Análisis retrospectivo de la anestesia regional en la cirugía de cadera: Auditoría clínica / Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit

Introducción: La artroplastia total de cadera es una de las intervenciones quirúrgicas más frecuentes en el contexto hospitalario. Sin embargo, sigue desconociéndose el método ideal para manejar el dolor postoperatorio. Las técnicas de analgesia multimodal basadas en la anestesia regional se encuentran entre las soluciones más prometedoras. Objetivos: El objetivo de este estudio fue evaluar el dolor postoperatorio tras la artroplastia total de cadera, de acuerdo con si se realizaron, o no, bloqueos del nervio periférico (bloqueo femoral, bloqueo de la fascia iliaca y bloqueo del grupo de nervios pericapsulares). Se midió el consumo de morfina intravenosa durante la estancia del paciente en la unidad de cuidados posanestésicos, así como el número de rescates con opioides transcurridas 24 y 48 h de la intervención. Como objetivos secundarios, se establecieron la prevalencia de la lesión nerviosa, la prolongación del bloqueo cuadricipital y el consumo de morfina, de acuerdo con otras variables de interés. Materiales y métodos: En este estudio retrospectivo observacional, se recopilaron datos de la historia clínica digital de 656 pacientes de cirugía traumatológica de abril de 2018 a agosto de 2020, con los criterios de inclusión siguientes: mayores de 18 años, ASA I-III, artroplastia total de cadera primaria con anestesia general o anestesia subaracnoidea (solo con bupivacaína hiperbárica) y uso de levobupivacaína para el bloqueo del nervio periférico. Resultados: Se seleccionó un total de 362 pacientes. La indicación quirúrgica principal fue coxartrosis (61,3%), seguida de fractura de cadera (22,6%). Se realizaron bloqueos del nervio periférico en 169 pacientes (66,3% femoral, 27,7% PENG, y 6% de fascia ilíaca). El consumo medio postoperatorio de opioides en la UCPA fue inferior en los pacientes que recibieron bloqueo PENG (2,2 mg) o femoral (3,27 mg), en comparación con los que no recibieron ninguno de los dos (6,69 mg)...(AU)

Introduction: Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. Objectives: The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. Materials and methods: In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. Results: A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48h after the procedure...(AU)

Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit.

INTRODUCTION: Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. OBJECTIVES: The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. MATERIALS AND METHODS: In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. RESULTS: A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). CONCLUSIONS: This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.

Fluorine sorption by soils developed from various parent materials in Galicia (NW Spain).

Fluorine is a phytotoxic element that can reach the soil from various industrial activities. Fluorine sorption by soil is crucial to protect water and food chain from fluorine pollution. In Galicia (NW Spain), various activities emit fluorine into the atmosphere, mainly ceramic industries and an aluminium smelter. This study, aiming to investigate fluorine sorption by Galician soils, was conducted on natural soil horizons representative of the area. Most soils were acid and rich in organic matter and showed strong fluorine sorption. The lowest sorptions were exhibited by a near-neutral serpentinite-derived soil (1001 mg kg(-1)) and the B horizons of soils developed from quartz schist (989 mg kg(-1)), and the highest by the A horizons of amphibolite-derived soils (1783 mg kg(-1)). In soils developed from quartz schist, biotitic schist and amphibolite, A horizons sorbed more fluoride than the corresponding B horizons (average 1621 and 1324 mg kg(-1), respectively), while the opposite is true in granite-derived soils (average 1644 and 1324 mg kg(-1), respectively). In the A horizons, the F sorption significantly correlated to soil pH (r=-0.79), pH in NaF (r=0.83) and oxalate Al (r=0.81). In the B horizons, sorption correlated to soil pH (r=-0.78), oxalate Fe (r=0.71) and organic C (r=0.66). F sorption can be described by both the Langmuir and Freundlich equations. The concentration of free fluoride in the equilibrium solutions increased above pH 6.

