Control del cancer en Latinoamérica y el Caribe

Control del cancer en Latinoamérica y el Caribe Non-communicable diseases, including cancer, are rapidly becoming the leading health-care problem in middle-income and low-income countries. In Latin America and the Caribbean, current cancer control plans vary widely between countries in this region, are largely reactionary to treating advanced cancers, and strongly favour a wealthy and educated minority. In this Commission and linked Comments, expert opinion from a multidisciplinary team of health-care professionals, policy makers, and others address the challenges to providing cancer care in this region and report on the critical steps that are required to reduce the rapidly rising human and economic burden of cancer in Latin America and the Caribbean http://www.thelancet.com/commissions/planning-cancer-control-in-latin-america-and-the-caribbean.

Atentamente
Dra. Argelia Lara Solares
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Manga gástrica laparoscópica en la remisión de la obesidad y comorbilidades asociadas

Manga gástrica laparoscópica en la remisión de la obesidad y comorbilidades asociadas


Laparoscopic sleeve gastrectomy in remission of obesity and associated co-morbidities.
Jadhav S, Borude S.
Med J DY Patil Univ [serial online] 2013 [cited 2013 Apr 10];6:151-4.

Abstract
Background: There is a lot of discussion on bariatric surgery and its effect on weight loss as well as resolution of associated conditions such as diabetes, sleep apnea, and thyroid imbalance. Recent reports also indicate role of laparoscopic sleeve gastrectomy (LSG) in non-obese diabetics. Aims: This study was undertaken to assess medium-term effects of LSG on body weight and co-morbid factors such as diabetes, hypertension, and thyroid imbalance. Materials and Methods: A total of 42 obese subjects (19 males and 23 females; age: 23-65 years; body mass index [BMI]: 45 ± 5 kg/m¼) underwent evaluation of anthropometric/clinical parameters and blood sugar, hypertension and thyroid function tests before, 3 and 9-15 months after LSG. Results: Mean BMI decreased from 45 to 38 after 3 months and 30 at 9-15 months after surgery. Remission of type 2 diabetes mellitus and hypertension occurred in all patients except one. Sleep apnea and asthma was cured in all five patients. Out of the five patients with thyroid imbalance, all except one were off medication within 5 months. Conclusion: Our study showed that LSG is effective in producing a significant and sustained weight loss and improving diabetes mellitus, hypertension, and other co-morbid factors in obese patients.
Keywords: Diabetes mellitus, hypertension, laparoscopic sleeve gastrectomy, morbid obesity
http://www.mjdrdypu.org/text.asp?2013/6/2/151/110304



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Listas de seguridad/Safety checklists

Revisión sistemática de las listas de control de seguridad para el uso de los equipos de atención médica en los hospitales agudos - pruebas limitadas de su efectividad.


Systematic review of safety checklists for use by medical care teams in acute hospital settings--limited evidence of effectiveness.
Ko HC, Turner TJ, Finnigan MA.
Centre for Clinical Effectiveness, Southern Health, Locked Bag 29, Clayton, Victoria, 3168, Australia. henry.ko@ctc.usyd.edu.au
BMC Health Serv Res. 2011 Sep 2;11:211. doi: 10.1186/1472-6963-11-211.
Abstract
BACKGROUND: Patient safety is a fundamental component of good quality health care. Checklists have been proposed as a method of improving patient safety. This systematic review, asked "In acute hospital settings, would the use of safety checklists applied by medical care teams, compared to not using checklists, improve patient safety?" METHODS: We searched the Cochrane Library, MEDLINE, CINAHL, and EMBASE for randomised controlled trials published in English before September 2009. Studies were selected and appraised by two reviewers independently in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori. RESULTS: Nine cohort studies with historical controls studies from four hospital care settings were included-intensive care unit, emergency department, surgery, and acute care. The studies used a variety of designs of safety checklists, and implemented them in different ways, however most incorporated an educational component to teach the staff how to use the checklist. The studies assessed outcomes occurring a few weeks to a maximum of 12 months post-implementation, and these outcomes were diverse.The studies were generally of low to moderate quality and of low levels of evidence, with all but one of the studies containing a high risk of bias.The results of these studies suggest some improvements in patient safety arising from use of safety checklists, but these were not consistent across all studies or for all outcomes. Some studies showed no difference in outcomes between checklist use and standard care without a checklist. Due to the variations in setting, checklist design, educational training given, and outcomes measured, it was unfeasible to accurately summarise any trends across all studies.
CONCLUSIONS: The included studies suggest some benefits of using safety checklists to improve protocol adherence and patient safety, but due to the risk of bias in these studies, their results should be interpreted with caution. More high quality and studies, are needed to enable confident conclusions about the effectiveness of safety checklists in acute hospital settings.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176176/pdf/1472-6963-11-211.pdf


