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PURPOSE: The aim of this study was to compare the analgesic efficacy of 4% articaine associated with epinephrine (1:100,000), and 2% lidocaine associated with epinephrine (1:100,000) in third molar extraction surgery. METHODS: Sixty patients who underwent surgeries to extract upper and lower third molars were included in this split-mouth, double-blind, randomized, controlled trial. The groups in this study were divided according to the anesthetic solution used to provide local anesthesia during extraction of upper and lower third molars: (1) 4% articaine associated with epinephrine (1:100,000); (2) 2% lidocaine associated with epinephrine (1:100,000). The time to the beginning and end of the sensation of analgesia, pain sensation according to the VAS scale, and number of anesthetic tubes necessary for supplementation were analyzed. RESULTS: It was found that the onset time for analgesia was shorter on the side anesthetized with articaine compared to the side anesthetized with lidocaine (122.1 ± 52.90 s vs. 144.5 ± 68.85 s) (p < 0.05). In addition, the number of tubes used for anesthetic supplementation was also reduced on the articaine side compared to the lidocaine side (0.26 ± 0.48 vs. 0.50 ± 0.75) (p < 0.05). There were no differences between the anesthetic solutions in the other evaluated parameters. CONCLUSION: It can be concluded that the use of 4% articaine associated with epinephrine (1:100,000) reduced the time of onset of analgesia and the necessity for anesthetic supplementation in third molar extraction surgeries compared to the use of 2% lidocaine associated with epinephrine (1:100,000).
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Anestésicos Locais , Carticaína , Epinefrina , Lidocaína , Dente Serotino , Dor Pós-Operatória , Extração Dentária , Humanos , Carticaína/administração & dosagem , Dente Serotino/cirurgia , Lidocaína/administração & dosagem , Método Duplo-Cego , Masculino , Anestésicos Locais/administração & dosagem , Feminino , Adulto , Epinefrina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Adulto Jovem , Medição da Dor , Anestesia Dentária/métodos , Adolescente , Anestesia Local/métodosRESUMO
Fundamento la toxicidad asociada a los tratamientos de quimioterapia y radioterapia eleva la morbilidad y la mortalidad en los pacientes oncológicos. Objetivo diseñar un modelo predictivo de toxicidad de la quimioterapia y la radioterapia en el paciente oncológico quirúrgico. Métodos estudio analítico, de casos y controles, en pacientes oncológicos quirúrgicos que cumplieron los criterios de inclusión para la predicción de toxicidad preoperatoria, en el periodo enero a diciembre de 2022, en el Hospital Provincial Docente Oncológico María Curie, de Camagüey. Mediante el paquete estadístico Statistical Package for the Social Sciences, se seleccionó una muestra aleatoria de 334 pacientes, 197 sin toxicidad (grupo control) y 137 con toxicidad (grupo de estudio). Se realizó estimación de predictores de toxicidad mediante regresión logística binaria. Se seleccionó el modelo de mejor ajuste. Resultados el modelo en el paso tres predice un porcentaje global de 83,5 % con respecto a los valores observados. La sensibilidad resultó ser de 81,8; y la especificidad, 84,8. El modelo presentó buen poder discriminativo. Las variables en la ecuación fueron: hipertensión arterial, fracción de eyección del ventrículo izquierdo y anemia. La comparación de la predicción con la realidad, mediante curva Receiver Operating Characteristic determinó un área bajo la curva de 0,901. Conclusión se obtuvo una función de regresión logística que permitió la estimación de la probabilidad de toxicidad en pacientes oncológicos quirúrgicos electivos, la cual proporcionó una herramienta para su predicción desde el preoperatorio.
Foundation the toxicity associated with chemotherapy and radiotherapy treatments increases morbidity and mortality in cancer patients. Objective to design a predictive model of chemotherapy and radiotherapy toxicity in surgical cancer patients. Methods analytical, case-control study, in surgical oncology patients who met the inclusion criteria for the prediction of preoperative toxicity, from January to December 2022, at the María Curie Provincial Teaching Oncology Hospital in Camagüey. Using the Statistical Package for the Social Sciences, a random sample of 334 patients was selected, 197 without toxicity (control group) and 137 with toxicity (study group). Toxicity predictors were estimated using binary logistic regression. The model with the best fit was selected. Results the model in step three predicts an overall percentage of 83.5% with respect to the observed values. The sensitivity turned out to be 81.8; and the specificity, 84.8. The model presented good discriminative power. The variables in the equation were: arterial hypertension, left ventricular ejection fraction, and anemia. The comparison of the prediction with reality, using the Receiver Operating Characteristic curve, determined an area under the curve of 0.901. Conclusion a logistic regression function was obtained that allowed the estimation of the toxicity probability elective surgical cancer patients, which provided a tool for its prediction from the preoperative period.
