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Abstract Introduction: The erector spinae plane block is a newly described and effective interfascial plane block for thoracic and abdominal surgery. This case report describes a patient with multiple rib fractures undergoing ultrasound-guided continuous erector spinae plane block for analgesia. Case report: A 37-year-old male patient was taken for surgical fixation of multiple rib fractures. At the end of the surgery, using ultrasound-guided longitudinal parasagittal orientation 3 cm to the lateral aspect of the T5 spinous process and an in-plane technique, 20 mL 0.25% bupivacaine was administered between the erector spinae muscle and the transverse process, and a catheter was then inserted in the same plane. Before the end of surgery, 1 g paracetamol and 50 mg dexketoprofen were administered. Postoperative analgesia was applied with patient controlled analgesia method using 0.25% bupivacaine via the catheter. The patient's Visual Analogue Scale score at rest in the first 24 h was 0. The patient was monitored for 3 days with Visual Analogue Scale < 4, and the catheter was removed on postoperative day 4. No opioid requirement other than paracetamol and dexketoprofen occurred during this time. No postoperative complications were recorded. Discussion: The erector spinae plane block is an alternative to paravertebral, intercostal, epidural or other regional techniques. It may be a suitable technique in anesthesia and algology practice due to providing analgesia in the postoperative period with a catheter in the erector spinae plane.

Resumo Introdução: O bloqueio do plano do eretor da espinha é um bloqueio do plano interfacial recentemente descrito e eficaz para cirurgia torácica e abdominal. Neste relato descrevemos o caso de um paciente com fratura de múltiplas costelas, submetido ao bloqueio contínuo do plano do eretor da espinha guiado por ultrassom para analgesia. Relato de caso: Paciente do sexo masculino, 37 anos, encaminhado para fixação cirúrgica de fratura de múltiplas costelas. Ao final da cirurgia, usando a orientação parassagital longitudinal guiada por ultrassom 3 cm em relação à face lateral do processo espinhoso T5 e a técnica no plano, 20 ml de bupivacaína a 0,25% foram administrados entre o músculo eretor da espinha e o processo transverso, e um cateter foi então inserido no mesmo plano. Antes do final da cirurgia, 1 g de paracetamol e 50 mg de dexcetoprofeno foram administrados. A analgesia pós-operatória foi aplicada com o método de analgesia controlada pelo paciente, com bupivacaína a 0,25% via cateter. Na Escala Visual Analógica, o escore do paciente em repouso nas primeiras 24 h foi zero. O paciente foi monitorado por três dias com a Escala Visual Analógica < 4, e o cateter foi removido no quarto dia de pós-operatório. Exceto por paracetamol e dexcetoprofeno, não houve necessidade de outro agente opioide durante esse tempo. Não houve registro de complicação pós-operatória. Discussão: O bloqueio do plano do eretor da espinha é uma alternativa às técnicas paravertebrais, intercostais, epidurais ou outras técnicas regionais. Pode ser uma técnica adequada na prática de anestesia e algologia devido ao fornecimento de analgesia no período pós-operatório mediante um cateter no plano do eretor da espinha.

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INTRODUCTION: The erector spinae plane block is a newly described and effective interfascial plane block for thoracic and abdominal surgery. This case report describes a patient with multiple rib fractures undergoing ultrasound-guided continuous erector spinae plane block for analgesia. CASE REPORT: A 37-year-old male patient was taken for surgical fixation of multiple rib fractures. At the end of the surgery, using ultrasound-guided longitudinal parasagittal orientation 3cm to the lateral aspect of the T5 spinous process and an in-plane technique, 20mL 0.25% bupivacaine was administered between the erector spinae muscle and the transverse process, and a catheter was then inserted in the same plane. Before the end of surgery, 1g paracetamol and 50mg dexketoprofen were administered. Postoperative analgesia was applied with patient controlled analgesia method using 0.25% bupivacaine via the catheter. The patient's Visual Analogue Scale score at rest in the first 24h was 0. The patient was monitored for 3 days with Visual Analogue Scale<4, and the catheter was removed on postoperative day 4. No opioid requirement other than paracetamol and dexketoprofen occurred during this time. No postoperative complications were recorded. DISCUSSION: The erector spinae plane block is an alternative to paravertebral, intercostal, epidural or other regional techniques. It may be a suitable technique in anesthesia and algology practice due to providing analgesia in the postoperative period with a catheter in the erector spinae plane.