Listas de control de neurocirugía: una revisión

Neurosurgical checklists: a review.
Zuckerman SL, Green CS, Carr KR, Dewan MC, Morone PJ, Mocco J.
Department of Neurological Surgery, Vanderbilt University School of Medicine, Tennessee, USA.
Neurosurg Focus. 2012 Nov;33(5):E2. doi: 10.3171/2012.9.FOCUS12257.
Abstract
Morbidity due to avoidable medical errors is a crippling reality intrinsic to health care. In particular, iatrogenic surgical errors lead to significant morbidity, decreased quality of life, and attendant costs. In recent decades there has been an increased focus on health care quality improvement, with a concomitant focus on mitigating avoidable medical errors. The most notable tool developed to this end is the surgical checklist. Checklists have been implemented in various operating rooms internationally, with overwhelmingly positive results. Comparatively, the field of neurosurgery has only minimally addressed the utility of checklists as a health care improvement measure. Literature on the use of checklists in this field has been sparse. Considering the widespread efficacy of this tool in other fields, the authors seek to raise neurosurgical awareness regarding checklists by reviewing the current literature.
http://thejns.org/doi/pdf/10.3171/2012.9.FOCUS12257




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Bibliotecas. Alerta

http://www.smo.edu.mx/pdf/cursos_cadaver2013.pdf

La biblioteca virtual del ICAM, la primera con más de 800 libros en ...
Europa Press
El Colegio de Abogados de Madrid (ICAM) es pionero en la puesta en marcha de la primera bibliotecavirtual con formato electrónico que cuenta con las últimas herramientas de las nuevas tecnologías de la información, ha informado el ICAM en un ...
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La Generalitat dedica una biblioteca virtual al asociacionismo y el ...
elEconomista.es
La Conselleria de Bienestar Social y Familia de la Generalitat ha dedicado una biblioteca virtual al asociacionismo y el voluntariado con cerca de 150 documentos de referencia, una cifra que se irá ampliando con el trabajo del equipo que coordina el ...
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La biblioteca de UM continúa infatigable labor para preservar la ...
El Nuevo Herald
La colección de patrimonio cubano, conocida en inglés como Cuban Heritage Collection (CHC), no es sólo un espacio donde se almacenan o se adquieren libros y revistas. Situada en el Pabellón Goizueta de la Biblioteca Otto Richter, en la Universidad de ...
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Biblioteca Nacional en llamas: El incendio que no debería repetirse
El Comercio (blog)
La cultura de un pueblo reposa en sus creaciones, las que permanecen vivas en las páginas de sus libros. Hojear un libro es caminar, experimentar la vida de otros, alimentarse de experiencias y pensamientos. Cuando el fuego consume una bibliotecano ...
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El Comercio (blog)


Un libro de fondo de biblioteca
La Nueva España
Ceferino de Blas Dicen que Jorge Luis Borges, lector incansable, imaginaba el cielo como una biblioteca inmensa. Con hileras de anaqueles repletas de volúmenes de todos los géneros, temas, épocas y encuadernaciones. Mucho más grande que el ...
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La Nueva España


Biblioteca Paul Rivet puente Francia y México
AlianzaTex
Texcoco, México.- (Texcoco Press).- La embajadora de Francia en México, Elizabeth Beton-Delegue visitó, junto con varios funcionarios diplomáticos, las instalaciones de laBiblioteca Pública del Estado de Jalisco Juan José Arreola, para conocer la ...
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AlianzaTex



