Continuous Ultrasound-Guided Lumbar Erector Spinae Plane Block for Thigh Cellulitis Analgesia: A Case Report.

The management of refractory acute medical pain can be challenging, especially if severe and decompensated systemic pathologies contraindicate neuraxial techniques and deep peripheral blocks. In this case report, we propose a continuous ultrasound-guided lumbar erector spinae plane block (ESPB) for multimodal analgesia of thigh cellulitis. The patient was an 80-year-old male, admitted to the intensive care unit due to septic shock originating from cellulitis of the right lower limb, associated with multiorgan dysfunction. To address refractory pain in the thigh, an ultrasound-guided lumbar ESPB at L3 was performed, with the placement of a perineural catheter and administration of 30 mL of 0.5% ropivacaine, followed by 30 mL boluses of 0.375% ropivacaine every six hours with progressive weaning. The patient maintained controlled pain without the need for rescue analgesia. Continuous ultrasound-guided lumbar ESPB is an effective and safe alternative for thigh analgesia in patients with refractory acute medical pain and systemic pathologies that contraindicate other regional techniques.

Ketamine in Chronic Pain: A Review.

Ketamine has been used in the treatment of several pain syndromes, particularly those with a relevant neuropathic component. Sub-anesthetic doses of ketamine produce a potent analgesic effect, due to its inhibition of N-methyl-D-aspartate receptors and enhancement of descending inhibitory pathways. Its short-term analgesic effect is well-documented perioperatively, with an associated reduction in postoperative chronic pain and opioid consumption. Despite some evidence regarding its long-term benefits, the number of clinical studies is still limited. In addition to its analgesic effects, ketamine also possesses an anti-depressive action, which might be useful in the treatment of chronic pain patients. Several side effects have been described, the psychomimetic ones being the most relevant due to their impact on treatment adhesion. At present, co-administration of ketamine and benzodiazepines or α2-agonists facilitates its clinical application. Despite current evidence and increasing use, further investigation is still needed regarding its long-term safety profile and clearer risk-benefit analysis.

Anesthetic considerations for a patient with hereditary angioedema - A clinical case / Considerações anestésicas perante um doente com angioedema hereditário - Caso clínico

Abstract Hereditary angioedema (HAE), with an estimated prevalence of 1:50,000, is a rare but potentially fatal disease. It may present with recurrent systemic edema of the subcutaneous tissue and mucous membranes. Patients with HAE are at increased risk for clinical worsening with surgical stress, and may develop respiratory distress syndrome due to impaired airway and hemodynamic instability. The perioperative management of these patients requires specific interventions. We present a clinical case of a woman, 50 years old, with HAE type II scheduled for ureteral stent placement via endoscopic approach.

Resumo O angioedema hereditário (AEH), com uma prevalência estimada de 1:50000 pessoas, é uma doença rara mas potencialmente fatal. Pode se apresentar com edema sistêmico recorrente do tecido subcutâneo e das mucosas. Os doentes com AEH têm um risco acrescido de agudização clínica com o estresse cirúrgico, podem desenvolver síndromes de dificuldade respiratória por compromisso da via aérea e de instabilidade hemodinâmica. A abordagem perioperatória desses doentes requer intervenções específicas. Apresentamos um caso clínico de uma mulher de 50 anos com AEH tipo II indicada para realizar ureteroscopia com colocação de stent.

[Anesthetic considerations for a patient with hereditary angioedema - A clinical case]. / Considerações anestésicas perante um doente com angioedema hereditário ­ Caso clínico.

Hereditary angioedema (HAE), with an estimated prevalence of 1:50 000, is a rare but potentially fatal disease. It may present with recurrent systemic edema of the subcutaneous tissue and mucous membranes. Patients with HAE are at increased risk for clinical worsening with surgical stress, and may develop respiratory distress syndrome due to impaired airway and hemodynamic instability. The perioperative management of these patients requires specific interventions. We present a clinical case of a woman, 50 years old, with HAE type II scheduled for ureteral stent placement via endoscopic approach.