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Sample records for bloqueo epidural con

  1. Bloqueo epidural lumbar continuo para espasmos vesicales incoercibles Continuous lumbar epidural uncontrollable bladder spasms

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    C. López Carballo

    2013-04-01

    Full Text Available Presentamos un caso clínico de espasmos vesicales por hiperactividad del detrusor de la vejiga, desencadenados por lavado vesical continuo aplicado en un paciente con hematuria, en el contexto de hipertrofia benigna de próstata. Los espasmos llegaron a ser refractarios a tratamiento sistémico con antimuscarínicos, espasmolíticos y opioides. Se optó por la colocación de un catéter epidural lumbar para infusión continua de anestésicos locales y opioides como terapia analgésica alternativa, que no solo proporcionó un aceptable grado de confort, sino que permitió el mantenimiento del sondaje uretral y el lavado vesical continuo. Realizamos una revisión bibliográfica sobre el uso del bloqueo epidural de la neurotransmisión de las aferencias sensitivas vesicales en dolor de origen disfuncional vesical, y analizamos algunas de la teorías publicadas sobre la fisiopatología y génesis de dolor en estos trastornos vesicales, con la intención de interpretar las peculiaridades y complejidad del dolor en el cuadro del caso presentado.We present a clinical case of bladder spasms due to detrusor overactitivity, triggered by continuous vesicoclysis therapy, which was applied in a patient with benign prostatic hypertrophy-related hematuria. Bladder spasms turned out to be refractory to combined antimuscarinic, spasmolytic and systemic opioid therapies. Implantation of a lumbar epidural catheter was chosen for continuous epidural infusion of local anesthetics and opioid drugs as an alternate analgesic therapy, which provided the patient an optimum comfort, but let urethral indwelling catheterization and the maintenance of continuous vesicoclysis therapy as well. We reviewed scientific literature concerning bladder-afferent neurotransmission blockade at epidural level for dysfunctional bladder pain therapy, and discussed several published theories about pain physiopathology and origin in those cases of dysfunctional bladder disturbance, with the

  2. Anestesia peridural lombar ou bloqueio do plexo lombar combinados à anestesia geral: eficácia e efeitos hemodinâmicos na artroplastia total do quadril Anestesia epidural lumbar o bloqueo del plexo lumbar combinados con la anestesia general: eficacia y efectos hemodinámicos en la artroplastia total de la cadera Epidural lumbar block or lumbar plexus block combined with general anesthesia: efficacy and hemodynamic effects on total hip arthroplasty

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    Leonardo Teixeira Domingues Duarte

    2009-12-01

    avanzada y de las enfermedades asociadas a los pacientes. El objetivo del estudio, fue evaluar si el bloqueo del plexo lumbar combinado con la anestesia general, equivale a la anestesia epidural lumbar en cuanto a la eficacia del bloqueo nociceptivo, efectos hemodinámicos secundarios, dificultad en su ejecución e influencia en el sangramiento operatorio en pacientes sometidos a la ATC. MÉTODO: Pacientes estado físico ASA I a III que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. En el grupo Epidural, se realizó la anestesia epidural lumbar continua con la ropivacaína a 0,5% 10 a 15 mL. En el grupo Lumbar, fue realizado el bloqueo del plexo lumbar por la vía posterior con ropivacaína a 0,5% 0,4 mL.kg-1. Todos los pacientes fueron sometidos a la anestesia general. Se estudiaron: la dificultad en la ejecución de los bloqueos, su eficacia y los efectos hemodinámicos secundarios. RESULTADOS: Cuarenta y un pacientes fueron incluidos en el estudio. El tiempo para la ejecución del bloqueo epidural fue menor, pero el número de intentos en colocar la aguja fue similar en los dos grupos. El bloqueo epidural fue más eficaz. En el grupo Lumbar, se registró un aumento de la presión arterial diastólica y media (PAM y en el doble producto. Después de la incisión, el consumo anestésico durante la operación fue mayor. Posteriormente al bloqueo, la PAM fue menor en los 50, 60 y 70 minutos después de la realización del bloqueo epidural. El sangramiento fue parecido en los dos grupos. CONCLUSIONES: La técnica epidural promovió un bloqueo nociceptivo más eficaz sin asociarse a la inestabilidad hemodinámica, cuando se le combinó con la anestesia general. El bloqueo del plexo lumbar fue una técnica útil en combinación con la anestesia general cuando la anestesia epidural estuvo contraindicada.BACKGROUND AND OBJECTIVES: Anesthesia for total hip arthroplasty (THA is a challenge due to the advanced age and associated diseases of patients. The objective

  3. Bloqueo epidural lumbar continuo para espasmos vesicales incoercibles Continuous lumbar epidural uncontrollable bladder spasms

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    C. López Carballo; S. Vázquez del Valle; M. Garrido García; J. Pico Veloso; R. Valle Yáñez; M. J. Bermúdez López; F. J. Pardo-Sobrino López

    2013-01-01

    Presentamos un caso clínico de espasmos vesicales por hiperactividad del detrusor de la vejiga, desencadenados por lavado vesical continuo aplicado en un paciente con hematuria, en el contexto de hipertrofia benigna de próstata. Los espasmos llegaron a ser refractarios a tratamiento sistémico con antimuscarínicos, espasmolíticos y opioides. Se optó por la colocación de un catéter epidural lumbar para infusión continua de anestésicos locales y opioides como terapia analgésica alternativa, que ...

  4. Fiabilidad técnica del bloqueo caudal guiado con ecografía

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    A. Mendiola de la Osa

    2014-12-01

    Full Text Available Introducción: el bloqueo-infiltración caudal es una técnica utilizada en las unidades de dolor para tratar el dolor de origen radicular lumbosacro. Esta técnica se ha realizado clásicamente mediante referencias anatómicas o guiado mediante fluoroscopia. Se presenta la realización de la técnica eco-guiada y las complicaciones surgidas tras la realización de la misma. Material y métodos: estudio observacional descriptivo en el que se estudiaron las complicaciones de la técnica. Se realizaron 126 procedimientos en pacientes adultos de ambos sexos. Procedimiento: se localizó el hiato sacro mediante ecografía y se insertó una aguja de Touhy 18 G en el espacio epidural caudal perforando el ligamento sacro-coccígeo. Resultados: no surgieron complicaciones graves en ninguno de los pacientes. No hubo casos de mala ventana ecográfica por lo que se pudo realizar la técnica en todos los enfermos programados. Conclusión: debido a la ausencia de complicaciones la realización de la técnica eco-guiada es una alternativa segura y fiable a la técnica guiada con fluoroscopia. Mediante esta técnica se evita la exposición de radiaciones ionizantes. Además el bloqueo caudal eco-guiado no necesita del uso de contrastes yodados y permite transportar el ecógrafo a la cabecera del enfermo en caso de ser necesario.

  5. Remifentanilo vs. bloqueo central epidural para control del dolor postoperatorio en cirugía vascular de urgencias Remifentanyl versus epidural central blockade for the management of postoperative pain in emergency vascular surgery

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    A. Quirante

    2004-12-01

    Full Text Available El correcto tratamiento del dolor postoperatorio constituye una prioridad dentro de los objetivos del anestesiólogo. En pacientes con patología vascular severa quirúrgica, el tratamiento analgésico efectivo se suele realizar mediante bloqueo continuo epidural. Sin embargo, la administración de analgésicos, tanto opiáceos como no opiáceos, por vía intravenosa, es una alternativa a la vía epidural cuando esta es desestimada. Caso clínico: Presentamos el caso de un paciente varón de 63 años portador de un bypass fémoro-poplíteo a primera porción en miembro inferior izquierdo, el cual es intervenido quirúrgicamente y con carácter urgente tras el diagnóstico de falso aneurisma séptico de arteria iliaca izquierda con rotura de anastomosis fémoro-poplítea. Se optó por una anestesia general basada en la analgesia con remifentanilo frente a bloqueo central epidural dado el carácter urgente de la cirugía y la ingesta habitual de antiagregantes plaquetarios. Se planificó como estrategia analgésica postoperatoria la administración de remifentanilo a dosis sedoanalgésicas (Introduction: The appropriate management of postoperative pain is a priority among the objectives of the anesthesiologist. In patients with severe surgical vascular pathology, an effective analgesic treatment is usually provided with epidural continuous blockade. However, the intravenous administration of analgesics, either opiates or non opiates, is an alternative to the epidural route when this has to be dismissed. Clinical case: We present the case of a 63-years old male patient carrying a femoro-popliteus bypass in the first portion of the left lower limb that underwent emergency surgery after being diagnosed of a false septic aneurysm in the left iliac artery with breakage of the femoro-popliteus anastomosis. General anesthesia based on remifentanyl was decided instead of epidural central blockade due to the urgent nature of the surgery and the regular

  6. Esclerosis sistémica complicada con síncope y bloqueo AV completo

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    Francisco Femenía

    2010-10-01

    Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.

  7. Síndrome de Horner y bloqueo del plexo braquial ipsilateral en un caso de analgesia epidural para el trabajo del parto Horner´s sydrome and ipsilateral brachial plexus block during an epidural analgesia labour procedure

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    J. Avellanosa; Vera, J.; P. Morillas; E. Gredilla; F. Gilsanz

    2006-01-01

    El Síndrome de Horner es una complicación de la anestesia epidural que aparece más frecuentemente en pacientes obstétricas debido a los cambios fisiológicos y anatómicos propios del embarazo; sin embargo, su incidencia es baja, y sólo se han descrito dos casos previos asociando un bloqueo del plexo braquial. Presentamos el caso de una gestante de 23 años que precisó analgesia epidural para el trabajo de parto. Tras comprobar la correcta colocación del catéter se administró una dosis inicial e...

  8. Bloqueo atrioventricular completo y reversible en un paciente con corazón estructuralmente sano

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    Oswaldo Gutiérrez-Sotelo

    2008-06-01

    Full Text Available Se presenta el caso de un paciente joven, deportista, quien presentó un episodio de síncope con pródromo breve, durante ejercicio físico. Se encontró el corazón estructuralmente normal y que durante la prueba de inclinación presentó bloqueo atrioventricular completo, que revirtió rápidamente con la posición de decúbito dorsal.We present the case of a young sportsman patient, who presented syncope with a brief prodrome, during physical activity. His heart is structurally normal and during head-up tilt testing he presented a complete atrioventricular block that fastly reverted rapidly with laying down position.

  9. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol

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    J. A. Delgado

    2005-05-01

    Full Text Available Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia. Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1 y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12: se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13: se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1 como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.. Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anot

  10. Histerectomía radical en paciente con enfermedad de Steinert: raquianestesia, ketamina y bloqueos TAP y de la vaina de los rectos

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    I. Armendáriz-Buil

    2015-12-01

    Full Text Available Se presenta el caso de una paciente con enfermedad de Steinert que fue intervenida de histerectomía radical. Debido a lo avanzado de su enfermedad con insuficiencia respiratoria crónica que requería ventilación mecánica no invasiva (VMNI nocturna, se escogió raquianestesia como tratamiento anestésico. En el momento de la linfadenectomía aórtica, la paciente refirió dolor moderado en hipogastrio, siendo bien controlado con bolos de 10 mg de ketamina. En el postoperatorio, se evitó la administración de opioides aplicando bloqueos de la pared abdominal: bloqueo del plano transverso del abdomen (TAP y bloqueo de la vaina de los músculos rectos abdominales. La evolución de la paciente fue satisfactoria siendo dada de alta el quinto día tras la intervención.

  11. Calidad de vida de pacientes con cáncer de próstata en tratamiento con bloqueo androgénico continuo vs intermitente: estudio prospectivo mediante la aplicación del cuestionario CAVIPRES

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    C.R. Sierra Labarta; D. Sánchez Zalabardo; Á. de Pablo Cárdenas

    2015-01-01

    Fundamento: El tratamiento con bloqueo androgénico intermitente (BAI) pretende mejorar la calidad de vida de los pacientes con cáncer de próstata con los mismos resultados oncológicos que el bloqueo androgénico continuo (BAC). El presente trabajo compara la calidad de vida mediante la aplicación del cuestionario CAVIPRES entre dos grupos de pacientes, uno tratado con BAC y otro con BAI. Material y métodos: Se realizó un estudio longitudinal de 24 meses de duración que incluyó 114 pacientes. T...

  12. Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

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    Monica Rossi Rodrigues

    2009-12-01

    con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección de PJC en niños. MÉTODO: Estudio randómico doble ciego, en niños sometidos a la intervención quirúrgica para liberación posteromedial de PJC, ubicadas en cuatro grupos conforme a la técnica anestésica: caudal (ACa; bloqueos isquiático y femoral (IF; bloqueos isquiático y safeno (IS; bloqueo isquiático y anestesia local (IL, asociados a la anestesia general. En las primeras 24 horas, los pacientes recibieron dipirona y paracetamol vía oral y fueron evaluados por un anestesiólogo que no conocía la técnica usada. Conforme a las puntuaciones de la escala CHIPPS (Children's and infants postoperative pain scale, se administraba morfina vía oral (0,19 mg.kg-1 por día. RESULTADOS: Fueron estudiados 118 niños distribuidos en los grupos ACa (30, IF (32, IS (28 IL (28. El tiempo promedio entre el bloqueo y la primera dosis de morfina fue de 6,16 horas en el grupo ACa, 7,05 horas en el IF, 7,58 horas en el IS y 8,18 horas en el IL. El consumo de morfina fue de 0,3 mg.kg-1 por día en los cuatro grupos. No hubo diferencia significativa entre los grupos. CONCLUSIONES: Los bloqueos nerviosos periféricos no promovieron un tiempo más elevado de analgesia, ni tampoco una reducción en el consumo de morfina en las primeras 24 horas, en niños sometidos a la corrección de PJC cuando se les comparó con el bloqueo epidural caudal.BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF is associated with

  13. Esclerosis sistémica complicada con síncope y bloqueo AV completo Systemic sclerosis complicated with syncope and complete AV block

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    Francisco Femenía

    2010-10-01

    Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.Systemic sclerosis is a complex disease that affects the connective tissue, the vascular system and the immune system. It typically produces skin and organ fibrosis. Cardiac bundle branch blocks and fascicular blocks occur in 25-75% of the cases and were found to be independent predictors of mortality. Second and third degree atrioventricular block are very rare. We present the case of a 47 year-old female with diagnosis of systemic sclerosis, presented with syncope secondary to complete atrioventricular block requiring permanent pacemaker implantation.

  14. Propuesta de procedimientos para mejorar los resultados obtenidos por la heurística NEH en el problema flow shop con bloqueos

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    Companys Pascual, Ramón; Ribas Vila, Immaculada; Mateo Doll, Manuel

    2010-01-01

    En este trabajo se han analizado formas de incrementar la calidad de las soluciones obtenidas por la heurística NEH al aplicarla al problema de programación de piezas en un sistema flow shop con bloqueos con el objetivo de minimizar el makespan. Los resultados obtenidos al analizar diferentes métodos indican que es aconsejable aplicar el procedimiento sobre el ejemplar directo e inverso reteniendo la mejor de las dos soluciones obtenidas así como substituir la regla de ordenación LPT por la M...

  15. Ropivacaína em bloqueio peridural torácico para cirurgia plástica Ropivacaína en bloqueo peridural torácico para cirugía plástica Thoracic epidural anesthesia with ropivacaine for plastic surgery

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    José Roberto Nociti

    2002-04-01

    resultados del bloqueo peridural torácico con ropivacaína a 0,5% asociado a sedación con infusión continua de propofol en cirugía plástica. MÉTODO: Participaron del estudio sesenta pacientes del sexo femenino con edades entre 18 y 62 años, estado físico ASA I ó II, sometidas a cirugías plásticas combinadas envolviendo mama, abdomen, glúteos, lipoaspiración. Después de punción peridural en T9-T10 óT10-T11, recibieron 40 ml de solución de ropivacaína a 0,5% y sufentanil 15 µg. Dosis subsecuentes de anestésico local fueron administradas a través de catéter cuando necesarias. La sedación fue obtenida con infusión venosa continua de propofol 40 a 50 µg.kg-1.min-1. Fueron evaluadas las características de instalación y regresión del bloqueo, la evolución de los parámetros hemodinámicos y respiratorios, la incidencia de eventos adversos. RESULTADOS: El nivel superior de bloqueo sensorial fue T2 en 52 pacientes (86,6%, C4 en 4 (6,6% e T3 en 4 (6,6%. La media para el tiempo de latencia fue 9,1 ± 8,2 minutos. Se obtuvo bloqueo motor grado 2 en 61,7% de las pacientes y grado 1 en 38,3%. La media para el tiempo de regresión completa del bloqueo motor fue 377,9 ± 68,5 minutos. La media para el tiempo de la primera queja espontanea de dolor fue 965,1 ± 371,3 minutos. Los valores medios de PAS, PAD, PAM y FC decrecieron significativamente en relación al control a partir de los 15 min después de la inyección de anestésico local, caracterizando anestesia hipotensiva. Trece pacientes (21,7% que presentaron PAS BACKGROUND AND OBJECTIVES: Thoracic epidural blockade is a method of hypotensive anesthesia able to reduce bleeding during surgery. This non-comparative study aimed at evaluating the results of thoracic epidural blockade with 0.5% ropivacaine associated to propofol continuous infusion sedation in plastic surgery. METHODS: Participated in this study 60 female patients aged 18 to 62 years, physical status ASA I or II, scheduled for combined plastic

  16. Bloqueo ciático continuo con catéter estimulador guiado mediante ecografía para tratamiento del miembro fantasma doloroso Ultrasound-guided continuous sciatic nerve block with stimulating catheter for the treatment of phantom limb pain

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    A. Martínez Navas

    2009-02-01

    Full Text Available Los bloqueos nerviosos periféricos pueden ser una alternativa a la analgesia intravenosa y epidural en el tratamiento del miembro fantasma doloroso. La dificultad en la localización del nervio ciático mediante neuroestimulación en pacientes con arteriopatía periférica y neuropatía puede verse aumentada por el hecho de presentar una amputación del miembro inferior, que imposibilita la observación de una respuesta motora en el pie coincidiendo con la localización del nervio. En estos casos, la ecografía puede convertirse en una técnica de localización nerviosa determinante del éxito de la analgesia ya que permite la identificación del nervio, así como la visualización en tiempo real de la posición relativa de la aguja y catéter respecto al nervio y la difusión del anestésico local administrado. Se presenta el caso de un paciente con miembro fantasma doloroso resistente al tratamiento convencional que se controló con un bloqueo ciático continuo con catéter estimulador guiado con ecografía.Peripheral nerve blocks can be an alternative to intravenous and epidural analgesia in the treatment of phantom limb pain. The difficulty of localizing the sciatic nerve through neurostimulation in patients with peripheral arteriopathy and neuropathy can be increased by lower limb amputation, making it impossible to observe a motor response in the foot coinciding with localization of the nerve. In these cases, ultrasonography can become a technique for nerve localization and determine the success of analgesic strategy, since it allows nerve identification, as well as visualization in real time of the relative position of the needle and catheter with respect to the nerve and the diffusion of the local anesthetic administered. We report the case of a patient with phantom limb pain refractory to conventional treatment, in whom pain control was achieved by ultrasound-guided continuous sciatic block with stimulating catheter.

  17. Bloqueo electrónico de la hebilla del cinturón de seguridad con detección del correcto abrochado

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    Prevosti Vives, Montserrat

    2011-01-01

    Impulsado por la problemática actual en el campo de la automoción, concretamente en el mal uso de los sistemas de retención de pasajeros, el presente proyecto consiste en el desarrollo de una idea, la investigación de su novedad, el análisis y estrategia de sus alternativas, el diseño de la solución, el cumplimiento de la normativa correspondiente y la redacción de una patente de la invención. La evolución de la idea nace con el concepto de un bloqueo electrónico de la hebilla ...

  18. Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso Uso del bloqueo combinado raquiepidural durante cirugía de colon en paciente de alto riesgo: relato de caso Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report

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    Luiz Eduardo Imbelloni

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado raqui-peridural (BCRP oferece vantagens sobre a anestesia peridural ou subaracnóidea com injeção única. O objetivo deste relato foi apresentar um caso onde a anestesia subaracnóidea segmentar pode ser técnica efetiva para intervenção cirúrgica gastrintestinal com respiração espontânea. RELATO DO CASO: Paciente estado físico ASA III, diabetes mellitus tipo II, com hipertensão arterial sistêmica e doença pulmonar obstrutiva crônica, foi escalada para ressecção de tumor de cólon direito. O BCRP foi realizado no interespaço T5 - T6 e foram injetados 8 mg de bupivacaína a 0,5% isobárica acrescida de 50 µg de morfina no espaço subaracnóideo. O cateter peridural (20G foi introduzido quatro centímetros em direção cefálica. Foi obtida sedação com doses fracionadas de 1 mg de midazolam (total de 6 mg. Bupivacaína a 0,5% foi administrada em bolus de 25 mg através do cateter duas horas após a anestesia subaracnóidea. Não houve necessidade de vasopressor nem atropina. CONCLUSÕES: Este caso proporciona evidências de que a raquianestesia segmentar pode ser uma técnica anestésica para operação gastrintestinal com respiração espontânea.JUSTIFICATIVA Y OBJETIVOS: El bloqueo combinado raquiepidural (BCRE, tiene ventajas sobre la anestesia epidural o subaracnoidea con inyección única. El objetivo de este relato, fue presentar un caso donde la anestesia subaracnoidea segmentaria, puede ser una técnica efectiva para la intervención quirúrgica gastrointestinal con respiración espontánea. RELATO DEL CASO: Paciente estado físico ASA III, diabetes mellitus tipo II, con hipertensión arterial sistémica y enfermedad pulmonar obstructiva crónica, que fue indicada para la resección del tumor de colon derecho. El BCRE se realizó en el interespacio T5 - T6, y se inyectaron 8 mg de bupivacaína a 0,5% isobárica con 50 µg más de morfina en el espacio subaracnoideo. El cat

  19. Analgesia postoperatoria tras artroplastia de rodilla mediante bloqueo femoral continuo con ropivacaína Postoperative analgesia after knee arthroplasty through continuous femoral blockage with ropivacaine

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    M. Reina

    2004-02-01

    Full Text Available Introducción: El objetivo del estudio es conocer el grado de dolor y satisfacción en el postoperatorio de los pacientes que han recibido analgesia mediante bloqueo femoral continuo en artroplastia total de rodilla. Material y método: Se incluyeron pacientes ASA I-III diagnosticados de gonartrosis e intervenidos de artroplastia total de rodilla bajo anestesia intradural. En la Sala de Despertar y bajo los efectos residuales de la anestesia intradural se colocó un catéter en la proximidad del nervio femoral, con neuroestimulación. Se administró un bolo inicial de ropivacaína 0,375% 30 ml, seguido de una perfusión continua de ropivacaína 0,125% 10 ml.h-1, que se mantuvo durante las primeras 48 horas del postoperatorio. Las variables registradas fueron las siguientes: dolor postoperatorio a las 24 y 48 horas mediante EVA, localización del dolor, existencia o no de bloqueo motor, parestesias-disestesias y efectos secundarios, así como fármacos utilizados en caso de analgesia insuficiente, dificultad de la técnica y grado de satisfacción a las 48 horas. Resultados: Se incluyeron 8 pacientes, con peso y altura media de 78 kg y 157 cm respectivamente. El análisis del dolor registrado a las 24 horas fue en un 62,5% de EVA 0, en un 25% EVA 5 y en un 12,5% EVA 6. A las 48 horas el 87,5% de los pacientes tenían un EVA 0 y un 12,5% EVA 4. Todos los pacientes con dolor lo localizaron en hueco poplíteo. En ningún caso hubo bloqueo motor. El 25% presentaron parestesias a las 24-48 horas y el 12,5% episodio de náuseas. En caso de analgesia insuficiente se complementó el tratamiento con AINE intravenosos y en un caso con bloqueo del nervio ciático por abordaje anterior. La técnica realizada resultó fácil en el 87,5% de los pacientes y muy difícil en el 12,5%. El grado de satisfacción fue superior a 7 en todos los pacientes. Conclusiones: El bloqueo 3 en 1 continuo en nuestra serie, proporcionó una analgesia eficaz en pacientes

  20. Hematoma epidural lombar pós-cirurgico em paciente com leucemia: relato de caso Hematoma epidural lumbar posquirúrgico en paciente con leucemia: relato de caso Postoperative lumbar epidural hematoma in a patient with leukemia: case report

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    Wagner Pasqualini

    2012-09-01

    Full Text Available A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente com leucemia.La ocurrencia de hematoma epidural, como complicación posquirúrgica, es relativamente baja. El reconocimiento de esa patología, en el diagnóstico diferencial en las paraplejías posquirúrgicas inmediatas y el tratamiento precoz por medio de intervención quirúrgica con la descompresión del canal, son factores que se relacionan directamente con la mejoría del cuadro neurológico. Este relato de caso es de un hematoma epidural en el posoperatorio inmediato, después de descompresión, por estenosis, del canal vertebral lumbar en paciente con leucemia.The occurrence of epidural hematoma as a postoperative complication is relatively low. The recognition of this condition in the differential diagnosis in the immediate postoperative paraplegia and the early surgical decompression are directly related with neurological improvement. We report a case of epidural hematoma in the early postoperative period of surgical decompression of the lumbar spinal canal, in a patient with leukemia.

  1. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico El bloqueo selectivo de los nervios supraescapular y axilar promueve una analgesia satisfactoria y un menor grado de bloqueo motor: comparación con el bloqueo interescalénico Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block

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    Patrícia Falcão Pitombo

    2013-02-01

    . El objetivo de este estudio fue comparar el bloqueo de los nervios supraescapular y axilar en las cirugías artroscópicas de hombro con el abordaje interescalénico del plexo braquial. MÉTODO: Sesenta y ocho pacientes fueron ubicados en dos grupos de 34, de acuerdo con la técnica utilizada: grupo Interescalénico (GI y grupo selectivo (GS, siendo ambos abordajes realizados con neuroestimulador. En el GI, y después de la respuesta motora adecuada, se inyectaron 30 mL de levopubivacaina en exceso enantiomérico de un 50% al 0,33% con adrenalina 1:200.000. En el GS, y después de la respuesta motora del nervio supraescapular y axilar, se inyectaron 15 mL de la misma sustancia en cada nervio. Enseguida se realizó la anestesia general. Las variables que se evaluaron fueron: tiempo para la realización de los bloqueos, analgesia, consumo de opioide, bloqueo motor, estabilidad cardiocirculatoria, satisfacción y aceptabilidad por parte del paciente. RESULTADOS: El tiempo para la ejecución del bloqueo interescalénico fue significativamente menor que para la realización del bloqueo selectivo. La analgesia fue significativamente mayor en el postoperatorio inmediato en el GI y en el postoperatorio tardío en el GS. El consumo de morfina fue significativamente mayor en la primera hora en el GS. El bloqueo motor fue significativamente menor en el GS. La estabilidad cardiocirculatoria, satisfacción y aceptabilidad de la técnica por el paciente no fueron diferentes entre los grupos. Ocurrió un fallo en el GI y dos en el GS. CONCLUSIONES: Ambas técnicas son seguras y eficaces con el mismo grado de satisfacción y de aceptabilidad. El bloqueo selectivo de ambos nervios presentó una analgesia satisfactoria, con la ventaja de proporcionar un bloqueo motor restringido al hombro.BACKGROUND AND OBJECTIVE: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular

  2. Calidad de vida de pacientes con cáncer de próstata en tratamiento con bloqueo androgénico continuo vs intermitente: estudio prospectivo mediante la aplicación del cuestionario CAVIPRES

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    C.R. Sierra Labarta

    2015-08-01

    Full Text Available Fundamento: El tratamiento con bloqueo androgénico intermitente (BAI pretende mejorar la calidad de vida de los pacientes con cáncer de próstata con los mismos resultados oncológicos que el bloqueo androgénico continuo (BAC. El presente trabajo compara la calidad de vida mediante la aplicación del cuestionario CAVIPRES entre dos grupos de pacientes, uno tratado con BAC y otro con BAI. Material y métodos: Se realizó un estudio longitudinal de 24 meses de duración que incluyó 114 pacientes. Tras 6 meses se aleatorizaron a ambos grupos de tratamiento (49 pacientes a BAC y 51 a BAI, controlándose posteriormente a los 6, 12 y 18 meses de aleatorizarlos. Se comparó la puntuación de los bloques de ítems y la puntuación global del cuestionario CAVIPRES entre ambos grupos de tratamiento y se estudió su variación a lo largo del tiempo. Resultados: Los pacientes con BAI presentaron mejor calidad de vida global que los pacientes con BAC (p=0,002. De los 5 bloques en los que se divide el cuestionario, el grupo BAI presentó mejor puntuación que el BAC en "Aspectos psicológicos" (p=0,009 y "Apoyo social y pareja" (p=0,008. El BAI mejoró la calidad de vida global de los pacientes a los 18 meses respecto al momento de la aleatorización (p=0,000, y la puntuación de "Vida Sexual" (p=0,000 y "Apoyo social y pareja" (p=0,002. El BAC no mejoró ni la calidad de vida global ni la puntuación de los diferentes bloques a largo del estudio (p>0,05. Conclusión: El BAI mejora la calidad de vida global de los pacientes a los 18 meses de la suspensión del tratamiento.

  3. Duración y calidad de la analgesia postoperatoria después del bloqueo del plexo braquial para cirugía del hombro: ropivacaína 0,5% frente a ropivacaína 0,5% con clonidina

    OpenAIRE

    Esteves, S; Sa, P.; Figueiredo, D.; Souto, A

    2002-01-01

    Resumen OBJETIVOS: Algunos estudios han demostrado que la duración de los bloqueos nerviosos realizados con anestésicos locales puede ser prolongada con clonidina. En este estudio evaluamos la duración y la calidad de la analgesia proporcionada por el bloqueo del plexo braquial por vía interescalénica para cirugía del hombro, comparando la ropivacaína 0,5% con la ropivacaína 0,5% asociada a clonidina. PACIENTES Y MÉTODOS: Treinta pacientes fueron distribuidos en ...

  4. Efectos de la estimulación sensorial sobre la marcha y bloqueos de paciente con Parkinson

    OpenAIRE

    Hernández Noriega, Blanca

    2015-01-01

    Los motivos que conducen a la elección del tema son: primero, el desarrollo de mi profesión como fisioterapeuta en una residencia de mayores. En segundo lugar, el observar algunas dificultades que supone la presencia de la enfermedad de Parkinson entre la población anciana, ya que es una enfermedad degenerativa crónica progresiva con alta prevalencia, y merma la calidad de vida. Hoy en día, debido al envejecimiento de la población, se están investigando cada día más las enfe...