La Biblioteca Accesible, a punto de ser realidad
La Nueva Provincia
A futuro vamos a pedir colaboración a las instituciones para que nos donen CDs, que serán enviados a la Biblioteca Accesible de Mar del Plata, que se comprometió a grabarnos toda la bibliografía con la que ellos cuentan, para que cuando se ponga en ...
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La biblioteca de Canet amplía su horario para el período de ...
El periódico de aquí
La concejala de Cultura, Antonia Albalat destaca, que "el Ayuntamiento aumentará los recursos destinados a la biblioteca municipal conscientes de la importancia que tiene para los estudiantes tener un lugar de estudio con un horario lo más amplio ...
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El periódico de aquí



Laboratorio para la ciudad soñada
ABC.es
De eso precisamente, del futuro de la ciudad con mayúsculas, se hablará durante dos meses en laBiblioteca de Castilla-La Mancha, en el marco de un interesante ciclo de conferencias-debate que -por estar su sede en el histórico baluarte del Alcázar ...
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Biblioteca Sant Joseph / Ramon Esteve
Plataforma Arquitectura
La biblioteca es un edificio independiente en una zona verde salpicado de árboles que penetran en las aberturas del edificio. Se trata de un prisma cuadrado donde los fragmentos interiores con planos que fluyen entre los espacios definen la ...
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Web 3 resultados nuevos de Biblioteca


Nosololibros: Una biblioteca amarilla
Blog de la Biblioteca del IES Francisco de los Ríos de Fernán Núñez (Córdoba, ... Esta es la elección hecha por la Biblioteca del IES Murgi, de EL Ejido.
bibliorios.blogspot.com/2013/05/una-biblioteca-amarilla.html


Biblioteca-UMB-ITAE (BiblioUMBITAE) on Twitter
The latest from Biblioteca-UMB-ITAE (@BiblioUMBITAE). http://www.facebook. com/bibliotecaumbitae.bucaramanga.
https://twitter.com/BiblioUMBITAE


El mexicano Enrique Norten diseña una nueva biblioteca pública en ...
Llena de luz, con unas amplias gradas para realizar eventos y una sala de ordenadores con la última tecnología es como el arquitecto mexicano Enrique ...
vidayestilo.terra.com/.../el-mexicano-enrique-norten-disena-un...

Seguridad en cirugía plástica/Patient safety during cosmetic surgery

                                 http://www.smo.edu.mx/pdf/cursos_cadaver2013.pdf

Consideraciones perioperatorias para la seguridad de los pacientes durante cirugía cosmética. Previniendo complicaciones  Perioperative considerations for patient safety during cosmetic surgery - preventing complications. Ellsworth WA, Basu CB, Iverson RE. Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas; Can J Plast Surg. 2009 Spring;17(1):9-16. Abstract Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential, and pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia staff have managed patient positioning and safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementing patient safety guidelines by the plastic surgeon is of increasing importance. A review of the Joint Commission's Universal Protocol highlights requirements set forth to prevent perioperative complications. In the present paper, the importance of implementing these guidelines into the cosmetic surgery practice is reviewed. Key aspects of patient safety in the operating room are outlined, including patient positioning, ocular protection and other issues essential for minimization of postoperative morbidity. Additionally, as the demand for body contouring surgery in the cosmetic practice continues to increase, special attention to safety considerations specific to the obese and massive weight loss patients is mandatory. After review of the present paper, the reader should be able to introduce the Joint Commission's Universal Protocol into their daily practice. The reader will understand key aspects of patient positioning, airway management and ocular protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese, massive weight loss patients and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patient's experience and surgical outcome. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705307/pdf/cjps17009.pdf     Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

eBooks. Alerta

http://www.smo.edu.mx/pdf/cursos_SEMEFO2013.pdf


COMUNICADO: Español.Free-eBooks.net lanza el nuevo Best ...
Europa Press
Los aficionados a la buena lectura tienen desde ya a su disposición, el primer tomo de este libro en formato digital, el cual se puede descargar a través del siguiente enlace:http://espanol.free-ebooks.net/best-seller. Son 12 tomos en total que se ...
Ver todos los artículos sobre este tema »
Europa Press

