Bloqueo axilar del plexo braquial / Axillary brachial plexus block

Agosto 11, 2017. No. 2777

La importancia de la posición de la extremidad superior para un bloqueo axilar seguro y efectivo. Estudio comparativo Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study. Öztürk Ö1, Tezcan AH1, Bilge A2, Erdem E1, Yağmurdur H1, Dost B3. Turk J Anaesthesiol Reanim. 2017 Jun;45(3):164-168. doi: 10.5152/TJAR.2017.33349. Epub 2017 Feb 1. Abstract OBJECTIVE: Our aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block. METHODS: In this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender. RESULTS: The shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients. CONCLUSION: Appropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration. KEYWORDS: Axillary block; median nerve; musculocutaneous nerve; ultrasound guidance PDF Influencia de la posición del brazo en la visibilidad ultrasónica del plexo braquial axilar. Influence of arm position on ultrasound visibility of the axillary brachial plexus. Frkovic V1, Ward C, Preckel B, Lirk P, Hollmann MW, Stevens MF, Wegener JT. Eur J Anaesthesiol. 2015 Nov;32(11):771-80. doi: 10.1097/EJA.0000000000000293. Abstract BACKGROUND: Contemporary axillary brachial plexus block is performed by separate injections targeting radial, median, ulnar and musculocutaneous nerve. These nerves are arranged around the axillary artery, making ultrasound visualisation sometimes challenging. In particular, the radial nerve can be difficult to localise deep to the artery. CONCLUSION: The visibility of the radial nerve was not improved by varying positions of the arm. S180°/E0° provided the best overall visibility and accessibility of nerves. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

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

Dolor / Pain

Agosto 1, 2017. No. 2767

Formación reticular y dolor: El pasado y el futuro. Reticular Formation and Pain: The Past and the Future. Martins I1,2,3,4, Tavares I1,2,3,4. Front Neuroanat. 2017 Jul 5;11:51. doi: 10.3389/fnana.2017.00051. eCollection 2017. Abstract The involvement of the reticular formation (RF) in the transmission and modulation of nociceptive information has been extensively studied. The brainstem RF contains several areas which are targeted by spinal cord afferents conveying nociceptive input. The arrival of nociceptive input to the RF may trigger alert reactions which generate a protective/defense reaction to pain. RF neurons located at the medulla oblongata and targeted by ascending nociceptive information are also involved in the control of vital functions that can be affected by pain, namely cardiovascular control. The RF contains centers that belong to the pain modulatory system, namely areas involved in bidirectional balance (decrease or enhancement) of pain responses. It is currently accepted that the imbalance of pain modulation towards pain facilitation accounts for chronic pain. The medullary RF has the peculiarity of harboring areas involved in bidirectional pain control namely by the existence of specific neuronal populations involved in antinociceptive or pronociceptive behavioral responses, namely at the rostroventromedial medulla (RVM) and the caudal ventrolateral medulla (VLM). Furthermore the dorsal reticular nucleus (also known as subnucleus reticularis dorsalis; DRt) may enhance nociceptive responses, through a reverberative circuit established with spinal lamina I neurons and inhibit wide-dynamic range (WDR) neurons of the deep dorsal horn. The components of the triad RVM-VLM-DRt are reciprocally connected and represent a key gateway for top-down pain modulation. The RVM-VLM-DRt triad also represents the neurobiological substrate for the emotional and cognitive modulation of pain, through pathways that involve the periaqueductal gray (PAG)-RVM connection. Collectively, we propose that the RVM-VLM-DRt triad represents a key component of the "dynamic pain connectome" with special features to provide integrated and rapid responses in situations which are life-threatening and involve pain. The new available techniques in neurobiological studies both in animal and human studies are producing new and fascinating data which allow to understand the complex role of the RF in pain modulation and its integration with several body functions and also how the RF accounts for chronic pain. KEYWORDS: analgesics; cognition; connectome; emotions; noradrenaline; opioids; serotonin PDF Avances recientes en la comprensión y manejo del dolor por cáncer. Recent advances in understanding and managing cancer pain. Chwistek M1. F1000Res. 2017 Jun 20;6:945. doi: 10.12688/f1000research.10817.1. eCollection 2017.Abstract Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host's immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques. KEYWORDS: biology of cancer pain; cancer pain; cancer-induced bone pain; cannabis; chemotherapy-induced peripheral neuropathy; intrathecal analgesia; medical marijuana; neuromodulation; opioids; scrambler therapy; spinal cord stimulation PDF  El Comité Ejecutivo de la IASP insta a Venezuela a centrarse en el acceso a medicamentos para el dolor a la luz de escasez crítica IASP Executive Committee Urges Venezuela to Focus on Access to Pain Medications in Light of Critical Shortages As the leading global organization that brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the study of pain with the goal of improved pain relief worldwide, the International Association for the Study of Pain (IASP) has been made aware that difficult conditions in Venezuela have resulted in inadequate access to pain treatment. Declaración / Statement XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

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

Dolor cronico / Chronic pain

Agosto 2, 2017. No. 2768

Dolor y psicología- Una relación recíproca. Pain and Psychology-A Reciprocal Relationship. Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Ochsner J. 2017 Summer;17(2):173-180. Abstract BACKGROUND: Depression typically affects 5% of the general population, but among patients with chronic pain, 30%-45% experience depression. Studies have shown that the relationship between depression and pain is bidirectional: depression is a positive predictor of the development of chronic pain, and chronic pain increases the risk of developing depression. METHODS: This literature review focuses on the relationship between psychology and pain, covering studies that have investigated the association between depression, pain sensitivity, opioid abuse, and gender differences in pain perception. We conducted a PubMed search pairing the word pain with depression, opioid use, and gender differences. RESULTS: The relationship between depression and pain is complex, as suggested by numerous studies that propose depression to be a moderator of the relationship between pain severity, physical functioning, and opioid use. Neuroimaging also suggests an anatomic overlap in the pathway of chronic pain and depression. Positive psychological factors, namely hope, pain acceptance, and optimism, affect the adjustment to persistent pain. CONCLUSION: The intricate relationship between pain and psychology is evidenced by the clinical overlap in their presentations and the overlap between the anatomic regions in the brain associated with the emotional and sensory features of pain and the areas affected by depression. Studies are beginning to improve our understanding of these two systems, but more studies are needed to elucidate the relationship. KEYWORDS: Analgesics-opioid; chronic pain; depression; pain; pain perception; psychology PDF Dolor crónico postoperatorio: hallazgos recientes en la comprensión y el manejo. Chronic postoperative pain: recent findings in understanding and management. Correll D. F1000Res. 2017 Jul 4;6:1054. doi: 10.12688/f1000research.11101.1. eCollection 2017. Abstract Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronicpostoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute painand the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn't changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations. KEYWORDS: multimodal analgesia; persistent postoperative pain; surgery PDF El Comité Ejecutivo de la IASP insta a Venezuela a centrarse en el acceso a medicamentos para el dolor a la luz de escasez crítica IASP Executive Committee Urges Venezuela to Focus on Access to Pain Medications in Light of Critical Shortages As the leading global organization that brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the study of pain with the goal of improved pain relief worldwide, the International Association for the Study of Pain (IASP) has been made aware that difficult conditions in Venezuela have resulted in inadequate access to pain treatment. Declaración / Statement

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