  5. Comparação entre raquianestesia, bloqueio combinado raqui-peridural e raquianestesia contínua para cirurgias de quadril em pacientes idosos: estudo retrospectivo Comparación entre raquianestesia, bloqueo combinado raqui-peridural y raquianestesia continua para cirugías de cuadril en pacientes ancianos: estudio retrospectivo Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study

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    Luiz Eduardo Imbelloni

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversas questões envolvem os estudos, as análises e o tamanho da amostra para que sejam demonstrados os benefícios da anestesia regional. Análise de dados geralmente custa menos e requer menos tempo quando comparado com amplo estudo aleatório controlado. Esta análise retrospectiva compara a raquianestesia contínua, o bloqueio combinado raqui-peridural e a raquianestesia simples para cirurgias de quadril em pacientes idosos durante quatro anos, para determinar as possíveis vantagens e desvantagens das três técnicas. MÉTODO: Foram avaliados 300 prontuários sendo que: 100 pacientes receberam raquianestesia simples (Grupo 1, 100 receberam bloqueio combinado raqui-peridural (Grupo 2 e 100 receberam raquianestesia contínua (Grupo 3 nos últimos quatro anos. Todos os bloqueios foram realizados em decúbito lateral esquerdo. Foram avaliados: sucesso de punção, nível da analgesia, bloqueio motor de membros inferiores, qualidade da anestesia, necessidade de complementação, incidência de falhas, parestesias, cefaléia pós-punção, alterações cardiovasculares, confusão mental e delírio, transfusão sangüínea e mortalidade. RESULTADOS: Não existiu diferença significativa entre os grupos em relação a idade, peso e sexo. Os pacientes do grupo 2 foram menores do que os do grupo 1 e 3. As doses utilizadas foram de 15,30 mg de bupivacaína no grupo 1; 23,68 mg no grupo 2 e 10,10 mg no grupo 3. Não foi encontrada diferença significativa (p JUSTIFICATIVA Y OBJETIVOS: Diversas cuestiones envuelven los estudios, las análisis y el tamaño de la muestra para que sean demostrados los beneficios de la anestesia regional. Las análisis de datos generalmente cuestan menos y requieren menos tiempo, cuando comparado con un amplio estudio aleatorio controlado. Esta análisis retrospectiva compara la raquianestesia continua, el bloqueo combinado raqui-peridural y la raquianestesia simple para cirugías de cuadril en

  6. Ketamina epidural en cirugía de hemiabdomen inferior Epidural ketamine in low abdominal surgery

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    S. F. González-Pérez

    2006-04-01

    Full Text Available Introducción: La ketamina de uso corriente es una droga utilizada principalmente para la inducción y el mantenimiento de la anestesia, compuesta por una mezcla racémica de enantiómeros R (- y S (+. En la década de los años 80 comienza la administración humana de la ketamina por vía epidural. A partir de entonces se han presentado disímiles investigaciones para justificar su acción analgésica en este espacio con varias hipótesis: 1 supresión específica laminar de las astas dorsales, 2 mediación por el sistema opioide endógeno y sustancia gris periacueductal, y 3 bloqueo de los canales del calcio por antagonismo no competitivo de los receptores N-metil-d-aspartato. Objetivo: Demostrar la eficacia de la ketamina por vía epidural como analgésico postoperatorio en la cirugía de hemiabdomen inferior. Material y Método: Se realizó un ensayo clínico aleatorizado y prospectivo en una muestra de 50 pacientes operados de hernia inguinal electiva. Los pacientes fueron divididos en dos grupos, un grupo tratado con 50 mg de ketamina y otro grupo al que se le administró una dosis de 2 mg de morfina liofilizada. Resultados: la ketamina por vía epidural en una dosis de 50 mg proporciona una analgesia adecuada por un período de al menos de 6 horas. La morfina brinda una analgesia por encima de las 18 horas. Conclusión: La ketamina por vía epidural es menos efectiva que la morfina desde el punto de vista analgésico, pero es una alternativa importante pues permite disminuir la dosis de morfina si se combinan ambos fármacos o se asocia a anestésicos locales.Introduction: Ketamine is a drug used for induction and maintenance of anesthesia, exists as a racemic mixture of R- and S+-enantiomers. Epidural ketamine starts to human administration about 80’ years. After that, various studies have been published about the mechanism of analgesic action of ketamine: lamina-specific suppression of dorsal-horn unit activity (1, opiate agonist at

  7. Analgesia epidural para el trabajo de parto en gestante con esclerosis múltiple Epidural analgesia during labour of a patient with multiple sclerosis

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    M.J. Mayorga Buiza

    2010-07-01

    Full Text Available La Esclerosis Múltiple (EM, es una enfermedad del SNC siendo 2 veces más frecuente su aparición en mujeres, el 70% de ellas en edad fértil. Desde el punto de vista anestésico nos encontramos ante una enfermedad con elevada susceptibilidad neurológica que podría agravarse tanto por la propia cirugía, la técnica anestésica como por la medicación utilizada. Por otra parte se plantea como atender la demanda de analgesia para el trabajo de parto en mujeres con EM, que es el grupo de edad con mayor incidencia de la enfermedad. Presentamos el caso de una mujer de 37 años diagnosticada de esclerosis múltiples 3 años antes, forma recidivante, remitente. La paciente es ingresada en dilatación con 37 semanas de amenorrea, presentando una buena evolución del trabajo de parto y encontrándose el feto en situación longitudinal y presentación cefálica. Avisan al Servicio de Anestesia para valoración de la indicación de epidural para analgesia del parto. La gestante previamente había acudido a consulta de preanestesia donde se le había informado del riesgo beneficio de la técnica y en concreto en su caso, habiendo entendido perfectamente las posibles complicaciones derivadas de la misma y firmado el consentimiento informado. Nosotros hemos preferido utilizar una técnica locoregional, vía epidural considerando también el riesgo potencial de cesárea urgente, para evitar, dado el caso la realización de una técnica intraraquídea o una anestesia general, con las posibilidades de desencadenar un brote que tienen estas técnicas. Además de aportar confort a la paciente durante el trabajo de parto, proporcionar analgesia durante el mismo, disminuye por este motivo el estrés de la gestante pudiendo paralelamente evitar la aparición de un brote.Multiple sclerosis (MS is a disease of the central nervous system (CNS, and twice as prevalent in women, 70% of whom are of fertile age. From an anaesthetics point of view, due to it being a

  8. Bloqueo de ganglio de Gasser con Radiofrecuencia lesión VS glicerol intragasseriano para neuralgia trigeminal The gasser ganglion blockade with radiofrequency vs intragasserian glycerol in the management of trigeminal neuralgia

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    E. Hernández-Ruiz

    2008-04-01

    Full Text Available Introducción y Objetivo. En la neuralgia trigeminal hasta el momento no existe un tratamiento definitivo debido a la diferente respuesta a los diversos manejos por lo cuál ha sido para el médico un reto el cómo mejorar esta entidad. Se han diseñado diversas medidas de tratamiento dentro de las cuales en nuestro estudio evaluamos a 2 de estas. Técnicas quirúrgicas menores son métodos relativamente sencillos en manos hábiles del médico especialista experimentado en Algología Intervencionista. Comparamos el bloqueo de ganglio de Gasser con radiofrecuencia lesión vs bloqueo de ganglio de Gasser con glicerol intragasseriano. Material y métodos. En un estudio retrospectivo, observacional, comparativo, longitudinal. Se estudiaron un total de 58 pacientes con neuralgia trigeminal idiopática a los cuales se les realizó bloqueo de ganglio de Gasser, se dividieron en 2 grupos; los pacientes del Grupo I (23 pacientes, se les realizó bloqueo con Radiofrecuencia lesión, y al Grupo II (35 pacientes se les realizó bloqueo con glicerol intragasseriano, se evaluó intensidad del dolor mediante EVA, previo al procedimiento, inmediato, al mes, de 6 a 12 meses y de 12 a 24 meses. La frecuencia de recidiva y el intervalo de tiempo en la que se presentó, la incidencia de rebloqueo en tiempo y número de veces, la frecuencia de efectos secundarios. Resultados. No se observaron diferencias epidemiológicas entre ambos grupos. La rama trigeminal más afectada en el Grupo I fue V2- V3 52%, comparado con el Grupo II V2-V3 54.2%. La evolución del alivio al dolor se realizó mediante la Escala Visual Analógica (EVA realizando análisis estadístico mediante la prueba de U-Mann-Whitney la cuál fue significativa en la evaluación inmediata con una p: 0.01 Grupo I con EVA 0.82 y Grupo II un EVA 2.22, de 6-12 meses en el Grupo I con EVA 1.34 y Grupo II EVA 1.86 de 12-24 meses Grupo I EVA de 1.34 y Grupo II 1.55, no existiendo significancia estadística en

  9. Bloqueo auriculoventricular transitorio de primer grado en paciente con poliintoxicación por drogas de abuso y etanol: The Holiday Heart Syndrome

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    P Poveda Velázquez

    2014-01-01

    Full Text Available Las intoxicaciones por alcohol y drogas de abuso son una causa frecuente de consulta en los Servicios de Urgencias. Las alteraciones electrocardiográficas y las arritmias debidas a la ingesta de alcohol se conocen como Holiday Heart Syndrome. Este síndrome se define como la presencia de alteraciones del ritmo o de la conducción cardiaca asociadas al consumo de alcohol que revierten tras la intoxicación y que se producen en una persona sin enfermedad cardiaca conocida. La alteración más común es la fibrilación auricular. Se presenta el caso de una paciente joven que ingresa en urgencias por intoxicación por alcohol y diferentes drogas y que presentaba un bloqueo auriculoventricular de primer grado transitorio. Se discute el posible efecto causal de las drogas y del alcohol en los cambios electrocardiográficos observados en esta paciente.

  10. Bloqueo caudal en dolor crónico lumbar: ¿Es necesario el apoyo radiológico para disminuir los fallos de la técnica?

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    M. Cortiñas Sáenz

    2012-08-01

    Full Text Available Introducción: las infiltraciones de esteroides epidurales no ofrecen beneficio a largo plazo en el tratamiento del dolor de espalda, pero pueden ser eficaces en los pacientes con dolor radicular lumbosacro agudo. Los bloqueos epidurales vía caudal de esteroides son eficaces en el alivio sintomático a corto plazo (evidencia de nivel II, así como a largo plazo (nivel de evidencia III. Objetivos: evaluar la eficacia del bloqueo caudal con y sin guía fluoroscópica. Material y métodos: estudio prospectivo, observacional y descriptivo para evaluar la tasa de fallos de la realización del bloqueo caudal mediante la técnica "a ciegas" respecto a la guiada por radiología. El análisis estadístico incluyó chi2 de Mantel y Haensel, t de Student y test ANOVA, considerándose una p Introduction: epidural steroid injections offer no long-term benefit for the treatment of low back pain but may be effective in the small subset of patients with acute lumbosacral radicular pain. Caudal epidural steroid injection was effective in producing short-term improvement (level II evidence as well as long-term relief (level III evidence. Objetives: to evaluate of the effectiveness of the caudal epidural block under fluoroscopic guidance. Material and methods: prospective, observational and descriptive study to assess the failure rates of caudal block using the technique "blind" with respect to radiological vision. Statistical comparisons were based on the chi2 test, the long-rank test, t test and ANOVA test, considering a statistically significant result p < 0.05. Results: we performed 129 caudal epidural blocks in 89 patients for chronic pain conditions. The overall success rate of caudal block with a blind technique was of 65.11%. Statistically significant differences in the rate of technical failure of the blind for the variables professional experience of the anesthesiologist and the presence of obesity. The most common malposition in our cohort is the

  11. Analgesia epidural para parto en la gestante obesa Epidural analgesia for labour in obese patients

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    E. Guasch

    2006-10-01

    Full Text Available La obesidad es un problema global de salud en continuo aumento en el mundo desarrollado. Dado que la incidencia de la obesidad es mayor en mujeres que en hombres, los anestesiólogos con especial dedicación a la obstetricia, tendrán mayor oportunidad de enfrentarse a este tipo de pacientes. Nuestro objetivo es determinar la dificultad en la realización de la técnica epidural para analgesia de parto y analizar la incidencia de complicaciones ocurridas durante la punción en las gestantes obesas, así como evaluar la eficacia de la analgesia epidural en este grupo de pacientes en un estudio observacional retrospectivo de todos los bloqueos epidurales para analgesia de parto realizados en un hospital universitario de nivel 4 durante un periodo de cuatro años. Se ha estudiado un total de 13616 pacientes, clasificándolas según el índice de masa corporal en Kg./m² (IMC. En las pacientes no obesas (IMCObesity is an increasing global health problem in Developer countries. As its incidence is grater in women than men, obstetric anesthesiologists wil be envolved in the care of the obese patient more often. Our aim is to study punction dificulties in obese parturients requiring epidural analgesia for labor, and to compare punction complications between obese and non obese parturients as analgesic efficacy between obese and non obese patients in a retrospective observational study among all the epidural analgesic blocks performed in a universitary hospital in a four years period. We studied 13616 patients, who were classified according to body mass index in Kg/m² (BMI. In the non obese group patients (BMI<30; first attempt epidural success was achieved in 76,5%. Mild obese patients (BMI 30-32, severe obese (BMI 33-39 and morbid obese (BMI≥40, the percents were 69, 3%, 63,2% y 47,4% respectively. The comparison among obese and non obese patients was significati-vely different (p<0,001. Punction complications did not show differences among groups

  12. Reversión del bloqueo neuromuscular residual por atracurio y vecuronio con dosis bajas de neostigmina Reversion of atracurium and vecuronium residual nondepolarising neuromuscular blockade with low doses of neostigmine

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    J.R. Ortiz-Gómez

    2006-08-01

    Full Text Available Objetivos. Comprobar la eficacia de dosis bajas de neostigmina en la reversión del bloqueo neuromuscular no despolarizante residual (BNM-R. Material y Métodos. Se realizó el trabajo con 119 pacientes adultos, ASA I-III, anestesiados con tiopental, fentanilo, O2-N2O-isoflurano y atracurio (n=62 o vecuronio (n=57. Se monitorizó el BNM-R mediante registro electromiográfico del adductor pollicis ante estímulo ulnar tipo tren de cuatro (TOF, considerando recuperación espontánea un TOF-Ratio 75%. En caso contrario se revertía el BNM-R en función del grado de bloqueo (0-1, 2, 3 ó 4 respuestas al TOF con neostigmina (0,035; 0,03; 0,025 ó 0,02 mg/kg y atropina (0,0175; 0,015; 0,0125 ó 0,01 mg/kg respectivamente. Se registró el tiempo de decurarización y los efectos secundarios. Resultados. Los grupos resultaron demográficamente homogéneos, con TOF-Ratio>75% el 25,8 (atracurio y 21,1% (vecuronio, mostrando el resto 0-1 respuestas al TOF (11,3 y 19,2%, 2 (6,5 y 11,5%, 3 (4,8 y 7,6% ó 4 respuestas (51,6 y 50% respectivamente, decurarizándose en 10,5±7 (atracurio y 10,3±6,4 min (vecuronio. Hubo predominio de efectos secundarios en el grupo del atracurio (p=0,027 a expensas de sialorrea, naúseas y vómitos. No se registró ningún caso de recurarización. Conclusiones. La reversión del BNM-R con dosis bajas de neostigmina y atropina ajustadas al grado de bloqueo es efectiva incluso en bloqueos profundos y reduce el riesgo de efectos secundarios de estos fármacos.Objectives. To assess the effectiveness of low doses of neostigmine in the reversion of residual nonpolarising neuromuscular blockade (RNMB. Material and methods. The work involved one hundred and nineteen adult patients, ASA I-III, anaesthetised with fentanyl, thiopental, O2-N2O-isoflurane and atracurium (n=62 or vecuronium (n=57. RNMB was monitored with continuous electromyography of adductor pollicis with TOF stimulation. When TOF-Ratio (TR < 75%, neostigmine 0.035, 0.03, 0

  13. Avulsión del plexo braquial traumático no controlado con remifentalino: Papel de la analgesia epidural cervical Traumatic brachial plexus root avulsion unresponsive to remifentanyl role cervical epidural analgesia

    OpenAIRE

    M. Cortiñas; G. Moreno-Pardo; S. Uña; M. Arcasa; M. R. Calero; Parra, R.; R. Gálvez

    2007-01-01

    Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8) de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6). El dolor es controlado en fase crónica (escala visual analógica 2) con age...

  14. Avulsión del plexo braquial traumático no controlado con remifentalino: Papel de la analgesia epidural cervical Traumatic brachial plexus root avulsion unresponsive to remifentanyl role cervical epidural analgesia

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    M. Cortiñas

    2007-04-01

    Full Text Available Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8 de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6. El dolor es controlado en fase crónica (escala visual analógica 2 con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol.We presented you a patient who suffered a left brachial plexus avulsión with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8. High-dose remifentanil infusión was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6 epidural catheter. At discharge pain remained controlled (visual analogue scale 2 with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol.

  15. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

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    J. A. Delgado

    2005-05-01

    Full Text Available Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia. Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1 y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12: se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13: se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1 como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.. Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anot

  16. Análisis de la eficacia y seguridad del bloqueo iliofascial continuo para analgesia postoperatoria de artroplastia total de rodilla Analysis of the efficiency and safety of the ileofascial block for postoperatory pain after total knee arthroplasty

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    J. López González

    2012-10-01

    Full Text Available Objetivo: la importancia del dolor agudo postoperatorio radica en su alta frecuencia, en su inadecuado tratamiento y en las repercusiones que tiene en la evolución y en la recuperación del paciente. El bloqueo iliofascial puede ser una técnica adecuada para analgesia postoperatoria en la artroplastia total de rodilla. El objetivo de este estudio es valorar la eficacia y seguridad del bloqueo iliofascial, en comparación con el bloqueo epidural, a efectos de analgesia postquirúrgica en pacientes sometidos a artroplastia total de rodilla bajo anestesia subaracnoidea. Se valoró además si la realización del bloqueo iliofascial es una técnica analgésica segura, las complicaciones derivadas de la misma, los efectos secundarios y el grado de satisfacción del paciente. Material y métodos: estudio multicéntrico, prospectivo, aleatorio, observacional, controlado, con evaluador ciego, en 54 pacientes, adultos, ASA I-III, de ambos sexos, sometidos a cirugía de artroplastia total de rodilla bajo anestesia intradural. Los pacientes incluidos en el estudio se dividieron en dos grupos, BIF y BE. En el grupo BIF (n = 27 se colocó un catéter iliofascial, mientras que en el otro grupo BE (n = 27 se colocó un catéter epidural lumbar (a nivel L3-L4, en ambos casos para la analgesia postoperatoria continua. Ambos grupos recibieron el mismo protocolo analgésico con paracetamol y metamizol pautados, y rescate con bolos de morfina intravenosa. Se utilizó t-Student para comparar las variables cuantitativas. Se consideró significativo (p Objective: the importance of acute postoperative pain lies in its high frequency, where inadequate treatment and the impact it has on the evolution and the patient's recovery. Iliofascial block may be a suitable technique for postoperative analgesia after total knee arthroplasty. The aim of this study is to assess the efficacy and safety of the blockade iliofascial compared with epidural analgesia in postoperative

  17. Generación de inclusiones no metálicas y su efecto sobre el bloqueo de boquillas de colada continua en aceros ultra bajo carbono estabilizados con titanio

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    Vega-Becerra, O.

    2005-12-01

    Full Text Available This work presents a thermodynamic and experimental analysis of the phases that precipitate in the non metallic inclusions depending on the contents of aluminium (Al, titanium (Ti and oxygen (O in the steel, and their influence on the nozzle clogging. For the thermodynamic analysis, the program FACT WIN (Facility For The Analysis of Chemical Thermodynamics subroutine Equilib. was used. The experimental tests were carried out in an TAMMANN furnace, in an argon atmosphere. The control of the content of dissolved oxygen was carried out by means of sensors of solid electrolyte bases zirconia. The characterization of the inclusions was carried out with SEM, EDS and by means of the technique of fractional reduction with carbon. A good agreement was observed between the thermodynamic predictions and the experimental results.

    En este trabajo se presenta un análisis termodinámico y experimental de las fases que precipitan en inclusiones no metálicas en función de los contenidos de aluminio (Al, titanio (Ti y oxígeno (O en el acero y su influencia sobre el bloqueo de boquillas de colada continua. Para el análisis termodinámico se utilizó el programa FACT-WIN (Facility For The Analysis of Chemical Thermodynamics subrutina Equilib. Las pruebas experimentales se realizaron en un horno TAMMANN, en atmósfera de argón. El control del contenido de oxígeno disuelto se llevó a cabo mediante sensores de electrólito sólido base zirconia. La caracterización de las inclusiones se realizó por SEM, EDS y mediante la técnica de reducción fraccionada con carbono. Se observó una buena concordancia entre las predicciones termodinámicas y los resultados experimentales.

  18. Hematoma epidural lombar pós-cirurgico em paciente com leucemia: relato de caso Hematoma epidural lumbar posquirúrgico en paciente con leucemia: relato de caso Postoperative lumbar epidural hematoma in a patient with leukemia: case report

    OpenAIRE

    Wagner Pasqualini; Marcos Antonio Tebet; Mareio Oliveira Penna de Carvalho

    2012-01-01

    A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente c...

  19. Epidural abscess

    Science.gov (United States)

    ... intracranial epidural abscess if it is inside the skull area. It is called a spinal epidural abscess if it is found in the ... of infection is found. An abscess inside the skull is called an ... is called a spinal epidural abscess. It may be seen in people ...

  20. Correlación automatizada de parámetros geométricos mediante contornos de bloqueo en engranajes cilíndricos con contacto exterior//Automatic correlation of geometric parameters by means of blocking contours in spur and helical external gear

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    Robert Hernández-Ortega

    2012-12-01

    Full Text Available Este trabajo tuvo como objetivo obtener un procedimiento, que al implementarse en un software para el diseño de transmisiones por engranajes cilíndricos con contacto exterior, correlacione automáticamente los parámetros geométricos mediante los contornos de bloqueo y así facilitar el trabajo del diseñador deengranajes. Para ello, se transformaron las expresiones matemáticas que definen las limitaciones geométricas para que puedan ser utilizadas en un programa que construya el contorno de bloqueo sin la intervención del diseñador. Se estableció además la secuencia en que estas deben ser calculadas. El procedimiento obtenido se implementó en un programa de computación obteniéndose una velocidad deejecución de 1 segundo aproximadamente. De esta forma se logró la correlación automática de los parámetros geométricos y un contorno de bloqueo que muestra el conjunto de valores de los coeficientes de corrección de las ruedas que pueden ser utilizados, construidos sin interacción con el diseñador.Palabras claves: contorno de bloqueo, engranajes, parámetros geométricos._______________________________________________________________________________AbstractThe aim of this work was to obtain a procedure, that when being implemented in the design software of spur and helical external gears, correlate the geometric parameters automatically by means of the blocking contours making easier the designer's work. The mathematical expressions that define the geometriclimitations were transformed so that they can be used in a program that it builds the blocking contour without the designer's intervention. Besides that it was settled down the sequence they should be calculated. The procedure was implemented in a calculation program obtaining an execution speed about 1 second. This way it was achieved the automatic correlation of the geometric parameters and a blockingcontour construction without the designer's intervention that it shows the

  1. Estudio descriptivo sobre bloqueos atrio-ventriculares en infartos posteroinferiores en el Hospital de Caldas ESE

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    Wilmar Alberto Díaz

    2005-09-01

    Full Text Available Introducción: El infarto agudo de miocardio (IAM es un problema de salud pública a escala mundial y nacional, que merece una prevención, diagnóstico y tratamiento oportunos. El IAM de cara inferior presenta entre sus complicaciones el bloqueo atrio-ventricular (bloqueo AV en sus diversas manifestaciones. Materiales y métodos: El presente es un estudio de tipo descriptivo, retrospectivo realizado en el Hospital Universitario de Caldas ESE, por medio de la revisión de historias clínicas corresponismo atrio-DACCION diagnóstico, de alta calidad y de gran importancia. dientes a los años 1999 a 2002, de los pacientes que presentaron infarto agudo de miocardio de cara inferior. Se tomaron de las historias variables como edad, sexo, consumo de alcohol, tabaco, sedentarismo y la presencia o ausencia de enfermedades previas tales como hipertensión arterial, diabetes mellitus, dislipidemias e infarto agudo de miocardio previo y el tiempo de aparición del bloqueo (menor o mayor de 24 horas. Resultados: Se encontró una asociación significativa entre la incidencia de bloqueos AV con la edad (p=0.017 y el IAM previo (p=0.001 y entre mortalidad y tipo de bloqueo (p=0.028. No se presentó asociación entre los factores de riesgo asociados para IAM y la presentación de bloqueo, excepto una posible relación con la hipertensión arterial (p=0.176, no del todo clara, por lo cual se recomienda que sea explorada por estudios posteriores; 32.7% de personas con infarto de cara inferior tuvieron algún tipo de bloqueo y 77.1% de los bloqueos fueron en las primeras 24 horas. Conclusiones: Los pacientes que presenten un IAM de cara inferior con una edad >65 años, se deben someter a seguimiento con monitoría continua por electrocardiograma durante las primeras 24 horas; lo mismo todo paciente con IAM de cara inferior, se debe incluir dentro del grupo de seguimiento clínico, electrocardiográfico y de monitoreo estricto.

  2. Estudio descriptivo sobre bloqueos atrio-ventriculares en infartos posteroinferiores en el Hospital de Caldas ESE.

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    Wilmar Alberto Díaz

    2009-11-01

    Full Text Available Introducción: El infarto agudo de miocardio (IAM es un problema de salud pública a escala mundial y nacional, que merece una prevención, diagnóstico y tratamiento oportunos. El IAM de cara inferior presenta entre sus complicaciones el bloqueo atrio-ventricular (bloqueo AV en sus diversas manifestaciones. Materiales y métodos: El presente es un estudio de tipo descriptivo, retrospectivo realizado en el Hospital Universitario de Caldas ESE, por medio de la revisión de historias clínicas corresponismo atrio-DACCION diagnóstico, de alta calidad y de gran importancia. dientes a los años 1999 a 2002, de los pacientes que presentaron infarto agudo de miocardio de cara inferior. Se tomaron de las historias variables como edad, sexo, consumo de alcohol, tabaco, sedentarismo y la presencia o ausencia de enfermedades previas tales como hipertensión arterial, diabetes mellitus, dislipidemias e infarto agudo de miocardio previo y el tiempo de aparición del bloqueo (menor o mayor de 24 horas. Resultados: Se encontró una asociación significativa entre la incidencia de bloqueos AV con la edad (p=0.017 y el IAM previo (p=0.001 y entre mortalidad y tipo de bloqueo (p=0.028. No se presentó asociación entre los factores de riesgo asociados para IAM y la presentación de bloqueo, excepto una posible relación con la hipertensión arterial (p=0.176, no del todo clara, por lo cual se recomienda que sea explorada por estudios posteriores; 32.7% de personas con infarto de cara inferior tuvieron algún tipo de bloqueo y 77.1% de los bloqueos fueron en las primeras 24 horas. Conclusiones: Los pacientes que presenten un IAM de cara inferior con una edad >65 años, se deben someter a seguimiento con monitoría continua por electrocardiograma durante las primeras 24 horas; lo mismo todo paciente con IAM de cara inferior, se debe incluir dentro del grupo de seguimiento clínico, electrocardiográfico y de monitoreo estricto.

  3. Bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5% Bloqueo del plexo braquial por la vía posterior con el uso de neuroestimulador y ropivacaína a 0,5% Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine

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    Lúcia Beato

    2005-08-01

    ícula y húmero proximal. El objetivo de este estudio fue mostrar los resultados observados en pacientes sometidos a bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5%. MÉTODO: Veintidós pacientes con edad entre 17 y 76 años, estado físico ASA I y II, sometidos a cirugías ortopédicas envolviendo el hombro, clavícula y húmero proximal fueron anestesiados con bloqueo de plexo braquial por la vía posterior utilizando neuroestimulador desde 1 mA. Lograda la contracción deseada, la corriente fue disminuida para 0,5 MA y, permaneciendo la respuesta contráctil, fueron inyectados 40 mL de ropivacaína a 0,5%. Fueron evaluados los siguientes parámetros: latencia, analgesia, duración de la cirugía, duración de la analgesia y del bloqueo motor, complicaciones y efectos colaterales. RESULTADOS: El bloqueo fue efectivo en 20 de los 22 pacientes; la latencia media fue de 15,52 min; la duración media de la cirugía fue de 1,61 hora. La media de duración de la analgesia fue de 15,85 horas y del bloqueo motor 11,16 horas. No fueron observados señales y síntomas clínicos de toxicidad del anestésico local y ningún paciente presentó efectos adversos del bloqueo. CONCLUSIONES: En las condiciones de este estudio el bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5% demostró que es una técnica efectiva, confortable para el paciente y de fácil realización.BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II

  4. Estudio observacional de la analgesia epidural para trabajo de parto: Complicaciones de la técnica en 5.895 embarazadas Observational study of epidural analgesia used in labour: Complications of this technique in 5,895 pregnant women

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    M. Calvo

    2005-04-01

    Full Text Available Objetivos: a Conocer la incidencia de las complicaciones relacionadas con la técnica de analgesia regional durante la realización de la técnica, durante la dilatación y en el postparto; y b conocer si las complicaciones del postparto relacionadas con la técnica analgésica son más frecuentes cuando se realiza la técnica combinada epidural-subaracnoidea (CES en comparación con la analgesia epidural. Material y método: Hemos realizado un estudio observacional descriptivo y analítico. Como sujetos del estudio hemos incluido a todas las mujeres que solicitaron la administración de analgesia regional a la Unidad de Analgesia Epidural de nuestro hospital (5.895 embarazadas y cumplían los criterios de inclusión, en un periodo de tiempo que empieza en el 1 de enero del año 2002 y termina el 1 de enero del año 2003. Las técnicas empleadas para el control del dolor del trabajo del parto fueron la analgesia epidural y la técnica combinada epidural-subaracnoidea. Resultados: La complicación que más frecuentemente apareció durante la realización de la técnica fueron las parestesias (43,5% seguido de la punción hemática (5,9%. La punción no intencionada de la duramadre ha ocurrido en el 0,6%. Las complicaciones que más frecuentemente aparecieron durante el periodo de dilatación fue el prurito (11,4% y la analgesia lateralizada (9%. La complicación más frecuente del periodo postparto fue el dolor de espalda (9,8% y la cefalea (2%. Las complicaciones en general han sido significativamente más frecuentes en las embarazadas a las que se les aplicó la técnica CES, en comparación con la analgesia epidural convencional. Conclusiones: Las complicaciones que pueden aparecer debido a este modo de analgesia van desde unas poco frecuentes y potencialmente peligrosas si pasan desapercibidas (como la inyección intravascular de anestésicos locales o el bloqueo espinal total a otras más frecuentes como las parestesias, con una repercusi

  5. Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência do fentanil associado ao anestésico local na qualidade do bloqueio e na analgesia pós-operatória Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia del fentanil asociado al anestésico local en la calidad del bloqueo y en la analgesia pos-operatoria Extraconal block for cataract extraction surgery with implantation of intraocular lens: contribution of fentanyl associated to local anesthetics for quality of block and postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Daniel Espada Lahoz

    2003-09-01

    melhorou a qualidade do bloqueio quanto à motilidade do músculo reto medial e diminuiu a necessidade de analgésicos no pós-operatório.JUSTIFICATIVA Y OBJETIVOS: La anestesia locorregional para cirugías oftalmológicas ofrece ventajas, como: mínimas alteraciones fisiológicas, anestesia completa, bloqueo de los reflejos oculares, pequeña incidencia de náuseas y vómitos, menor tiempo de recuperación y analgesia pos-operatoria. La preocupación constante con la calidad del bloqueo, así como la abordaje de la analgesia pos-operatoria debe quedar bajo la responsabilidad del anestesiologista. El objetivo de este estudio fue evaluar si el fentanil contribuye en la calidad del bloqueo extraconal y en la analgesia pos-operatoria de facectomias con implantación de lente intra-ocular. MÉTODO: Se estudió la asociación del fentanil y bupivacaína a 0,75% en la calidad del bloqueo ocular y en la analgesia pos-operatoria en 164 pacientes sometidos a facectomia con implantación de lente intra-ocular (técnica extracapsular, de ambos sexos con homogeneidad de parámetros antropométricos, ojo operado, clasificación del estado físico (ASA e índice de riesgo cardíaco de Goldman. Los pacientes fueron distribuidos en dos grupos (82 pacientes en cada grupo por sorteo de forma aleatoria, con y sin fentanil. Se evaluó la calidad del bloqueo por: aparecimiento de dolor en el per-operatorio, manutención de movimentación de los párpados o del globo ocular, persistencia del reflejo de Bell, número de bloqueos realizados para la obtención de condiciones quirúrgicas y evaluación del bloqueo por el cirujano. La analgesia pos-operatoria fue evaluada por la necesidad de complementación analgésica por el paciente. RESULTADOS: Fentanil asociado a la solución anestésica en el bloqueo extraconal aumentó significativamente el bloqueo del músculo recto medial (con fentanil - 17,1%, sin fentanil - 32,9% y diminuyó el consumo de analgésicos en el período pos-operatorio (uso

  6. Analgesia postoperatoria en la cirugía del pie y tobillo mediante bloqueo ciático poplíteo lateral con ropivacaína Postoperative analgesia in foot and ankle surgery through lateral popliteal sciatic blockade with ropivacaine

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    G. Valladares

    2004-03-01

    Full Text Available Introducción: El bloqueo del nervio ciático en la fosa poplítea proporciona una adecuada y prolongada analgesia postoperatoria en la cirugía del pie y tobillo. La principal ventaja del abordaje lateral es que no es preciso modificar la posición de decúbito supino del paciente para la realización de la técnica, mientras que en el abordaje posterior el paciente ha de colocarse en decúbito prono, lo cual puede resultar difícil e incluso desaconsejable en determinadas situaciones: estados avanzados de gestación, inestabilidad hemodinámica y ventilación mecánica. Material y método: Se incluyeron pacientes valorados con riesgo anestésico ASA I-II, programados para cirugía ortopédica-traumatológica del pie o tobillo. Se realizó un bloqueo del nervio ciático en la fosa poplítea mediante abordaje lateral según la técnica descrita por Vloka J.D y Hadzic A, empleándose una aguja para neuroestimulación, biselada de calibre 22G x 80 mm. Se consideró como respuesta motora adecuada cualquier movimiento del pie o dedos a intensidad inferior a 0,4 mA y superior a 0,1 mA. La observación de una respuesta motora a intensidad de estimulación de 0,1 mA se consideró como localización intraneural de la aguja. Se inyectaron 40 mL de ropivacaína 0,5%. Las principales variables que se registraron a las 8, 16 y 24 horas tras la realización del bloqueo fueron el dolor en reposo y en movimiento según la escala visual analógica (EVA de 0-10 y el grado de satisfacción. Resultados: Se incluyeron 21 pacientes ASA I-II. El dolor medio en reposo fue valorado como de intensidad 1 en las primeras 8 horas y de intensidad 3 a las 16 h y 24 h tras la realización del bloqueo. El dolor medio con el movimiento articular fue valorado como de intensidad 2 a las 8 h y de intensidad 4 a las 16 h y 24 h tras el bloqueo. El grado de satisfacción medio referido por los pacientes fue de 9. Discusión: El abordaje lateral, como en la serie que presentamos, nos

  7. Espondilodiscitis y absceso epidural candidiásico Candida spondylodiscitis and epidural abscess

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    Gisela Di Stilio

    2006-08-01

    Full Text Available La espondilodiscitis candidiásica asociada a absceso epidural es una enfermedad de aparición excepcional. Se presenta el caso de un paciente con linfoma de Hodgkin en tratamiento quimioterápico que desarrolló candidiasis sistémica complicada con espondilodiscitis y absceso epidural por dicho germen.Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess.