«E-books» al rescate de la industria editorial británica
ABC.es
Probablemente, E L James no esperaba convertirse en la escritora más exitosa de la novela erótica cuando escribió «Cincuenta sombras de Gray». Cuatro años después, su trilogía acapara el podio de los «best sellers» en Reino Unido. Además de a sus ...
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eBooks para profesores universitarios
InfoBAE.com
Los profesores universitarios que son a la vez autores de textos de referencia para sus materias tienen la posibilidad de percibir ingresos adicionales por derechos de autor sobre sus libros en papel. Claro que estos ingresos adicionales están ...
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Editorial Digital del Tecnológico de Monterrey cuenta con 100 eBooks
Milenio.com
Refirió que la distribución del catálogo editorial se compone con un 37 por ciento deeBooks de ingeniería y arquitectura; 28 por ciento de humanidades y ciencias sociales; tecnologías de información, y la administración y finanzas cuentan con 16 por ...
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Milenio.com

Llega a 100 eBooks Editorial del Tecnológico de Monterrey
LaCronica.com
Están por cumplirse tres años del lanzamiento de la primera convocatoria en la que se invitaba a los profesores del Tecnológico de Monterrey a enviar sus propuestas para la creación de eBooks, periodo que es más significativo al tener a la puerta la ...
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Cuenta con 100 eBooks Editorial Digital del TEC de Monterrey
Frontera.info
MONTERREY, Nuevo León(Agencias) La Editorial Digital del Instituto Tecnológico de Monterrey reveló que ya cuentan con la obra interactiva número 100 (eBooks) en su acervo, que es utilizado desde hace tres años por estudiantes en todo América Latina.
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Suma ya 100 eBooks Editoral Digital del Tec
El Porvenir
Ya cuentan con la obra interactiva número 100 (eBooks) en su acervo, que es utilizado desde hace tres años por estudiantes en todo América Latina. Monterey, N. L.- La Editorial Digital del Instituto Tecnológico de Monterrey reveló que ya cuentan con la ...
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Regalarán Starbucks y el FCE ebooks
El Golfo Info
De la misma manera que lo hace con las aplicaciones y música, Starbucks ofrecerá un ebook completo de manera gratuita a los visitantes por medio de una tarjeta, que contiene un código de descarga canjeable en la iBookstore de Apple. Sobre la ...
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Sub-Urbano eBooks | SUB URBANO
Nos da mucho gusto anunciar nuestro nuevo gran proyecto: Sub-Urbano eBooks . Un sello editorial digital donde publicaremos volúmenes de literatura breve o ...
sub-urbano.com/sub-urbano-ebooks/
e-books videogames | Gamedots.mx
e-books videogames. Aprovecha la oferta del paquete de diez e-books sobre videojuegos. Creado por: el Lun, 06 de Mayo de 2013, 09:44 am. Aprovecha la ...
www.gamedots.mx/e-books-videogames
Editorial Digital del Tecnológico de Monterrey cuenta con 100 eBooks
La Editorial Digital del Instituto Tecnológico de Monterrey reveló que ya cuentan con la obra interactiva número 100 eBooks en su acervo, que es utilizado ...
monterrey.milenio.com/.../e159c53518eb127b640d1083455e...
«E-books» al rescate de la industria editorial británica - Qué.es
Además de a sus lectores, la autora debería agradecérselo a los «e-books», que inflaron las ventas de su obra hasta los diez millones y medio de copias en ...
www.que.es/.../201305070200-books-rescate-industria-editori...

Books Update NYT

http://www.smo.edu.mx/pdf/cursos_SEMEFO2013.pdf

Books Update

http://www.nytimes.com/indexes/2013/05/10/books/booksupdate/index.html

On the Cover of Sunday's Book Review

On the Brink
By HAROLD EVANS


Two new books take the reader back to the complicated web of events leading up to World War I.
Up Front: Harold Evans








Amanda Knox: By the Book


The author of "Waiting to Be Heard" says that reading Marilynne Robinson's "Housekeeping" in prison helped, because it explores themes of loneliness and alienation.
By the Book: Archive

APPLIED READING
Seussian Software
By J. D. BIERSDORFER


The Cat in the Hat and other old friends are keeping up with the technological times.

'A Thousand Pardons'
By JONATHAN DEE
Reviewed by KATHARINE NOEL


When her husband deserts her, this novel's protagonist becomes a public relations adviser for sinful celebrities.