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OBJECTIVES: Novel fascial plane blocks may allow early tracheal extubation and discharge from the intensive care unit (ICU). The present study primarily aimed to determine whether fascial plane blocks, in comparison with intravenous analgesia alone, significantly shortened tracheal extubation times in patients undergoing cardiac surgery. The secondary objectives were to compare each block's performance with that of intravenous analgesia alone in terms of the individual tracheal extubation time and length of ICU stay. DESIGN: Retrospective observational study. SETTING: Single-center study. PARTICIPANTS: Patients who underwent cardiac surgery between 2018 and 2019 were identified from a prospective clinical registry. After obtaining ethics approval, the clinical and electronic records of patients undergoing cardiac surgery in 2018 were analyzed. Data of patients receiving fascial plane blocks (erector spinae plane [ESP], pectoral plane I and II [PECs], and serratus anterior plane [SAP] blocks) with intravenous analgesia were compared with those of patients receiving only intravenous analgesia. A propensity score (PS) model was used to control for differences in the baseline characteristics. Adjusted p < 0.05 was considered statistically significant. MEASUREMENTS AND MAIN RESULTS: Of the 589 patients screened, 532 met the inclusion criteria; 404 received a fascial plane block. After PS matching, weighted linear regression revealed that by receiving a block, the predicted extubation time difference was 9.29 hours (b coefficient; 95% CI: -11.98, -6.60; p = 0.022). Similar results were obtained using PS weighting, with a reduction of 7.82 hours (b coefficient; 95% CI: -11.89, -3.75; p < 0.001) in favor of the block. In the fascial-plane-block group, ESP block achieved the best performance. The length of ICU stay decreased by 1.1 days (b coefficient; 95% CI: -1.43, -0.79; p = 0.0001) in the block group. No complications were reported. CONCLUSIONS: Fascial plane block is associated with reduced extubation times and lengths of ICU stay. ESP block achieved the best performance, followed by PECs and SAP blocks. After PS matching, only ESP block reduced the extubation time.
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Extubação , Procedimentos Cirúrgicos Cardíacos , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Alta do Paciente , Procedimentos Cirúrgicos Cardíacos/métodos , Unidades de Terapia Intensiva , Dor Pós-Operatória/tratamento farmacológico , Analgésicos OpioidesRESUMO
Abstract Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
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Humanos , Dor Aguda/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Anestesia por Condução/efeitos adversos , Anestesia Epidural/efeitos adversos , Atenção Terciária à Saúde , Estudos Retrospectivos , Abscesso/complicações , Hematoma/etiologia , HospitaisRESUMO
Abstract: Erector spinae plane block is an ultrasound-guided technique who has seen a growing role as a perioperative analgesic technique due to its safety profile and versatility. We describe a case of an elderly female with a history of ischemic heart disease and atrial fibrillation, who underwent segmental colectomy by left subcostal laparotomy under general anesthesia, for removal of a colon tumor. An erector spinae plane catheter was placed at the T7 level under ultrasound guidance, and then used for postoperative analgesia. Ropivacaine 0.2% (initial bolus + infusion at 8 mL/h) was used through the catheter, together with intravenous paracetamol and metamizol. This analgesic regimen was maintained for 72 hours, with excellent pain control, after which the catheter was removed. The patient's pain remained controlled and rescue analgesia was not required until her discharge at seven days postoperative. Continuous ESP block was an effective technique for postoperative analgesia in this case, allowing excellent pain control with a low risk of complications and avoiding the use of opioids.
Resumen: El bloqueo del plano del músculo erector espinal es una técnica ecoguiada que ha ganado popularidad como técnica analgésica perioperatoria debido a su perfil de seguridad y versatilidad. Se describe el caso de una anciana con cardiopatía isquémica y fibrilación auricular, a la que se le realizó colectomía segmentaria mediante laparotomía subcostal izquierda bajo anestesia general, para la escisión de un tumor de colon. Se colocó un catéter en el plano del músculo erector espinal al nivel T7 bajo guía ultrasónica y luego se utilizó para analgesia postoperatoria (ropivacaína 0.2% bolo + infusión a 8 mL/h) junto con paracetamol intravenoso y metamizol. Este régimen analgésico se mantuvo durante 72 horas, con excelente control del dolor, tras lo cual se retiró el catéter. La paciente permaneció con adecuada analgesia sin opioides de rescate hasta su alta a los siete días del postoperatorio. El bloqueo del plano del erector espinal torácico continuo fue una técnica eficaz para la analgesia postoperatoria en cirugía abdominal abierta, con bajo riesgo de complicaciones y evitando el uso de opioides.