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Los accidentes automovilísticos, como traumas de alta energía, producen múltiples lesiones. Es objetivo de este trabajo describir la conducta seguida y la evolución de una paciente de 21 años de edad que, cuando viajaba de acompañante en una bicicleta con motor, fue impactada por un automóvil y proyectada a más de 20 m de distancia. Llegó al Hospital Militar Central "Dr. Carlos J. Finlay" en estado de shock hipovolémico agudo y con grandes deformidades en ambos miembros inferiores. Se constataron 13 fracturas; se trató el shock hipovolémico y fue operada de urgencia. Se le realizó la osteosíntesis interna con láminas AO auto compresivas. Posterior al tratamiento quirúrgico, tuvo varias complicaciones que fueron tratadas de forma oportuna y adecuada. La paciente evolucionó satisfactoriamente, con solo una discrepancia de longitud de 2 cm del miembro inferior derecho en relación con el izquierdo(AU)

ABSTRACT Automobile accidents, such as high-energy trauma, produce multiple injuries. The purpose of this paper is to describe the behavior and evolution of a 21-year-old patient who, when traveling as a passenger on a motorized bicycle, was hit by a car and projected more than 20 m away. He arrived at Dr. Carlos J. Finlay Central Military Hospital in an acute state of hypovolemic shock, with large deformities in both lower limbs. There were 13 fractures; hypovolemic shock was treated and he was operated on urgently. Internal osteosynthesis was performed with self-compressive AO sheets. After surgical treatment, he had several complications that were treated in a timely and properly. The patient evolved satisfactorily, with only a discrepancy of length of 2 cm of the right lower limb in relation to the left(AU)

RÉSUMÉ Les accidents de la circulation, impliquant des traumatismes à haute énergie, provoquent des lésions multiples. Le but de ce travail est de décrire le procédé suivi et l'évolution d'une patiente âgée de 21 ans ayant été heurtée par une voiture et projetée à une distance de plus de 20 mètres, quand elle voyageait à bicyclette à moteur comme accompagnatrice. Elle est arrivée à l'hôpital militaire «Dr. Carlos J. Finlay¼ en état de choc hypovolémique aigu et souffrant de grands traumatismes au niveau des membres inférieurs. Treize fractures ont été constatées; la patiente a été prise en charge pour le choc hypovolémique et opérée en urgence. Le geste chirurgical a consisté à une ostéosynthèse interne par plaques auto-compressives AO. Après l'intervention, les complications survenues ont été convenablement corrigées. L'évolution de la patiente a été satisfaisante, sauf une disparité de 2 cm de longueur du membre inférieur droit par rapport au gauche(AU)

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PURPOSE: Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures. METHODS: A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05). RESULTS: In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality. CONCLUSION: Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.

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Panfacial fractures are considered the most aggressive and complex facial fracture, and most of them are the results of a high energy trauma. Therefore, a clinical report of a male patient with a panfacial fracture and Richards type 3 fracture resulting in an airway obstruction is presented. This type of fracture can promote an upper airway obstruction, which needs a correct and fast diagnosis to the life support of the patient.

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Abdominal urethral rupture commonly occurs in male dogs after traumatic pelvic fractures and can lead to uroperitoneum, causing peritonitis and azotemia. The primary complications of urethral damage include strictures, incontinence and innervation injury. Here, we describe a case report of prostatic urethral rupture, treated by primary suture repair, that yielded early healing and recovery in a ten-year-old, male, mixed-breed dog who visited our facility within 24 hours of being struck by a car. Positive contrast urethrocystography resulted in leakage of the contrast medium into the abdominal cavity in a point caudal to the urinary bladder. Additional radiography revealed multiple pelvic fractures. During surgery, we found a laceration of the right prostatic lobe causing urethral rupture. We performed a full thickness simple continue suture with 7-0 polyglactin 910 to reestablish urethral continuity. The prostate capsule was also sutured in a simple continue pattern. A previously placed indwelling urinary catheter was kept inside to divert urine flow. On the third postoperative day, the animal withdrew the urinary catheter and started to urinate by himself. The conservative treatment of pelvic fractures enabled complete return to function on the 55th day. One hundred and fifty days after the trauma, no evidence of urinary stricture or another clinical sign was observed. Urethral wounds can be treated surgically by primary suturing and urinary diversion. A short healing time was experienced, and the indwelling urinary catheter was removed three days after surgery since there was no more urine leakage and the animal began voiding normally.(AU)

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Abdominal urethral rupture commonly occurs in male dogs after traumatic pelvic fractures and can lead to uroperitoneum, causing peritonitis and azotemia. The primary complications of urethral damage include strictures, incontinence and innervation injury. Here, we describe a case report of prostatic urethral rupture, treated by primary suture repair, that yielded early healing and recovery in a ten-year-old, male, mixed-breed dog who visited our facility within 24 hours of being struck by a car. Positive contrast urethrocystography resulted in leakage of the contrast medium into the abdominal cavity in a point caudal to the urinary bladder. Additional radiography revealed multiple pelvic fractures. During surgery, we found a laceration of the right prostatic lobe causing urethral rupture. We performed a full thickness simple continue suture with 7-0 polyglactin 910 to reestablish urethral continuity. The prostate capsule was also sutured in a simple continue pattern. A previously placed indwelling urinary catheter was kept inside to divert urine flow. On the third postoperative day, the animal withdrew the urinary catheter and started to urinate by himself. The conservative treatment of pelvic fractures enabled complete return to function on the 55th day. One hundred and fifty days after the trauma, no evidence of urinary stricture or another clinical sign was observed. Urethral wounds can be treated surgically by primary suturing and urinary diversion. A short healing time was experienced, and the indwelling urinary catheter was removed three days after surgery since there was no more urine leakage and the animal began voiding normally.

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