'Country Girl: A Memoir'
By EDNA O’BRIEN
Reviewed by STACY SCHIFF


From the restraints of her Irish childhood to literary stardom - Edna O'Brien reflects on a fraught and distinguished life.

'Picking Up'
By ROBIN NAGLE
Reviewed by DAN SALTZSTEIN


New York's sanitation workers are arguably invisible but unquestionably essential, Robin Nagle writes.

'The Business of Baby'
By JENNIFER MARGULIS
Reviewed by ANNIE MURPHY PAUL


A journalist finds flaws in the care of mothers and infants.

'Equilateral'
By KEN KALFUS
Reviewed by ANDREA WULF


A British astronomer attempts to signal Mars in Ken Kalfus's novel.

'The Way of the Knife'
By MARK MAZZETTI
Reviewed by FRED KAPLAN


Mark Mazzetti argues that the C.I.A. gave up its traditional functions as it embraced manhunting.

'Tirza'
By ARNON GRUNBERG. Translated by SAM GARRETT.
Reviewed by SCOTT HUTCHINS


Arnon Grunberg's hero wants to throw his daughter the best party ever.

'The Enchanted Wanderer and Other Stories'
By NIKOLAI LESKOV. Translated by RICHARD PEVEAR and LARISSA VOLOKHONSKY.
Reviewed by CLAIRE MESSUD


A collection of short stories by the Russian writer Nikolai Leskov, a contemporary of Dostoyevsky and Tolstoy.

'Algerian Chronicles'
By ALBERT CAMUS. Translated by ARTHUR GOLDHAMMER. Edited by ALICE KAPLAN.
Reviewed by SUSAN RUBIN SULEIMAN


Albert Camus's writing on Algeria reveals both hope and dread.

'A Tale for the Time Being'
By RUTH OZEKI
Reviewed by LESLEY DOWNER


A diary washes ashore, linking a teenager in Japan and an author in Canada in Ruth Ozeki's latest novel.
What the Tide Brought In

'News From Heaven'
By JENNIFER HAIGH
Reviewed by JOAN SILBER


In Jennifer Haigh's linked stories, restlessness and regret loom over a Pennsylvania coal-mining town for generations.

'Life After Life'
By JILL MCCORKLE
Reviewed by ROY HOFFMAN


Jill McCorkle returns to the fictional Fulton, N.C., in her sixth novel.

'The Federalist Society: How Conservatives Took the Law Back From Liberals'
By MICHAEL AVERY and DANIELLE McLAUGHLIN
Reviewed by JEFFREY ROSEN


A primer on the Federalist Society and its extraordinary influence.

Children's Books

'The 5th Wave'
By RICK YANCEY
Reviewed by JUSTIN CRONIN


In this Y.A. novel, aliens land on earth and the apocalypse begins.

Over, Under and Through
By TOM LICHTENHELD


There's never a dull moment for the explorers in these picture books.

'Gorgeous'
By PAUL RUDNICK
Reviewed by LIBBA BRAY


The plain heroine of Paul Rudnick's novel is transformed.

'The Rithmatist'
By BRANDON SANDERSON. Illustrated by BEN McSWEENEY.
Reviewed by PATRICK NESS


Brandon Sanderson's hero longs to join a magical cadre.

All in the Family
By TAFFY BRODESSER-AKNER


Three picture books look at intergenerational relationships.

Bookshelf: Bicycles
By PAMELA PAUL


New picture books about people of all ages and their bikes.

Endangered Daughters
By LINDA SUE PARK


In far-flung regions, two girls' dreams are impeded by family obligations.

'The Lucy Variations'
By SARA ZARR
Reviewed by VIVIEN SCHWEITZER


A girl pushed into musical excellence confronts her own desires.

'Better to Wish: The First Generation'
By ANN M. MARTIN
Reviewed by J. COURTNEY SULLIVAN


A multigenerational series by the creator of the Baby-Sitters Club.

Bookshelf: Misbehavior
By PAMELA PAUL


New picture books about throwing things, pitching fits and breaking the rules.

The Stuff of Legend
By MARJORIE INGALL


Norse mythology and the occult intrude on the modern world in these tales.