  8. Bloqueo neurolítico del tercer ganglio simpático dorsal en pacientes con síndrome de Raynaud: Una serie de casos Neurolytic blocking third dorsal simpathetic ganglion in patients with Raynaud´s syndrome: A number of cases

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    J. A. Flores Cantisani

    2013-04-01

    Full Text Available Introducción: El fenómeno de Raynaud es un trastorno vascular, frecuente en la población general, que consiste en la aparición paroxística de espasmo vascular distal, en pequeñas arterias y arteriolas cutáneas de las extremidades, con escasa repercusión sistémica. Existen bases anatómicas y fisiológicas para producir un bloqueo simpático selectivo utilizando agentes neurolíticos en los ganglios torácicos T2 y T3, considerados estaciones sinápticas que se distribuyen en el miembro superior. Objetivo: Determinar la eficacia del bloqueo neurolítico del tercer ganglio dorsal en el síndrome de Raynaud de una serie de casos. Material y métodos: Se realizó la revisión de expedientes de una serie de ocho casos con fenómeno de Raynaud de causa multifactorial, en la Clínica del Dolor de la Unidad Médica de Alta Especialidad Monterrey; Nuevo León, México. Casos: Ocho casos de 41 a 72 años de edad con fenómeno de Raynaud, tratados médicamente, a los cuales se les realizaron simpaticolisis del tercer ganglio dorsal. Conclusiones: El fenómeno de Raynaud tiene una prevalencia que va del 1 al 25%, en este hay una actividad simpática aumentada por lo que al realizar una simpaticolisis selectiva se logra mejorar el dolor isquémico, el cual está determinado por la insuficiencia total o parcial en el aporte de oxígeno a los tejidos, además de que tenemos bases anatómicas y fisiológicas para limitar el bloqueo a los ganglios T2 y T3, considerados como las estaciones sinápticas que interrumpen los impulsos que se distribuyen en el miembro superior, siendo por tanto más selectivos y con menores efectos adversos para el paciente.Background: Raynaud's phenomenon, a vascular disorder that is common in the general population, consists of paroxysmal onset distal vasospasm in small cutaneous arteries and arterioles of extremities, usually with little systemic impact. There are anatomical and physiological bases to produce a selective

  9. Epidural block

    Science.gov (United States)

    ... Drugs & Supplements Videos & Tools Español You Are Here: Home ... It numbs or causes a loss of feeling in the lower half your body. This lessens the pain of contractions during childbirth. An epidural block may also be used to ...

  10. Bloqueo y ensombrecimiento en un grupo de vertebrados filogenéticamente antiguo: los anfibios

    Directory of Open Access Journals (Sweden)

    M. Florencia Daneri

    2013-01-01

    Full Text Available En este artículo se describe el estudio de los fenómenos de bloqueo y ensombrecimiento en una tarea de aprendizaje espacial en un anfibio, el sapo terrestre Rhinella arenarum. Ambos fenómenos de aprendizaje, ampliamente observados en otras clases de vertebrados, se describen por primera vez en un grupo con un cerebro filogenéticamente antiguo, como es el caso de los anfibios. Específicamente, se observó durante el aprendizaje espacial: (1 bloqueo entre claves visuales asociadas a una meta, y (2 ensombrecimiento de una clave visual lejana por la presencia de una clave cercana. Este hecho permite sentar un precedente para estudiar posteriormente los mecanismos biológicos que rigen el aprendizaje espacial, en búsqueda de patrones funcionales comunes con otras clases de vertebrados, potencialmente presentes en un ancestro común.

  11. Cronobiología en anestesia epidural Obstétrica: Efecto de la noche sobre el índice de complicaciones Cronobiology in obstetric epidural anesthesia: consequences of the sleep deprivation among anestresiologist in the complications rate

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    F. Martínez-Jiménez

    2006-03-01

    Full Text Available Introducción: Los efectos del trabajo continuado y nocturno sobre la atención y la incidencia de complicaciones en desarrollo habitual de las labores del médico han sido previamente estudiados, aunque con resultados poco concluyentes. Objetivo: Comparar la incidencia de complicaciones, durante la punción, en el curso del bloqueo, como consecuencia de una analgesia incompleta y evaluar las diferencias que existen entre el día y la noche definiendo día como el periodo entre 9:00 y 21:59 h y noche: de 22:00 a 8:59 h. Material y métodos: Hemos realizado un estudio de los bloqueos recogidos en nuestra base de datos informatizada de pacientes a quienes se practicó algún bloqueo central para analgesia del parto realizados en un hospital universitario de grado 4, con atención durante las 24 horas, durante un periodo de 2 meses. Resultados: Se ha estudiado un total de 1097 pacientes, homogéneas en su distribución (variables demográficas y obstétricas, entre el día y la noche. El número de pacientes a las que se les practica un bloqueo analgésico para trabajo de parto no muestra diferencias entre el día y la noche. No hemos encontrado diferencias en la incidencia de complicaciones en la punción ni de analgesia incompleta, deficiente o necesidad de re-punción. Conclusiones: Parece que el cansancio o la falta de sueño no influyen en la incidencia de complicaciones en la analgesia para el trabajo de parto en una unidad de atención las 24 horas. Probablemente, los médicos se ven incentivados por la realización de una tarea interesante.Introduction: Sleep deprivation effects in vigilance, performance and complications have been previously studied in general population and in medical tasks too. Results from these studies weren’t definitive. Aim: Our objective is to compare the number of complications during the epidural puncture itself, (haematic, paresthesias, accidental dural puncture and others during the analgesia period (lateral

  12. Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência da via de acesso (superior ou inferior na qualidade da anestesia Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia de la vía de acceso (superior o inferior en la calidad de la anestesia Extraconal block for cataract extraction surgery with implantation of intraocular lens: influence of access way (upper or lower in anesthetic outcome

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    Daniel Espada Lahoz

    2003-08-01

    implante de lente intra-ocular.JUSTIFICATIVA Y OBJETIVOS: En las intervenciones quirúrgicas para oftalmología no se encontró técnica de anestesia totalmente segura, la introducción de la anestesia extraconal hizo que aumentasen las indicaciones de cirugías oculares con bloqueo, ya que la incidencia de complicaciones graves es menor, un hecho ya descrito por Hay, en 1991. Los bloqueos extraconales pueden ser realizados por varias vías de acceso, entre ellas, la superior y la inferior. El objetivo de este estudio fue evaluar cual vía de acceso (superior o inferior promueve bloqueo anestésico de mejor calidad. MÉTODO: Fueron incluidos en este estudio 164 pacientes, de ambos sexos, con edades entre 23 y 92 años, estado físico ASA I a IV, índice cardíaco 1 y 2 de Goldman, con indicación de facectomia con implantación de lente intra-ocular. Los pacientes fueron distribuidos aleatoriamente en dos grupos de 82 de acuerdo con la vía de acceso primaria del bloqueo extraconal: grupo ES (extraconal superior y EI (extraconal inferior. La calidad del bloqueo fue evaluada por el aparecimiento de dolor en el per-operatorio, manutención de movimentación de las pálpebras o del globo ocular, persistencia del reflejo de Bell, número de bloqueos realizados para la obtención de condiciones quirúrgicas y evaluación del bloqueo por el cirujano. RESULTADOS: La vía de acceso superior presentó mayor incidencia de acinesis de pálpebras (Vía superior - 56,1%; vía inferior - 36,6% del músculo recto superior (vía superior 93,9%; vía inferior 65,9%, así como menor necesidad de bloqueos complementares (vía superior 29,3%; vía inferior 42,7%. La vía de acceso inferior presentó mayor acinesis del músculo recto inferior (vía superior 72%; vía inferior - 84,1% sin diferencia estadística. CONCLUSIONES: En las condiciones de este estudio, la vía extraconal superior demostró que es superior en relación a la vía extraconal inferior, como vía de acceso primaria para

  13. Tratamiento epidural del dolor en la isquemia vascular periférica (I Treatment of epidural pain in peripheral vascular ischemia (I

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    M.J. Orduña González

    2009-03-01

    Full Text Available La isquemia arterial periférica puede ser el resultado de diversas enfermedades que afectan la vascularización de los miembros, generando dolor, discapacidad y deterioro de la calidad de vida del paciente, y en los casos de isquemia crítica produciendo una considerable morbimortalidad y dolor crónico. El objetivo ha sido realizar una revisión histórica de publicaciones científicas acerca de los distintos tipos de isquemia periférica, del dolor derivado, de su tratamiento analgésico por vía epidural y de las peculiaridades que hay que tener en cuenta en dicha patología. Se ha realizado una búsqueda en MEDLINE y se han recopilado los principales datos respecto a la evolución y las principales líneas de investigación científicas publicadas en las áreas de la analgesia epidural y el dolor en el contexto de la isquemia arterial periférica. Desde su introducción terapéutica en la isquemia periférica, la analgesia con perfusión de fármacos epidurales ha constituido un método eficaz analgésico, que en el caso de los anestésicos locales, además, aporta efectos hemorreológicos positivos a través de un bloqueo simpático. La neuroestimulación eléctrica epidural (NEE medular es una modalidad analgésica crónica con indicaciones específicas dentro de la isquemia periférica, con potencial efecto trófico y capacidad de preservación de miembros, incluso en isquemia crítica aterooclusiva. El efecto, tanto analgésico como trófico de las distintas modalidades analgésicas epidurales, varía según sus características técnicas y según los distintos tipos de isquemia periférica. Se deben tener en cuenta las limitaciones y riesgos del tratamiento analgésico epidural en la isquemia de miembros. Se necesitan estudios científicos que evalúen la eficiencia y la efectividad de la NEE en la isquemia periférica de naturaleza no aterooclusiva, así como la investigación de parámetros clínicos vasculares que puedan actuar como

  14. Hematoma epidural secundario a anestesia espinal: Tratamiento conservador Epidural hematoma secondary to spinal anesthesia: Conservative treatment

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    M. Bermejo

    2004-11-01

    Full Text Available Introducción: El hematoma epidural secundario a una anestesia neuroaxial es una complicación poco frecuente, pero de gran trascendencia tanto por sus implicaciones clínicas como por las médico legales; según algunos autores su incidencia puede oscilar entre 1/190.000-1/200.000 para las punciones peridurales y 1/320.000 en el caso de las espinales. El aspecto prioritario en su manejo terapéutico es el del diagnóstico y tratamiento precoz, antes de las 6-12 primeras horas. No obstante, en determinados pacientes como en el caso que presentamos puede no ser precisa la cirugía, resolviéndose el cuadro con tratamiento conservador. Caso clínico: Varón de 73 años, ASA IV, con antecedentes de cirrosis con hipertensión portal, hiperesplenismo, EPOC, obesidad, cardiopatía hipertensiva e insuficiencia tricuspídea. Se programa para alcoholización prostática al haber sido desechada la cirugía. En la analítica preoperatoria destacaba una actividad de protrombina del 80% y 90.000 plaquetas. Se realizaron varios intentos fallidos de punción espinal, finalmente fue precisa una anestesia general con ventilación espontánea mediante mascarilla laríngea, propofol, fentanilo y sevoflurano. A las 36 horas, comienza la clínica en forma de dolor intenso lumbar, sin irradiación y arreflexia cutáneo plantar, confirmándose en la RMN la presencia de un hematoma epidural de L1 a L4. Ante la ausencia de paraparesia flácida, afectación esfinteriana u otros signos sensitivo-motores y tras consulta con la Unidad de Raquis y con el Servicio de Neurología se decide tratamiento conservador y actitud expectante en forma de analgesia y monitorización neurológica estricta, clínica y radiológica. Evolucionando favorablemente en los siguientes días. Discusión: Determinadas condiciones clínicas pueden influir en la aparición de un hematoma tras la realización de un bloqueo regional central: heparinas de bajo peso molecular, punciones dificultosas

  15. Determinación de la eficacia analgésica de los bloqueos del ganglio estrellado en el síndrome doloroso regional complejo con dolor mediado por el sistema nervioso simpático: estudio preliminar Study of the analgesic efficacy of stellate ganglion blockade in the management of the complex regional pain syndrome in patients with pain mediated by sympathetic nervous system: preliminary study

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    R. F. Rodríguez

    2006-05-01

    Full Text Available Objetivo: Este estudio fue realizado con el propósito de determinar la eficacia analgésica de los bloqueos del ganglio estrellado, en el alivio del dolor mediado por el sistema nervioso simpático, en pacientes con síndrome doloroso regional complejo. Pacientes y métodos: Se realizó un ensayo clínico controlado con asignación aleatoria y enmascaramiento simple. Treinta y nueve pacientes fueron tratados con una serie de bloqueos de ganglio estrellado, terapia física y tratamiento farmacológico, mientras que treinta y dos pacientes fueron tratados con fisioterapia y el mismo esquema farmacológico. Para determinar la asociación entre las variables se utilizó el riesgo relativo con sus respectivos intervalos de confianza. Resultados: En la evaluación clínica realizada un mes postratamiento se encontró alivio del dolor en 84,6% de los pacientes del grupo de intervención y en 78,1% de los controles (RR= 1,08; I.C. 95%=0,8-1,4; p=0.48, sin encontrarse diferencias estadísticamente significativas. No se encontró asociación entre la eficacia analgésica y tabaquismo, dominancia, género, tipo de SDRC, causa desencadenante y nivel educativo.Objective: The purpose of this study was to determine the analgesic efficacy of stellate ganglion blockade in pain mediated by the sympathetic nervous system in patients with Complex Regional Pain Syndrome (CRPS. Patients and methods: A randomized, simple-blinded controlled clinical trial was conducted. Thirty nine patients were randomly assigned to an intervention group which was treated with a series of stellate ganglion blockades, physical therapy and pharmacological treatment, and thirty two to a control group which was treated with physical therapy and the same pharmacological treatment. Risk ratio was used to evaluate outcome and determine association with predictor variables. Results: At the end of the first month post treatment, it was found that 84.6% of patients in the intervention group had

  16. Peridural torácica alta associada ou não à peridural torácica baixa em pacientes ambulatoriais: implicações clínicas Peridural torácica alta asociada o no a la peridural torácica baja en pacientes ambulatoriales: implicaciones clínicas High thoracic epidural anesthesia associated or not to low thoracic epidural anesthesia in outpatient procedures: clinical implications

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    Djalma Sperhacke

    2004-08-01

    así como en los miembros superiores e inferiores. MÉTODO: Treinta y dos pacientes, estado físico ASA I y II, sin molestia pulmonar broncoespástica, en actividad y peso corporal igual o superior a 50 kg, fueron sometidos a 21 bloqueos peridurales torácicos aislados en T2-T3 y las 11 restantes, a bloqueos peridurales torácicos en T11-T12, con ropivacaína a 7,5% (45 a 90 mg asociada al sufentanil (10 a 20 µg. Repercusiones hemodinámicas, respiratorias y motoras en los miembros superiores e inferiores fueron evaluadas respectivamente, sobre monitorización no invasiva, espirometria, fuerza de preensión de la mano y escala de Bromage. RESULTADOS: La media de duración de las cirugías mamarias fue de 105 min con depresión motora de los miembros superiores (p BACKGROUND AND OBJECTIVES: Hemodynamic changes are easily controlled under low or median thoracic epidural block. Since high thoracic epidural block (T2-T3 often affects brachial plexus roots (C4 C5-T1(T2, some of them responsible for phrenic nerve formation (C3-C4-C5, potential motor repercussions on this nerve are to be expected. Our study performed during cosmetic surgeries under isolated segmental epidural block in T2-T3 or associated to segmental epidural block in T11-T12, has evaluated motor repercussions on respiratory dynamics, upper and lower limbs. METHODS: Participated in this study 32 patients physical status ASA I and II, without active bronchospastic pulmonary disease and body weight equal to or above 50 kg, 21 of whom were submitted to isolated thoracic epidural blocks in T2-T3 and the remaining patients (11 were submitted to a combined thoracic epidural blocks in T11-T12 with 7.5% ropivacaine (45 to 90 mg associated to sufentanil (10 to 20 µg. Hemodynamic, respiratory and upper and lower limbs motor repercussions were evaluated by noninvasive monitoring, spirometry hand grasping strength and Bromage score, respectively. RESULTS: Mean mammary surgeries duration was 105 minutes with upper

  17. Síndrome de Horner contralateral asociado a bloqueo de ganglio estrellado: reporte de caso y revisión de la literatura

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    A. Cadavid Puentes; F. Bermúdez Guerrero; M.V. Zea Medina

    2014-01-01

    Se describe un caso de síndrome de Horner contralateral luego de bloqueo de ganglio estrellado. Se trata de un varón de 56 años con diagnóstico de síndrome doloroso regional complejo tipo II en miembro superior derecho quien posterior a la aplicación de anestésico local guiado por ecografía en proximidad al ganglio estrellado derecho presenta síndrome de Horner izquierdo. El síndrome de Horner contralateral a un bloqueo de ganglio estrellado es una entidad de ocurrencia supremamente rara, en ...

  18. Uso de la ecografía para el bloqueo de nervios periféricos del miembro torácico en el gato (Felis catus L:)

    OpenAIRE

    Ansón Fernández, Agustina

    2016-01-01

    Objetivos 1. Describir los abordajes ecográficos para la evaluación del plexo braquial (PB) y los principales nervios del miembro torácico, así como la anatomía y apariencia ecográfica normales correlacionando las imágenes ecográficas con la disección anatómica y las criosecciones. 2. Establecer los abordajes ecográficos para el bloqueo ecoguiado del PB. 3. Determinar la eficacia de los diferentes abordajes para el bloqueo anestésico ecoguiado del PB, mediante la evaluación de la d...

  19. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1 com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1 con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1 and spinal anesthesia with morphine

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    Neuber Martins Fonseca

    2003-04-01

    perivascular inguinal, llamado de bloqueo 3 en 1, ha sido utilizado para analgesia pós-operatoria. El objetivo de este estudio fue comparar la analgesia pós-operatoria del bloqueo 3 en 1 a la de la morfina subaracnóidea en pacientes sometidos a cirugías ortopédicas en miembro inferior (MI. MÉTODO: Fueron estudiados 40 pacientes escalados para cirugía ortopédica de MI, de ambos sexos, estado físico ASA I y II, con edades entre 15 y 75 años, distribuidos en 2 grupos (M y BPL. Fue realizada anestesia subaracnóidea en todos los pacientes, en L3-L4 ó L4-L5, con 20 mg de bupivacaína isobárica a 0,5%. En el grupo M (n = 20 fue asociado 50 µg de morfina al anestésico local. En el grupo BPL (n = 20 fue realizado el bloqueo 3 en 1 al término de la cirugía, utilizando 200 mg de ropivacaína a 0,5%. Se evaluó la analgesia y la intensidad del dolor a las 4, 8, 12, 14, 16, 20 y 24 horas después del término de la cirugía, el nivel del bloqueo subaracnóideo, el tiempo quirúrgico y las complicaciones. RESULTADOS: La duración de la analgesia en el grupo BPL fue de 13,1 ± 2,47, en cuanto en el grupo M todos los pacientes referían dolor y ausencia de bloqueo motor en el primero instante evaluado (4 horas. Hubo falla del bloqueo de uno de los 3 nervios en 3 pacientes. La incidencia de náusea y prurito fue significativamente mayor en el grupo M. Cuanto a la retención urinaria, no hubo diferencia significante entre los grupos. No hubo depresión respiratoria, hipotensión arterial o bradicardia. La analgesia pós-operatoria fue mas efectiva en el grupo BPL, comparada al grupo M a las 4, 8, 12,14 y 16 horas. A las 20 y 24 horas no hubo diferencia significante entre los grupos.BACKGROUND AND OBJECTIVES: Perivascular Lumbar plexus inguinal block, (3-in-1 block has been used for postoperative analgesia. This study aimed at comparing postoperative analgesia of 3-in-1 block and spinal morphine in patients submitted to lower limb orthopedic surgeries (LL. METHODS: Forty ASA I

  20. Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2% Prevalencia de parálisis diafragmática después del bloqueo del plexo braquial por la vía posterior con ropivacaína a 0,2% Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

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    Marcos Guilherme Cunha Cruvinel

    2006-10-01

    consecuencias es la parálisis diafragmática. En pacientes con algún grado de disfunción pulmonar previa, esa parálisis puede conllevar a la insuficiencia respiratoria. El abordaje del plexo braquial por vía posterior ha conquistado espacio. El objetivo de este estudio fue el de determinar la prevalencia de parálisis diafragmática, después del bloqueo de plexo braquial interescalénico por vía posterior con el uso de ropivacaína a 0,2%. MÉTODO: Veinte y dos pacientes sometidos al bloqueo del plexo braquial interescalénico por vía posterior con ropivacaína a 0,2% fueron evaluados en el postoperatorio con el objetivo de identificar señales radiológicas de elevación de la cúpula diafragmática sugestivas de parálisis hemidiafragmática. En 20 pacientes se utilizó 40 mL de ropivacaína a 0,2%, en ellos fue realizada la radiografía de tórax en inspiración. En dos fueron utilizados 20 mL de ropivacaína a 0,2%, con la siguiente evaluación fluoroscópica. RESULTADOS: No hubo complicaciones relacionadas con la realización del bloqueo. En todos los pacientes, el bloqueo fue efectivo y proporcionó una buena analgesia postoperatoria. Se observó una elevación de la cúpula diafragmática compatible con la parálisis hemidiafragmática en todos los casos estudiados. CONCLUSIONES: En las condiciones de este estudio se pudo observar que el bloqueo del plexo braquial por vía posterior es una técnica que está asociada a la alta prevalencia de parálisis diafragmática, incluso cuando se utilizan bajas concentraciones de anestésico local.BACKGROUND AND OBJECTIVES: Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become

  1. Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica Obstetric epidural analgesia: failures and neurological complications of the technique

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    M. I. Segado-Jiménez

    2011-10-01

    Full Text Available Objetivos: Estudiar la incidencia de fallos y complicaciones neurológicas de la analgesia epidural en obstetricia, así como hacer un seguimiento y análisis de las mismas. Pacientes y método: Estudio observacional prospectivo de gestantes que recibieron analgesia epidural para el trabajo de parto en un hospital terciario durante 2009 y 2010. Se registraron los datos demográficos maternoinfantiles, del trabajo de parto y el tipo de parto así como las complicaciones que se produjeron tanto durante la realización de la técnica como durante el peri- y postparto. Se siguieron a todas las pacientes hasta su alta hospitalaria identificándose y tratándose las posibles complicaciones hasta su resolución. Resultados: Se incluyeron 438 gestantes. Se dividieron las complicaciones en 2 etapas: peripartum y postpartum. En el periparto se identificaron, de mayor a menor frecuencia, las siguientes complicaciones: analgesia lateralizada (16,4%, punción hemática (8,7%, parestesias (8,2%, técnica dificultosa (5,2%, analgesia ineficaz (2,7%, hipotensión arterial (2,5% y bloqueo subdural (0,2%. En el postparto: lumbalgia (18,5%, retención urinaria (3,4%, cefalea post-punción dural (1,4%, neuropatías periféricas (0,9% e hipoestesia prolongada (0,2%. Todas las complicaciones se resolvieron ad integrum con tratamiento conservador salvo un caso de cefalea que precisó la realización de un parche hemático. Conclusiones: La alta tasa de fallos de la analgesia epidural en obstetricia así como la posibilidad de complicaciones neurológicas pueden resolverse siguiendo unas normas de buena práctica que incluyen la aspiración previa a la inyección, la dosis test y la revisión periódica del catéter. Resulta imprescindible conocer dichas complicaciones para su evaluación y tratamiento precoz.Objectives: To determine the incidence of failures and neurological complications related to the epidural analgesia for labour and to analyze their evolution and

  2. Efeitos da clonidina por via muscular e perineural no bloqueio do nervo isquiático com ropivacaína a 0,5% Efectos de la clonidina por vía muscular y perineural en el bloqueo del nervio isquiático con ropivacaína a 0,5% Effects of intramuscular and perineural clonidine on sciatic nerve block with 0.5% ropivacaine

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    Pablo Escovedo Helayel

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Foram estudados os efeitos da clonidina sobre a latência, a qualidade da anestesia e a duração da analgesia do bloqueio do nervo isquiático com ropivacaína a 0,5%. MÉTODO: Quarenta pacientes adultos foram submetidos a cirurgias sobre o pé e/ou a face lateral do tornozelo sob bloqueios combinados de nervos femoral e isquiático, por via anterior, em que foram alocados, segundo números aleatórios em grupo 1: 25 mL de ropivacaína a 0,5% e placebo perineural; grupo 2: 2 µg.kg-1 de clonidina por via muscular e 25 mL de ropivacaína a 0,5% perineural; e grupo 3: 2 µg.kg-1 de clonidina e 25 mL de ropivacaína a 0,5% perineural, injetados após obtidas respostas motoras com correntes de 0,2 e 0,5 mA. A sensibilidade e a motricidade foram avaliadas por 30 minutos após o bloqueio. Um escore de efetividade total do bloqueio foi atribuído. A qualidade da anestesia cirúrgica foi classificada com sucesso ou falha, segundo a necessidade de suplementação sistêmica. A duração foi o tempo desde a realização do bloqueio até a primeira solicitação de analgésico. RESULTADOS: As latências medianas foram 5, 12,5 e 17,5 minutos nos grupos 1 a 3, respectivamente (p = 0,11. As taxas de sucesso foram de 100%, 93% e 75%, respectivamente (p = 0,12. A duração da analgesia pós-operatória foi de 14,5, 13,5, e 13,75 horas, respectivamente (p = 0,15. CONCLUSÕES: A clonidina por via muscular ou perineural não influenciou a latência, a qualidade de anestesia ou a duração da analgesia do bloqueio do nervo isquiático com ropivacaína a 0,5%.JUSTIFICATIVA Y OBJETIVOS: Se estudiaron los efectos de la clonidina sobre la latencia, la calidad de la anestesia y la duración de la analgesia de lo bloqueo del nervio isquiático con ropivacaína a 0,5%. MÉTODO: Cuarenta pacientes adultos fueron sometidos a cirugías sobre el pie y/o la faz lateral del tobillo bajo bloqueos combinados de nervios femoral e isquiático, por v

  3. Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego Ropivacaína, articaína o la combinación de ropivacaína y articaína en la anestesia epidural para cesárea: estudio aleatorio, prospectivo y doble ciego Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study

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    Derya Arslan Yurtlu

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Iniciar a anestesia peridural com anestésicos locais de longa duração consome uma quantidade significativa de tempo, o que pode ser problemático em centros de anestesia obstétrica muito movimentados. Aventamos a hipótese de que uma combinação de articaína e ropivacaína proporcionaria início mais rápido e mesmo uma recuperação precoce das características do bloqueio sensório-motor. MÉTODOS: Sessenta parturientes a termo agendadas para cesariana eletiva foram randomicamente alocadas em três grupos para receber 20 mL de articaína a 2% (Grupo A, 10 mL de articaína a 2% + 10 mL de ropivacaína a 0,75% (Grupo AR ou 20 mL de ropivacaína a 0,75% (Grupo R via cateter peridural. O tempo de início do bloqueio sensorial até T10-T6 e o nível máximo de bloqueio, o tempo para a regressão de dois segmentos do nível máximo de bloqueio sensorial e o tempo de início e duração do bloqueio motor foram todos registrados. A necessidade de analgésicos adicionais, intra- e pós-operatoriamente, também foi registrada. RESULTADOS: Os dados demográficos foram semelhantes. Os tempos de início do bloqueio sensorial até os níveis T10 e T6 foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p JUSTIFICATIVA Y OBJETIVOS: Iniciar la anestesia epidural con anestésicos locales de larga duración consume una cantidad significativa de tiempo, siendo un problema en los centros de anestesia obstétrica que tienen mucho movimiento. Barajamos la hipótesis de que una combinación de articaína y ropivacaína proporcionaría un inicio más rápido e incluso una rápida recuperación de las características del bloqueo sensitivo motor. MÉTODOS: Sesenta parturientes a término que tenían cita para la cesárea electiva se ubicaron aleatoriamente en tres grupos para recibir 20 mL de articaína al 2% (Grupo A, 10 mL de articaína al 2% + 10 mL de ropivacaína al 0,75% (Grupo AR o 20 mL de ropivaca

  4. Efeitos da associação da clonidina à ropivacaína na anestesia peridural Efectos de la asociación de la clonidina y ropivacaína en la anestesia peridural Clinical evaluation of clonidine associated to ropivacaine for epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Túlio César Azevedo Alves

    2002-07-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os efeitos e o potencial sinergismo entre a clonidina, um agonista alfa2-adrenérgico, e a ropivacaína ainda não foram estudados em pacientes sob anestesia peridural. O objetivo da pesquisa foi estudar os efeitos da associação da clonidina com a ropivacaína, nas características do bloqueio peridural. MÉTODO: Participaram do estudo duplamente encoberto, 60 pacientes distribuídos em dois grupos de 30 pacientes. No grupo G controle, foi usada apenas a ropivacaína a 0,75% (150 mg na anestesia peridural; no grupo G clonidina, foram utilizadas clonidina (300 µg e ropivacaína a 0,75% (150 mg na anestesia peridural. Foram analisados os seguintes atributos: bloqueio analgésico completo (tempo de latência, instalação do bloqueio motor, duração dos bloqueios analgésico e motor, nível máximo do bloqueio analgésico, nível de consciência, necessidade de analgesia e sedação complementar no per-operatório, ocorrência de hipotensão arterial no per e pós-operatórios, intensidade da dor pós-operatória, duração da analgesia e efeitos colaterais. RESULTADOS: A clonidina (300 µg, por via peridural, não influenciou a latência (p > 0,05; porém prolongou a duração dos bloqueios analgésico e motor (p JUSTIFICATIVA Y OBJETIVOS: Los efectos y el potencial sinergismo entre la clonidina, un agonista alfa2-adrenérgico, y la ropivacaína aun no fueron estudiados en pacientes bajo anestesia peridural. El objetivo de la pesquisa fue estudiar los efectos de la asociación de la clonidina con la ropivacaína, en las características de bloqueo peridural. MÉTODO: Participaron del estudio duplamente encubierto, 60 pacientes distribuidos en dos grupos de 30 pacientes. En el grupo G control, fue usada apenas la ropivacaína a 0,75% (150 mg en la anestesia peridural; no grupo G clonidina, fueron utilizadas clonidina (300 µg y ropivacaína a 0,75% (150 mg en la anestesia peridural. Fueron analizados los siguientes

  5. Analgesia continua de miembro superior por bloqueo de plexo braquial en dolor crónico oncológico Continuous analgesia of the upper limb with brachial plexus blockade in chronic cancer pain

    OpenAIRE

    M. Narváez; K. Glasinovic; A. Condori; A. Ballon; M. Torres

    2005-01-01

    Objetivo: Evaluar la utilizdad del bloqueo del plexo braquial en el tratamiento del dolor intenso oncológico. Método: Evaluamos en 6 pacientes con metástasis óseas del miembro superior la efectividad de un bloqueo continuo del plexo braquial. Resultados: Todos los pacientes del estudio tuvieron una evolución favorable y un incremento en la analgesia con el tratamiento sin que se produjeran efectos adversos. Conclusiones: La analgesia continua del plexo braquial es un método efectivo para el c...

