mixture. An AAI monitor was used. Continuous intravenous infusions of 1% propofol or 2.5% thiopental were administered at a rate of 120 mL·h-1 until an AAI of less than 40 (clinical hypnosis) and then an AAI of less than 20 (surgical hypnosis) were obtained. Vital signs, induction doses required to reach an AAI of 40 and of 20, and induction times were recorded. RESULTS: One hundred sixty patients with a body mass index of less than 30 kg/m2 were enrolled. The biological parameters and vital signs were similar in the 4 groups of 40 patients each. The induction doses of thiopental and propofol and the induction times were significantly reduced in the groups in which the mixture of 50% N2O and 50% oxygen was used in comparison with the groups breathing 100% oxygen, in terms of both AAI target values of 20 and 40 (P<.01). There were no complications in any patient. CONCLUSIONS: The doses of both thiopental and propofol are reduced and induction times are shorter when the drugs are administered with a mixture of 50% N2O and 50% oxygen. Monitoring the AAI facilitates the titration of thiopental and propofol dosing during anesthetic induction (AU)

Fentanilo intradural disminuye los requerimientos de propofol utilizado para sedación durante la anestesia espinal / Intrathecal fentanyl reduces the dose of propofol required for sedation during spinal anesthesia

OBJETIVOS: Evaluar los efectos de dos dosis de fentanilo(F) intradural sobre los requerimientos de propofol(P) en perfusión endovenosa como sedación en pacientesintervenidos bajo anestesia raquídea (AR).MATERIAL Y MÉTODO: Ensayo clínico, prospectivo,controlado en pacientes con estado físico ASA I, distribuidosaleatoriamente en 3 grupos: Grupo 1: Bupivacaína0,75% hiperbara (BHB), 12,5 mg; Grupo 2: BHB12,5 mg + 15 μg F; Grupo 3: BHB 12,5 mg + 25 μg F.Tras la AR, se instaló monitor BIS XP® A-2000 paramedición de índice biespectral (BIS), y se inició sedacióncon una perfusión de propofol TCI (Base PrimeaOrchestra®) con dosis iniciales de 2,5 μg mL–1 a sitioefecto,las cuales fueron modificadas para mantener unBIS entre 60 y 75. Se registraron los valores de BIS,ECG, PANI, SatO2, EtCO2 nasal, dosis promedio deinfusión de propofol (DPI), dosis total utilizada de propofol(DTP), tiempo de despertar (TDD), consumo depropofol (CP) y efectos adversos.RESULTADOS: Se incluyeron 75 pacientes (25 en cadagrupo). Los datos biológicos, signos vitales y valores deBIS fueron similares en todos los grupos. Las dosis depropofol utilizadas así como el tiempo de despertar fueronsignificativamente menores en los Grupos 2 y 3 encomparación al Grupo 1 (p<0,01). La incidencia deprurito fue significativamente mayor en los Grupos 2 y3.CONCLUSIONES: La adición de 15 ó 25 μg de fentaniloa la bupivacaína hiperbara disminuye las dosis de perfusiónendovenosa de propofol utilizadas para sedaciónen pacientes bajo anestesia raquídea

OBJECTIVES: To assess the effects of 2 dosages of intrathecal fentanyl on the requirement for propofol infused intravenously for the sedation of patients under spinal anesthesia. MATERIAL AND METHODS: We conducted a prospective controlled clinical trial enrolling patients in ASA physical status class 1 randomly assigned to 3 groups. Group 1 received 12.5 mg of 0.75% hyperbaric bupivacaine; group 2, 12.5 mg of bupivacaine plus 15 μg of fentanyl; group 3, 12.5 mg of bupivacaine plus 25 μg of fentanyl. After initiation of spinal anesthesia, monitoring of the bispectral (BIS) index (BIS XPA-2000) was begun, and sedation was maintained with a propofol infusion through a targetcontrolled infusion device (Orchestra Base Primea) for an initial effect-site concentration of 2.5 μg mL–1, which was adjusted to maintain the BIS index between 60 and 75. We recorded BIS indices, noninvasive blood pressure, electrocardiogram, oxygen saturation, nasal end-tidal carbon dioxide pressure, mean infusion dose of propofol, total infusion dose of propofol, time until awakening, propofol consumption, and adverse effects. RESULTS: Seventy-five patients (25 in each group) were enrolled. Patient characteristics and BIS indices were similar in all groups. Propofol doses were significantly lower and times until awakening were significantly shorter in groups 2 and 3 than in group 1 (P < .01). The incidences of pruritus were significantly higher in groups 2 and 3. CONCLUSIONS: Adding 15 or 25 μg of fentanyl to hyperbaric bupivacaine lowers the dose of intravenous propofol required for sedation of patients under spinal anesthesia

Bloqueo femoral para analgesia postoperatoria en reconstrucción de ligamento cruzado anterior de rodilla. Comparación de dos concentraciones de bupivacaína asociada a clonidina en 3 modos de administración / Femoral nerve block for postoperative analgesia after anterior cruciate ligament reconstruction: comparison of 2 concentrations of bupivacaine with clonidine in 3 modes of administration