'Doll Bones'
By HOLLY BLACK. Illustrated by ELIZA WHEELER.
Reviewed by LAUREN OLIVER


Three friends must lay a ghost to rest in Holly Black's latest novel.

'Kindness for Weakness'
By SHAWN GOODMAN
Reviewed by ETHAN BRONNER


A teenage boy, who is caught acting as his brother's drug courier, is sent to a juvenile detention center.

'Winger'
By ANDREW SMITH
Reviewed by A. J. JACOBS


A 14-year-old rugby player pines for an older classmate.

'Hero on a Bicycle'
By SHIRLEY HUGHES
Reviewed by MONICA EDINGER


In a novel set in 1944, a family in Florence aids the partisans.

Bloqueo interescalénico/Interscalene block

http://www.smo.edu.mx/pdf/cursos_SEMEFO2013.pdf

Bloqueo interescalénico posterior: Serie de casos guiados con ultrasonido y visión general de historia, anatomía y técnicas  Posterior interscalene block: an ultrasound-guided case series and overview of history, anatomy and techniques. McNaught A, McHardy P, Awad IT. Department of Anesthesia, Sunnybrook Health Sciences Centre and Holland Orthopedic and Arthritic Centre, University of Toronto, Toronto, Ontario, Canada. Pain Res Manag. 2010 Jul-Aug;15(4):219-23. Abstract BACKGROUND: The posterior interscalene block has been described as an alternative to the lateral interscalene block. However, this technique has not gained popularity because of the close proximity of the approach to vascular and central neural structures. OBJECTIVE: To describe the posterior interscalene block technique using ultrasound imaging, and to review the history of its evolution. METHODS: The use of ultrasound imaging to facilitate the insertion of interscalene catheters using the posterior approach in 11 patients undergoing total shoulder arthroplasty is described. RESULTS: All 11 patients had satisfactory analgesia in the first 24 h of the postoperative period. None of the patients complained of neck pain, as had been found in earlier techniques using the posterior approach. CONCLUSIONS: This modification of the posterior approach is a safe and effective method for the insertion of interscalene brachial plexus catheters. These catheters are also comfortable for patients and, in the present study, none of the catheters inadvertently fell out. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935721/pdf/prm15219.pdf     Bloqueo interescalénico posterior del plexo braquial guiado con ultrasonido: estudio randomizado, ciego triple, placebo controlado.  Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Cheng GS, Choy LP, Maldonado RC, Ilfeld BM. Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California 92037-7651, USA. Anesth Analg. 2009 May;108(5):1688-94. doi: 10.1213/ane.0b013e318199dc86. Abstract BACKGROUND:  The posterior approach for placing continuous interscalene catheters has not been studied in a controlled investigation. In this randomized, triple-masked, placebo-controlled study, we tested the hypothesis that an ultrasound-guided continuous posterior interscalene block provides superior postoperative analgesia compared to a single-injection ropivacaine interscalene block after moderately painful shoulder surgery. METHODS: Preoperatively, subjects received a stimulating interscalene catheter using an ultrasound-guided, in-plane posterior approach. All subjects received an initial bolus of ropivacaine. Postoperatively, subjects were discharged with oral analgesics and a portable infusion device containing either ropivacaine 0.2% or normal saline programmed to deliver a perineural infusion over 2 days. The primary outcome was average pain on postoperative day (POD) 1 (scale: 0-10). Secondary outcomes included least and worst pain scores, oral opioid requirements, sleep disturbances, patient satisfaction, and incidence of complications. RESULTS: Of the 32 subjects enrolled, 30 perineural catheters were placed per protocol. Continuous ropivacaine perineural infusion (n = 15) produced a statistically and clinically significant reduction in average pain (median [10th-90th percentile]) on POD 1 compared with saline infusion (n = 15) after initial ropivacaine bolus (0.0 [0.0-5.0] versus 3.0 [0.0-6.0], respectively; P < 0.001). Median oral opioid consumption (oxycodone) was lower in the ropivacaine group than in the placebo group on POD 1 (P = 0.002) and POD 2 (P = 0.002). Subjects who received a ropivacaine infusion suffered fewer sleep disturbances than those in the placebo group (P = 0.005 on POD 0 and 1 nights) and rated their satisfaction with analgesia higher than subjects who received normal saline (P < 0.001). CONCLUSIONS: Compared to a single-injection interscalene block, a 2-day continuous posterior interscalene block provides greater pain relief, minimizes supplemental opioid requirements, greatly improves sleep quality, and increases patient satisfaction after moderate-to-severe painful outpatient shoulder surgery. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745838/pdf/nihms131871.pdf    Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Analgesia opioide periférica/Peripheral opioid analgesia

