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 Abstract 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. PDF 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 Abstract 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 PDF 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) Abstract 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 PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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

Dolor neuropático / Neurophatic pain

Febrero 18, 2018. No. 2998

Fenotipo sensorial y factores de riesgo para la neuropatía diabética dolorosa: un estudio observacional transversal. Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study. Raputova J1, Srotova I, Vlckova E, Sommer C, Üçeyler N, Birklein F, Rittner HL, Rebhorn C, Adamova B, Kovalova I, Kralickova Nekvapilova E, Forer L, Belobradkova J, Olsovsky J, Weber P, Dusek L, Jarkovsky J, Bednarik J. Author information Pain. 2017 Dec;158(12):2340-2353. doi: 10.1097/j.pain.0000000000001034. Abstract Different sensory profiles in diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) may be associated with pain and the responsiveness to analgesia. We aimed to characterize sensory phenotypes of patients with painful and painless diabetic neuropathy and to assess demographic, clinical, metabolic, and electrophysiological parameters related to the presence of neuropathic pain in a large cohort of well-defined DSPN subjects. This observational cross-sectional multi-center cohort study (performed as part of the ncRNAPain EU consortium) of 232 subjects with nonpainful (n = 74) and painful (n = 158) DSPN associated with diabetes mellitus of type 1 and 2 (median age 63 years, range 21-87 years; 92 women) comprised detailed history taking, laboratory tests, neurological examination, quantitative sensory testing, nerve conduction studies, and neuropathy severity scores. All parameters were analyzed with regard to the presence and severity of neuropathic pain. Neuropathic pain was positively correlated with the severity of neuropathy and thermal hyposensitivity (P < 0.001). A minority of patients with painful DSPN (14.6%) had a sensory profile, indicating thermal hypersensitivity that was associated with less severe neuropathy. Neuropathic pain was further linked to female sex and higher cognitive appraisal of pain as assessed by the pain catastrophizing scale (P < 0.001), while parameters related to diabetes showed no influence on neuropathic pain with the exception of laboratory signs of nephropathy. This study confirms the value of comprehensive DSPN phenotyping and underlines the importance of the severity of neuropathy for the presence of pain. Different sensory phenotypes might be useful for stratification of patients with painful DSPN for analgesic treatment and drug trials. PDF Tratamientos tópicos para dolor neuropático localizado Topical Treatments for Localized Neuropathic Pain. Casale R1, Symeonidou Z2,3, Bartolo M4. Author information Curr Pain Headache Rep. 2017 Mar;21(3):15. doi: 10.1007/s11916-017-0615-y. Abstract PURPOSE OF REVIEW: Topical therapeutic approaches in localized neuropathic pain (LNP) syndromes are increasingly used by both specialists and general practitioners, with a potentially promising effect on pain reduction. In this narrative review, we describe the available compounds for topical use in LNP syndromes and address their potential efficacy according to the literature. RECENT FINDINGS: Local anaesthetics (e.g., lidocaine, bupivacaine and mepivacaine), as well as general anaesthetic agents (e.g., ketamine), muscle relaxants (e.g., baclofen), capsaicin, anti-inflammatory drugs (e.g., diclofenac), salicylates, antidepressants (e.g., amitriptyline and doxepin), α2 adrenergic agents (e.g., clonidine), or even a combination of them have been tested in various applications for the treatment of LNP. Few of them have reached a sufficient level of evidence to support systematic use as treatment options. Relatively few systemic side effects or drug-drug interactions and satisfactory efficacy seem to be the benefits of topical treatments. More well-organized and tailored studies are necessary for the further conceptualization of topical treatments for LNP. KEYWORDS: Localized neuropathic pain; Topical amitriptyline; Topical baclofen; Topical clonidine; Topical ketamine; Topical lidocaine PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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

Quemaduras por energía eléctrica, su origen, sus manifestaciones clínicas, sus complicaciones y el manejo

Conferencia por el Dr. Luis Ramiro García López, donde describe las quemaduras por energía eléctrica, su origen, sus manifestaciones clínicas, sus complicaciones y el manejo. Describe atinadamente el manejo hospitalario de estos niños según su evolución y la gravedad de su lesión. Genero muchas preguntas de la audiencia la cuales fueron resueltas puntualmente.



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Más sobre adicciones / More on addictions