INTRODUCCIÓN: El bloqueo femoral continuo (BFC) seutiliza en la analgesia postoperatoria ortopédica.OBJETIVO: Evaluar la utilidad del BFC, comparandodos concentraciones de bupivacaína asociada a clonidina,en 3 esquemas de administración.MAT E R I A L Y MÉ TO D O: Estudio randomizado enpacientes ASA I-II divididos en seis grupos. En los 3grupos numéricos se usó bupivacaína 0,125% + clonidina.Los 3 grupos alfa-numéricos usaron bupivacaína0,0625% + clonidina. Grupo 1 y 1A: 10 mL h–1 en Infusióncontinua (IC); Grupo 2 y 2A: 5 mL h–1 IC + 2,5 mLc/30 min en sistema controlado por el paciente (PCRA);Grupo 3 y 3A : 5 mL c/30 min en PCRA. Se registróe n t re las 2 y 48 horas dolor postquirúrgico medianteEVA, consumo de bupivacaína y de morfina.RESULTADOS: Se incluyeron 105 pacientes: Grupo 1 (n =17), Grupo 1A(n = 18), Grupo 2 (n = 18), Grupo 2A(n = 17),Grupo 3 (n = 17), Grupo 3A (n = 18). No hubo diferenciasentre los datos demográficos, EVApostoperatorio y consumode morfina entre las 2 y 48 horas entre los seis grupos.CO N C L U S I O N E S: El BFC es útil para el manejo deldolor postoperatorio en la reconstrucción de ligamentocruzado anterior de rodilla. Un débito de 5 mL h–1 en ICo en bolos PCRA asegura excelente analgesia postoperatoria.Concentraciones de bupivacaína 0,0625% disminuyeel consumo de anestésicos locales, sin detrimentoen la calidad de la analgesia

BACKGROUND: The continuous femoral nerve block isused for postoperative orthopedic analgesia.OBJECTIVE: To evaluate 2 concentrations of bupivacainewith clonidine in 3 methods of administration forperforming a continuous femoral nerve block.MATERIAL AND METHODS: Randomized controlled trialin ASA 1-2 patients in 6 groups. In groups 1, 2, and 3, thecombination used was 0.125% bupivacaine plus clonidine.In groups 1a, 2a, and 3a, the combination was 0.0625%bupivacaine plus clonidine. Methods of administrationwere as follows: groups 1 and 1a, 10 mL·h–1 in continuousinfusion; groups 2 and 2a, 5 mL·h–1 in continuous infusionplus 2.5 mL e v e ry 30 minutes through a patient-controlledanalgesia (PCA) system; groups 3 and 3a, 5 mL e v e ry 30minutes in a PCA system. Pain on a visual analog scale(VAS) and amounts of bupivacaine and morphine usedwere recorded 2 and 48 hours after surgery.RESULTS: A total of 105 patients were enrolled: 17 ingroup 1, 18 in group 1a, 18 in group 2, 17 in group 2a,17 in group 3, and 18 in group 3a. No significant differencesbetween any of the 6 groups were observed forpatient characteristics, postoperative VAS scores, ormorphine use.CONCLUSIONS: A continuous femoral nerve block isuseful for managing pain after anterior cruciate ligamentsurgery. The application of 5 mL·h–1 in continuousinfusion or in PCA system bolus doses provides excellentpostoperative analgesia. Use of 0.0625% bupivacained e c reases overall consumption of analgesic and is notdetrimental to quality of analgesia

Adición de bicarbonato de sodio y/o clonidina a la mepivacaína. Influencia sobre las características del bloqueo de plexo braquial por vía axilar / Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics

INTRODUCCIÓN: El bloqueo del plexo braquial (BPB)por vía axilar es un procedimiento anestésico habitual.La adición de variados fármacos coadyuvantes se hamostrado efectiva en la mejoría de los resultados conesta técnica. Este estudio evalúa la incorporación debicarbonato de sodio y/o clonidina al BPB con mepivacaína.MATERIAL Y MÉTODO: Se realizó un estudio controladorandomizado de 60 pacientes, entre 18 y 70 años, ASA 1a 3 estables, que recibieron anestesia con técnica deBPB. Se dividieron en 4 grupos de 15 pacientes: GrupoI (control) recibió 40 mL de mepivacaína (MEP) 1% conadrenalina (A) + 5 mL de suero fisiológico (SF); el GrupoII, 40 mL MEP 1% con A + 4 mL NaHCO3 + 1 mLSF; el Grupo III, 40 mL MEP 1% con A + 150 µg clonidina+ 4 mL SF y el Grupo IV, 40 mL MEP 1% con A +4 mL NaHCO3 + 150 µg de clonidina.RESULTADOS: El tiempo de instalación del BPB fue significativamentemenor en los grupos II y IV. La duracióndel BPB fue mayor en el grupo III, la analgesia obtenidaen el grupo 3 fue significativamente mayor.CONCLUSIONES: La adición de bicarbonato de sodio ala mepivacaína disminuye el tiempo de latencia del BPBpor vía axilar, la incorporación de clonidina prolonga laduración de la anestesia y analgesia, la adición conjuntade bicarbonato de sodio y clonidina reduce el tiempo delatencia pero no incrementa la duración de la anestesiay analgesia