  6. A dexmedetomidina para sedação, por via venosa, não interfere com a duração dos bloqueios sensitivo e motor da raquianestesia La dexmedetomidina para sedación, por vía venosa, no interfiere con la duración del bloqueo sensitivo y motor de la raquianestesia Intravenous dexmedetomidine for sedation does not interfere with sensory and motor block duration during spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2006-02-01

    ansiedad, necesitando en ese caso sedación. Los benzodiazepínicos, opioides y propofol son ampliamente utilizados para este propósito. Los agonistas alfa 2-adrenérgicos tienen propiedades hipnóticas y sedativas y son una alternativa terapéutica por la estabilidad hemodinámica y mínima depresión respiratoria. El objetivo de este estudio es evaluar la seguridad e interacciones de dexmedetomidina y midazolam por vía intravenosa en la duración del bloqueo sensitivo y motor de la raquianestesia. MÉTODO: Fueron estudiadas 35 pacientes adultas, estado físico ASA I y II, que recibieron raquianestesia con bupivacaína a 0,5% hiperbárica (15 mg, para cirugía ginecológica electiva, distribuidas de modo aleatorio en 2 grupos: grupo M (n = 17 - sedación con midazolam en infusión continua a 0,25 µg.kg-1.min-1 y grupo D (n = 18 - sedación con dexmedetomidina en infusión continua a 0,5 µg.kg-1.min-1. La velocidad de infusión fue ajustada para mantener el valor del BIS entre 60 y 80. Fueron analizados los valores de PAS, PAD, FC, SpO2, BIS, extensión y duración del bloqueo sensitivo motor (escala de Bromage. RESULTADOS: No hubo diferencia estadística entre los grupos en edad, peso, nivel de bloqueo sensitivo y duración bloqueo sensitivo motor, como de la frecuencia cardíaca y presión arterial. CONCLUSIONES: La dexmedetomidina utilizada en sedación, por vía venosa, no alteró los parámetros hemodinámicos, duración o extensión de los bloqueos sensitivo y motor de la raquianestesia, representando una buena opción para sedación durante anestesia regional.BACKGROUND AND OBJECTIVES: The association among local and regional anesthesia is a very useful and common practice. However, some patients may become anxious and require sedation. Benzodiazepines, opioids and propofol are widely used for this aim. Alpha2-adrenergic agonists have hypnotic and sedative properties and represent an alternative to promote hemodynamic stability and minor respiratory depression

  7. Bloqueo caudal en dolor crónico lumbar: ¿Es necesario el apoyo radiológico para disminuir los fallos de la técnica?

    Directory of Open Access Journals (Sweden)

    M. Cortiñas Sáenz

    2012-08-01

    Full Text Available Introducción: las infiltraciones de esteroides epidurales no ofrecen beneficio a largo plazo en el tratamiento del dolor de espalda, pero pueden ser eficaces en los pacientes con dolor radicular lumbosacro agudo. Los bloqueos epidurales vía caudal de esteroides son eficaces en el alivio sintomático a corto plazo (evidencia de nivel II, así como a largo plazo (nivel de evidencia III. Objetivos: evaluar la eficacia del bloqueo caudal con y sin guía fluoroscópica. Material y métodos: estudio prospectivo, observacional y descriptivo para evaluar la tasa de fallos de la realización del bloqueo caudal mediante la técnica "a ciegas" respecto a la guiada por radiología. El análisis estadístico incluyó chi2 de Mantel y Haensel, t de Student y test ANOVA, considerándose una p < 0,05 con significación estadística. Resultados: se realizaron 129 bloqueos epidurales caudales en 89 pacientes por cuadros de dolor crónico. La tasa global de éxito del bloqueo caudal con la técnica a ciegas fue de un 65,11%. Existen diferencias estadísticamente significativas en la tasa de fallos de la técnica a ciegas para las variables: experiencia profesional del médico anestesiólogo y la presencia de obesidad. La mal posición más frecuente en nuestra cohorte es la colocación subcutánea de la aguja, que representa un 80% de los casos (36/45. Conclusiones: recomendamos el uso de la visión radiológica para realizar los bloqueos epidurales caudales.

  8. Bloqueo de Ganglio Estrellado en el tratamiento de angina de pecho refractaria: un posible tratamiento coadyuvante

    Directory of Open Access Journals (Sweden)

    Isaías Salas Herrera

    2002-04-01

    Full Text Available El presente trabajo corresponde una revisión bibliográfica de los estudios clínicos realizados en síndromes anginosos refractarios al tratamiento convencional, utilizando como tratamiento el bloqueo de ganglio estrellado. Se realizó una búsqueda de literatura publicada entre los años 1.900 al 2.000 en las bases de datos MDConsult, Medline y ProQuest. A su vez se revisaron las publicaciones en la Biblioteca del Hospital Rafael Ángel Calderón Guardia y en la Biblioteca del BINASSS (Biblioteca Nacional de Salud del Seguro Social. De acuerdo a los estudios analizados el bloqueo de ganglio estrellado se describe como posibilidad terapéutica para el control de dolor de la angina de pecho refractaria . La descripción clásica de la inervación cardíaca consiste en tres nervios simpáticos mayores originados de los ganglios cervicales superior, medio e inferior. Esta inervación simpática en conjunto con diversos nervios parasimpáticos, se describen como el plexo cardíaco. En contraste Jane et. al. (1986 en un estudio anatómico de 23 cadáveres describe que la inervación cardiopulmonar en el hombre se origina en el ganglio estrellado y las mitades caudales de las cadenas simpáticas cervicales junto con nervios que se originan del nervio recurrente laríngeo o del vago. De estas estructuras derivan los dos plexos cardiopulmonares. De estos plexos derivan tres nervios cardíacos mayores que se proyectan hacia el corazón. Se estima que determinado porcentaje de los pacientes diagnosticados con angina inestable progresará a desarrollar una angina refractaria al tratamiento. El bloqueo de ganglio estrellado podría ser un nuevo método terapéutico para controlar el dolor de dicha condición. Sin embargo se necesitan estudios clínicos randomizados a doble ciego para obtener resultados concluyentes.

  9. Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial Analgesia pos-operatoria con bloqueo bilateral del nervio pudendo con bupivacaína S75:R25 a 0,25%: estudio piloto en hemorroidectomia bajo régimen ambulatorial Bilateral pudendal nerves block for postoperative analgesia with 0.25% S75:R25 bupivacaine: pilot study on outpatient hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2005-12-01

    permitirão demonstrar se esta técnica deve ser a primeira opção para analgesia em hemorroidectomias. A permanência de anestesia perineal por 20,21 horas deverá induzir novos trabalhos com o bloqueio dos nervos pudendos orientado por estimulador para o ato cirúrgico.JUSTIFICATIVA Y OBJETIVOS: La hemorroidectomia puede ser realizada bajo varias técnicas anestésicas y en régimen ambulatorial. El dolor pos-operatorio es intenso y puede atrasar el retorno para el hogar. El objetivo de este estudio fue evaluar las ventajas y la realización del bloqueo bilateral de los nervios pudendos para analgesia pos-operatoria en hemorroidectomias. MÉTODO: El bloqueo bilateral de los nervios pudendos con bupivacaína S75:R25 a 0,25% fue realizado con estimulador de nervios en 35 pacientes sometidos a la hemorroidectomia bajo raquianestesia. Fueron evaluadas intensidad del dolor, duración de la analgesia, analgesia de demanda y eventuales complicaciones relacionadas a la técnica. Los datos fueron evaluados a las 6, 12, 18, 24 y 30 horas después del término de la intervención quirúrgica. RESULTADOS: En todos los pacientes, fue logrado éxito con la estimulación de ambos los nervios pudendos. En ningún momento de la evaluación ocurrió dolor intenso. Hasta 12 horas después del bloqueo, todos los pacientes presentaron anestesia en la región perineal; con 18 horas, 17 pacientes y 24 horas, 10 pacientes A analgesia pos-operatoria fue óptima en 18 pacientes; satisfactoria, en cinco pacientes; e insatisfactoria, en siete pacientes. La duración media de la analgesia fue de 23,77 horas. No ocurrieron alteraciones de la presión arterial, de la frecuencia cardiaca, ni fueron observados náuseas o vómitos. Todos los pacientes tuvieron micción espontánea. Ninguna complicación local o sistémica fue relacionada al anestésico local. Veintisiete pacientes clasificaron de excelente la técnica de analgesia y apenas tres pacientes del sexo masculino quedaron satisfechos

  10. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  11. Comparação das técnicas transarterial e de estimulação de múltiplos nervos para bloqueio do plexo braquial por via axilar usando lidocaína com epinefrina Comparación de las técnicas transarterial y de estimulación de múltiples nervios para bloqueo del plexo braquial por vía axilar usando lidocaína con epinefrina Comparison of transarterial and multiple nerve stimulation techniques for axillary block using lidocaine with epinephrine

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2005-02-01

    resulta en alta efectividad para el bloqueo axilar del plexo braquial. La técnica de utilizar múltiples estímulos exige más tiempo y mayor experiencia. Este estudio prospectivo compara la latencia y el índice de éxito del bloqueo del plexo braquial usando dos técnicas de localización: transarterial o múltipla estimulación de los nervios. MÉTODO: La lidocaína con epinefrina, 800 mg, fue usada inicialmente para el bloqueo axilar. En el grupo transarterial, 30 mL de lidocaína a 1,6% con epinefrina fueron inyectados profundamente y 20 mL superficialmente a la arteria axilar. En el grupo de múltipla estimulación, tres nervios fueron localizados eléctricamente y bloqueados con volúmenes 20 mL, 20 mL y 10 mL de la solución. El bloqueo fue considerado efectivo cuando la analgesia estaba presente en todos los nervios en la área distal al codo. RESULTADOS: El tiempo de latencia (8,8 ± 2,3 min versus 10,2 ± 2,4 min; p-valor = 0,010 fue significativamente menor en el grupo transarterial. Bloqueos sensitivos completos en los cuatro nervios (mediano, ulnar, radial y musculocutáneo fueron logrados en un 92,5% versus 83,3% en el grupo de múltipla estimulación y acceso transarterial, respectivamente sin diferencia significativa (p-valor = 0,68. El nervio musculocutáneo fue significativamente más fácil de bloquear con el estimulador de nervio periférico (p = 0,034. CONCLUSIONES: La técnica de múltipla estimulación para el bloqueo axilar usando estimulador de nervios (3 inyecciones y la técnica transarterial (2 inyecciones producen resultados semejantes en la calidad del bloqueo. El nervio musculocutáneo es más facilmente bloqueado con el uso del estimulador del nervio periférico. La técnica de múltipla estimulación necesitó menor suplementación del bloqueo y aumentó el tiempo para el inicio de la cirugía.BACKGROUND AND OBJECTIVES: High-dose transarterial technique results in highly effective axillary block. The multiple nerve stimulation technique

  12. Identificación de factores predictores de técnica epidural dificultosa en la paciente obstétrica

    Directory of Open Access Journals (Sweden)

    L. M. Charco Roca

    2013-10-01

    Full Text Available Introducción: Los intentos repetidos de punción son factores de riesgo para la aparición de complicaciones neurológicas secundarias a la práctica de la analgesia espinal y aumentan la ansiedad del paciente. El objetivo de este estudio es determinar qué factores son mejores predictores de la colocación dificultosa del catéter epidural en la paciente obstétrica. Material y método: Estudio observacional y prospectivo en 120 gestantes a término que solicitan la analgesia epidural para el trabajo de parto. Se recogen variables demográficas y antecedentes de anestesia espinal previa no exitosa o considerada dificultosa por la paciente. Se identifican variables anatómicas y se clasifica la calidad de los puntos de referencia anatómicos según los criterios publicados por Chien en cuatro grados. Las condiciones de la técnica y la experiencia del anestesiólogo son similares en todos casos. Consideramos punción dificultosa si se necesita más de una punción en la piel o una punción pero más de un cambio de dirección de aguja en el espacio interespinoso. Se recoge el éxito obtenido y las complicaciones de la técnica. Resultados: Fueron calificadas de punción difícil según los criterios del estudio en el 36,67 % de los casos. En la mayoría de los casos la técnica fue efectiva obteniendo una adecuada analgesia. La incidencia de repunción epidural fue de 5 %. En las pacientes clasificadas en el grado 4, la tasa de punción epidural considerada dificultosa supuso un 90 %, necesitando en el 80 % de esos casos 3 o más intentos. En las pacientes con antecedentes personales de técnica neuroaxial dificultosa se encontró dificultad de punción epidural en un 28,57 % de los casos. El hábito corporal no tuvo efecto significativo sobre la tasa de éxito con el primer intento. Discusión: Nuestro estudio representa una buena estimación de la dificultad técnica de un bloqueo neuroaxial. Seria difícil saber si los datos reflejados ser

  13. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove;

    1995-01-01

    of central nervous system infection of at least 0.7% at Odense University Hospital. This degree of infection is of the same magnitude as that reported for intravascular devices. We found that the patients with generalized symptoms of infection had been catheterized for a longer time, and were older than......Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence...... patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more...

  14. Primary spinal epidural lymphomas

    Directory of Open Access Journals (Sweden)

    Goutham Cugati

    2011-01-01

    Full Text Available An epidural location for lymphoma is observed in 0.1-6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: "primary," "spinal," "epidural," and "lymphoma" were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner

  15. Ocorrência de hematoma peridural após anestesia geral associada à analgesia pós-operatória com cateter peridural em paciente em uso de heparina de baixo peso molecular: relato de caso Ocurrencia de hematoma postanestesia general asociada a analgesia postoperatoria con cateter peridural en paciente que usa heparina de bajo peso molecular: relato de caso Epidural hematoma after general anesthesia associated with postoperative analgesia with epidural catheter in patient using low molecular weight heparin: case report

    Directory of Open Access Journals (Sweden)

    Ranger Cavalcante da Silva

    2006-04-01

    drenaje del hematoma la paciente recuperó gradualmente la fuerza en los miembros inferiores, recibió alta en diez días con cuadro de disfunción de esfínteres. Después de tres meses el cuadro remitió y no hubo secuela neurológica definitiva. CONCLUSIONES: El rápido diagnóstico con intervención quirúrgica precoz es el tratamiento más eficaz para la reducción de la lesión neurológica, en pacientes que desarrollan hematoma peridural postoperatorio. La utilización de heparina de bajo peso molecular, con uso actual de catéter peridural, exige la adhesión estricta a protocolos establecidos, para que se reduzcan los riesgos del desarrollo de hematoma peridural.BACKGROUND AND OBJECTIVES: Presents a patient case with epidural hematoma, in the course of the use of epidural catheter and low molecular weight heparin, her clinical condition and treatment. CASE REPORT: A 75-year old female patient, submitted to the fixation of lumbar spine by anterior route, who, in the postoperative period, developed a clinical condition of progressive paralysis of the lower limbs, with loss of sensitivity and presenting no intense radicular pain. The treatment was the immediate medullar decompression, with drainage and surgical cleaning of a epidural hematoma, which extended from the 5th to the 10th thoracic vertebrae. After the drainage of the hematoma, the patient gradually recovered the strength in the lower limbs, was discharged in ten days with a condition of sphincterian dysfunction. After three months, the condition receded and there was no definitive neurological sequel. CONCLUSIONS: The quick diagnosis with early surgical intervention is the most effective treatment for the reduction of neurological damage, in patients that develop postoperative epidural hematoma. The use of low molecular weight heparin, in the course of the use of epidural catheter, requires the strict compliance with the established protocols so that the risks of epidural hematoma development can be

  16. Bloqueo del ganglio estrellado y anestesia subaracnoidea: Caso Clínico Blockade of the inferior cervical ganglion with subarachnoid anesthesia: Clinical case

    Directory of Open Access Journals (Sweden)

    L. San Norberto

    2007-06-01

    Full Text Available El ganglio estrellado está formado por la unión del ganglio cervical inferior y el primer ganglio torácico. El bloqueo de dicho ganglio es usado para el diagnóstico y tratamiento de diversos síndromes dolorosos crónicos. Esta técnica con anestésicos locales suele ser segura aunque no exenta de complicaciones como convulsiones, neumotórax o anestesia espinal entre otras. Estas complicaciones pueden minimizarse con una adecuada vigilancia, monitorización y recursos adecuados. Para un correcto diagnóstico y tratamiento de las posibles complicaciones. Presentamos el caso de un bloqueo espinal completo tras la realización de un bloqueo del ganglio estrellado.The stellate ganglion refers to the ganglion formed by fusion of the inferior cervical and the first thoracic ganglion. Stellate ganglion blockade is a procedure mainly used for the diagnosis and treatment of chronic painful syndromes. This technique with local anesthetic is a safe procedure, his risk, though infrequent; include seizures, pneumothorax, spinal block and others. These complications can be minimized with adequate monitoring, surveillance and resources in order to diagnostic and treatment of complications. We present a case with spinal block following stellate ganglion blockade.

  17. Dispersión del QRS como índice de disincronía en el bloqueo de rama izquierda y de sincronía tras la terapia de resincronización cardíaca, una variable de respuesta exitosa / QRS dispersion as an index of dyssynchrony in left bundle branch block and of

    OpenAIRE

    Elibet Chávez González; Alain Alonso Herrera; Raimundo Carmona Puerta; Damián Pérez Cabrera; Ramiro R Ramos Ramírez; Walker Gómez Paima; Francisco L Moreno-Martínez

    2015-01-01

    Introducción: En pacientes con insuficiencia cardíaca, el bloqueo de rama izquierda del haz de His constituye un importante marcador de mal pronóstico, en ellos la tera-pia de resincronización puede mejorar la función del ventrículo izquierdo. Objetivo: Describir variables electrocardiográficas asociadas a una mejor respuesta de la resincronización cardíaca. Método: Se estudiaron 19 pacientes, 7 mujeres y 12 hombres con bloqueo de rama izquierda y fracción de eyección ≤ 35 %. Se realizó elect...

  18. del diagnóstico al encuentro con la persona

    Directory of Open Access Journals (Sweden)

    Javier Armenta Mejía

    2006-01-01

    Full Text Available El presente escrito aborda un enfoque centrado en la persona en el tratamiento de personas con psicosis o que tienen bloqueos en el contacto psicológico. Se revisa el trabajo de Garry Prouty sobre la preterapia, a la vez que se establece una diferencia con el tratamiento tradicional psiquiátrico.

  19. Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 30 μg/ml para el manejo de dolor crónico en pacientes con síndrome de cirugía fallida de espalda Effectiveness of the implementation of epidural and paravertebral ozone at a concentration of 30 μg/ml for the management of chronic pain in patients with failed back surgery

    Directory of Open Access Journals (Sweden)

    B. D. Hernández Guinea

    2012-02-01

    Full Text Available Objetivo: determinar la eficacia de la infiltración de ozono epidural y paravertebral a una concentración de 30 μg/ml para el control del dolor crónico en pacientes con síndrome de cirugía fallida de espalda lumbar. Método: se realizó un ensayo clínico cuasi experimental, prospectivo, estudiando 30 pacientes con dolor crónico secundario a síndrome cirugía fallida de espalda, realizando un total de 4 infiltraciones con ozono; en la primera se infiltró 20 ml de ozono a una concentración de 30 μg/ml por vía epidural caudal y 10 ml de ozono a la misma concentración a nivel paravertebral lumbar en L3, L4 y L5 en forma bilateral, con un total de 60 ml paravertebral. Realizándose las siguientes infiltraciones cada semana únicamente en la región paravertebral. Se evaluó la calidad analgésica mediante la escala visual análoga y la funcionalidad por el índice de discapacidad de Oswestry, previo al procedimiento inicial, a la semana, 4 semanas y 2 meses. Resultados: de los 30 pacientes estudiados el 70% fueron mujeres (21 y 30% hombres (9. No se encontró mejoría en el alivio del dolor de acuerdo a la evaluación de la escala visual análoga, con un promedio inicial de 7,2 y un final de 7,4. Tampoco se encontró mejoría en la capacidad funcional evaluada mediante el índice de discapacidad de Oswestry, inicial de 63,47 y final de 64,37, ambos sin significancia estadística. Se presentaron como complicaciones: dolor a la aplicación 40% (12, aumento de discapacidad 13,33% (4 y cefalea 3% (1. Conclusión: el uso de ozono epidural y paravertebral a una concentración de 30 μg/ml, no es eficaz para el alivio del dolor crónico secundario a síndrome de cirugía fallida de espalda.Objective: to determine the efficacy of epidural and paravertebral infiltration of ozone at a concentration of 30 μg/ml for chronic pain control in patients with failled back surgery syndrome. Method: a quasi-experimental clinical trial, prospective study

  20. Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5% Bloqueo del plexo lumbar por la vía posterior para analgesia postoperatoria en artroplastia total de la cadera: estudio comparativo entre Bupivacaína a 0,5% con Epinefrina y Ropivacaína a 0,5% Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-06-01

    diferentes bloqueos de nervios periféricos. El objetivo de este estudio, fue comparar la eficacia de la analgesia postoperatoria, resultante de la administración en dosis única de la bupivacaína a 0,5% o de la ropivacaína a 0,5% en el bloqueo del plexo lumbar por la vía posterior en la artroplastia total de la cadera. MÉTODO: Treinta y siete pacientes fueron ubicados aleatoriamente en dos grupos según el anestésico local utilizado en el bloqueo: Grupo B - bupivacaína a 0,5% con epinefrina 1:200.000 o Grupo R - ropivacaína a 0,5%. Durante el período postoperatorio, los puntajes de dolor y el consumo de morfina en la analgesia controlada por el paciente, fueron comparados entre los grupos. El sangramiento durante la operación y la incidencia de efectos adversos y de complicaciones también fueron comparados. RESULTADOS: Pese a que los puntajes de dolor hayan sido menores en el Grupo R 8 horas, 12 horas y 24 horas después del bloqueo, esas diferencias no fueron clínicamente significativas. La regresión lineal múltiple no identificó el anestésico local como una variable independiente. No hubo diferencia en el consumo de morfina, en el sangramiento intraoperatorio y en la incidencia de complicaciones y efectos adversos entre los dos grupos. CONCLUSIONES: La bupivacaína a 0,5% y la ropivacaína a 0,5%, ofrecieron un alivio eficaz y prolongado del dolor postoperatorio después de la artroplastia total de la cadera, sin diferencia clínica, cuando dosis equivalentes fueron administradas en el bloqueo del plexo lumbar por la vía posteriorBACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in

  1. Bloqueo aurículo-ventricular de primer grado en tirotoxicosis aguda First degree atrio-ventricular block in acute thyrotoxicosis

    OpenAIRE

    Antonio R. Vilches; Jorge Lerman

    2004-01-01

    El cuadro clínico de la tirotoxicosis incluye síntomas cardiovasculares variados. La taquicardia sinusal es el trastorno electrocardiográfico más frecuente y los trastornos de conducción son extremadamente raros como modo de presentación. Comunicamos un caso de bloqueo aurículo-ventricular de primer grado en una paciente con hipertiroidismo recién diagnosticado y que comenzó días antes de la consulta con un cuadro general inespecífico. Su evaluación ulterior demostró que se trataba de una tir...

  2. Bloqueo del ganglio estrellado y anestesia subaracnoidea: Caso Clínico Blockade of the inferior cervical ganglion with subarachnoid anesthesia: Clinical case

    OpenAIRE

    L. San Norberto; F. Hernández-Zaballos; Santos, J.; F. J. Sánchez-Montero; Vaquero, M.; E. Sánchez-Barrado; Muriel, C.

    2007-01-01

    El ganglio estrellado está formado por la unión del ganglio cervical inferior y el primer ganglio torácico. El bloqueo de dicho ganglio es usado para el diagnóstico y tratamiento de diversos síndromes dolorosos crónicos. Esta técnica con anestésicos locales suele ser segura aunque no exenta de complicaciones como convulsiones, neumotórax o anestesia espinal entre otras. Estas complicaciones pueden minimizarse con una adecuada vigilancia, monitorización y recursos adecuados. Para un correcto d...

  3. Análisis de la eficacia y seguridad de la administración de cloruro mórfico epidural para el dolor postoperatorio tras cesárea An analysis of the efficacy and safety of epidural morphic chloride administration for postoperative pain following Caesarian section

    Directory of Open Access Journals (Sweden)

    M. Doniz

    2011-02-01

    Full Text Available Objetivo: el control del dolor postcesárea es un punto importante, pues se ha tratado de implementar una técnica analgésica que ocasione mínimos efectos secundarios pero que provea de una buena calidad y duración de la misma, para tener un rápido alivio del dolor, buena recuperación y disminución de los costes de hospitalización. El objetivo de este estudio fue analizar la eficacia y seguridad de la administración de un único bolo de dos miligramos de cloruro mórfico por catéter epidural como coadyuvante analgésico tras cesárea. Material y métodos: estudio multicéntrico prospectivo aleatorio observacional de casos y controles a lo largo de tres años, en 400 pacientes, ASA I-II, con edades comprendidas entre 18 y 39 años, intervenidas de cesárea bajo anestesia epidural. Las pacientes se distribuyeron en dos grupos, un primer grupo denominado GM formado por 200 pacientes a las que se administró dos miligramos de cloruro mórfico, diluidos hasta 10 cm³ con suero fisiológico, a través del catéter epidural, posteriormente a la finalización de la cesárea y tras recuperación de bloqueo sensitivo y motor. El otro grupo denominado GC constituido por las 200 pacientes restantes y a las que no se administró morfina peridural. Ambos grupos recibieron el mismo protocolo analgésico con paracetamol y metamizol pautados, y rescate con bolos de morfina intravenosa en la Unidad de Recuperación Postoperatoria y Ketorolaco en planta. Se utilizó t-Student para comparar las variables cuantitativas. Se consideró significativo p Objective: pain control after cesarean section is an important point, as it has tried to implement an analgesic technique that causes minimal side effects while still providing a good quality and duration of it, to have a quick pain relief, good recovery and decreased hospitalization costs. The aim of this study was to analyze the effectiveness and safety of a single bolus administration of two milligrams of

  4. Traumatic epidural hematoma in children.

    Science.gov (United States)

    Rocchi, Giovanni; Caroli, Emanuela; Raco, Antonino; Salvati, Maurizio; Delfini, Roberto

    2005-07-01

    The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions.

  5. Bloqueo y radiofrecuencia de la articulación sacroilíaca Block and radiofrequency sacroiliac joint

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    J. De Andrés Ares

    2012-12-01

    Full Text Available La articulación sacroilíaca (ASI es una importante fuente de dolor axial, contribuyendo en hasta un 15% del dolor crónico axial. Existen numerosas pruebas diagnósticas, aunque el examen físico, las pruebas radiológicas son insuficientes para el adecuado diagnóstico. El criterio diagnóstico más aceptado es el alivio del dolor de la ASI tras uno o varios bloqueos diagnósticos intra-articulares con anestésicos locales, realizados de manera adecuada. El proceder ante la positividad del bloqueo es la radiofrecuencia de las ramas que inervan la ASI. En el siguiente artículo se repasará la anatomía, el diagnóstico y los distintos tratamientos intervencionistas del dolor de origen sacroilíaco.Sacroiliac joint (ASI is an important source of pain, contributing to 15% of chronic back pain. There are numerous diagnostic tests, although historical and physical examination findings and radiological imaging are insufficient for a proper diagnosis. An analgesic response to a properly performed diagnostic block, is the most reliable method to diagnose sacroiliac joint pain. If there is a positive block, radiofrequency denervation of the ASI is performed for a longterm pain-free period. The following article will review the anatomy, diagnosis and interventional treatment of sacroiliac joint pain.

