Bloqueo TAP en analgesia post cirugía bariiátrica / TAP block and bariatric surgery analgesia

unio 25, 2017. No. 2730

Infiltración del plano transversus abdominis en banda gástrica laparoscópica: Un estudio piloto. Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study. Jr GS1, Fitzgerald P1, Ahmad S1, Kim J1, Rahangdale R1, McCarthy R1. World J Gastrointest Surg. 2014 Feb 27;6(2):27-32. doi: 10.4240/wjgs.v6.i2.27. Abstract AIM: To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidlyobese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted. KEYWORDS: Gastric band; Infiltration; Pain; Recovery; Transversus abdominis plane PDF Factibilidad y eficacia analgésica del bloqueo del plano transverso del abdomen después de la laparoscopía de un solo puerto en pacientes con cirugía bariátrica. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery. Wassef M1, Lee DY1, Levine JL1, Ross RE1, Guend H1, Vandepitte C1, Hadzic A1, Teixeira J1. J Pain Res. 2013 Nov 27;6:837-41. doi: 10.2147/JPR.S50561. eCollection 2013. Abstract PURPOSE: The transversus abdominis plane (TAP) block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS) scores. PATIENTS AND METHODS: After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG) were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone) postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL), a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test) was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups. RESULTS: Sensory block ranged from T5-L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04) within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4-10) after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery was similar for both groups. CONCLUSION: Ultrasound-guided TAP blocks in morbidly obese patients are feasible and result in satisfactory analgesia following SPSG in the immediate postoperative period. KEYWORDS: analgesia; nerve blocks; postoperative pain; regional anesthesia; ultrasound PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Factores pronósticos de un resultado funcional satisfactorio en pacientes con amputaciones unilaterales de extremidad superior por arriba de la muñeca que utilizan próstesis de extremidad superior

http://www.ortopediaenpediatrica.com.mx/academia/factores-pronosticos-de-un-resultado-funcional-satisfactorio-en-pacientes-con-amputaciones-unilaterales-de-extremidad-superior-por-arriba-de-la-muneca-que-utilizan-prostesis-de-extremidad-superior-2/

Prognostic factors of a satisfactory functional result in patients with unilateral amputations of the upper limb above the wrist that use an upper limb prosthesis

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/25532695

http://www.elsevier.es/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-resumen-factores-pronosticos-un-resultado-funcional-S188844151400246X

De:

Dabaghi-Richerand A1,Haces-García F2,Capdevila-Leonori R2.

Rev Esp Cir Ortop Traumatol. 2015 Sep-Oct;59(5):343-7.

 doi: 10.1016/j.recot.2014.11.001. Epub 2014 Dec 19.

Todos los derechos reservados para:

Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Resumen

Objetivo

El objetivo de este artículo es evaluar los factores pronósticos para una adecuada adaptación protésica de extremidad superior y qué variables condicionan un resultado funcional satisfactorio en pacientes con una amputación por encima del tercio proximal del antebrazo.

Discusión

Se encontró que la etiología congénita es de buen pronóstico, al igual que el caso de aquellos que utilizan la prótesis más de 6h/día. Por medio de este trabajo se pudieron demostrar mejores resultados funcionales en los pacientes a los que se les adapta una prótesis de extremidad superior antes de los 6 años y preferentemente por una etiología congénita. También se encontró que el número de horas de uso al día correlaciona con un resultado funcional favorable.

AbstractPurpose

The purpose of this study is to determine the prognostic factors of a satisfactory functional outcome in patients using upper extremity prosthetics with a proximal third forearm stump, and above, level of amputation.

Discussion

It was found that when adapting a patient with an upper extremity prosthetic, which has a high rejection rate of up to 49%, better functional outcomes are found in those who started using it before 6 years of age, and preferably because of a congenital etiology. It was also found that the number of hours/day strongly correlates with a favorable functional outcome.

.

Palabras clave

Amputación de miembro torácico, Prótesis, Resultado funcional

Keywords

Amputation upper extremity, Prosthetics, Functional outcome

#Amputación#amputation#miembro torácico#upper extremity#Prótesis#Prosthetics#Resultado funcional#functional outcome

Características radiológicas del desarrollo de la tuberosidad tibial anterior

http://www.ortopediaenpediatrica.com.mx/ortopedia-pediatrica/caracteristicas-radiologicas-del-desarrollo-de-la-tuberosidad-tibial-anterior/

Radiographic features of the development of the anterior tibial tuberosity

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/26917430

http://www.elsevier.es/es-revista-radiologia-119-resumen-caracteristicas-radiologicas-del-desarrollo-tuberosidad-S0033833816000199

De:

Vergara-Amador E1,Davalos Herrera D2,Moreno LÁ3.

Radiologia. 2016 Jul-Aug;58(4):294-300. doi: 10.1016/j.rx.2016.01.005. Epub 2016 Feb 22.

Todos los derechos reservados para:

Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Resumen

Objetivo

Existen pocos estudios que evalúen las características radiológicas del desarrollo de la tuberosidad tibial anterior (TTA). El presente trabajo tiene por objeto evaluar las características radiológicas de la TTA en una población pediátrica de acuerdo a grupos de edad.

Conclusión

La osificación de la TTA se inicia distalmente, posteriormente se fusiona su parte proximal con el resto de la epífisis y finalmente se fusiona en su parte distal a la tibia. Este estudio ayuda a un mejor análisis de la TTA cuando nos enfrentamos a un dolor de rodilla.

AbstractObjective

Few studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups.

Conclusion

The ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain.

Palabras clave

Tibia, Osteocondrosis, Placa de crecimiento

Keywords

Tibia, Osteochondrosis, Growth plate

#tibia#osteocondrosis#placa de crecimiento#Osteochondrosis#growth plate