BACKGROUND AND OBJECTIVE: The axillary brachialplexus block is a frequently performed anesthetic technique.Adding a variety of coadjuvant drugs has beenshown to improve results. This study evaluated the additionof sodium bicarbonate (NaHCO3) and/or clonidineto mepivacaine for performing the block.MATERIAL AND METHODS: Sixty patients between 18and 70 years old, ASA 1-3 in stable condition receivedaxillary brachial plexus blocks in a randomized controlledstudy. Four groups of 15 patients each were formed:group I (control group) received 40 mL of 1% mepivacainewith adrenaline plus 5 mL of saline; group II, 40mL of 1% mepivacaine with adrenaline plus 4 mL ofNaHCO3 and 1 mL of saline; group III, 40 mL of 1%mepivacaine with 150 µg of clonidine plus 4mL of saline;and group IV, 40 mL of 1% mepivacaine with adrenalineplus 4 mL of NaHCO3 and 150 µg of clonidine.RESULTS: The onset time was significantly shorter ingroups 2 and 4. The duration of the block was longer ingroup 3 and the analgesic effect was significantlybetter.CONCLUSIONS: Adding NaHCO3 to mepivacaine shortensthe time of onset of an axillary brachial plexus block.Including clonidine prolongs the duration of anesthesiaand analgesia. The addition of both NaHCO3 and clonidineshortens time to onset but does not prolong durationof anesthesia or analgesia

[Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics]. / Adición de bicarbonato de sodio y/o clonidina a la mepivacaína. Influencia sobre las características del bloqueo de plexo braquial por vía axilar.

BACKGROUND AND OBJECTIVE: The axillary brachial plexus block is a frequently performed anesthetic technique. Adding a variety of coadjuvant drugs has been shown to improve results. This study evaluated the addition of sodium bicarbonate (NaHCO3) and/or clonidine to mepivacaine for performing the block. MATERIAL AND METHODS: Sixty patients between 18 and 70 years old, ASA 1-3 in stable condition received axillary brachial plexus blocks in a randomized controlled study. Four groups of 15 patients each were formed: group I (control group) received 40 mL of 1% mepivacaine with adrenaline plus 5 mL of saline; group II, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 1 mL of saline; group III, 40 mL of 1% mepivacaine with 150 microg of clonidine plus 4mL of saline; and group IV, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 150 microg of clonidine. RESULTS: The onset time was significantly shorter in groups 2 and 4. The duration of the block was longer in group 3 and the analgesic effect was significantly better. CONCLUSIONS: Adding NaHCO3 to mepivacaine shortens the time of onset of an axillary brachial plexus block. Including clonidine prolongs the duration of anesthesia and analgesia. The addition of both NaHCO3 and clonidine shortens time to onset but does not prolong duration of anesthesia or analgesia.

[Femoral nerve block for postoperative analgesia after anterior cruciate ligament reconstruction: comparison of 2 concentrations of bupivacaine with clonidine in 3 modes of administration]. / Bloqueo femoral para analgesia postoperatoria en reconstrucción de ligamento cruzado anterior de rodilla. comparación de dos concentraciones de bupivacaína asociada a clonidina en 3 modos de administración.

BACKGROUND: The continuous femoral nerve block is used for postoperative orthopedic analgesia. OBJECTIVE: To evaluate 2 concentrations of bupivacaine with clonidine in 3 methods of administration for performing a continuous femoral nerve block. MATERIAL AND METHODS: Randomized controlled trial in ASA 1-2 patients in 6 groups. In groups 1, 2, and 3, the combination used was 0.125% bupivacaine plus clonidine. In groups la, 2a, and 3a, the combination was 0.0625% bupivacaine plus clonidine. Methods of administration were as follows: groups 1 and la, 10 mL x h(-1) in continuous infusion; groups 2 and 2a, 5 mL h x (-1) in continuous infusion plus 2.5 mL every 30 minutes through a patient-controlled analgesia (PCA) system; groups 3 and 3a, 5 mL every 30 minutes in a PCA system. Pain on a visual analog scale (VAS) and amounts of bupivacaine and morphine used were recorded 2 and 48 hours after surgery. RESULTS: A total of 105 patients were enrolled: 17 in group 1, 18 in group la, 18 in group 2, 17 in group 2a, 17 in group 3, and 18 in group 3a. No significant differences between any of the 6 groups were observed for patient characteristics, postoperative VAS scores, or morphine use. CONCLUSIONS: A continuous femoral nerve block is useful for managing pain after anterior cruciate ligament surgery. The application of 5 mL x h(-1) in continuous infusion or in PCA system bolus doses provides excellent postoperative analgesia. Use of 0.0625% bupivacaine decreases overall consumption of analgesic and is not detrimental to quality of analgesia.