http://www.smo.edu.mx/pdf/cursos_cadaver2013.pdf

Apertura transitoria de la barrera perineural para administración de fármacos  Transient opening of the perineurial barrier for analgesic drug delivery. Hackel D, Krug SM, Sauer RS, Mousa SA, Böcker A, Pflücke D, Wrede EJ, Kistner K, Hoffmann T, Niedermirtl B, Sommer C, Bloch L, Huber O, Blasig IE, Amasheh S, Reeh PW, Fromm M, Brack A, Rittner HL. Department of Anesthesiology, University Hospitals Wurzburg, Julius Maximilians University, 97080 Würzburg, Germany. Proc Natl Acad Sci U S A. 2012 Jul 17;109(29):E2018-27. doi: 10.1073/pnas.1120800109. Epub 2012 Jun 25. Abstract Selective targeting of sensory or nociceptive neurons in peripheral nerves remains a clinically desirable goal. Delivery of promising analgesic drugs is often impeded by the perineurium, which functions as a diffusion barrier attributable to tight junctions. We used perineurial injection of hypertonic saline as a tool to open the perineurial barrier transiently in rats and elucidated the molecular action principle in mechanistic detail: Hypertonic saline acts via metalloproteinase 9 (MMP9). The noncatalytic hemopexin domain of MMP9 binds to the low-density lipoprotein receptor-related protein-1, triggers phosphorylation of extracellular signal-regulated kinase 1/2, and induces down-regulation of the barrier-forming tight junction protein claudin-1. Perisciatic injection of any component of this pathway, including MMP9 hemopexin domain or claudin-1 siRNA, enables an opioid peptide ([D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin) and a selective sodium channel (NaV1.7)-blocking toxin (ProToxin-II) to exert antinociceptive effects without motor impairment. The latter, as well as the classic TTX, blocked compound action potentials in isolated nerves only after disruption of the perineurial barrier, which, in return, allowed endoneurally released calcitonin gene-related peptide to pass through the nerve sheaths. Our data establish the function and regulation of claudin-1 in the perineurium as the major sealing component, which could be modulated to facilitate drug delivery or, potentially, reseal the barrier under pathological conditions. http://www.pnas.org/content/109/29/E2018.full.pdf+html     Coadministración de agonistas de los receptores δ- y μ promueve función de receptores periféricos opioides  Co-administration of δ- and μ-opioid receptor agonists promotes peripheral opioid receptor function. Schramm CL, Honda CN. Department of Neuroscience and Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA. Pain. 2010 Dec;151(3):763-70. doi: 10.1016/j.pain.2010.09.009. Abstract Enhancement of peripheral opioid analgesia following tissue injury or inflammation in animal models is well-documented, but clinical results of peripheral opioid therapy remain inconsistent. Previous studies in the central nervous system have shown that co-administration of μ- and δ-opioid receptor agonists can enhance analgesic outcomes; however, less is known about the functional consequences of opioid receptor interactions in the periphery. The present study examines the effects of intraplantar injection of the μ- and δ-opioid receptor agonists, morphine and deltorphin, alone and in combination on behavioral tests of nociception in naïve rats and on potassium-evoked release of CGRP from sciatic nerves of naïve rats. Neither drug alone affected nociceptive behaviors or CGRP release. Two separate measures of mechanical nociceptive sensitivity remained unchanged after co-administration of the two drugs. In contrast, when deltorphin was co-injected with morphine, dose-dependent and peripherally restricted increases in paw withdrawal latencies to radiant heat were observed. Similarly, concentration-dependent inhibition of CGRP release was observed when deltorphin and morphine were administered in sequence prior to potassium stimulation. However, no inhibition was observed when morphine was administered prior to deltorphin. All combined opioid effects were blocked by co-application of antagonists. Deltorphin exposure also enhanced the in vivo and in vitro effects of another μ-opioid receptor agonist, DAMGO. Together, these results suggest that under normal conditions, δ-opioid receptor agonists enhance the effect of μ-opioid receptor agonists in the periphery, and local co-administration of δ- and μ-opioid receptor agonists may improve results of peripheral opioid therapy for the treatment of pain http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978509/pdf/nihms-249520.pdf    Opioides con acción periférica y sus implicaciones en el manejo del dolor  Peripherally acting opioids and clinical implications for pain control. Sehgal N, Smith HS, Manchikanti L. University of Wisconsin School of Medicine and Public Health, Madison, WI 53595, USA. NSehgal@uwhealth.org Pain Physician. 