  6. Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente Comparación de la morfina administrada por vía intravenosa y vía epidural con /sin bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía con la técnica de analgesia controlada por el paciente Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique

    Directory of Open Access Journals (Sweden)

    Esra Mercanoğlu

    2013-04-01

    ón por vía intravenosa o epidural de morfina, bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía. MÉTODOS: Sesenta pacientes sometidos a procedimientos de toracotomía electiva fueron aleatoriamente ubicados en cuatro grupos con el uso de la técnica de sobres lacrados. Los grupos MIV, ME, MEB y MER recibieron morfina controlada por el paciente por vía intravenosa, epidural, morfina-bupivacaína y morfina-ropivacaína, respectivamente. La frecuencia cardíaca, presión arterial y la saturación de oxígeno perioperatorias y el dolor postoperatorio en reposo y durante la tos, los efectos colaterales y la necesidad de analgésicos de rescate fueron registrados a los 30 y 60 minutos y las 2, 4, 6, 12, 24, 36, 48 y 72 horas. RESULTADOS: La necesidad de sodio diclofenaco durante el estudio fue menor en el grupo ME. El área bajo la curva de tiempo en la VAS fue menor en el grupo ME en comparación con el Grupo MIV, pero similar al Grupo MEB y MER. Las puntuaciones de dolor en reposo fueron mayores en los tiempos 12, 24, 36 y 48 horas en el Grupo MIV en comparación con el grupo ME. Las puntuaciones de dolor en reposo fueron mayores a los 30 y 60 minutos en los Grupos ME y MIV en comparación con el Grupo MEB. Las puntuaciones de dolor durante la tos a los 30 minutos fueron mayores en el grupo ME en comparación con el Grupo MEB. No hubo diferencia entre los Grupos MIV y MER. CONCLUSIONES: La morfina administrada por vía epidural fue más eficaz que por la vía intravenosa. La eficacia fue mayor en el grupo EM en el período postoperatorio tardío y en el Grupo MEB en el período postoperatorio inicial. Concluimos entonces que la morfina administrada por vía epidural fue la más eficaz y nuestra preferida.BACKGROUND AND OBJECTIVEs: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management

  7. Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 30 μg/ml para el manejo de dolor crónico en pacientes con síndrome de cirugía fallida de espalda

    Directory of Open Access Journals (Sweden)

    B. D. Hernández Guinea

    2012-02-01

    Full Text Available Objetivo: determinar la eficacia de la infiltración de ozono epidural y paravertebral a una concentración de 30 μg/ml para el control del dolor crónico en pacientes con síndrome de cirugía fallida de espalda lumbar. Método: se realizó un ensayo clínico cuasi experimental, prospectivo, estudiando 30 pacientes con dolor crónico secundario a síndrome cirugía fallida de espalda, realizando un total de 4 infiltraciones con ozono; en la primera se infiltró 20 ml de ozono a una concentración de 30 μg/ml por vía epidural caudal y 10 ml de ozono a la misma concentración a nivel paravertebral lumbar en L3, L4 y L5 en forma bilateral, con un total de 60 ml paravertebral. Realizándose las siguientes infiltraciones cada semana únicamente en la región paravertebral. Se evaluó la calidad analgésica mediante la escala visual análoga y la funcionalidad por el índice de discapacidad de Oswestry, previo al procedimiento inicial, a la semana, 4 semanas y 2 meses. Resultados: de los 30 pacientes estudiados el 70% fueron mujeres (21 y 30% hombres (9. No se encontró mejoría en el alivio del dolor de acuerdo a la evaluación de la escala visual análoga, con un promedio inicial de 7,2 y un final de 7,4. Tampoco se encontró mejoría en la capacidad funcional evaluada mediante el índice de discapacidad de Oswestry, inicial de 63,47 y final de 64,37, ambos sin significancia estadística. Se presentaron como complicaciones: dolor a la aplicación 40% (12, aumento de discapacidad 13,33% (4 y cefalea 3% (1. Conclusión: el uso de ozono epidural y paravertebral a una concentración de 30 μg/ml, no es eficaz para el alivio del dolor crónico secundario a síndrome de cirugía fallida de espalda.

  8. Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 50 μg/ml en pacientes con dolor crónico secundario a síndrome postlaminectomía Effectiveness of the administration of epidural and paravertebral ozone at a concentration of 50 μg/ml in patients with chronic pain secondary to postlaminectomy syndrome

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    Y. M. Riestra Grijalva

    2012-04-01

    Full Text Available Introducción: el dolor crónico es una entidad que afecta a la salud física y psicológica de los pacientes. El síndrome postlaminectomía consiste en la aparición o persistencia de dolor lumbar y/o radicular en un paciente que ha tenido uno o más procedimientos quirúrgicos en la columna. Objetivo general: evaluar la efectividad de la administración de ozono epidural y paravertebral, a una concentración de 50 μg/ml, en pacientes con dolor crónico asociado a síndrome postlaminectomía lumbar. Material y métodos: durante el periodo comprendido entre el 15 de julio y el 30 de diciembre del 2010 se realizó un estudio prospectivo, en 30 pacientes de ambos géneros, con edades comprendidas entre los 18 y los 85 años de edad, que tenían un diagnóstico de dolor crónico secundario a síndrome postlaminectomia lumbar. La media de las EVAs iniciales fue 6,8 sobre 10. La primera infiltración se realizó bajo sedación endovenosa y con control fluoroscópico de la región lumbosacra; se administró vía caudal un volumen de 20 ml de ozono a una concentración de 50 μg/ml en el espacio epidural, y en la región muscular paravertebral lumbar bilateral (L3, L4 y L5 se administraron 10 ml de ozono a la misma concentración en cada nivel. En total, el volumen infiltrado fue de 60 ml. La infiltración en la región paravertebral se repitió, al mismo volumen y concentración, en intervalos de 7 días durante 3 semanas consecutivas. Para medir la efectividad del tratamiento se evaluó la intensidad del dolor considerando las medias inicial y final en la escala visual analógica (EVA. Como medida de la funcionalidad se usó el índice de discapacidad de Oswestry, que se registró previo a la infiltración y a las semanas 4 y 8. El análisis estadístico se realizó mediante el programa Statistical 7.0, aplicando el test de Friedman para las dos variables principales, y la estadística descriptiva (media y desviación estándar para el an

  9. Modificación de los criterios de Sgarbossa para el diagnóstico de infarto agudo de miocardio en presencia de bloqueo de rama izquierda

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    Nelson Leandro Moreno-Ruiz

    2015-01-01

    Full Text Available Un bloqueo de rama izquierda dificulta el diagnóstico de infarto agudo de miocardio. Los criterios de Sgarbossa, mencionados en las guías de manejo de las diferentes sociedades científicas, son útiles pero con limitaciones bien reconocidas. Recientemente, se ha publicado una modificación a estos criterios que puede mejorar su rendimiento diagnóstico, y así ser parte de un algoritmo de manejo para los pacientes; aunque, hasta el momento, hacen falta estudios para validar lo anterior.

  10. Raquianestesia total após bloqueio do plexo lombar por via posterior: relato de caso Raquianestesia total después del bloqueo del plexo lumbar por vía posterior: relato de caso Total spinal block after posterior lumbar plexus blockade: case report

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2006-10-01

    anestesiologista conhecimento minucioso da anatomia, treinamento na técnica e vigilância constante.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar puede ser bastante útil en procedimientos quirúrgicos de la cadera, del muslo y de la rodilla, pero exige práctica del anestesiólogo teniendo en cuenta sus potenciales complicaciones. El presente relato tiene como objetivos presentar un caso de raquianestesia total después del bloqueo del plexo lumbar por la vía posterior y discutir el probable mecanismo fisiopatológico. RELATO DEL CASO: Paciente del sexo masculino, 34 años, 97 kg, estado físico ASA I, programado para artroplastia total de la cadera. Fue realizada anestesia general seguida de bloqueo del plexo lumbar derecho por la vía posterior con auxilio de estimulador de nervio periférico. La aguja fue introducida hasta una profundidad de 8 cm, perpendicular a la piel, y a una distancia de 4 cm de la línea media sobre una línea perpendicular al proceso espinoso de L4. Después de la identificación de respuesta motora en el cuadriceps, la intensidad de la corriente de estimulación se redujo hasta 0,35 mA, siendo entonces administrada ropivacaína a 0,5% (39 mL. Durante la inyección, fueron verificadas contracciones intermitentes del cuadriceps. Después del bloqueo, el paciente evolucionó con apnea, hipotensión arterial y midriasis bilateral. Al final de la cirugía, presentaba bloqueo motor en los dos miembros inferiores que solo mejoró nueve horas después de la realización del bloqueo. En el postoperatorio, el paciente se quejó de dolor intenso, recibiendo alta hospitalaria 12 días después de la cirugía sin anormalidades motora o sensitiva. CONCLUSIONES: La identificación del compartimento del psoas, donde está el plexo lumbar, exige la utilización de intensidad de corriente entre 0,5 e 1 mA. La incidencia de respuesta motora con bajas corrientes puede indicar posicionamiento de la aguja dentro del recubrimiento que envuelve la raíz nerviosa y

  11. Bloqueo dual del sistema renina-angiotensina frente a la monoterapia: revisión sistemática y metanálisis acumulativo de ensayos clínicos y estudios observacionales

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    Ferrán Catalá-López

    2014-01-01

    Full Text Available Fundamentos: Trabajos previos han sugerido que el bloqueo dual con inhibidores del sistema renina-angiotensina (SRA estaría asociado a un incremento de efectos adversos comparado con la monoterapia. Se reexamina la seguridad del doble bloqueo del SRA, especialmente en pacientes de riesgo y se explora la estabilidad de la evidencia acumulada a lo largo de los años. Método: Revisión sistemática con metaanálisis de efectos aleatorios. Se revisaron 15 metaanálisis publicados anteriormente como punto de partida. Se realizó una búsqueda en PubMed/Medline de estudios observacionales y de ensayos clínicos controlados recientes. Las variables dependientes estudiadas fueron: mortalidad (general y cardiovascular, hiperpotasemia, hipotensión, insuficiencia renal, accidente cerebrovascular y la retirada del tratamiento por efectos adversos. Se calcularon los riesgos relativos (RR y su intervalo de confianza (IC95%Resultados: El bloqueo dual del SRA no se asoció con una reducción del RR de la mortalidad general (RR:1,00; IC95%: 0,96-1,05; 21 estudios, ni de la mortalidad cardiovascular (RR:1,01; 0,94-1,09; 13 estudios ni del riesgo de accidente cerebrovascular (RR:1,02; 0,94-1,11; 11 estudios en comparación con la monoterapia. El bloqueo dual se asoció a un riesgo aumentado de hiperpotasemia (RR:1,58; 1,37-1,81; 34 estudios, hipotensión (RR:1,66; 1,41-1,95; 25 estudios, daño renal (1,52; 1,28-1,81; 29 estudios y retirada del tratamiento por efectos adversos (RR:1,26; 1,22-1,30; 37 estudios. Los resultados fueron consistentes en las cohortes de pacientes con diabetes mellitus, enfermedad renal o insuficiencia cardiaca. Conclusiones: El bloqueo dual del SRA vs monoterapia incrementa los riesgos de hiperpotasemia, hipotensión, insuficiencia renal e interrupción del tratamiento por efectos adversos. Además no ofrece beneficios adicionales por reducción de la mortalidad general, mortalidad cardiovascular o accidente cerebrovascular. Estos

  12. Epidural injections for back pain

    Science.gov (United States)

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... pillow under your stomach. If this position causes pain, you either sit up or lie on your ...

  13. Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain

    Directory of Open Access Journals (Sweden)

    V. Domingo

    2004-05-01

    Full Text Available Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféricos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se realiza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía.There is increasing interest in peripheral nerve blocks (PNB because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block

  14. Eficacia y tolerabilidad de esteroides epidurales vs. Dosis bajas de esteroides mas metamizol mas D-propoxifeno administrados por vía paravertebral en pacientes con síndrome post-laminectomía Efficacy and tolerability of epidural steroids vs low doses of steroids plus metamizol plus propoxyphene administered paravertebrally for postaminectomy syndrome patients

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    J. A. Aldrete

    2006-10-01

    Full Text Available El reconocimiento de la acción antinociceptiva de los antiinflamatorios no esteroideos (AINEs ha motivado su combinación con dosis moderadas de opiáceos con objeto de obtener una mayor analgesia, mientras que se reduce la necesidad de emplear dosis altas de esteroides. Un grupo de 142 pacientes adultos, que habían desarrollaron radiculopatía y lumbalgia después de la primera discectomia, en los que se demostró radiologicamente fibrosis y cicatriz periradicular, en el sitio de operación, se dividieron en dos subgrupos al azar. El grupo A (69 pacientes, fue tratado con inyecciones peridurales de 80 mg de metilprednisolona (MTP en 3ml de bupivacaína 0.25% (BPV después de obtener medidas controles de dolor, actividad física y la ingestión de medicamentos usando el Esquema del Progreso del Dolor, obteniendo un promedio control antes de iniciar el tratamiento. El grupo B (73 pacientes fue tratado con inyecciones paravertebrales en los niveles L4-L5 y L5-S1, de 5 mg de metamizol (DPN, y 12.5 mg de propoxifeno (PPX agregados a 10 mg de MTP y 1 ml de BPV 0.5%, bilateralmente en cuatro sesiones. Las mismas evaluaciones se llevaron a cabo cada 3 semanas después de cada tratamiento. Todos los pacientes mejoraron clínicamente, sin observarse diferencias significativas entre ambos grupos; Cuando se compararon los valores totales de mejoría clínica, se observaron los niveles controles significativos (p> 0.05 solo cuando se compararon con las mediciones de mejoría clínica, tomadas antes de iniciar el tratamiento en ambos grupos. Se presentaron efectos secundarios como incremento de peso, equimosis, edema fascies lunar y eritema facial en los pacientes del grupo A. La punción dural incidental (3 y cefalea por punción dural (2 se encontraron solo en el grupo A. Un paciente requirió ser tratado con un parche hematico epidural. Ocurrió parestesia en 1 paciente de cada grupo. No se encontraron diferencias significativas de mejoria entre grupos

  15. Bloqueio peribulbar com a associação da mistura enantiomérica de bupivacaína (S75-R25 a 0,5% e lidocaína a 2%: efeitos da adição de hialuronidase Bloqueo peribulbar con la asociación de la mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2%: efectos de la adición de hialuronidasa Peribulbar block with the association of 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 2% lidocaine: effects of hyaluronidase addition

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Soares

    2002-07-01

    realización de bloqueo peribulbar con la asociación de la mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2%. MÉTODO: Fueron estudiados 35 pacientes divididos en grupo 1, que recibió una combinación de iguales volúmenes de mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2% con adrenalina 5 µg.ml-1 y grupo 2, que recibió la misma solución anestésica adicionada de hialuronidasa 50 UI.ml-1. La motilidad de los músculos rectos, orbicular del ojo y elevador de la pálpebra fue evaluada 1, 5, 10 y 15 minutos después del bloqueo. RESULTADOS: Los escores de motilidad de los músculos extra-oculares diminuyeron significativamente durante el período de observación, sin diferencias entre los grupos. Los porcentuales de pacientes que presentaron acinesia del globo ocular en cada momento del estudio no diferiran significativamente entre los grupos. Los escores de dolor a la inyección del anestésico local no diferiran entre los grupos. La anestesia quirúrgica fue satisfactoria en todos los pacientes. CONCLUSIONES: Este estudio no demostró ningún efecto de la adición de hialuronidasa en la concentración de 50 UI.ml-1 sobre la acinesia de los músculos rectos, elevador de la pálpebra y orbicular del ojo durante la instalación de bloqueo peribulbar realizado con la asociación de la mistura enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2% con adrenalina 5 µg.ml-1.BACKGROUND AND OBJECTIVES: The benefits of adding hyaluronidase to local anesthetics for peribulbar blockade remain controversial. This study aimed at comparing the effects of hyaluronidase on the akinesia of rectis muscles, elevator muscle of upper eyelid and orbicular muscle of the eye after peribulbar blockade with 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 2% lidocaine. METHODS: Participated in this study 35 adult patients, who were distributed in group 1, receiving a 1:1 association of 0.5% enantiomeric mixture of bupivacaine (S75-R25

  16. Epidural anesthesia in repeated cesarean section. Anestesia epidural en la cesárea iterativa.

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    Norma Mur Villar

    2003-05-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

    Fundamento: La anestesiología ha experimentado durante los últimos años un desarrollo espectacular en las diferentes áreas de su competencia, entre las que se encuentra sin lugar a dudas, la que centra su actividad asistencial en la paciente obstétrica y todo lo relacionado con su práctica adecuada en estas. Objetivo: Evaluar la eficacia de la anestesia epidural en la cesárea iterativa. Métodos: Estudio descriptivo retrospectivo de una serie de casos (112 en que fue

  17. Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural Estudio comparativo entre bupivacaína a 0,5% y mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% en anestesia peridural Comparative study between 0.5% bupivacaine and 0.5% enantiomeric mixture of bupivacaine (S75-R25 in epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Rosane Fossatti Gonçalves

    2003-04-01

    analgésico en el período pós-operatorio fue superior para el grupo S75-R25, comparado al grupo Bupivacaína (596 ± 436 minutos versus 463 ± 270 minutos, respectivamente; p = 0,04572. La incidencia de efectos adversos fue semejante entre los grupos. CONCLUSIONES: La mezcla enantiomérica de bupivacaína (S75-R25 presentó mayor tiempo analgésico y menor grado de bloqueo motor, comparada con la solución de bupivacaína racémicaBACKGROUND AND OBJECTIVES: A bupivacaine formulation containing 25% of R(+ and 75% of S(- isomer has been used because its anesthetic properties with less toxicity than the racemic bupivacaine. This study aimed at evaluating the racemic bupivacaine as compared to B25/75 in epidural anesthesia. METHODS: Participated in this study 44 patients who were distributed in two groups (n = 22, namely Bupivacaine and S75-R25. Patients were premedicated with intravenous midazolam. Epidural anesthesia was induced at L3-L4 or L2-L3 interspace with 16 to 24 ml of the anesthetic solution. Group Bupivacaine received 0.5% bupivacaine with vasoconstrictor. Group S75-R25 received the enantiomeric mixture of 0.5% bupivacaine with vasoconstrictor. The following parameters were evaluated: lower limb temperature before and after epidural block, blockade onset, type of sensation referred by the patient, possible sensory failures, metameric sensory level and motor block level. Time for first analgesic request in the PACU was also recorded. RESULTS: Forty-one patients completed the study. Groups were demographically similar. Perioperative midazolam dose, epidural anesthetic volume, blockade onset, sensory failures at pinprick, lower limb temperature in different moments, type of paresthesia sensation and anesthetic depth in dermatomes were similar between groups. Motor block was less intense in group S75-R25 (p = 0.0117 as compared to group Bupivacaine. Time to first postoperative analgesic dose was longer for group S75-R25 as compared to group Bupivacaine (596 ± 436

  18. Epidural extramedullary haemopoiesis in thalassaemia

    International Nuclear Information System (INIS)

    lntrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31-year-old-man with a known diagnosis of β-thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone-marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow-up MRI was performed for evaluation efficacy of the treatment. Copyright (2002) Blackwell Science Pty Ltd

  19. Bloqueio inadvertido do neuroeixo durante artroplastia vertebral: relato de caso Bloqueo no percibido del neuroeje durante la artroplastia vertebral: relato de caso Accidental spinal block during vertebral artroplasty: case report

    Directory of Open Access Journals (Sweden)

    Michelle Nacur Lorentz

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cirurgia de artroplastia vertebral com uso do cimento ósseo tem suas particularidades e complicações. Na maioria das vezes o procedimento é realizado sob anestesia local com sedação, mas algumas vezes é realizado bloqueio subaracnóideo ou peridural com morfina com o intuito de fornecer analgesia pós-operatória. O objetivo deste relato foi discutir as possíveis complicações em cirurgias de artroplastia vertebral. RELATO DO CASO: Paciente do sexo masculino, 76 anos, apresentando fratura patológica em T12, foi admitido para cirurgia de artroplastia vertebral e biopsia óssea. Foi realizada sedação com midazolam e fentanil, o paciente foi colocado em decúbito ventral e o cirurgião infiltrou anestésico local desde a pele até o corpo vertebral de T12 a seguir biopsiou a vértebra e injetou 6 mL de cimento ósseo em T12. Ao final do procedimento o paciente apresentava paralisia dos membros inferiores. CONCLUSÕES: A intervenção cirúrgica na coluna vertebral não é procedimento isento de complicações. Quando se associa bloqueio espinal pode-se retardar o diagnóstico de complicação cirúrgica; além disto corre-se o risco de se imputar à anestesia um problema proveniente do procedimento cirúrgico.JUSTIFICATIVA Y OBJETIVOS: A cirugía de artroplastia vertebral con uso del cimiento óseo tiene sus particularidades y complicaciones. En la mayoría de las veces el procedimiento se realiza bajo anestesia local con sedación, pero en algunos casos se realiza el bloqueo subaracnoideo o peridural con morfina con el interés de suministrar analgesia postoperatoria. El objetivo de este relato fue el de discutir las posibles complicaciones en cirugías de artroplastia vertebral. RELATO DEL CASO: Paciente del sexo masculino, 76 años, presentando fractura patológica en T12, fue admitido para cirugía de artroplastia vertebral y biopsia ósea. Se realizó sedación con midazolam y fentanil, el paciente fue

  20. Neuropatía periférica tras el parto: Implicaciones de la anestesia epidural Peripheral neuropathy after delivery implications for epidural anaesthesia

    OpenAIRE

    Velázquez, S.; E. Guasch; B. Martínez; Mª A. López; Gilsanz, F.

    2006-01-01

    La incidencia de lesiones neurológicas de miembros inferiores en la práctica obstétrica es del 0,08% y 0,92%. La incidencia de complicaciones neurológicas asociadas a la técnica epidural ha sido estimada en 2 casos de cada 10.000 epidurales. Durante los últimos años, con la generalización de la analgesia epidural para el trabajo de parto, es posible que algunas de las neuropatías sean atribuidas a esta técnica, olvidando que hay otros mecanismos de lesión en estas situaciones. Presentamos el ...

  1. Evaluación del efecto de bloqueo en el condicionamiento clásico de preferencias

    Directory of Open Access Journals (Sweden)

    César A. Contreras-Bejarano

    2011-02-01

    Full Text Available Esta investigación experimental tuvo como objetivo poner a prueba el efecto de bloqueode Kamin en el condicionamiento clásico de preferencias. Se diseñaron tres partes: Estudio1, Experimento 1 y Experimento 2. El Estudio preliminar (n = 54 consistió en laelección de los estímulos condicionados (marcas publicitarias ficticias y del estímulo incondicionado(figura femenina con una proporción controlada de la medida de cintura/cadera. En el Experimento 1 (n = 60 se efectuó el entrenamiento en condicionamientoclásico de preferencias. Finalmente, en el Experimento 2 (n = 40, se examinó el efecto debloqueo en el condicionamiento clásico de preferencias con pruebas de tipo cognoscitivoy afectivo. Participaron estudiantes universitarios de diferentes carreras entre 17 y 25años. Los resultados indican que se manifestó un efecto de bloqueo en tres de las cuatropruebas utilizadas para evaluar dicho fenómeno. Se plantea, a manera de conclusión,que este efecto potencialmente explica diferentes fenómenos en los campos de la publicidady el mercadeo, especialmente en lo que concierne a competencia de marcas.

  2. Epidural analgesia for cardiac surgery

    NARCIS (Netherlands)

    V. Svircevic; M.M. Passier; A.P. Nierich; D. van Dijk; C.J. Kalkman; G.J. van der Heijden

    2013-01-01

    Background A combination of general anaesthesia (GA) with thoracic epidural analgesia (TEA) may have a beneficial effect on clinical outcomes by reducing the risk of perioperative complications after cardiac surgery. Objectives The objective of this review was to determine the impact of perioperativ

  3. Bupivacaína racêmica a 0,5% e mistura com excesso enantiomérico de 50% (S75-R25 a 0,5% no bloqueio do plexo braquial para cirurgia ortopédica. Estudo comparativo Bupivacaína racémica a 0,5% y mezcla con exceso enantiomérico del 50% (S75-R25 a 0,5% en el bloqueo del plexo braquial para cirugía ortopédica. Estudio comparativo Comparative study of 0.5% racemic bupivacaine versus enantiomeric mixture (S75-R25 of 0.5% bupivacaine in brachial plexus block for orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Roberto Tsuneo Cervato Sato

    2005-04-01

    cirurgia ortopédica de membro superior.JUSTIFICATIVA Y OBJETIVOS: Con la finalidad de encontrar una droga más segura que la bupivacaína racémica, varios estudios fueron realizados con sus isómeros. Este estudio tiene como objetivo evaluar la eficacia de la mezcla con exceso enantiomérico del 50% (MEE50% de bupivacaína (S75-R25 a 0,5% comparada la de la bupivacaína racémica a 0,5% en el bloqueo del plexo braquial en pacientes sometidos a cirugía ortopédica de miembros superiores. MÉTODO: Participaron de este estudio, aleatorio y doblemente encubierto, 40 pacientes, con edade entre 18 y 90 años, estado físico ASA I y II, sometidos a cirugía ortopédica de miembros superiores, distribuidos en dos grupos: Grupo R, que recibió la solución de bupivacaína racémica a 0,5%, y Grupo L, que recibió la solución de la mezcla con exceso enantiomérico del 50% de bupivacaína (S75-R25 a 0,5%, ambas con epinefrina 1:200.000 y en un volumen de 0,6 mL.kg-1 (3 mg.kg-1, limitados a 40 mL. Fueron investigadas las características motoras y sensoriales de cada nervio envolvido (nervios musculocutáneo, radial, mediano, ulnar y cutáneo medial del antebrazo, bien como la incidencia de efectos colaterales. RESULTADOS: No hubo diferencia estadística significativa con relación a los aspectos demográficos. Los parámetros hemodinámicos fueron semejantes entre los grupos, solo que la presión arterial sistólica fue mayor en el Grupo R. No hubo diferencia significativa con relación al tiempo necesario para alcanzar la mayor intensidad de los bloqueos motor y sensitivo. Con una excepción, la latencia del bloqueo motor del grupo muscular inervado por el n. ulnar fue mayor en el Grupo L (10,75 versus 14,25 minutos. CONCLUSIONES: En ambos grupos fueron observados bloqueos motor y sensitivo adecuados para la realización de la cirugía, con pocos efectos colaterales, sugiriendo que la mezcla con exceso enantiomérico del 50% de bupivacaína (S75-R25 a 0,5% con epinefrina es

  4. Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 50 μg/ml en pacientes con dolor crónico secundario a síndrome postlaminectomía

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    Y. M. Riestra Grijalva

    2012-04-01

    Full Text Available Introducción: el dolor crónico es una entidad que afecta a la salud física y psicológica de los pacientes. El síndrome postlaminectomía consiste en la aparición o persistencia de dolor lumbar y/o radicular en un paciente que ha tenido uno o más procedimientos quirúrgicos en la columna. Objetivo general: evaluar la efectividad de la administración de ozono epidural y paravertebral, a una concentración de 50 μg/ml, en pacientes con dolor crónico asociado a síndrome postlaminectomía lumbar. Material y métodos: durante el periodo comprendido entre el 15 de julio y el 30 de diciembre del 2010 se realizó un estudio prospectivo, en 30 pacientes de ambos géneros, con edades comprendidas entre los 18 y los 85 años de edad, que tenían un diagnóstico de dolor crónico secundario a síndrome postlaminectomia lumbar. La media de las EVAs iniciales fue 6,8 sobre 10. La primera infiltración se realizó bajo sedación endovenosa y con control fluoroscópico de la región lumbosacra; se administró vía caudal un volumen de 20 ml de ozono a una concentración de 50 μg/ml en el espacio epidural, y en la región muscular paravertebral lumbar bilateral (L3, L4 y L5 se administraron 10 ml de ozono a la misma concentración en cada nivel. En total, el volumen infiltrado fue de 60 ml. La infiltración en la región paravertebral se repitió, al mismo volumen y concentración, en intervalos de 7 días durante 3 semanas consecutivas. Para medir la efectividad del tratamiento se evaluó la intensidad del dolor considerando las medias inicial y final en la escala visual analógica (EVA. Como medida de la funcionalidad se usó el índice de discapacidad de Oswestry, que se registró previo a la infiltración y a las semanas 4 y 8. El análisis estadístico se realizó mediante el programa Statistical 7.0, aplicando el test de Friedman para las dos variables principales, y la estadística descriptiva (media y desviación estándar para el an

  5. Contrast study of the epidural space

    Energy Technology Data Exchange (ETDEWEB)

    Sipukhin, Ya.M.; Murzin, V.E.; Artyushenko, V.S. (Vladivostokskij Meditsinskij Inst. (USSR))

    The results of contrast epidurography of 69 patients with various diseases of the vertebral column and spinal marrow are presented. Two methods were used: sacral and transdural. Cardiotrast, urotrast, urografin and verografin were used as contrast substances; during epidural administration the amount did not exceed 4 ml. X-ray signs of changes of the epidural space, such as obstruction, stenosis, deformity, make it possible to diagnose disk hernia, tumors and epiduritis. Complications associated with examination were not observed.

  6. MR imaging of spinal epidural sepsis

    International Nuclear Information System (INIS)

    Spinal epidural abscess is uncommonly found in adults and children. Early diagnosis and treatment improves prognosis and prevents serious neurologic sequelae. Four patients with spinal epidural infections were recently evaluated with MR and CT of the spine. In all cases, MR and CT localized the site of infection accurately and showed adjacent bony osteomyelitis. MR proved superior in characterizing infection (abscess vs. inflammatory edema) and demonstrating epidural involvement and spinal cord compression. In all cases, MR obviated the need for myelography. Early recognition by MR of spinal epidural sepsis led to expeditious treatment and better clinical outcome

  7. MR findings of the spinal epidural lesions

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun; Lee, Ho Kyu; Shin, Ji Hoon; Choi, Choong Gon; Suh, Dae Chul; Shin, Myung Jin; Rhim, Seung Chul [Ulsan Univ. College of Midicine, Seoul (Korea, Republic of); Park, Sung Tae [Dongguk Univ. College of Midicine, Kyungju (Korea, Republic of)

    2001-04-01

    The spinal canal takes the form of a series of cylinders designated by their relationship to the meninges and is divided by the dura mater into the epidural or extradural space and intradural space. The epidural space is composed of spinal ligaments, connective and areolar tissue, the epidural venous plexus, lymphatic channels and supporting elements, and various pathologic entities are found there. MR imaging can accurately depict the extent and characteristics of lesions, and in some cases specific diagnosis is possible. In this pictorial essay, we illustrate a variety of spinal epidural lesions and their MR findings.