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Objetivo: Analizar el control del dolor en el postoperatorio inmediato del servicio en servicio de cirugía en el servicio de cirugía del Hospital Docente Ambato Ecuador. Método: Descriptiva observacional en 99 pacientes quirúrgicos. Resultados: 52% de pacientes intervenidos quirúrgicamente se les diagnóstico una apendicitis aguda, seguido por la litiasis vesicular como patología quirúrgica con un 37, 4 % de representatividad. Conclusión: Para el bienestar del paciente es necesario el uso de medidas analgésicas frente a la consecuencia del acto quirúrgico, que es el dolor, se obtienen resultados positivos mediante la administración de medicación intravenosa (IV), manejo ambiental: confort y la vigilancia usando estas como las medidas base en el control de estos pacientes.
Objective: To analyze pain control in the immediate postoperative period in the surgery service at the surgery service of the Hospital Docente Ambato - Ecuador. Methods: Descriptive observational study in 99 surgical patients. Results: 52% of patients who underwent surgery were diagnosed with acute appendicitis, followed by vesicular lithiasis as a surgical pathology with 37.4% of representativeness. Conclusion: For the well-being of the patient it is necessary the use of analgesic measures against the consequence of the surgical act, which is pain, positive results are obtained through the administration of intravenous (IV) medication, environmental management: comfort and surveillance using these as the basic measures in the control of these patients.
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BACKGROUND: Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. METHODS: A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. RESULTS: From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. CONCLUSION: Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
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Dor Aguda , Anestesia por Condução , Anestesia Epidural , Traumatismos dos Nervos Periféricos , Abscesso/complicações , Dor Aguda/etiologia , Anestesia por Condução/efeitos adversos , Anestesia Epidural/efeitos adversos , Hematoma/etiologia , Hospitais , Humanos , Traumatismos dos Nervos Periféricos/etiologia , Estudos Retrospectivos , Atenção Terciária à SaúdeRESUMO
RESUMO A cirurgia de aumento primário de mamas ocupa o topo do ranking dos procedimentos estéticos mais realizado entre as mulheres. Na população masculina, outra cirurgia mamária ocupa lugar de destaque: a ginecomastia. A anestesia regional para as cirurgias plásticas faz parte de uma estratégia de analgesia multimodal que pode reduzir custos, diminuir a hospitalização e a dor no período pós-operatório. O objetivo deste trabalho é revisar e comparar as técnicas de anestesia regional guiadas por ultrassom mais utilizadas para analgesia perioperatória nas cirurgias plásticas estéticas das mamas. Foi realizada a revisão de estudos clínicos que investigaram a associação dos bloqueios anestésicos regionais guiados por ultrassom com cirurgias plásticas estéticas das mamas nos últimos 5 anos na base de dados MEDLINE/PubMed. Foram selecionados 14 artigos para revisão. As técnicas de anestesia regional guiada por ultrassom mais frequentemente relatadas foram o bloqueio paravertebral (BPV), os bloqueios interfasciais (PECS 1 e PECS 2), bloqueio do plano do serrátil (BPS) e bloqueio intercostal (BI). O menor consumo de opioides e melhor controle álgico pós-operatório foi associado ao BPV, PECS 1 e PECS 2 e BPS. O BPV apresentou maior incidência de complicações e os PECS 1 e PECS 2 mostraram-se de execução mais fácil. Os bloqueios interfasciais (PECS 1 e PECS 2) se mostraram mais seguros e de fácil execução nas cirurgias plásticas estéticas das mamas do que as outras modalidades de bloqueios. Promovem diminuição do uso de opioides e seus efeitos colaterais, redução no tempo de internação e na recuperação no pós-operatório.