2011 May-Jun;14(3):249-58. Abstract Opioid receptors are widely expressed in the central and peripheral nervous system and in the non-neuronal tissues. Data from animal and human clinical studies support the involvement of peripheral opioid receptors in analgesia, especially in the presence of inflammation. Inflammation has been shown to increase the synthesis of opioid receptors in the dorsal root ganglion neurons and enhance transport and accumulation of opioid receptors in the peripheral terminals of sensory neurons. Under the influence of chemokines and adhesion molecules, opioid peptide-containing immune cells extravasate and accumulate in the injured tissues. Stress, chemokines, cytokines, and other releasing factors in inflamed tissues stimulate these granulocytes to release opioid peptides. Once secreted, opioid peptides bind to and activate peripheral opioid receptors on sensory nerve fibers and produce analgesia by decreasing the excitability of sensory nerves and/or inhibiting release of pro-inflammatory neuropeptides. Research has revealed that local application of exogenous opioid agonists produces a potent analgesic effect by activating peripheral opioid receptors in inflamed tissues. The analgesic activity occurs without activation of opioid receptors in the central nervous system (CNS), and therefore centrally mediated side effects, such as respiratory depression, mental clouding, altered consciousness, or addiction, are not associated with peripheral opioid activity. This discovery has stimulated research on developing peripherally restricted opioid agonists that lack CNS effects. In addition, it has been recognized that opioid receptors modulate inflammation, and that opioids have anti-inflammatory effects. The anti-inflammatory actions of opioids are not well known or understood. Conflicting reports on mu-opioids suggest both anti-inflammatory and pro-inflammatory effects. This article will present the basis for peripheral opioid analgesia and describe current research directed at developing novel treatments for pain with improved side effect profiles. http://www.painphysicianjournal.com/2011/may/2011;14;249-258.pdf    Mecanismos periféricos del dolor y de analgesia       Peripheral mechanisms of pain and analgesia. Stein C, Clark JD, Oh U, Vasko MR, Wilcox GL, Overland AC, Vanderah TW, Spencer RH. Department of Anesthesiology and Critical Care Medicine, Charité Campus Benjamin Franklin, Freie Universität Berlin, Germany. Brain Res Rev. 2009 Apr;60(1):90-113 . doi: 10.1016/j.brainresrev.2008.12.017. Epub 2008 Dec 31. Abstract This review summarizes recent findings on peripheral mechanisms underlying the generation and inhibition of pain. The focus is on events occurring in peripheral injured tissues that lead to the sensitization and excitation of primary afferent neurons, and on the modulation of such mechanisms. Primary afferent neurons are of particular interest from a therapeutic perspective because they are the initial generator of noxious impulses traveling towards relay stations in the spinal cord and the brain. Thus, if one finds ways to inhibit the sensitization and/or excitation of peripheral sensory neurons, subsequent central events such as wind-up, sensitization and plasticity may be prevented. Most importantly, if agents are found that selectively modulate primary afferent function and do not cross the blood-brain-barrier, centrally mediated untoward side effects of conventional analgesics (e.g. opioids, anticonvulsants) may be avoided. This article begins with the peripheral actions of opioids, turns to a discussion of the effects of adrenergic co-adjuvants, and then moves on to a discussion of pro-inflammatory mechanisms focusing on TRP channels and nerve growth factor, their signaling pathways and arising therapeutic perspectives.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730351/pdf/nihms112893.pdf

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