viernes, 11 de abril de 2014

Priapismo y anestesia/Priapism and anaesthesia

Priapismo. Una complicación rara después de infusión epidural continua de morfina y bupivacaína

Priapism--a rare complication following continuous epidural morphine and bupivacaine infusion.
Ruan X, Couch JP, Shah RV, Liu H, Wang F, Chiravuri S.
Pain Physician. 2007 Sep;10(5):707-11.
BACKGROUND: Intraspinal drug delivery (IDD) therapy has been increasingly used in patients with intractable, nonmalignant pain who fail to respond to conventional treatment or can not tolerate systemic opioid therapy due to side effects. By infusing a small amount of analgesics directly into the cerebrospinal fluid (CSF) in close proximity to the receptor sites in the spinal cord, one is able to achieve the spinally mediated analgesia, sparing side effects ffrom systemic opioids. Prior to permanent intraspinal pump implantation, an intraspinal opioid screening trial is required to document the efficacy of intraspinal opioid for analgesia. Although there are a few approaches in conducting such screening trials, a patient-controlled continuous epidural morphine infusion trial, performed in an outpatient setting, is widely accepted by many interventional pain specialists. The major advantage of conducting an outpatient functional opioid infusion trial versus an inpatient trial is that it more closely mimics what the patient does in his or her usual activities of daily living, therefore minimizing the false positive rate of the inpatient screening trial. OBJECTIVE: To describe a rare complication, priapism, observed during an outpatient continuous epidural morphine and bupivacaine infusion trial. CASE REPORT: A 49-year-old male with intractable, chronic low back pain due to diffuse lumbar degenerative disc disease, lumbar spondylosis referred to our clinic for consideration of IDD therapy, after failing to respond to multi-modality pain management including medications, physical therapy with modality, transcutaneous nerve stimulation (TENS), and various interventional procedures. Following a pre-implant psychological evaluation, he was scheduled for the outpatient epidural morphine and bupivacaine infusion trial. A tunneled lumbar epidural a catheter was placed at L3-L4 with the catheter tip advanced to L1 under fluoroscopic guidance. The proximal tip of the catheter was then tunneled, subcutaneously, and connected to a Microject PCEA pump (Codman, Raynham, MA, USA) and reservoir bag containing preservative-free morphine 0.4 mg/mL and bupivacaine 0.016%. The pump was programmed to deliver a basal rate of 0.5 mL/h. The bolus dose was 0.2 mL with a 60-minute lock out interval. The patient was instructed how to use the pump properly before discharging home. Two hours following the initiation of infusion trial, the patient started to experience penile erection. It was initially painless, but became progressively painful and intensified. The unremitting priapism lasted 8 hours, finally resolving 2 to 3 hours after discontinuing the infusion. The patient recovered fully without any sequelae. CONCLUSION: Priapism may occur as a rare complication following epidural morphine administration. This report represents the third case report thus far in the literature revealing priapism induced by epidural morphine administration, yet, it is the only report, to our knowledge, describing priapism occurring in a patient undergoing an outpatient epidural morphine and bupivacaine infusion trial. We believe that epidural morphine, rather than bupivacaine, is responsible for causing priapism in this patient, through a yet to be defined spinal mechanism.;10;707-711.pdf

Propofol y priapismo

Propofol and priapism.
Indian J Pharmacol. 2010 Aug;42(4):238-9. doi: 10.4103/0253-7613.68430.
Senthilkumaran S1, Shah S, Ganapathysubramanian, Balamurgan N, Thirumalaikolundusubramanian P.
Propofol-induced priapism in a 25-year-old male confirmed by rechallenge is reported for its rarity and to create awareness among practitioners, because propofol is used frequently in India for the induction and maintenance of anesthesia or sedation. The probable mechanisms are highlighted. Because propofol causes low-flow priapism, early alleviation is essential to minimize and/or avert the long-term complications.
KEYWORDS:Diisopropylphenol, early recognition, low-flow priapism, mechanisms, propofol, rechallenge

Priapismo durante cirugía transuretral bajo raquianestesia. Implicaciones y revisión de las opciones de tratamiento
Priapism during transurethral surgery under spinal anaesthesia: Implications and review of management options.
Das J, Deuri A, Roy PM, Pant V.
Indian J Anaesth. 2010 Nov;54(6):576-7. doi: 10.4103/0019-5049.72654.

Anestesiología y Medicina del Dolor
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