  8. Síndrome doloroso regional complejo tipo 1: Tratamiento mediante bloqueos simpáticos y más... Complex regional pain syndrome type I: Management with sympathetic blockade and other therapies…

    OpenAIRE

    B. Garrido; L. Fernández-Suárez; Bosch, F.; M. C. Rabí; M. Hernández-Arteaga

    2005-01-01

    Introducción: El síndrome doloroso regional complejo tipo 1 (SDRC-I) cursa con una fase aguda de inflamación neurogénica regional, que conduce a una fase crónica de desórdenes neuropáticos. La participación del sistema nervioso simpático en su génesis y mantenimiento es significativa, pero no exclusiva. De ahí la importancia de un tratamiento precoz y multifactorial, dirigido a los mecanismos fisiopatológicos. Objetivos: Estudiar el uso de los bloqueos simpáticos, asociados a otros procederes...

  9. Unusual cervical spine epidural abscess.

    Science.gov (United States)

    Liou, Jr-Han; Su, Yu-Jang

    2015-10-01

    A 48-year-old man presented to the emergency department with complain of severe neck pain and anterior chest pain. Intermittent fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed leukocytosis and high C-reactive protein level. Urine drug screen was positive for opiate. Empirical antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of epidural abscess and 2 sets of blood culture all yielded methicillin-sensitive Staphylococcus aureus. For epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal abscess in drug abusers after treatment. PMID:26298050

  10. Bacteriological Profile of Epidural Catheters

    Directory of Open Access Journals (Sweden)

    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  11. Sistemas de liberação controlada com bupivacaína racêmica (S50-R50 e mistura enantiomérica de bupivacaína (S75-R25: efeitos da complexação com ciclodextrinas no bloqueio do nervo ciático em camundongos Sistemas de liberación controlada con bupivacaína racémica (S50-R50 y mescla enantiomérica de bupivacaína (S75-R25: efectos de la complexación con ciclodextrinas en el bloqueo del nervio ciático en ratones Drug-delivery systems for racemic bupivacaine (S50-R50 and bupivacaine enantiomeric mixture (S75-R25: cyclodextrins complexation effects on sciatic nerve blockade in mice

    Directory of Open Access Journals (Sweden)

    Daniele Ribeiro de Araújo

    2005-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os efeitos adversos associados ao uso de bupivacaína levaram à procura por novos anestésicos locais (AL com perfil de bloqueio semelhante e menos tóxicos, surgindo novas preparações como a mistura enantiomérica de bupivacaína (S75-R25. Os sistemas de liberação controlada, contendo AL em carreadores como ciclodextrinas (CD, têm como objetivo melhorar a eficácia anestésica e o índice terapêutico dessas drogas. Este estudo visou a preparação, a caracterização e a avaliação da eficácia anestésica dos complexos de inclusão da mistura enantiomérica da bupivacaína (S75-R25 e da bupivacaína racêmica (S50-R50 com hidroxipropilb-ciclodextrina (HPb-CD comparando-os com as preparações atualmente utilizadas na clínica. MÉTODO: Os complexos de inclusão foram preparados misturando-se quantidades apropriadas de HPb-CD e S50-R50 ou S75-R25 nas razões molares (1:1 e 1:2 e caracterizados por estudos de solubilidade de fases. Determinaram-se as constantes de afinidade (K de cada AL pela HPb-CD. Os bloqueios motor e sensorial induzidos pelas drogas livres e complexadas foram avaliados, em camundongos, através do bloqueio do nervo ciático. Para a realização dos experimentos, utilizaram-se três concentrações de AL: 0,125%; 0,25% e 0,5%. RESULTADOS: Os estudos de solubilidade indicaram a formação de complexos de inclusão de S50-R50 e S75-R25 com HPb-CD, com valores de constante de afinidade (K similares para os dois anestésicos: 14,7 M-1 (S50-R50:HP-bCD e 14,3 M-1 (S75-R25:HP-bCD. Os testes em animais mostraram que a complexação potencializou o bloqueio nervoso diferencial induzido pelos AL: i a duração do bloqueio motor induzido por S75-R25 foi similar à do S50-R50, mas menos intenso (p JUSTIFICATIVA Y OBJETIVOS: Los efectos adversos asociados al uso de bupivacaína llevaron a la búsqueda por nuevos anestésicos locales (AL con perfil de bloqueo semejante y menos tóxicos, surgiendo nuevas

  12. Vascular lesions of the lumbar epidural space: magnetic resonance imaging features of epidural cavernous hemangioma and epidural hematoma

    Directory of Open Access Journals (Sweden)

    Basile Júnior Roberto

    1999-01-01

    Full Text Available The authors report the magnetic resonance imaging diagnostic features in two cases with respectively lumbar epidural hematoma and cavernous hemangioma of the lumbar epidural space. Enhanced MRI T1-weighted scans show a hyperintense signal rim surrounding the vascular lesion. Non-enhanced T2-weighted scans showed hyperintense signal.

  13. Analgesia pós-toracotomia com associação de morfina por via peridural e venosa Analgesia pós-toracotomia con asociación de morfina por vía peridural y venosa Comparison of intravenous and epidural morphine analgesia after thoracotomy

    Directory of Open Access Journals (Sweden)

    Neuber Martins Fonseca

    2002-09-01

    bolus de 25 µg.kg-1, por 30 horas. Análisis de gases arteriales, frecuencias cardíaca y respiratoria, presencia de prurito, náuseas y vómitos y analgesia pós-operatoria fueron evaluados a cada 6 horas, hasta un total de 30 horas del pós-operatorio. La analgesia fue evaluada por escala de graduación numérica (EGN de 0 a 10. RESULTADOS: A EGN presentó reducción en el grupo I apenas en el momento M2 no ocurriendo en los demás intervalos. Nos grupos II y III ocurrieron reducción del dolor a partir de 18 horas en relación a los valores iniciales y en relación al grupo I. Hubo mayor necesidad de analgesia complementar en el grupo I de que en los otros grupos. CONCLUSIONES: Se observó mejor efecto analgésico con morfina venosa o con la asociación de vías venosa y peridural utilizando menos dosis de morfina. Esta diferencia fue expresiva cuando menos cantidades de analgésicos complementares fueron utilizados en estos grupos, ofreciendo un efectivo método de analgesia para el pós-operatorio de cirugía de tórax con menores efectos depresivos respiratorios e emetogénicos.BACKGROUND AND OBJECTIVES: Patients undergoing thoracotomy experience severe postoperative pain. This study aimed at evaluating postoperative analgesia with the association of intravenous and epidural morphine as compared to a single route. METHODS: Participated in this study 20 patients of both genders, physical status ASA I, II or III, scheduled for thoracotomy. Patients were premedicated with intravenous midazolam (3 to 3.5 mg in the OR. Monitoring consisted of continuous ECG, invasive blood pressure, pulse oximetry, capnography, CVP, diuresis and temperature. Continuous epidural anesthesia was induced in T7-T8 with 10 ml of 0.25% bupivacaine followed by fentanyl (5 µg.kg-1, etomidate(0.2 to 0.3 mg.kg-1 and succinylcholine (1 mg.kg-1. Tracheal intubation was performed with a double lumen tube and complemented with pancuronium(0.08 to 0.1 mg.kg-1 and mechanically controlled ventilation

  14. Infektioner i forbindelse med epidural kateterisation

    DEFF Research Database (Denmark)

    Holt, H M; Gahrn-Hansen, B; Andersen, S S;

    1996-01-01

    Seventy-eight patients with culture-positive epidural catheters were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had en epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence...

  15. Spinal epidural empyema in two dogs

    International Nuclear Information System (INIS)

    Extensive, diffuse, epidural spinal cord compression was visualized myelographically in two dogs presented for rapid development of nonambulatory tetraparesis and paraplegia, respectively. Purulent fluid containing bacterial organisms was aspirated percutaneously under fluoroscopic guidance from the epidural space of each dog. One dog responded poorly to aggressive medical therapy, which included installation of an epidural lavage and drainage system. Both dogs were euthanized due to the severe nature of their disorder and the poor prognosis. Spinal epidural empyema (i.e., abscess) is a rare condition in humans and has not been reported previously in the veterinary literature. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with painful myelopathies, especially when accompanied by fever

  16. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  17. Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5% Volúmenes anestésicos efectivos en el bloqueo del nervio isquiático: comparación entre los abordajes parasacral e infraglúteo-parabicipital con bupivacaína a 0,5% con adrenalina y ropivacaína a 0,5% Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2009-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O volume e a massa das soluções de anestésico local (AL influenciam a taxa de sucesso dos bloqueios periféricos. Desta forma, o objetivo principal do estudo foi determinar os volumes de anestésico local para o bloqueio do nervo isquiático (BNI nas abordagens parassacral e infraglútea-parabiceptal. MÉTODO: Cento e um pacientes foram alocados aleatoriamente em 4 grupos e submetidos ao BNI nas abordagens infraglútea-parabiceptal ou parassacral, utilizando ropivacaína a 0,5% ou bupivacaína a 0,5% com adrenalina 5 µg.mL-1. Sucesso foi definido como bloqueio sensitivo e motor completo do nervo isquiático 30 minutos após a injeção do AL. Os volumes foram calculados pelo método up-and-down. RESULTADOS: Na abordagem parassacral o volume efetivo médio da ropivacaína foi 17,6 mL (IC 95%: 14,9 - 20,8 e da bupivacaína 16,4 mL (IC 95%: 12,3 - 21,9. Na abordagem infraglútea-parabiceptal o volume efetivo médio da ropivacaína foi 21,8 mL (IC 95%: 18,7 - 25,5 e bupivacaína 20,4 mL (IC 95%: 18,6 - 22,5. Volumes foram significativamente menores (p JUSTIFICATIVA Y OBJETIVOS: El volumen y la masa de las soluciones de anestésico local (AL, influyen en la tasa de éxito de los bloqueos periféricos. Así, el objetivo principal del estudio fue determinar los volúmenes de anestésico local para el bloqueo del nervio isquiático (BNI en los abordajes parasacral e infraglúteoparabicipital. MÉTODO: Ciento y un pacientes se ubicaron aleatoriamente en 4 grupos y fueron sometidos al BNI para los abordajes infraglúteoparabicipital o parasacral, utilizando ropivacaína a 0,5% o bupivacaína a 0,5% con adrenalina 5 µg.mL-1. El éxito se definió como bloqueo sensitivo y motor completo del nervio isquiático 30 minutos después de la inyección del AL. Los volúmenes se calcularon a través del método up-and-down. RESULTADOS: En el abordaje parasacral, el volumen efectivo promedio de la ropivacaína fue de 17,6 mL (IC 95

  18. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Loubert, C; O'Brien, P J; Fernando, R; Walton, N; Philip, S; Addei, T; Columb, M O; Hallworth, S

    2011-05-01

    We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.

  19. Neuropatía periférica tras el parto: Implicaciones de la anestesia epidural Peripheral neuropathy after delivery implications for epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    S. Velázquez

    2006-05-01

    Full Text Available La incidencia de lesiones neurológicas de miembros inferiores en la práctica obstétrica es del 0,08% y 0,92%. La incidencia de complicaciones neurológicas asociadas a la técnica epidural ha sido estimada en 2 casos de cada 10.000 epidurales. Durante los últimos años, con la generalización de la analgesia epidural para el trabajo de parto, es posible que algunas de las neuropatías sean atribuidas a esta técnica, olvidando que hay otros mecanismos de lesión en estas situaciones. Presentamos el caso de una paciente primigesta de 21 años de edad y 139 cm de altura sin antecedentes de interés, que 24 horas tras una epidural para parto y un expulsivo prolongado resuelto con fórceps, desarrolla un "pie caído", que evolucionó a la resolución funcional completa. El pie caído puede darse como consecuencia de una lesión del nervio peroneo, del ciático, o de una raíz del plexo lumbo-sacro. La clínica unida al uso de pruebas como la resonancia magnética (RNM y el electromiograma (EMG, ayudan en el diagnóstico diferencial de la lesión. Parece necesario el estudio del las neuropatías relacionadas con el parto para descartar su relación con la técnica anestésica empleada. Con frecuencia, estas lesiones se deben a mecanismos ajenos a la analgesia-anestesia epidural, si bien debemos procurar minimizar su incidencia con la realización de punciones a niveles adecuados, evitando la inyección de anestésicos cuando existen parestesias, valorando los factores de riesgo en obstetricia y, una vez producida la lesión, con un seguimiento clínico estrecho.Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.92%. Neurological damage secondary to epidural technique is about 2:10,000. In last years, epidural anesthesia has become a generalized practice in obstetrics. Because of it, sometimes, the postpartum neurological damage can be attributed to epidural analgesia, forgetting other mechanisms. We

  20. Propuesta de una vía de abordaje y técnica para el tratamiento de los síndromes de atrapamiento nervioso lumbar postcirugía (SANLPC, como alternativa a las técnicas de adhesiolisis o epidurolisis Proposal for a new approach and technique for the treatment of post-surgery lumbar nerve entrapment syndromes, as an alternative to adhesiolysis or epidu-ral lysis techniques

    Directory of Open Access Journals (Sweden)

    R. González-Durán

    2006-08-01

    Full Text Available Objetivo: Describir una vía supracicatricial de abordaje y la técnica para la realización de epidurolisis, adhesiolisis y/o bloqueos repetidos radiculares, en síndromes dolorosos por atrapamiento nervioso cicatricial posterior a cirugías de columna lumbar, como alternativa a la epidurolisis caudal descrita en la literatura. Considerando que puede presentar menos complicaciones y puede presentar mejores resultados. Material y método: Ocho pacientes que presentan dolor posterior a cirugías de columna lumbar, con cuadros clínicos de lumbalgia, lumbociatalgia o ciática, con clínica y estudios de imagen (RNM, TAC, mieloTAC sugerentes de fibrosis epidural, estudios de EMG y PESS que indicaban daño en raíces lumbares igual o más que en raíces sacras. Los pacientes no presentaban patología asociada o contraindicaciones para la realización de la técnica. En todos los casos se utilizo: antibioterapia previa, sedación y monitorización del paciente. Se coloca al paciente en decúbito prono, con apoyo abdominal para reducir la lordosis fisiológica posicional y se localiza el espacio interespinoso inmediatamente superior a la cicatriz, para abordar el espacio epidural. Se localiza el espacio epidural con una aguja RX Coudé Curva 8,75 cm 15 g de Epimed® con el bisel orientado caudalmente, confirmando con escopia de alta resolución, mediante la inyección de 0,5 mL de contraste. Se introduce el catéter Tun-L-Kath Epimed® de 19 g y 84,5 cm y se orienta caudalmente hacia el nivel y el lugar con mayor sintomatología con control radiológico directo, hasta la parada en la progresión del catéter y se inyecta contraste para verificar el obstáculo, con la difusión retrógrada del mismo, producida por la fibrosis cicatricial. Se intenta progresar comprobando que al hacerlo hay reproducción de las sensaciones del dolor del paciente. Se extrae la aguja y se vigila la inmovilidad de la punta del catéter con control radiológico. Se tuneli

  1. Valoración a largo plazo de los resultados de tratamiento mediante osteosíntesis con miniplacas en sus diferentes usos en cirugía craneomaxilofacial

    OpenAIRE

    Marí Roig, Antonio

    2003-01-01

    [spa] Después de la introducción de la osteosíntesis con miniplacas hace más de 25 años, siguen existiendo controversias en su aplicación en determinadas situaciones de la cirugía craneomaxilofacial. En las fracturas mandibulares se utilizan diferentes tipos de placas asociadas o no a bloqueo intermaxilar con un indice de complicaciones muy variable (James y col, 1981; Limchayseng 1988); el tratamiento más adecuado cuando existen dientes en el foco de fractura. La utilización del bloqueo inte...

  2. Relación entre daño mitocondrial y producción de H2O2 en embriones bovinos producidos in vitro con alto y bajo potencial de desarrollo

    OpenAIRE

    Marlene Jiménez; Carlos Vélez; Martha Olivera Angel; César Serrano

    2001-01-01

    Los embriones producidos in vitro (EPIV) presentan bloqueo en el
    desarrollo en el momento de la activación del genoma (8-16 células en bovinos), limitando la producción de blastocitos (35%). Este fenómeno ha sido relacionado con la producción de Especies Reactivas de Oxígeno (ERO). Entre las fuentes de ERO se han descrito altas tensiones de oxígeno, exposición a la luz y alteración del metabolismo oxidativo (1). Los EPIV con baja competencia para superar el bloqueo present...

  3. Bloqueo aurículo-ventricular de primer grado en tirotoxicosis aguda First degree atrio-ventricular block in acute thyrotoxicosis

    Directory of Open Access Journals (Sweden)

    Antonio R. Vilches

    2004-02-01

    Full Text Available El cuadro clínico de la tirotoxicosis incluye síntomas cardiovasculares variados. La taquicardia sinusal es el trastorno electrocardiográfico más frecuente y los trastornos de conducción son extremadamente raros como modo de presentación. Comunicamos un caso de bloqueo aurículo-ventricular de primer grado en una paciente con hipertiroidismo recién diagnosticado y que comenzó días antes de la consulta con un cuadro general inespecífico. Su evaluación ulterior demostró que se trataba de una tirotoxicosis aguda autoinmune, y su tratamiento con metimazol corrigió el trastorno totalmente. Se discuten los mecanismos fisiopatológicos involucrados y las implicancias clínicas desde el punto de vista del internista.Thyrotoxicosis may present with a variety of cardiovascular symptoms. Sinus tachycardia is the most frequently encountered electrocardiographic abnormality and conduction disturbances are extremely uncommon. We present a case of first degree atrio-ventricular block in a patient with newly diagnosed hyperthyroidism and discuss the underlying pathophysiological mechanisms and the clinical implications from the internist’s standpoint.

  4. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  5. [Epidural analgesia in combination with general anesthesia].

    Science.gov (United States)

    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  6. Epidural labour analgesia using Bupivacaine and Clonidine

    OpenAIRE

    Syal, K; R K Dogra; A Ohri; Chauhan, G.; Goel, A.

    2011-01-01

    Background: To compare the effects of addition of Clonidine (60 μg) to Epidural Bupivacaine (0.125%) for labour analgesia, with regard to duration of analgesia, duration of labour, ambulation, incidence of instrumentation and caesarean section, foetal outcome, patient satisfaction and side effects. Patients & Methods: On demand, epidural labour analgesia was given to 50 nulliparous healthy term parturients (cephalic presentation), divided in two groups randomly. Group I received bupivacain...

  7. [History and Technique of Epidural Anaesthesia].

    Science.gov (United States)

    Waurick, Katrin; Waurick, René

    2015-07-01

    In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique.

  8. Patrón visual de jugadoras experimentadas de voleibol durante la acción del bloqueo

    Directory of Open Access Journals (Sweden)

    Sara Vila-Maldonado

    2015-01-01

    Full Text Available El objetivo del presente estudio fue analizar el com- portamiento visual de las jugadoras de voleibol en una situación de bloqueo basándose en la figura de la colo- cadora. La muestra quedó compuesta por 29 jugadoras de voleibol (23.10 ± 3.74 años que competían de mane- ra federada. Se analizó el comportamiento visual de las jugadoras utilizando secuencias de vídeo proyectadas a tamaño real. Las participantes visionaron el mismo número de colocaciones, realizadas por dos jugadoras distintas, de su mismo nivel competitivo. Dentro del comportamiento visual se analizó la duración, núme- ro y orden de las fijaciones visuales, y los movimientos sacádicos. El número medio de fijaciones de las parti- cipantes fue de 3.61, con una duración media de 3.56 s. Encontramos un patrón en el comportamiento visual de las participantes del estudio basado en sus fijaciones visuales. Inicialmente las participantes utilizaban la vi- sión periférica para detectar diferentes estímulos de la escena y posteriormente su tendencia fue a utilizar la visión fóvea centrándose en distintas zonas concretas. Las zonas más fijadas por las participantes, de las cua- les extraen la información para su toma de decisiones, son fondo (FD y codo-muñeca (CM en primer lugar, seguidas de cabeza (CB, balón (BA, hombro-codo (HC, balón-muñeca (BM y tronco (TR.

  9. EVOLUCIÓN DE FENÓMENOS BÁSICOS DE APRENDIZAJE EN TAREAS DE MEMORIA ESPACIAL: BLOQUEO, ENSOMBRECIMIENTO E INHIBICIÓN LATENTE EN ANFIBIOS

    Directory of Open Access Journals (Sweden)

    MARÍA FLORENCIA DANERI

    2015-01-01

    Full Text Available En este artículo se describen desde una perspectiva comparativa los fenómenos de bloqueo, ensombrecimiento e inhibición latente, enfatizando su presencia en tareas de aprendizaje espacial. Estos fenómenos de aprendizaje, ampliamente observados en otras clases de vertebrados e invertebrados, han sido recientemente descriptos por primera vez en anfibios, un grupo de vertebrados con un cerebro filogenéticamente antiguo. Tomando como modelo al sapo terrestre Rhinella arenarum, se revisarán los tres fenómenos de aprendizaje asociativo mencionados en una situación de aprendizaje espacial: (1 bloqueo entre claves visuales asociadas a una meta, (2 ensombrecimiento de una clave visual lejana por la presencia de una clave cercana y (3 inhibición latente debida a la pre-exposición a una cla ve visual. Todos los entrenamientos se llevaron a cabo en una arena circular de color blanco, utilizando agua como recompensa. Dentro de la arena, se distribuyeron cuatro piletas de acrílico en forma de cruz contra las paredes laterales (sólo una tenía acceso a la recompensa. En las paredes interiores de la arena circular se colocaron varias señales visuales para guiar a los animales. Los resultados obtenidos en sapos indican que estos fenómenos, observados previamente en aves y mamíferos, también se encuentran en este grupo (uti lizando un paradigma de aprendizaje espacial con claves visuales cercanas y lejanas. Este primer registro en anfibios sugiere que los mecanismos biológicos de estos fenómenos de aprendizaje han surgido muy tempranamente en el curso de la evolución de los vertebrados totalmente terrestres y que los mismos han sido fuertemente conservados. El análisis comparado de estos hallazgos contribuirá a mejorar el entendimiento de los mecanismos biológicos que subyacen al aprendizaje espacial, en busca de patrones funcionales comunes con otras clases de vertebrados y potencialmente presentes en un ancestro común.

  10. Tratamiento epidural del dolor en isquemia vascular periférica: Parte II. Revisión bibliográfica basada en la evidencia del tratamiento epidural en la isquemia vascular periférica Epidural pain treatment in peripheral vascular ischemia: (II

    Directory of Open Access Journals (Sweden)

    M.J. Orduña González

    2009-04-01

    Full Text Available Introducción: La isquemia arterial periférica puede ser el resultado de diversas enfermedades que afectan la vascularización de los miembros, generando dolor, discapacidad y deterioro de la calidad de vida del paciente, y en los casos de isquemia crítica, produciendo una considerable morbimortalidad y dolor crónico. Objetivo: Realizar una revisión histórica y crítica de publicaciones científicas sobre la analgesia epidural como método de control del dolor por isquemia vascular periférica y de sus efectos tróficos vasculares, y compararlos con otras técnicas analgésicas, así como recopilar diversas pautas de analgesia epidural y sus resultados. Material y métodos: Búsqueda en Medline, recopilación de datos y posterior análisis crítico, siguiendo los criterios de la medicina basada en la evidencia, de las publicaciones científicas sobre analgesia epidural y el dolor en el contexto de la isquemia arterial periférica. Resultados: a La analgesia con infusión de fármacos epidurales en isquemia de miembros sólo alcanzó un nivel de evidencia 4 en la presente revisión; b la anestesia epidural lumbar para cirugía de revascularización de miembros inferiores se relaciona con unas menores tasas de trombosis postoperatoria y de reintervenciones de revascularización que la anestesia general (nivel de evidencia 2b; c no hay evidencia científica concluyente que apoye la utilización de analgesia epidural preventiva de los síndromes de dolor crónico postamputación de extremidades con isquemia, y d la aplicación de neuroestimulación epidural medular en la isquemia crítica de origen ateroclusivo de miembros no reconstruibles mediante técnicas quirúrgicas está apoyada por un nivel de evidencia 1. En la enfermedad de Buerger, la enfermedad de Raynaud y trastornos vasoespásticos, la aplicación de la neuroestimulación eléctrica epidural viene avalada por un nivel de evidencia 4. Conclusiones: a La isquemia arterial perif

  11. Bloqueo interescalénico ecoguiado: ventajas en pediatría Ultrasound-guided interscalenic block: advantages in pediatrics

    Directory of Open Access Journals (Sweden)

    E. Segura Grau

    2009-02-01

    Full Text Available La anestesia locorregional es uno de los mejores métodos para el control y manejo del dolor intra y postoperatorio. En el paciente pediátrico este tipo de analgesia normalmente se realiza junto con anestesia general o sedación profunda, por la escasa o nula colaboración de los niños. Para la cirugía de hombro y antebrazo uno de los bloqueos periféricos más eficaces es el del plexo braquial por abordaje interescalénico, considerando siempre su elevada incidencia de complicaciones como la parálisis frénica ipsolateral, entre otras. Presentamos el caso de un niño de 13 años de edad propuesto para injerto de húmero de cadáver en miembro superior derecho. Un año antes se realizó resección de tumor refiriéndose un mal manejo del dolor postoperatorio con mórficos en PCA. Como técnica anestésica se realizó una anestesia general y, posteriormente, un bloqueo del plexo braquial por vía interescalénica con ecografía y neuroestimulador, y posterior colocación de catéter para analgesia en el postoperatorio. Se administraron 10 ml de levobupivacaína al 0,5%, sin necesidad de más analgésicos suplementares durante las 6 h que duró la intervención quirúrgica. Al finalizar la cirugía el paciente fue extubado en quirófano objetivando ausencia de dolor, síndrome de Horner y parálisis diafragmática izquierda sin repercusión clínica. Durante las 24 h siguientes se administraron 10 ml/h de ropivacaína al 0,25% a través del catéter, y así se consiguió una analgesia excelente y sin necesidad de bolos a demanda de anestésico local. En conclusión, la anestesia locorregional aporta una adecuada analgesia peri y postoperatoria, disminuyendo la necesidad de analgésicos adyuvantes. La utilización de la ecografía en la realización del bloqueo interescalénico permite no sólo una disminución de las dosis necesarias de anestésico local, sino también una visualización directa en la zona de administración, por lo que podr

  12. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  13. Extracranial epidural emphysema: pathway, aetiology, diagnosis and management

    OpenAIRE

    Cloran, F; Bui-Mansfield, L T

    2011-01-01

    Extracranial epidural emphysema is an uncommon phenomenon that refers to the presence of gas within the epidural space. As an isolated finding, it is typically benign, but it can be a secondary sign of more ominous disease processes, such as pneumothorax, pneumoperitoneum and epidural abscess. Although the phenomenon has been cited in case reports, a comprehensive review of this topic is lacking in the radiology literature. The authors' aim is to report our experience with extracranial epidur...

  14. Effects of epidural lidocaine anesthesia on bulls during electroejaculation.

    OpenAIRE

    Falk, A J; Waldner, C L; Cotter, B S; Gudmundson, J.; Barth, A D

    2001-01-01

    Two experiments were conducted to determine whether caudal epidural lidocaine anesthesia reduces a stress response to electroejaculation. In the 1st experiment, changes in cortisol and progesterone concentrations in serial blood samples were used to assess the stress response to restraint (control), transrectal massage, caudal epidural injection of saline, electroejaculation after caudal epidural injection of lidocaine, and electroejaculation without epidural lidocaine. In the 2nd experiment,...

  15. Bloqueo mediático, redes sociales y malestar ciudadano. Para entender el movimiento español del 15-M

    Directory of Open Access Journals (Sweden)

    Xosé Ramón Rodríguez-Polo

    2013-01-01

    Full Text Available El movimiento del 15-M ha sido la movilización más importante que ha vivido España en los últimos años. En este trabajo proponemos analizar este fenómeno mediante el estudio de cuatro elementos que consideramos que presentan las claves para entender algunas de sus causas y el enorme respaldo social que alcanzó. Empleando el análisis secundario de datos abordamos el estudio de la situación de bloqueo del debate público, la incidencia política que facilitan los medios sociales, los colectivos activistas y el descontento de la ciudadanía española. Del análisis de la opinión pública se colige que el problema económico de la crisis derivó, por causa de su gestión, en un problema social, para transformarse finalmente en un problema político, manifestado en un clima de enorme descontento con la situación política y con el gobierno. La irrupción del 15-M hizo aflorar todo el malestar acumulado, convirtiendo un acto organizado por colectivos minoritarios en toda una marea ciudadana de repulsa.

  16. Acute spontaneous spinal epidural haematoma in a child

    International Nuclear Information System (INIS)

    Spontaneous spinal epidural haematomas rarely occur. Patients tend to be in their sixties or seventies. Acute spontaneous spinal epidural haematomas in children without a predisposition for bleeding disorders, trauma, vascular malformations or anticoagulant therapy have seldom been described. We present a case of a 4-year-old girl with a spontaneous cervical epidural haematoma diagnosed with MR. (orig.)