Febrero 15, 2018. No. 2995

Sustratos biológicos de las adicciones Biological substrates of addiction. Joffe ME1, Grueter CA2, Grueter BA2. Author information Wiley Interdiscip Rev Cogn Sci. 2014 Mar;5(2):151-171. doi: 10.1002/wcs.1273. Epub 2014 Jan 14. Abstract This review is an introduction to addiction, the reward circuitry, and laboratory addiction models. Addiction is a chronic disease hallmarked by a state of compulsive drug seeking that persists despite negative consequences. Most of the advances in addiction research have centered on the canonical and contemporary drugs of abuse; however, addictions to other activities and stimuli also exist. Substances of abuse have the potential to induce long-lasting changes in the brain at the behavioral, circuit, and synaptic levels. Addiction-related behavioral changes involve initiation, escalation, and obsession to drug seeking and much of the current research is focused on mapping these manifestations to specific neural pathways. Drug abuse is well known to recruit components of the mesolimbic dopamine system, including the nucleus accumbens and ventral tegmental area. In addition, altered function of a wide variety of brain regions is tightly associated with specific manifestations of drug abuse. These regions peripheral to the mesolimbic pathway likely play a role in specific observed comorbidities and endophenotypes that can facilitate, or be caused by, substance abuse. Alterations in synaptic structure, function, and connectivity, as well as epigenetic and genetic mechanisms are thought to underlie the pathologies of addiction. In preclinical models, these persistent changes are studied at the levels of molecular pharmacology and biochemistry, ex vivo and in vivo electrophysiology, radiography, and behavior. Coordinating research efforts across these disciplines and examining cell type- and circuit-specific phenomena are crucial components for translating preclinical findings to viable medical interventions that effectively treat addiction and related disorders. WIREs Cogn Sci 2014, 5:151-171. doi: 10.1002/wcs.1273 Conflict of interest: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website. PDF Dependencia química y el médico. Chemical dependency and the physician. Berge KH1, Seppala MD, Schipper AM. Author information Mayo Clin Proc. 2009 Jul;84(7):625-31. doi: 10.1016/S0025-6196(11)60751-9. Abstract Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician. PDF Abuso de Drogas, Adicción y Dependencia Drug Abuse, Addiction and Dependence Alewu Benjamin1 and Nosiri Chidi Pharmacology and Therapeutics Edited by Sivakumar Joghi Thatha Gowder, ISBN 978-953-51-1620-2, 356 pages, Publisher: InTech, Chapters published July 02, 2014 under CC BY 3.0 license Introduction Before the dawn of civilization, they are natural substances that were discovered e.g euphoria's, narcotics, hallucinogens, excitants. Some of these were used by farmers. In fact, there were dope addict long before they were farmers. There are certain drives that persuade or compel somebody to resort to drug to obtain vacation from intolerable selfhood. One of the principal appetite of the soul is the urge to escape if for a few seconds the painful aspect of life, acquisition of wealth which may not be forthcoming. The distinguishing facts between legitimate use of drug for social purpose and their abuse are not certain if not indistinct. It is not a matter of which drug but the amount taken and if directed anti-socially or not. For instance normal people use alcohol for their occasional purpose without harm but, here there is appropriate degree of mental abnormality to the individual and the society as well. These people may then depend on it physically or emotionally. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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

Descompresión subacromial artroscópica para el dolor subacromial de hombro

www.mihombroycodo.com.mx/academia/descompresion-subacromial-artroscopica-para-el-dolor-subacromial-de-hombro-csaw-un-ensayo-quirurgico-aleatorizado-multicentrico-pragmatico-de-grupos-paralelos-controlado-con-placebo-de-tres-gru/

Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.

La #acromioplastia, la operación más frecuente de #hombro que se realiza en nuestro medio, puede no estar indicada, según este estudio https://www.ncbi.nlm.nih.gov/pubmed/29169668 publicado en Lancet que seguro cambiará la práctica clínica.

Fuente

Este artículo es originalmente oublicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29169668

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803129/

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext

  De:

Beard DJ¹, Rees JL², Cook JA³, Rombach I³, Cooper C³, Merritt N³, Shirkey BA², Donovan JL⁴, Gwilym S², Savulescu J⁵, Moser J², Gray A⁶, Jepson M⁴, Tracey I⁷, Judge A², Wartolowska K², Carr AJ⁸; CSAW Study Group.

Lancet. 2018 Jan 27;391(10118):329-338. doi: 10.1016/S0140-6736(17)32457-1. Epub 2017 Nov 20.

  Todos los derechos reservados para:

Author information ► Copyright and License information ▼

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

 

Abstract

BACKGROUND:

Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression.

INTERPRETATION:

Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process.

FUNDING:

Arthritis Research UK, the National Institute for Health Research Biomedical Research Centre, and the Royal College of Surgeons (England).  

 

Resumen

 

ANTECEDENTES:

La descompresión subacromial artroscópica (descompresión del espacio subacromial mediante la eliminación de espolones óseos y tejidos blandos artroscópicamente) es una cirugía común para el dolor subacromial del hombro, pero su eficacia es incierta. Hicimos un estudio para evaluar su efectividad e investigar el mecanismo para la descompresión quirúrgica. INTERPRETACIÓN: Los grupos quirúrgicos tuvieron mejores resultados para el dolor y la función del hombro en comparación con ningún tratamiento, pero esta diferencia no fue clínicamente importante. Además, la descompresión quirúrgica pareció no ofrecer ningún beneficio adicional sobre la artroscopia solamente. La diferencia entre los grupos quirúrgicos y ningún tratamiento podría ser el resultado de, por ejemplo, un efecto placebo o fisioterapia posoperatoria. Los hallazgos cuestionan el valor de esta operación para estas indicaciones, y esto debe ser comunicado a los pacientes durante el proceso de toma de decisiones de tratamiento compartido.  

FONDOS:

Arthritis Research UK, el Instituto Nacional de Investigación en Salud, el Centro de Investigación Biomédica, y el Royal College of Surgeons (Inglaterra).  

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

PMID: 29169668 PMCID: PMC5803129 DOI: 10.1016/S0140-6736(17)32457-1

Free PMC Article

   

La #acromioplastia, la operación más frecuente de #hombro que se realiza en nuestro medio, puede no estar indicada, según este estudio https://t.co/iL72RGK8Lq publicado en Lancet que seguro cambiará la práctica clínica pic.twitter.com/et02KTMXas

— Santiago Arauz (@arauz_santiago) 6 de febrero de 2018