Abstract Primary breast augmentation surgery is one of the most performed cosmetic procedures among women. In the male population, another breast surgery occupies a prominent place: gynecomastia. Regional anesthesia for plastic surgery is part of a multimodal analgesia strategy that can reduce costs, reduce hospitalization, and pain in the postoperative period. The purpose of this article is to review and compare the most used ultrasound-guided regional anesthesia techniques for perioperative analgesia in aesthetic plastic surgery of the breasts. A review of clinical studies that investigated the association of regional anesthesia techniques guided by ultrasound with cosmetic plastic surgery of the breast in the last 5 years was carried out in the MEDLINE/PubMed database. Fourteen articles were selected for review. The most frequently reported techniques of regional anesthesia guided by ultrasound were paravertebral block (PVB), interfascial block (PECS 1 and PECS 2), serratus plane block (SPB), and intercostal block (IB). The lower consumption of opioids and better postoperative pain control were associated with PVB, PECS 1 and PECS 2, and SPB. PVB had a higher incidence of complications and PECS 1 and PECS 2 proved to be easier to perform. Interfascial blocks (PECS 1 and PECS 2) proved to be safer and easier to perform in cosmetic plastic surgery of the breasts than other types of blocks. They decrease the use of opioids and its side effects, reduce the length of hospital stay and recovery in the postoperative period.
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RESUMEN Introducción: la anestesia general libre de opioides surge ante la necesidad de evasión del uso de opioides en el transoperatorio y sus efectos indeseados en el posoperatorio. Objetivo: evaluar el comportamiento hemodinámico y la recuperación anestésica en pacientes intervenidas mediante cirugía ambulatoria por cáncer de mama, en las cuales se administró anestesia general total intravenosa libre de opioides o general balanceada. Métodos: se realizó un estudio cuasiexperimental, prospectivo en pacientes a las que se aplicó anestesia general balanceada (n=34) y total intravenosa libre de opioides (n=34) intervenidas quirúrgicamente por cáncer de mama, en el Hospital General Docente "Abel Santamaría Cuadrado", durante el 2018. Resultados: el grupo de anestesia general balanceada mostró mayor variación intraoperatoria de los parámetros evaluados, con diferencias significativas (p=0,019). El tiempo medio de despertar fue menor en el grupo de anestesia total intravenosa (2,10 ± 0,907 min vs 5,35 ± 1,250 min; p<0,01), al igual que el dolor, con diferencia significativa (p<0,05) y el tiempo de recuperación, donde una hora después de la intervención, el 85 % cumplía los criterios de alta anestésica. El retraso en el alta de la unidad de recuperación ocurrió principalmente por el bajo nivel de actividad motora, con mayor incidencia en el grupo de anestesia general balanceada (71 % vs 26 %; p=0,00). Conclusiones: la anestesia total intravenosa libre de opioides fue superior al método general balanceado, pues mostró mayor estabilidad hemodinámica y analgesia, menor incidencia de complicaciones posoperatorias y menor tiempo de estancia en sala de recuperación posanestésica.
ABSTRACT Introduction: opioid-free general anesthesia arises from the need to avoid the use of opioids in the transoperative period and the undesirable effects in the postoperative period. Objective: to assess the hemodynamic behavior and anesthetic recovery in patients who underwent ambulatory surgery for breast cancer and those who were given either opioid-free intravenous general or balanced general anesthesia. Methods: a quasi-experimental, prospective study was carried out on patients who received balanced general anesthesia (n=34) and total opioid-free intravenous anesthesia (n=34), who underwent breast cancer surgery at Abel Santamaria Cuadrado General Teaching Hospital during 2018. Results: the group of balanced general anesthesia showed greater intraoperative variation of the parameters assessed, with significant differences (p=0.019). The mean time of awakening was lower in the intravenous total anesthesia group (2.10 ± 0,907 min vs. 5,35 ± 1,250 min; p<0.01), as was pain, with significant difference (p<0.05) and the recovery time, where one hour after the surgery, 85 % met the criteria for anesthesia discharge. The delay in discharge from the recovery unit occurred mainly because of the low level of motor activity, with a higher incidence in the group of balanced general anesthesia (71% vs. 26 %; p=0.00). Conclusions: intravenous opioid-free total anesthesia was higher to the balanced general approach because it showed greater hemodynamic and analgesic stability, lower incidence of postoperative complications, and shorter time spent in the post-anesthesia recovery room.
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The erector spinae plane block is a safe and effective regional anesthesia technique, which has earned new indications perioperatively since its description. We introduce two pediatric anesthesia cases in which we performed the erector spinae plane block during intermediate/major orthopedic surgeries. The first patient is a 2 year-old girl submitted to surgical treatment of developmental dysplasia of the hip. The second patient is a 14 year-old boy submitted to surgical treatment of bilateral clubfoot. This last patient is potentially the first published case in which the erector spinae plane block was performed for ankle and foot surgery. Both cases experienced excellent analgesia, avoiding opiate requirement completely.