  17. Depth of the thoracic epidural space in children.

    NARCIS (Netherlands)

    Masir, F.; Driessen, J.J.; Thies, K.C.; Wijnen, M.H.W.A.; Egmond, J. van

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epid

  18. Lumbosacral epidural lipomatosis: MRI grading

    Energy Technology Data Exchange (ETDEWEB)

    Borre, Daniel G. [Department of MRI, RM-Hastings, Clinica Monte Grande, Monte Grande, Buenos Aires (Argentina); Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires (Argentina); Sociedad Argentina de Radiologia, Arenales 1985 P.B., Ciudad Autonoma de Buenos Aires C1124AAC (Argentina); Borre, Guillermo E. [Department of MRI, RM-Hastings, Clinica Monte Grande, Monte Grande, Buenos Aires (Argentina); Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires (Argentina); Aude, Flavio [Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires (Argentina); Palmieri, Gladys N. [Department of MRI, RM-Hastings, Clinica Monte Grande, Monte Grande, Buenos Aires (Argentina)

    2003-07-01

    Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18-84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index {>=}1.5, EF/Spi C index {<=}40%; LEL grade I: DuS/EF index 1.49-1, EF/Spi C index 41-50% (mild EF overgrowth); LEL grade II: DuS/EF index 0.99-0.34, EF/Spi C index 51-74% (moderate EF overgrowth); LEL grade III: DuS/EF index {<=}0.33, EF/Spi C index {>=}75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65-0.93] to 0.82 (95% CI, 0.70-0.95); interobserver, kappa range 0.76 (95% CI, 0.62-0.91) to 0.85 (95% CI, 0.73-0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e

  19. Neonatal respiratory depression associated with epidural analgesia

    Directory of Open Access Journals (Sweden)

    Alberto Gálvez Toro

    2013-06-01

    Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

  20. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

    2006-06-15

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

  1. Solitary Spinal Epidural Metastasis from Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Taisei Sako

    2016-01-01

    Full Text Available Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

  2. Anestesia combinada raqui-peridural em paciente portadora de esclerose lateral amiotrófica: relato de caso Anestesia combinada raquiepidural en paciente portadora de esclerosis lateral amiotrófica: relato de caso Combined spinal-epidural block in a patient with amyotrophic lateral sclerosis: case report

    Directory of Open Access Journals (Sweden)

    Adriano Bechara de Souza Hobaika

    2009-04-01

    transtrocantérica de fémur. Cuadro de debilidad en los miembros superiores e inferiores, disartria, consciente y orientada. Aparato respiratorio: tos ineficaz, reducción de la fuerza de los músculos intercostales y diafragma y reducción del murmurio vesicular en bases pulmonares. Primeramente, la punción epidural fue realizada en L3/L4, donde un catéter de silicona fue introducido 5 cm. A continuación, la punción raquídea se hizo en L4/L5 con administración de 7.5 mg de bupivacaína hiperbárica. Más 37 mg de ropivacaína a 0,37% se administraron por el catéter epidural para que el bloqueo sensitivo llegase al dermatomo T10. El procedimiento transcurrió sin complicaciones y la paciente recibió alta tres días después. CONCLUSIONES: Las evidencias han demostrado que la administración de bloqueos de neuro eje, parece ser segura en pacientes con esclerosis lateral amiotrófica, pues evita la manipulación de las vías aéreas y las complicaciones ventilatorias.BACKGROUND AND OBJECTIVES: Amyotrophic lateral sclerosis starts between the fifth and sixth decades of life, causing degeneration and death of upper and lower motor neurons. When the muscles responsible for ventilation are affected, the patient dies of respiratory failure within a few years. CASE REPORT: This is a 63 years old female with amyotrophic lateral sclerosis who underwent surgical treatment of a transtrochanteric fracture of the femur. The patient presented weakness of upper and lower limbs and dysarthria, and she was awake and oriented. Respiratory function: ineffective cough, decreased strength of the intercostal muscles and diaphragm, and reduction of the breath sounds in both lung bases. Initially, the L3/L4 epidural space was punctured and a silicon catheter was introduced to 5 cm. This was followed by a spinal puncture in the L4/L5 space and the administration of 7.5 mg of hyperbaric bupivacaine. This was followed by the administration of 37 mg of 0.37% ropivacaine through the epidural

  3. Hematoma após anestesia peridural: tratamento conservador. Relato de caso Hematoma posterior a la anestesia peridural: tratamiento conservador. Relato de caso Hematoma after epidural anesthesia: conservative treatment. Case report

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2007-04-01

    ós sete meses, mostrou o canal vertebral completamente normal. CONCLUSÕES: A eficiência da abordagem conservadora mostrou-se uma alternativa importante à intervenção cirúrgica em casos específicos. A avaliação da progressão ou a estabilização do comprometimento neurológico, sobretudo após a oitava hora após a punção peridural, é essencial para a escolha do tratamento.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresión espinal después de la anestesia peridural es una complicación neurológica grave, a pesar de la pequeña incidencia relatada (1:150.000. Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresión quirúrgica de urgencia. Recientemente, en casos específicos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperación neurológica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperación neurológica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 años, estado físico ASA I, sin ningún historial de coagulopatía o terapia anticoagulante, sometida a la anestesia peridural con punción única, en L2-L3, para tratamiento quirúrgico de várices en los miembros inferiores. Ocho horas después de la anestesia regional, todavía presentaba bloqueo motor completo (escala de Bromage, reducción de las sensibilidades térmica y dolorosa por debajo del nivel L3, hiperalgesia en la región plantar izquierda, preservación de los reflejos tendinosos y ausencia de dolor lumbar. La tomografía computadorizada reveló hematoma peridural en L2 con compresión del saco dural. Diez horas después de la punción peridural no había progresión de las señales y síntomas neurológicos. Se optó entonces por el tratamiento con metilprednisolona en infusión venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes. Ocho horas después del inicio del tratamiento, la paciente recuper

  4. Simulação de bloqueios periféricos guiados por ultra-som: curva de aprendizado dos residentes de anestesiologia do CET-SMA/HSL Simulacro de bloqueos periféricos guiados por ultrasonido: curva de aprendizaje de los residentes de anestesiología del CET-SMA/HSL Simulation of ultrasound-guided peripheral nerve block: learning curve of CET-SMA/HSL anesthesiology residents

    Directory of Open Access Journals (Sweden)

    Marilia Bonifácio Baranauskas

    2008-04-01

    por ultrasonido a través de modelo experimental de gelatina. MÉTODO: Fue desarrollado un modelo experimental con un recipiente lleno de gelatina y aceituna sumergida. Nueve residentes se distribuyeron aleatoriamente en tres grupos (G1, G2, G3 compuestos cada uno, por un R1, un R2 y un R3. Los tres grupos recibieron una explicación teórica. El G1 recibió dos horas de entrenamiento práctico, el G2 una hora y el G3 no fue entrenado. Acto seguido, se les solicitó a los participantes que pusiesen la aguja en el punto medio de la pared de la aceituna, cerca del transductor y reposicionar la aguja entre la aceituna y el fondo del recipiente, simulando la inyección perineural del anestésico. Se evaluaron la velocidad y la eficacia de las tareas, además de las fallas técnicas. RESULTADOS: El G1 presentó un promedio de tiempo para la realización de las tareas de 37,63 segundos, sin fallas técnicas; en el G2 se observó un promedio de 64,40 segundos, ocurriendo dos fallas técnicas y el G3 presentó un promedio de 93,83 segundos, con doce fallas técnicas. CONCLUSIONES: El estudio permite concluir que el mayor tiempo de entrenamiento en un modelo experimental de bloqueos periféricos guiados por ultrasonido mejoró la curva de aprendizaje en el simulacro de la técnica.BACKGROUND AND OBJECTIVES: The use of ultrasound imaging in peripheral nerve block has been increasing. However, there are few reports in the literature on the learning curve of the ultrasound technique. The objective of this report was to evaluate the learning curve of CET-SMA/HSL Anesthesiology residents of ultrasound-guided peripheral block using an experimental agar model. METHODS: An experimental model was developed by filling a bowl with agar and olives. Nine residents were randomly divided in three groups (G1, G2, and G3, each one with a R1, a R2, and a R3. All three groups received theoretical explanation. G1 also had two hours of practical training, G2 had one hour, and G3 had no training

  5. Lumbar Epidural Varix Mimicking Disc Herniation

    Science.gov (United States)

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  6. Lumbar Epidural Varix Mimicking Disc Herniation.

    Science.gov (United States)

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.

  7. Lumbar Epidural Varix Mimicking Disc Herniation.

    Science.gov (United States)

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  8. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    Radulović Danilo

    2005-01-01

    Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

  9. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma.

    Science.gov (United States)

    Eap, C; Bannwarth, M; Jazeron, J-F; Kleber, J-C; Theret, É; Duntze, J; Litre, C-F

    2015-12-01

    Epidural angiolipomas are uncommon benign tumors of the spine. Their clinical presentation is usually a progressive spinal cord compression. We report the case of a 22-year-old patient who presented with an acute paraparesis and a spontaneous epidural hematoma, which revealed a epidural angiolipoma which extended from C7 to T3. The patient underwent a C7-T3 laminectomy, in emergency, with evacuation of the hematoma and extradural complete resection of a fibrous epidural tumor bleeding. The postoperative course was favorable with regression of neurological symptoms. Epidural angiolipomas can be revealed by spontaneous intratumoral hemorrhage without traumatism. The standard treatment is total removal by surgery. PMID:26597606

  10. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    -structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings...... analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman’s type of emotional reaction to epidural analgesia and her possible intricate worries. 2014 Australian College of Midwives. Published...

  11. Postoperative epidural hematoma. Five cases of epidural hematomas developed after supratentorial craniotomy on the contralateral side

    Energy Technology Data Exchange (ETDEWEB)

    Sato, M. (Shiga Univ. of Medical Science, Ohtsu (Japan)); Mori, K.; Handa, H.

    1981-10-01

    Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. The mechanism of this complication is not clearly understood. In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.

  12. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.

    Science.gov (United States)

    van Rappard, Juliaan R M; Tolenaar, Jip L; Smits, Anke B; Go, Peter M N Y H

    2015-08-20

    We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.

  13. Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

    Directory of Open Access Journals (Sweden)

    J.R. Ortiz-Gómez

    2014-12-01

    Full Text Available La analgesia epidural es hoy día el método de elección para el tratamiento del dolor del trabajo de parto, el expulsivo y el alumbramiento. Sin embargo, esta técnica puede fallar y aliviar de forma inadecuada (o nula a la parturienta. En el presente artículo se revisan los factores de riesgo, las posibles causas y las alternativas terapéuticas posibles a la analgesia inadecuada, ya sea mediante terapias farmacológicas (neuroaxiales, bloqueos periféricos o administración de analgésicos vía intravenosa o inhalatoria o no farmacológicas (técnicas de relajación, psicológicas o mecánicas. En todos los casos posibles se revisan la eficacia y las indicaciones de las terapias alternativas en función de la literatura publicada, especialmente desde el punto de vista de la medicina basada en la evidencia. Se insiste en la necesidad de aplicar una aproximación terapéutica multifactorial a la embarazada, no limitándonos solo a eliminar el dolor del parto.

  14. Epidural fentanyl decreases the minimum local analgesic concentration of epidural lidocaine

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian; ZHENG Yue-ying; FENG Zhi-ying; CHEN Chao-qin; ZHU Sheng-mei

    2012-01-01

    Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly,but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration(MLAC)of lidocaine is not known.We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions:lidocaine,or lidocaine plus fentanyl 1 μg/ml,2 μg/ml,or 3 μg/ml.The first patient in each group was administered 1% lidocaine weight by volume;subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments.Efficacy was assessed using a visual analog pain scale,and accepted if this was ≤10 mm on a 100 mm scale within 30 minutes.The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery,respectively.Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785%(95%C/0.738-0.864).A significant dose-dependent reduction was observed with the addition of fentanyl:the MLAC of lidocaine with fentanyl at 2 μg/ml was 0.596%(95%Cl 0.537-0.660)and 0.387% with fentanyl at 3 μg/ml(95%Cl 0.329-0.446,P<0.001).Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects.

  15. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    OpenAIRE

    Lin Y; Li Q; Yang R; Liu J

    2016-01-01

    Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI) and programmed intermittent epidural bolus (IEB) analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred ...

  16. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...

  17. MRI features of spinal epidural angiolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Su; Hu, Chun Hong; Wang, Xi Ming; Dai, Hui [Dept. of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu (China); Hu, Xiao Yun; Fang, Xiang Ming [Dept. of Radiology, Wuxi People' s Hospital Affiliated to Nanjing Medical University, Jiangsu (China); Cui, Lei [Dept. of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu (China)

    2013-10-15

    To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

  18. Spontaneous extracranial decompression of epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Neely, John C. [Marshall University School of Medicine, Huntington, WV (United States); Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Crone, Kerry R. [Cincinnati Children' s Hospital Medical Center, Division of Neurosurgery, Cincinnati, OH (United States)

    2008-03-15

    Epidural hematoma (EDH) is a common sequela of head trauma in children. An increasing number are managed nonsurgically, with close clinical and imaging observation. We report the case of a traumatic EDH that spontaneously decompressed into the subgaleal space, demonstrated on serial CT scans that showed resolution of the EDH and concurrent enlargement of the subgaleal hematoma. (orig.)

  19. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso Phrenic nerve block after interscalene brachial plexus block: case report

    Directory of Open Access Journals (Sweden)

    Luis Henrique Cangiani

    2008-04-01

    embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective

  20. Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral? Control del dolor postoperatorio de la artroplastia total de la rodilla: ¿es necesario asociar el bloqueo del nervio isquiático al bloqueo del nervio femoral? Control of postoperative pain following total knee arthroplasty: is it necessary to associate sciatic nerve block to femoral nerve block?

    Directory of Open Access Journals (Sweden)

    Affonso H. Zugliani

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO: Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9 foi realizado bloqueio do nervo femoral e no Grupo B (n = 8, bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1. RESULTADOS: A mediana do tempo de analgesia (M1 no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001. Não foram observadas complicações atribuíveis às técnicas utilizadas. CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.JUSTIFICATIVA Y OBJETIVOS: La artroplastia total de la rodilla (ATR promueve gran trauma del tejido produciendo un intenso dolor en el postoperatorio. La analgesia de postoperatorio de buena calidad es fundamental, debiendo considerar que la movilización articular precoz es un importante aspecto para la obtención de buenos resultados. Existen controversias en la literatura sobre la eficacia del bloqueo aislado del nervio femoral. El objetivo de este estudio fue evaluar la analgesia en postoperatorio con la asociaci

  1. Bloqueos diagnóstico-terapéuticos de carillas articulares cervicales Diagnostic-therapeutic cervical facet joint blocks

    Directory of Open Access Journals (Sweden)

    M.L. Franco

    2009-03-01

    Full Text Available El 66% de los adultos experimenta dolor cervical a lo largo de su vida y el 54% lo ha experimentado durante los pasados 6 meses. Sólo el 5% presentará dolor crónico intenso acompañado de incapacidad funcional. El 80% del dolor cervical se produce por lesiones óseas o musculares como consecuencia de la degeneración discal y facetaria, a lo que se pueden sumar agentes externos, como traumatismo, sobrepeso, sobrecargas laborales, estrés, etc. El diagnóstico del dolor cervical se basa, fundamentalmente, en la exploración física y en la clínica del paciente. Ante la presencia de dolor cervical irradiado a nuca, cintura escapulohumeral y miembro superior derecho sin patrón radicular con exploración positiva en carillas articulares, están indicados los bloqueos diagnóstico-terapéuticos de éstas. En el trabajo se describe la anatomía de la región cervical, cuyo conocimiento es imprescindible tanto para garantizar los buenos resultados, como para minimizar los riesgos, así como las indicaciones y práctica de la técnica.Cervical pain is experienced by 66% of adults during their lifetime and by 54% in the previous 6 months. Only 5% will experience intense chronic pain with functional disability. Eighty percent of cervical pain is produced by skeletal or muscular lesions as a result of disc and facet degeneration. External causative agents include trauma, overweight, occupational demands, stress, etc. Diagnosis of cervical pain is mainly based on physical examination and clinical findings. In cervical pain radiating to the neck, scapulohumeral girdle and upper right arm without a radicular pattern and positive examination of the facet joints, diagnostic-therapeutic facet joint blocks are indicated. The present article describes the anatomy of the cervical region. Knowledge of this region is essential to guarantee good results and to minimize risks. The indications and practical features of the technique are also discussed.

  2. Bloqueo tricompartimental del hombro doloroso: estudio preliminar Tricompartmental blockade of painful shoulder: A preliminary study

    Directory of Open Access Journals (Sweden)

    D. Abejón

    2009-10-01

    Full Text Available Introducción: El hombro doloroso constituye una de las consultas más frecuentes en atención primaria, y afecta entre el 7 y el 34% de la población general adulta. La etiología más frecuente es la disfunción del manguito de los rotadores, que supone más del 70% de los casos, incluyendo aquí la tendinitis, la bursitis y la rotura de éste o de alguno de sus componentes. Se han postulado diversos tratamientos para el hombro doloroso. El objetivo del estudio es exponer una nueva técnica para los pacientes que son resistentes a los tratamientos convencionales. Material y métodos: Se analizó la eficacia de la técnica mediante una escala analógica visual (EVA que se pasó a los pacientes en el momento basal y al mes posterior a su realización. En el mismo período se valoró el grado de satisfacción de los pacientes y el porcentaje de mejoría de éstos. Por último, se analizaron las complicaciones, si existieron, y se preguntó a los pacientes si repetirían la técnica o no. Resultados: La técnica se realizó en 12 pacientes. La EVA basal media fue de 8,5 ± 1 y descendió a 5,5 ± 3 tras el procedimiento. Cuando se analizan los pacientes en los que se obtuvo beneficio, el descenso de la EVA fue cercano a 5 puntos con respecto al basal. Cuando se analizan estos datos se podría decir que en patología artrósica el valor de la técnica es mayor que en los pacientes en los que predomina la patología de partes blandas. El porcentaje medio de mejoría en la muestra completa fue de 45,83 ± 42,05. Los pacientes en los que se realizó la técnica, ante la pregunta de si repetirían o no la técnica, 7 repetirían frente a 5 que no lo harían. No se recogió ninguna complicación derivada del procedimiento. Conclusiones: El bloqueo tricompartimental del hombro parece una técnica prometedora en el tratamiento del hombro doloroso, principalmente en los casos en los que la patología subyacente es de origen artrósico.Introduction: Painful

  3. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA?

    Directory of Open Access Journals (Sweden)

    F. Caba

    2010-05-01

    Full Text Available La analgesia epidural se ha convertido en una técnica rutinaria en el manejo perioperatorio de los pacientes quirúrgicos que se ha extendido fuera de los quirófanos y de las unidades de alta dependencia hacia las salas de hospitalización. La irrupción en este nuevo escenario ha mejorado la analgesia postoperatoria con aceptables márgenes de seguridad, lo que le ha servido para colocarse en un lugar predominante entre las pautas analgésicas de las Unidades de Dolor Agudo (UDA. La analgesia epidural con anestésicos locales y opioides frente a la sistémica con opioides ha presentado históricamente una superior eficacia analgésica, y una disminución de complicaciones derivadas de la atenuación del estrés quirúrgico y de la mejora en la función cardiorrespiratoria. Sin embargo, frente a estas ventajas la analgesia epidural también presenta inconvenientes como la hipotensión arterial o la retención urinaria, junto a las potencialmente graves derivadas del daño neurológico ocasionado por un hematoma epidural, una infección o una lesión directa del tejido nervioso. Si sus ventajas han resultado consistentes y fundamentadas, en este momento no lo parecen tanto. El avance que ha supuesto la cirugía mínimamente invasiva con altas más precoces, junto al desarrollo de estrategias multimodales, está conduciendo a un replanteamiento de la utilización de técnicas como la epidural y a una reevaluación de sus indicaciones. Las últimas evidencias nos inducen a pensar que la epidural probablemente haya tocado techo en el tratamiento del dolor postoperatorio y comenzará a perder terreno frente a otras técnicas igualmente efectivas, con menores complicaciones y efectos secundarios. Este será un proceso lento en el que deberá quedar asegurado que las alternativas analgésicas ofrecen realmente mejores resultados en cuanto a eficacia, seguridad, tolerabilidad y calidad de la recuperación desde la perspectiva del paciente.

  4. Recurrent acute low back pain secondary to lumbar epidural calcification

    International Nuclear Information System (INIS)

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  5. Pleural puncture with thoracic epidural: A rare complication?

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  6. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  7. Epidural catheter fragment entrapment: a case report

    Directory of Open Access Journals (Sweden)

    Mohammadi M

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous. "n"nCase presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperative epidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT- scan was performed and shows a fragment of catheter in the sub- laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic."n"nConclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT- scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.

  8. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    International Nuclear Information System (INIS)

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  9. Epidural spinal electrical stimulation in severe angina pectoris.

    OpenAIRE

    Mannheimer, C; Augustinsson, L E; Carlsson, C A; Manhem, K; Wilhelmsson, C

    1988-01-01

    The short term effects of epidural spinal electrical stimulation were studied in 10 patients with angina pectoris of New York Heart Association functional class III or IV. The antianginal pharmacological treatment given at entry to the study was regarded as optimal and was not changed during the study. The effects of epidural spinal electrical stimulation were measured by repeated bicycle ergometer tests. Treatment with epidural spinal electrical stimulation increased the patients' working ca...

  10. Bloqueo espacial

    OpenAIRE

    Rodrigo i Calduch, Mª Teresa

    1996-01-01

    [spa] ¿Cómo resuelven los animales las discriminaciones espaciales o encuentran el camino a una meta situada en una determinada localización? O'Keefe y Nadel (1978) consideran que las ratas pueden aprender el camino hacia una meta en un laberinto de dos maneras diferentes. Una de ellas es mediante el aprendizaje táxico, que engloba dos estrategias distintas: la estrategia de respuesta u orientación, que consiste en el condicionamiento de movimientos de orientación (giros especificas a la dere...

  11. Lab in a needle for epidural space identification

    Science.gov (United States)

    Carotenuto, B.; Micco, A.; Ricciardi, A.; Amorizzo, E.; Mercieri, M.; Cutolo, A.; Cusano, A.

    2016-05-01

    This work relies on the development of a sensorized medical needle with an all-optical guidance (Lab in a Needle) system for epidural space identification. The device is based on the judicious integration of a Fiber Bragg grating sensor inside the lumen of an epidural needle to discriminate between different types of tissue and thus providing continuous and real time measurements of the pressure experienced by the needle tip during its advancement. Experiments carried out on an epidural training phantom demonstrate the validity of our approach for the correct and effective identification of the epidural space.

  12. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  13. Fracturas del húmero proximal: su tratamiento con clavos bloqueados proximales

    OpenAIRE

    Arenas Planelles, Antonio; D'Arrigo, A.; Arenas Miquélez, A.; Duart, J.

    2012-01-01

    Se presentan 27 casos de fractura de húmero proximal tratados mediante osteosíntesis con clavo proximal bloqueado. Los resultados fueron buenos en la mayor parte de los pacientes, con un dolor medio de 11,67/15 en la cotación cifrada de Constant, una fuerza de 14/25 puntos y una movilidad de 20,52/40 puntos. Las complicaciones más importantes fueron el conflicto subacromial (29,6%), la consolidación viciosa de la fractura en varo (29,6%) y la protrusión de los tornillos de bloqueo...

  14. Riscos cardiovasculares do bloqueio androgênico Riesgos cardiovasculares del bloqueo androgénico Cardiovascular risks of androgen deprivation therapy

    Directory of Open Access Journals (Sweden)

    Adriano Freitas Ribeiro

    2010-09-01

    Full Text Available O adenocarcinoma de próstata é o câncer mais comum no sexo masculino após o câncer de pele. Entre as várias formas de tratamento do câncer de próstata, a terapia de bloqueio androgênico é uma modalidade consagrada nos pacientes com doença metastática ou localmente avançada, que provavelmente resulta em aumento de sobrevida. No entanto, o bloqueio androgênico é causador de uma série de consequências adversas. Complicações como osteoporose, disfunção sexual, ginecomastia, anemia e alterações na composição corporal são bem conhecidas. Recentemente, uma série de complicações metabólicas foi descrita como aumento da circunferência abdominal, resistência à insulina, hiperglicemia, diabete, dislipidemia e síndrome metabólica com consequente aumento do risco de eventos coronarianos e mortalidade cardiovascular nessa população específica. Este artigo de atualização apresenta uma revisão bibliográfica realizada no MEDLINE de toda literatura publicada em inglês no período de 1966 até junho de 2009, com as seguintes palavras-chave: androgen deprivation therapy, androgen supression therapy, hormone treatment, prostate cancer, metabolic syndrome e cardiovascular disease, no intuito de analisar quais seriam os reais riscos cardiovasculares da terapia de deprivação androgênica, também chamada bloqueio androgênico, nos pacientes com câncer de próstata.El adenocarcinoma de próstata es el cáncer más común en el sexo masculino después del cáncer de piel. Entre las varias formas de tratamiento del cáncer de próstata, la terapia de bloqueo androgénico es una modalidad consagrada en los pacientes con enfermedad metastásica o localmente avanzada, que probablemente resulta en aumento de sobrevida. Mientras tanto, el bloqueo androgénico es causante de una serie de consecuencias adversas. Complicaciones como osteoporosis, disfunción sexual, ginecomastia, anemia y alteraciones en la composición corporal son

  15. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    during the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myocloniaduring the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has...

  16. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    during the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose...

  17. Correlación clinicorradiográfica de la fibrosis epidural en el síndrome poslaminectomía mediante epidurografía Clinical/radiography correlation of epidural fibrosis in postlaminectomy syndrome by epidurography

    Directory of Open Access Journals (Sweden)

    G. Cardona

    2010-05-01

    Full Text Available Introducción: La epidurografía es un recurso invasivo que evalúa deformidades y eventual ocupación del espacio epidural, además de ser un estudio fácilmente realizable, confiable, económico y que forma parte del algoritmo de manejo del síndrome poslaminectomía. Objetivo: Verificar si la localización y la extensión de la fibrosis epidural se correlacionan con el cuadro clínico presente en los pacientes con síndrome poslaminectomía. Material y métodos: Se incluyó a 30 pacientes con diagnóstico de síndrome poslaminectomía lumbar divididos en dos grupos: grupo A (n=15 pacientes con lumbalgia y dolor neuropático del miembro pélvico unilateral y grupo B (n=15 pacientes con lumbalgia con dolor neuropático bilateral. En todos los pacientes se realizó el abordaje caudal bajo control fluoroscópico en decúbito prono con aguja Tuohy #17. La epidurografía se realizó inyectando medio de contraste ioversol al 63%, acetato de metilprednisolona y lidocaína al 2%. Se relacionó la localización de la fibrosis con el cuadro clínico además de valorar la intensidad del dolor utilizando la escala visual analógica previa al procedimiento a las 2 y a las 4 semanas de realizado este. Resultados: Del total de la población, el 53,3% (16 tuvo correlación clinicorradiográfica, lo cual no se considera estadísticamente significativo (p=0,259. En relación con la evaluación de la escala visual analógica inicial se observó disminución significativa a las 2 semanas de realizado el procedimiento (p=0,0001. Conclusión: La epidurografía diagnóstica no tiene utilidad al momento de intentar correlacionar el sitio de fibrosis epidural con la presentación clínica en los pacientes con síndrome poslaminectomía.Introduction: Epidurography is an invasive technique that evaluates deformities and eventual occupation of the epidural space, besides being easy to perform, reliable and inexpensive, is part of the management algorithm of post

  18. The Epidural Treatment of Sciatica: Its Origin and Evolution.

    Science.gov (United States)

    Ter Meulen, Bastiaan C; Weinstein, Henry; Ostelo, Raymond; Koehler, Peter J

    2016-01-01

    Epidural injection with corticosteroids is a common treatment option for patients with lower back pain or sciatica. In this paper we review its origin and evolution. The first injections were given around 1900 in Paris by Jean Sicard (1872-1929) and Fernand Cathelin (1873-1945), who worked independently. They both injected small volumes of cocaine into the sacral hiatus. After a slow start, the epidural treatment of back pain and sciatica gradually spread to other parts of Europe and Northern America. In the early 1950s, corticosteroids were introduced for epidural use. Since the 1970s, there have been numerous clinical trials that show a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term. Despite an ongoing debate about effectiveness and safety, epidural injections remain popular. PMID:26820578

  19. Idiopathic Lumbar Epidural Lipomatosis Mimicking Disc Herniation: A Case Report.

    Science.gov (United States)

    Duran, Efe; Ilik, Kemal; Acar, Turker; Yıldız, Melda

    2016-05-01

    Spinal epidural lipomatosis is a rare condition which is described as the accumulation of fat in the extradural territory and often causes dural impingement. Spinal epidural lipomatosis has been implicated in causing a variety of neurologic impairments ranging from back pain, radiculopathy, claudication, myelopathy or even cauda equina syndrome. We report a 46-year-old female with obesity and a history of chronic back pain and radiculopathy who developed idiopathic Spinal epidural lipomatosis diagnosed by magnetic resonance imaging. The purpose of this report is to present a case of spinal epidural lipomatosis presenting with symptomatic cord compression and also remind this rare condition as a the differential diagnosis of epidural lesions in patients with risk factors. PMID:27309484

  20. Tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção acidental da duramáter em paciente HIV positivo: relato de caso Tampón peridural con dextran 40 en la profilaxia de la cefalea pós-punción accidental de la duramáter en paciente SIDA positivo: relato de caso Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2002-11-01

    han sido relatadas. El objetivo de este articulo es presentar un caso del uso del tampón peridural con dextran 40 en la profilaxia de la cefalea pós-punción de duramáter en paciente portador del virus de la imunodeficiencia humana (HIV, con historia de cefalea en anestesia subaracnóidea anterior. Relato do caso: Paciente masculino, 31 años, 70 kg, estado físico ASA II, portador de SIDA, para tratamiento de condilomatosis anal recidivada, con relato de cefalea intensa y limitante durante dos semanas después de anestesia subaracnóidea (aguja Quincke 25G. Durante la tentativa de anestesia peridural con aguja de Tuohy 18G en L3-L4, hubo perforación accidental de la duramáter. Fueron inyectados, por dos veces, 20 ml de dextran 40 a 10% por catéter peridural; la primera, 150 minutos después de la administración de los anestésicos y la segunda en la mañana siguiente a la cirugía. El paciente evoluyó asintomático y recibió alta al día siguiente a su internación. CONCLUSIONES: El uso del tampón con soluciones coloides como el dextran 40 no está bien establecido, sin embargo existen algunos relatos de su uso con suceso y entendemos que su potencial debe ser mejor explorado.BACKGROUND AND OBJECTIVES: Postdural puncture headache is a well-known complication of spinal and epidural anesthesia and, so far, its most effective treatment is the epidural blood patch. Nevertheless this is an invasive procedure subject to severe complications. Its use in special patient populations (HIV positive patients and leukemias is controversial. Several alternatives have been reported. This study aimed at showing a case of prophylactic epidural dextran 40 patch in an HIV patient with previous history of headache following spinal anesthesia. CASE REPORT: Male patient, 31 years old, 70 kg, physical status ASA II, HIV positive, presented for recurrent anal condylomatosis treatment, with a history of severe and limiting headache for two weeks following spinal anesthesia. (25G

  1. Epidural analgesia during labor vs no analgesia: A comparative study

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    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  2. El blocao (y el bloqueo de José Díaz Fernández

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    Luis Fernando Bueno Morillas

    2015-06-01

    Full Text Available El blocao (1928 fue la primera novela de José Díaz Fernández. Supuso un éxito editorial insólito hasta entonces porque reunía tres características novedosas: una actitud crítica ante la guerra de Marruecos, una integración de las novedades vanguardistas en la que su autor llamó literatura de avanzada y un posicionamiento del intelectual al lado de las reivindicaciones del pueblo. Sin embargo, aunque publicó otra novela un año después (La Venus mecánica, un libro teórico en el que definía la literatura que él propugnaba y practicaba (El nuevo romanticismo y algunas narraciones breves, Díaz Fernández se bloqueó y dejó la literatura narrativa que tan buenas expectativas levantó. Analizaremos las posibles causas de ese bloqueo.

  3. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.

    Science.gov (United States)

    Zeng, X Z; Xu, Y M; Cui, X G; Guo, Y P; Li, W Z

    2014-03-01

    Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). The C group received epidural 0.75% levobupivacaine 12 ml with 1 ml of isotonic sodium chloride solution, while the D group received epidural 0.75% levobupivacaine 12 ml with 1 ml (0.5 µg/kg) of dexmedetomidine. Haemodynamic changes, onset time and duration of sensory and motor block, muscle relaxation score, verbal rating score for pain, sedation score and the total postoperative analgesic consumption were evaluated. Sensory blockade duration was longer in the D group than in the C group (P=0.01). The incidence of motor block and the muscle relaxation score were significantly higher in the D group compared with the C group (P=0.01). Compared with the C group, pain scores were significantly lower in the first four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was significantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 µg/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine.