Role of secondary hyperparathyroidism in the development of post-transplant acute tubular necrosis.

Post-transplant cure tubular necrosis (ATN) represents the most frequent cause of delayed graft function in the immediate post-transplant period. Several causes have been associated with the development of post-transplant ATN such as donor and recipient ages, cold-warm ischemia times, HLA mismatches, and postoperative hypotension. In the present study, we retrospectively evaluated the role of secondary hyperparathyroidism and high parathyroid hormone (PTHi) blood levels in the development of post-transplant ATN. One hundred patients submitted to cadaveric renal transplant between January 1992 and March 1993 in our unit were included. Twenty-seven patients (27%) developed post-transplant ATN and seventy-three (73%) did not. Post-transplant ATN was significantly associated with gender (p < 0.01), recipient age (p < 0.01), number of transplantations (p < 0.01), time on hemodialysis (p < 0.001), cold ischemic time (p < 0.05) and PTHi levels (p < 0.001). The bivariate and multivariate statistical analyses demonstrated that the development of post-transplant ATN was significantly more frequent in females; retransplanted patients, patients with a time on dialysis of more than 5 years, recipients over 60 years old, patients with a PTHi blood level higher than 240 pg/ml (4 times normal level) and a cold ischemia time of more than 18 h. Based on these results, we conclude that high PTHi blood levels in the renal transplant recipients represent a relevant factor in the development of post-transplant ATN. The administration of intravenous pulsed of 1,25(OH)2D3 and/or a calcium channel blocker in the perioperative period could be useful to decrease the incidence and severity of post-transplant ATN in these patients.

Standardization of the prick test. A comparative study of three methods.

The different needles and methods used in the prick test give rise to disparate results. This has significance when carrying out multi-centre studies and when using the technique in the standardization of allergenic extracts. With test reliability as our objective, prick tests were carried out on 30 subjects: 10 patients sensitive to Dermatophagoides pteronyssinus received a glycerine extract of known allergenic potency, 10 healthy individuals 2.5% codeine phosphate in a glycerine solution, and another 10, histamine 1/1000. The total prick tests per individual was 27 with each of the needles employed (Allergy Pricker, the Morrow-Brown needle and Insulin needle in accordance with Pepy's procedure). The tests were carried out systematically by three different testers, and the total number of prick tests performed was 810. With the Allergy Pricker, no differences were observed among results obtained by the same tester, nor when the results of the three testers were compared. With the Morrow-Brown needle, the results varied in the same person and from one tester to another, and on many occasions the test was negative. With the Pepys method, no falsely negative results were obtained, but there was considerable variation in the size of the wheal. The variation coefficient is 41% with the Allergy Pricker, and 115% and 64% with the Morrow-Brown and Pepys method, respectively. In conclusion, the results obtained clearly indicate that the highest degree of reproducibility is obtained with the Allergy Pricker.

The effect of sodium cromoglycate in preventing aspirin induced bronchospasm.

Seventeen patients with aspirin-induced asthma were studied, the majority being intolerant to more than one analgesic. In addition to asthma, eleven patients had sinusitis and eight had nasal polyps. Serum IgE levels were normal with a mean of 295 iu/ml. However, some patients had positive cutaneous and PK tests against inhalants and non-analgesic drugs. Spirometry showed the bronchial obstruction to be mild. However, all patients were hyper-reactive to acetylcholine. Oral provocation tests with aspirin alone and also with the prior administration of sodium cromoglycate (SCG) by inhalation were performed and the results assessed by spirometry and clinical examination. The results suggest that the obstruction is probably due to oedema of the bronchial mucosa together with pulmonary congestion rather than a simple spasm of the bronchi. SCG was found to prevent significantly the ventilatory obstruction induced by aspirin. It is suggested that non-immunological factors are responsible for the asthma and that SCG may have an effect on the altered receptors protecting them from the action of aspirin on kinins.