domingo, 18 de febrero de 2018

Avances en anestesia regional / Advances in regional anaesthesia

Febrero 17, 2018. No. 2997

Avances en anestesia regional: una revisión de la práctica actual, técnicas más nuevas y resultados
Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes
Wahal C, Kumar A, Pyati S.
Indian J Anaesth 2018;62:94-102
Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance.
Evaluar los avances en anestesia regional mediante sus representaciones en los metanálisis: una visión alternativa del progreso reciente
Assessing advances in regional anesthesia by their portrayals in meta-analyses: an alternative view on recent progress
Vlassakov and Kissin BMC Anesthesiology (2017) 17:112 DOI 10.1186/s12871-017-0406-3
Background: The aim of this study was to delineate research reflecting advances in regional/local anesthesia where recent clinical progress was clearly defined by meta-analysis. Methods: We conducted a search to identify all articles with meta-analyses of randomized clinical trials related to the field of regional/local anesthesia. From 279 titles, after multiple exclusions, 16 meta-analyses on important clinical practice developments with high potential for a positive conclusion on the effectiveness of the treatment were left for the assessment. The assessment was performed in two steps. The first step was related to verification of proof-of-concept: the effect is statistically reliable (p-value, effect size, heterogeneity across different RCTs) and the risk of bias not too high. The second step was devoted to attempts to form an opinion on the real clinical benefits of a new development. Results: The assessment revealed that seven recent developments passed the proof-of-concept step. At the same time, positive conclusion on real clinical benefits was reached only by one of these seven developments: ultrasound guidance for peripheral nerve blocks (at least with some of the blocks). Meaningful clinical improvements with other developments remains uncertain. The assessment of the relationships between analyzed advancements over the past 30 years and earlier similar developments indicated that their evolution was usually incremental. The most original advancement was found to be the introduction of the transversus abdominis plane block. Conclusion: The assessment of recent advances in regional/local anesthesia, based on the evaluation of related metaanalyses, revealed only incremental progress with mostly marginal benefits. The progress was the most notable with ultrasound guidance for some of peripheral nerve blocks. Keywords: Epidural anesthesia, Spinal anesthesia, Nerve blocks, Minimal clinically important difference, Real-world evidence
Epidemiología, tendencias y disparidades en anestesia regional para cirugía ortopédica
Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery
C. Cozowicz, J. Poeran and S. G. Memtsoudis
British Journal of Anaesthesia, 115 (S2): ii57-ii67 (2015)
Recent studies have linked the use of regional anaesthesia to improved outcomes. Epidemiological research on utilization, trends, and disparities in this field is sparse; however, large nationally representative database constructs containing anaesthesia-related data, demographic information, and multiyear files are now available. Together with advances in research methodology and technology, these databases provide the foundation for epidemiological research in anaesthesia. We present an overview of selected studies that provide epidemiological data and describe current anaesthetic practice, trends, and disparities in orthopaedic surgery in particular. This literature suggests that that even among orthopaedic surgical procedures, which are highly amenable to regional anaesthetic techniques, neuraxial anaesthetics and peripheral nerve blocks are used in only a minority of procedures. Trend analyses show that peripheral nerve blocks are gaining in popularity, whereas use of neuraxial anaesthetics is remaining relatively unchanged or even declining over time. Finally, significant disparities and variability in anaesthetic care seem to exist based on demographic and health-care-related factors. With anaesthesia playing an increasingly important part in population-based health-care delivery and evidence indicating improved outcome with use of regional anaesthesia, more research in this area is needed. Furthermore, prevalent disparities and variabilities in anaesthesia practice need to be specified further and addressed in the future. Key words: anaesthesia; anaesthesia, spinal; epidemiological data; epidemiology; healthcare disparities; regional anaesthesia; trends
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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