  4. Meningite após técnica combinada para analgesia de parto: relato de caso Meningitis después de técnica combinada para analgesia de parto: relato de caso Meningitis after combined spinal-epidural analgesia for labor: case report

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2002-06-01

    nuca. En el 13º día los síntomas pasaron a ser más intensos. Fue realizada punción lumbar. La historia clínica y el examen del líquor fueron compatibles con meningitis bacteriana. CONCLUSIONES: La técnica combinada (raqui-peridural para analgesia de parto está próxima de lo ideal. Cuidados con la técnica de anti-sepsia son necesarios para realización de bloqueos espinales. La complicación presentada ocurrió sin la aparente falla en la realización de la técnica, siendo una cuestión que es inherente al riesgo - beneficio que la técnica proporciona.BACKGRAUND AND OBJECTIVES: Meningitis is a serious complication, although rare in regional anesthesia. This report aimed at presenting a case which evolved to meningitis after combined labor spinal-epidural analgesia. CASE REPORT: Laboring patient, 25 years old, second gestation and previous c-section. Combined labor spinal-epidural analgesia was induced with double-puncture. Twenty-four hours later she presented with headache at rest, fever and mild chills, which regressed with symptomatic medication. Headache worsened in the 5th day. There were vomiting and neck pain in the 10th day. Symptoms became more severe in the 13th day. Lumbar puncture was performed. Clinical history and CSF analysis were compatible with bacterial meningitis. CONCLUSIONS: Combined labor spinal-epidural analgesia is very close to being the ideal technique. Care must be taken with the sterile technique to induce spinal blockade. The reported complication has occurred without an apparent technique failure and is inherent to technique’s risk-benefit ratio.

  5. Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome Migración epidural posterior de fragmento de disco lumbar secuestrado que causa síndrome de cauda equina Migração epidural posterior de fragmento de disco lombar sequestrado que causa síndrome da cauda equina

    Directory of Open Access Journals (Sweden)

    Abolfazl Rahimizadeh

    2013-01-01

    Full Text Available Posterior epidural migration (PEM of a sequestered free lumbar disc fragment is rare. The rarity is due to presence of several anatomical restraints which restrict a free fragment to move to the posterior compartment. This unusual presentation of disc herniation appeared in the literature either as a single case report or in small series from two to six cases. Herein two new demonstrative cases will be presented with a brief review of the literature.La migración epidural (PEM posterior Epidural Migration de fragmento de disco lumbar libre secuestrado es rara. La rareza se debe a la existencia de varias restricciones anatómicas impidiendo que el fragmento libre se mueva hacia el compartimento posterior. Esa presentación no común de hernia de disco apareció en la literatura como un relato de caso único o en pequeñas series de dos a seis casos. En este artículo, se presentan dos casos nuevos demostrativos, conjuntamente con una revisión breve de la literatura.A migração epidural posterior (PEM posterior epidural migration de fragmento de disco lombar livre sequestrado é rara. A raridade deve-se à presença de várias restrições anatômicas que impedem que o fragmento livre se mova para o compartimento posterior. Essa apresentação incomum de hérnia de disco apareceu na literatura como relato de caso único ou em pequenas séries de dois a seis casos. Neste artigo, são apresentados dois novos casos demonstrativos, com uma breve revisão da literatura.

  6. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2006-12-01

    dos cinco nervos do plexo lombar.JUSTIFICATIVA Y OBJETIVOS: Este estudio evaluó la eficacia de la inyección única de bupivacaína a 0,25% en el compartimiento del psoas o perivascular inguinal a través del estimulador de nervios periféricos para analgesia postoperatoria en pacientes sometidos a intervenciones quirúrgicas ortopédicas. MÉTODO: Cien pacientes recibieron bloqueo del plexo lumbar a través del compartimiento del psoas y fueron comparados con 100 pacientes que recibieron bloqueo del plexo lumbar vía perivascular inguinal, identificados por el estimulador de nervios periféricos con la inyección de 40 mL bupivacaína a 0,25% sin epinefrina. La analgesia en los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fue evaluada a las 4, 8, 12, 16, 20 y 24 horas después del final de la intervención quirúrgica. La intensidad del dolor también fue medida en el mismo período. La cantidad de opioides administrada en el postoperatorio fue anotada. En cinco pacientes de cada grupo, un estudio radiográfico con contraste no iónico se realizó para medir la dispersión de la solución anestésica. RESULTADOS: Los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fueron bloqueados en 92% de los pacientes en el compartimiento del psoas versus 62% en el bloqueo perivascular inguinal. El bloqueo del plexo lumbar redujo la necesidad de opioides y 42% de los pacientes sometidos al bloqueo del compartimiento del psoas y 36% de los pacientes en el bloqueo inguinal no necesitaron analgésico adicional en el postoperatorio. La duración de la analgesia fue de aproximadamente 21 horas con el bloqueo del compartimiento del psoas y 15 horas en el bloqueo perivascular inguinal. CONCLUSIONES: El bloqueo del compartimiento del psoas y perivascular inguinal es una excelente técnica para la analgesia postoperatoria en intervenciones quirúrgicas ortopédicas reduciendo la necesidad de opioides. Ese

  7. Uso de la ecografía para el bloqueo de los nervios periféricos del miembro pelviano en el gato (Felis catus L.)

    OpenAIRE

    Haro Álvarez, Ana Paulina

    2013-01-01

    El presente estudio fue llevado a cabo para describir la apariencia ecográfica y desarrollar los abordajes ecoguiados para el bloqueo de los nervios ciático y femoral, así como evaluar la eficacia clínica del bloqueo ecoguiado del nervio ciático en el gato. Se realizaron disecciones anatómicas y criosecciones para determinar las marcas anatómicas para localizar los nervios de interés. La apariencia ecográfica de los nervios ciático y femoral fue estudiada tanto en cadáveres como en gatos vivo...

  8. Enfermedad de Chagas en pacientes con miocardiopatía dilatada idiopática en Costa Rica

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    Oswaldo Gutiérrez-Sotelo

    2007-04-01

    Full Text Available Justificación y objetivo: Determinar la prevalencia de la enfermedad de Chagas en un grupo de pacientes con miocardiopatía dilatada, bradiarritmias y taquiarritmias ventriculares en Costa Rica. Material y métodos: Estudio observacional, descriptivo, prospectivo de una serie de casos. Se seleccionaron pacientes con diagnóstico clínico y ecocardiográfico de miocardiopatía dilatada, bloqueo atrioventricular o intraventricular documentados o con arritmia ventricular compleja, excluyéndose aquellos en quienes hubiera uno o más factores causales (enfermedad arterial coronaria o cardiopatía hipertensiva. Mediante consentimiento informado, se les realizó un estudio con 2 pruebas serológicas de diferente fuente para detectar IgG anti-Trypanosoma cruzi. Resultados: De aproximadamente 15.000 a 20.000 vistos pacientes por año en la Consulta Externa del Servicio de Cardiología del Hospital México, unos 500 se presentan con el diagnóstico de miocardiopatía dilatada. Excluidos los pacientes con causa conocida de su cardiopatía, entre febrero de 2004 y noviembre de 2005 se reclutó a 74 pacientes, 41 hombres y 33 mujeres, con edades comprendidas entre los 13 y los 87 años (promedio 47,9, de los cuales la mayoría (n=51; 68,9% tenían miocardiopatía dilatada idiopática, con una fracción de eyección promedio del 29,2%; 18 (24,33% se incluyeron por bloqueo atrioventricular y 5 por arritmia ventricular compleja. De los 78 pacientes, 5 (6,8% resultaron tener serología positiva por enfermedad de Chagas; de estos: 3 con miocardiopatía dilatada, uno con bloqueo atrioventricular completo y uno con arritmia ventricular compleja. Cabe destacar que solo uno de los 3 pacientes dilatados tiene el electrocardiograma característico de la fase crónica de la enfermedad de Chagas: bloqueo AV de primer grado, bloqueo completo de rama derecha y hemibloqueo anterior izquierdo. Conclusión: Los datos obtenidos en esta investigación revelan que la

  9. Analgesia epidural torácica para el tratamiento de la angina inestable Thoracal epidural analgesia for the management of unstable angina

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    M. Castro

    2005-07-01

    Full Text Available La miocardiopatía isquémica en pacientes con angina inestable refractaria al tratamiento médico constituye un escenario clínico complicado. Una anatomía desfavorable o un riesgo quirúrgico excesivamente alto pueden desaconsejar la realización de una angioplastia o de una cirugía de derivación coronaria. En este artículo se pretende revisar la utilización de la analgesia/anestesia epidural torácica para el tratamiento y estabilización de este tipo de pacientes, a través de una breve descripción de la fisiopatología de la isquemia cardiaca, estudios experimentales en animales y humanos, uso en cirugía cardiaca y efectos secundarios.Ischemic cardiomyopathy in patients with unstable angina refractory to medical therapy is a difficult medical condition. Unfavorable anatomy or excessive surgical risk can advise against the performance of angioplasty or coronary bypass surgery. This study has reviewed the use of thoracal epidural analgesia/anesthesia for the management and stabilization of this type of patients, with a brief description of the physiopathology of cardiac ischemia, experimental studies in animals and human beings, use of cardiac surgery and side effects.

  10. Depth of the thoracic epidural space in children.

    Science.gov (United States)

    Masir, F; Driessen, J J; Thies, K C; Wijnen, M H; van Egmond, J

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epidural puncture in 61 children. The epidural puncture was performed using the loss of resistance technique with saline 0.9%. The distance from the needle tip to the point where the needle emerged from the skin was measured. The post-operative analgesia parameters were also measured. Skin to epidural distance correlated significantly with the age and weight of the children. The equation for the relation between SED (cm) and age was 2.15 + (0.01 x months) and for SED vs weight was 1.95 + (0.045 x kg). Despite considerable variability among individuals, the observed correlation of SED with both age and weight shows that this parameter may be helpful to guide thoracic epidural puncture in anaesthetized children. PMID:17067139

  11. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

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    Ozlem Bilir

    2014-01-01

    Full Text Available Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

  12. Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

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    Nathaniel H. Greene

    2015-01-01

    Full Text Available Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD on computed tomography (CT to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P35 changed this relationship (P=0.007. The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs>0.9. Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

  13. Bloqueio do nervo maxilar para redução de fraturas do osso zigomático e assoalho da órbita Bloqueo del nervio maxilar para reducción de fracturas del hueso zigomático y suelo de la órbita Maxillary nerve block for zygoma and orbital floor fractures reduction

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    Karl Otto Geier

    2003-08-01

    fracturas del hueso zigomático y del suelo de la órbita. MÉTODO: Quince pacientes fueron sometidos al bloqueo del nervio maxilar por la técnica de Moore (abordaje infrazigomática para reducción de fracturas aisladas del arco zigomático (ocho pacientes y asociadas al suelo de la órbita (siete pacientes. Ningún paciente recibió medicación pre-anestésica. Después de sedación y anestesia local con 2 ml de lidocaína a 1,5% con adrenalina a 1:300.000, el nervio maxilar fue abordado con 8 ml de la misma solución anestésica a través de una aguja 22G, 10 cm de largo de punta romba. Fueron evaluados: el tiempo de bloqueo, la latencia, el tiempo de analgesia, la incidencia de fallas, la necesidad de anestesia general y las complicaciones. RESULTADOS: Los primeros tres bloqueos fueron difíciles, resultando en dos bloqueos parciales y una falla. Los restantes fueron efectivos y los pacientes no mencionaron ninguna incomodidad o dolor durante el bloqueo y la cirugía. El tiempo para la realización del bloqueo varió de 5 a 20 minutos, en cuanto la latencia anestésica quedó entre 3 y 10 minutos. Fueron registradas 7 ocurrencias de punción vascular, sin embargo, sin relatos de formación de hematomas. CONCLUSIONES: Reducción de fracturas zigomáticas son factibles bajo bloqueo del nervio maxilar, cuando realizadas en la fosa ptérigo palatina, permitiendo anestesia de sus dos ramos distales, nervio zigomático-temporal y nervio zigomático-frontal.BACKGROUND AND OBJECTIVES: There are few reports of zygomatic orbital floor or zygomatic arch fractures reduction under regional anesthesia. This study aimed at evaluating extraoral maxillary nerve block for zygoma and orbital floor fractures reduction. METHODS: Participated in this study 15 patients submitted to maxillary block according to Moore’s technique (lateral approach of the pterygoid plate for reduction of isolated zygomatic arch fractures (8 patients or orbit floor fractures associated to zygomatic arch

  14. Anestesia peridural contínua com ropivacaína a 0,2% associada a anestesia geral para cirurgia do abdômen superior em crianças Anestesia peridural contínua con ropivacaína a 0,2% asociada a anestesia general para cirugía del abdomen superior en niños Continuous epidural anesthesia with 0.2% ropivacaine associated to general anesthesia for upper abdominal surgery in children

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2003-04-01

    el grupo Propofol, sin embargo, la intensidad y duración de la sedación fueron mayores en ese grupo en relación al grupo Sufentanil. Los escores de recuperación fueron similares en los dos grupos. Después de 3 horas en la SRPA, todos los pacientes habían llegado a los criterios de transferencia para las enfermarías. Hipotensión arterial transitoria fue observada en 2 pacientes del grupo Sufentanil. CONCLUSIONES: La combinación de la anestesia peridural torácica continua con ropivacaína a 0,2% (1,5 ml.kg-1 asociada a la infusión de propofol promueve anestesia efectiva y segura para cirugías abdominales altas en niños. El ritmo de infusión de propofol y el tiempo de sedación fueron reducidos con la adición de sufentanil.BACKGROUND AND OBJECTIVES: Several anesthetic techniques have been proposed for different pediatric surgeries to promote postoperative analgesia, among other advantages. This study aimed at evaluating propofol infusion rate and postanesthetic recovery of children submitted to upper abdominal surgeries under epidural anesthesia with 0.2% ropivacaine associated to general anesthesia with propofol or propofol plus sufentanil. METHODS: Participated in this study 26 children physical status ASA I, II and III, aged 0 to 4 years, were scheduled to upper abdominal surgeries under thoracic epidural anesthesia (T7-T8 with 0.2% ropivacaine (1.5 ml.kg-1. They were randomly distributed in two groups: Propofol (propofol infusion and Sufentanil (propofol infusion plus 1 µg.kg-1 sufentanil. Propofol infusion rates were 20 and 10 mg.kg-1.h-1 for the Propofol and Sufentanil groups, respectively, adjusted to maintain blood pressure in approximately 20% of baseline values and withdrawn 10 to 15 minutes before estimated surgery completion. Postanesthetic recovery was evaluated by a modified Aldrete-Kroulik scale and sedation was evaluated by a 5 grade score. RESULTS: Techical difficulties excluded two children of each group. Infusion rate was significantly

  15. COMPARISON OF PATIENT CONTROLLED EPIDURAL ANALGESIA WITH CONTINUOUS EPIDURAL INFUSION FOR LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sumaiah Tahseen

    2016-07-01

    Full Text Available We conducted a study to compare the efficacy and safety of Patient Controlled Epidural Analgesia (PCEA with that of Continuous Infusion of Epidural Analgesia (CIEA for maintenance of labour analgesia and evaluated the quality of analgesia and obstetric and safety outcomes. METHODS The study was a hospital-based prospective, randomised control trial on 80 parturients who had a normal antenatal period. Each parturient received 500-1000 mL lactated ringer solution Intravenously (IV prior to initiating epidural blockade. Epidural catheter placement was performed in a standard manner and all patients received an initial dose of 8-10 mL bupivacaine 0.25%. Parturients self-administered 0.125% bupivacaine with fentanyl 2.5 µg/mL using PCA pumps programmed as follows: 4 mL bolus with a 20 mins Lockout Interval (LI. Group B received CIEA of 8 mL 0.125% bupivacaine with fentanyl 2.5/mL. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, analgesic supplements, bupivacaine and fentanyl consumption. RESULTS Data from 80 patients showed no differences among groups in pain relief. Maternal satisfaction was greater in PCEA group. Anaesthetic interventions by way of supplemental doses of Bupivacaine and Fentanyl in the PCEA group were minimal (4 and 2 vs 25 and 12 P <0.001 compared to CEI group. PCEA group received less local anaesthetic (5.2 vs 9.4 p <0.001 and few patients in PCEA group had motor weakness compared to CEI group (6 vs 17 p <0.05. Both methods were safe for mother and newborn. CONCLUSION Patients who received PCEA required less anaesthetic interventions, required lower doses of local anaesthetic, fentanyl and have less motor weakness than those who received CEI.

  16. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA? Should epidural analgesia still be a routine technique in pain units?

    Directory of Open Access Journals (Sweden)

    F. Caba

    2010-05-01

    Full Text Available La analgesia epidural se ha convertido en una técnica rutinaria en el manejo perioperatorio de los pacientes quirúrgicos que se ha extendido fuera de los quirófanos y de las unidades de alta dependencia hacia las salas de hospitalización. La irrupción en este nuevo escenario ha mejorado la analgesia postoperatoria con aceptables márgenes de seguridad, lo que le ha servido para colocarse en un lugar predominante entre las pautas analgésicas de las Unidades de Dolor Agudo (UDA. La analgesia epidural con anestésicos locales y opioides frente a la sistémica con opioides ha presentado históricamente una superior eficacia analgésica, y una disminución de complicaciones derivadas de la atenuación del estrés quirúrgico y de la mejora en la función cardiorrespiratoria. Sin embargo, frente a estas ventajas la analgesia epidural también presenta inconvenientes como la hipotensión arterial o la retención urinaria, junto a las potencialmente graves derivadas del daño neurológico ocasionado por un hematoma epidural, una infección o una lesión directa del tejido nervioso. Si sus ventajas han resultado consistentes y fundamentadas, en este momento no lo parecen tanto. El avance que ha supuesto la cirugía mínimamente invasiva con altas más precoces, junto al desarrollo de estrategias multimodales, está conduciendo a un replanteamiento de la utilización de técnicas como la epidural y a una reevaluación de sus indicaciones. Las últimas evidencias nos inducen a pensar que la epidural probablemente haya tocado techo en el tratamiento del dolor postoperatorio y comenzará a perder terreno frente a otras técnicas igualmente efectivas, con menores complicaciones y efectos secundarios. Este será un proceso lento en el que deberá quedar asegurado que las alternativas analgésicas ofrecen realmente mejores resultados en cuanto a eficacia, seguridad, tolerabilidad y calidad de la recuperación desde la perspectiva del paciente.Epidural

  17. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    ão necessários para avaliar diferença na incidência de cesarianas.JUSTIFICATIVA Y OBJETIVOS: El alivio del dolor en el trabajo de parto ha recibido una atención constante objetivando el bienestar materno, disminuyendo el estrés causado por el dolor y reduciendo las consecuencias de éste sobre el concepto. Innumerables técnicas pueden ser utilizadas para la analgesia de parto. Este trabajo tuvo como objetivo comparar la técnica peridural continua con la combinada, ambas con el uso de bupivacaína a 0,25% en exceso enantiomérico 50% y fentanil como agentes. MÉTODO: Participaron del estudio 40 parturientes en trabajo de parto con dilatación cervical entre 4 y 5 cm que se repartieron en de los grupos iguales de forma aleatoria. El Grupo I recibió anestesia peridural continua. El Grupo II recibió anestesia combinada. Se evaluaron: medidas antropométricas, edad de embarazo, dilatación cervical, tiempo entre el bloqueo y la ausencia de dolor a través de la escala analógica visual, posibilidad de deambulación, tiempo entre el inicio de la analgesia y la dilatación cervical completa, duración del período expulsivo, parámetros hemodinámicos maternos y vital edad del recién nacido. Posibles complicaciones como depresión respiratoria, hipotensión arterial materna, prurito, náuseas y vómitos también fueron observados. Para la comparación de los promedios se utilizó el teste t de Student y para la paridad y tipo de parto se utilizó el teste del Qui-cuadrado. RESULTADOS: No hubo diferencia estadística significativa entre los de los grupos con relación al tiempo entre el inicio de la analgesia y la dilatación cervical completa, como también con relación al tiempo de la duración del período expulsivo, incidencia de cesárea relacionada con la analgesia, parámetros hemodinámicos maternos y vital edad del recién nacido. CONCLUSIONES: Las dos técnicas fueron eficaces y seguras para la analgesia del trabajo de parto, aunque la técnica combinada haya

  18. Nuestra experiencia con un programa conjunto de mejora de eficiencia en pacientes con patología de raquis Our experiences with a joint efficiency improvement program in patients with spinal diseases

    Directory of Open Access Journals (Sweden)

    M. V. Ribera Canudas

    2011-06-01

    Full Text Available Objetivo: evaluar el alivo del dolor mediante la escala visual analógica (EVA en pacientes con dolor crónico de origen vertebral después de la valoración conjunta y recibir tratamiento por un equipo multidisciplinar. Material y método: estudio prospectivo de 82 pacientes consecutivos con patología raquídea que han sido valorados por el Grupo de trabajo médico (Servicio de Rehabilitación y Unidad del dolor. Se ha volarado la intensidad del dolor mediante el EVA, previo al tratamiento específico según la etiopatogenia del dolor, y a los 3 meses de su realización. Asimismo se han evaluado las patologías asociadas (PA y su correlación con la causa y el alivio del dolor. Estudio estadístico mediante el programa SPSS. Resultados: el tiempo de evolución del problema de salud fue de 31,1 meses (DE 22,17. La espera para la visita conjunta fue de 2,9 semanas (DE 1,95. La clínica principal fue la lumbociatalgia en un 83,5% de los pacientes, siendo la patología de canal estrecho el diagnóstico principal en el 45,1% de los casos, seguido de la patología degenerativa (14,6% y de la estenosis foraminal (11,7%. Se evaluó el EVA inicial y a los 3 meses de la intervención terapéutica ya sea con tratamiento conservador o con técnicas mínimamente invasivas (TMI. Las técnicas terapéuticas empleadas fueron: infiltraciones epidurales (28 casos, bloqueos foraminales (15, bloqueos facetarios (5, estimulación eléctrica transcutánea (3, tratamiento farmacológico (15 y en 16 casos se requirió más de una técnica. El EVA medio inicial fue de 7,75 y a los 3 meses fue de 4,94 existiendo diferencias clínicamente significativas. Asimismo existe una correlación positiva entre la edad y el número de PA, pero no entre el EVA inicial/final y el número de PA. También se ha observado correlación positiva entre el EVA y la etiopatogenia del dolor. Conclusión: los resultados obtenidos reafirman la necesidad de optimizar los recursos sanitarios

  19. Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína Bloqueo del plexo braquial por vía supraclavicular: estudio clínico comparativo entre bupivacaína y levobupivacaína Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine

    Directory of Open Access Journals (Sweden)

    José Ricardo Pinotti Pedro

    2009-12-01

    braquial es el territorio potencial para la absorción de anestésicos locales. Estudios de los estereoisómeros de la bupivacaína han venido demostrando un menor potencial de toxicidad de la fracción levógira (levobupivacaína, sobre el sistema cardiovascular. Sin embargo, se discute la eficacia anestésica (bloqueo sensitivo y motor, de la levobupivacaína en anestesia del neuro eje. Este estudio pretende demostrar la eficacia anestésica de la levobupivacaína, comparándola con la bupivacaína racémica en bloqueo de plexo braquial por la vía perivascular subclavia. MÉTODO: Cincuenta pacientes adultos de ambos sexos, ASA I y II, fueron sometidos a la anestesia de plexo braquial vía perivascular subclavia para procedimientos ortopédicos de miembros superiores con la ayuda de un neuroestimulador. Se dividieron de modo aleatorio, en dos grupos: G BUPI - bupivacaína racémica, G LEVO - levobupivacaína, en un volumen de 30 mL a 0,5%. El bloqueo sensitivo fue evaluado por el método de "picada de aguja" en los metámeros de C5 a C8; y el bloqueo motor, en los intervalos en minutos: 1, 2, 5, 10, 15, 20, 25, 30, o hasta la instalación del bloqueo en los movimientos de los dedos, la mano el antebrazo y el brazo. RESULTADOS: No hubo ninguna diferencia estadística entre los dos grupos en cuanto a la latencia, incidencia de fallas, grado del bloqueo motor e incidencia de fallas y grado del bloqueo motor e incidencia de fallas del bloqueo sensitivo, pero sí que se verificó la diferencia estadística de la latencia del bloqueo sensitivo en todos los metámeros analizados. No hubo efectos adversos inherentes a la aplicación del anestésico local. CONCLUSIONES: La levobupivacaína demostró una eficacia anestésica en el bloqueo de plexo braquial, igualable a la solución racémica usualmente utilizada.BACKGROUND AND OBJECTIVES: Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local

  20. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer;

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase when...... hypotension is present, which may have implications for the choice of treatment of hypotension. However, no long-term information or measurements of plasma volumes with or without hypotension after epidural anesthesia are available. METHODS: In 12 healthy volunteers, the authors assessed plasma (125I...... volunteers receiving hydroxyethyl starch. RESULTS: Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure. Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic...

  1. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    and two months later. The midwives were interviewed two hours after the birth. Method of analysis: The “Idealtype-” method, the “importance-” method and the “process-” method described by Bo Eneroth. Results: Two ideal-types were discovered: the worried and the unworried mother. Important and common...... factors influencing the relationship with the midwives were: the very choice of an epidural, the midwives accept of that choice, satisfaction with the presence of the midwifes, the continuity of the process, and a high level of information. Clearly, the establishment of an epidural implies important...... midwives handle the epidurals. Conclusion: In particular, the use of an epidural does not diminish the need for an individual approach. The woman’s level of consciousness and the entire situation makes her very sensitive to the midwives care....

  2. Central temperature changes are poorly perceived during epidural anesthesia.

    Science.gov (United States)

    Glosten, B; Sessler, D I; Faure, E A; Karl, L; Thisted, R A

    1992-07-01

    Hypothermia and shivering are common during epidural anesthesia for cesarean delivery but are not always accompanied by a sensation of coldness. To test the hypothesis that central temperature changes are not perceived during epidural anesthesia, we measured central and skin temperatures and thermal perception in 30 patients undergoing cesarean delivery with epidural anesthesia. Central temperature decreased 1.0 +/- 0.6 degrees C from control values during anesthesia and surgery, but thermal perception scores did not reflect central temperatures (P = 0.56) or changes in central temperature (P = 0.63). A feeling of warmth was significantly correlated with increased mean skin temperature (P = 0.02) and increased upper body skin temperature (P = 0.03). We conclude that central temperature is poorly perceived and is less important than skin temperature in determining thermal perception during high levels of epidural anesthesia.

  3. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  4. Delayed Allergic Reaction to Secondary Administrated Epidural Hyaluronidase

    OpenAIRE

    Park, A Reum; Kim, Woong Mo; Heo, Bong Ha

    2015-01-01

    We are reporting a rare case of a delayed hypersensitivity reaction caused by hyaluronidase allergy following a lumbar transforaminal epidural block. Using an intradermal skin test, we have provided evidence that the systemic allergic reaction resulted from hypersensitivity to hyaluronidase. To our knowledge, this is a rare case of a delayed hypersensitivity reaction to epidural hyaluronidase, comprised of an initial exposure to hyaluronidase with no subsequent allergic response in prior bloc...

  5. Transverse myelitis following general and thoracic epidural anaesthesia

    OpenAIRE

    Drnovsek Globokar, Mojca; Paver Erzen, Vesna; Novak Jankovic, Vesna

    2010-01-01

    Acute bacterial transverse myelitis, secondary to an epidural catheter, developed in a 49-year-old man who underwent surgery for carcinoma of the left lung. Left pneumonectomy was performed under combined general and epidural (Th6-7) anesthesia. The operative procedure, anaesthesia and early postoperative course were uneventful. On the fifth postoperative day, the patient developed neurological deficits consistent with high-level paraplegia. Elevated inflammatory parameters along with the res...

  6. Combined Spinal Epidural versus Epidural Sufentanil and Bupivacaine in Labour (Clinical and Histological comparative Study

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    Nagia M. Abd El Moeti, *Zinab B. Youssef, *Soaad S. Abd El Aal

    2006-12-01

    Full Text Available Introduction:- Regional analgesia provides excellent pain relif in labour. This study was designed to compare combined spinal eqidural (CSE versus epidural block using a narcotic (sufentanil and local anaesthetic bupivacaine regarding their effects on progress of labour, method of delivery, pain relif, side effects and neonatal outcome. Patients and Methods :-Forty pregnant women ASA I and II were enrolled in this study. The women were randomly allocated to receive either CSE or epidural ( 20 patient of each . In CSE group analgesia was initiated with 10ug sufentanil with 2mg bupivacaine. In epidural group 10ml bupivacaine 0.125%.and 10ug sufentanil injected epidurally. In both groups the continuous infusion of 0.83% bupivacaine with 0.33ug/ml sufentanil at 10ml/hr adjusted as required. Maternal haemodynamics, analgesia characteristics VAPS, degree of motor block, were measured. Duration of labour, cervical dilation, maternal satisfaction and mode of delivery were assessed. Foetal outcome was assessed by 1 and 5 min. Apgar score and umbilical venous blood gases. Maternal and neonatal side effects were observed. The experimental study was done on 30 rats divided into 3 groups 10 rats of each. Control group (A injected intrathecally with saline, group (B injected intrathecally with 1.5ug/kg sufentanil (low dose, and group (C injected intrathecally with 7.5ug/kg sufentanil (high dose, the pervious doses were injected every 2hr. for 3 times then the spinal cord was obtained and stained for histological evaluation. Results:- The clinical study showed that no difference between the 2 groups for the degree of motor block or adequacy of analgesia, mode of delivery and Foetal outcome. The onset of analgesia was faster with CSE technique, more patient satisfaction and more pruritis. The histological results revealed that no detectable significant neurotoxic changes with the use of small dose of intrathecal sufentanil but mild changes occurred with high

  7. A randomised controlled trial using the Epidrum for labour epidurals.

    LENUS (Irish Health Repository)

    Deighan, M

    2015-03-01

    The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9\\/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3\\/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.

  8. Epidural catheterization in cardiac surgery: The 2012 risk assessment

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    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  9. Cervical epidural abscess caused by brucellosis.

    Science.gov (United States)

    Lampropoulos, Christos; Kamposos, Panagiotis; Papaioannou, Ioanna; Niarou, Vasiliki

    2012-01-01

    A 70-year-old Greek lady presented with fever, arthralgias of knees, cervical and lumbar pain during the last month. On clinical examination the patient was found to have tenderness of the cervical and the lumbar spine with great motion restriction. The blood tests revealed high erythrocyte sedimentation rate and C-reactive protein, abnormal liver function tests and a positive rheumatoid factor. Serological test for Brucella was positive while cervical MRI revealed epidural abscess and spondylodiscitis. Conservative treatment with streptomycin (it was substituted by rifampicin after the third week) and doxycyclin for 4 months significantly improved her symptoms. The frequency as well as the diagnosis and management of this manifestation are discussed. PMID:23188848

  10. Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia

    OpenAIRE

    Agarwal, Kiran; Agarwal, Navneet; Agrawal, V. K.; Agarwal, Ashok; Sharma, Mahender

    2012-01-01

    Background: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the partu-rient adequate degree of comfort and promotes physical reco-very and a sense of well being. Materials and Methods: This randomized controlled study was designed to assess the analgesic efficacy and side effects of 1.20 mg single-dose epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine (0.5 mg) with bupivacaine (Group2) for postoperative analgesi...

  11. Levobupivacaína versus bupivacaína em anestesia peridural para cesarianas: estudo comparativo Levobupivacaína versus bupivacaína en anestesia peridural para cesáreas: estudio comparativo Levobupivacaine versus bupivacaine in epidural anesthesia for cesarean section: comparative study

    Directory of Open Access Journals (Sweden)

    Felipe Bergamaschi

    2005-12-01

    uso de bupivacaína racémica con levobupivacaína en anestesia peridural de pacientes sometidas a cesárea electiva. MÉTODO: Ensayo clínico eventual, doblemente encubierto, con gestantes estado físico ASA I y II. Las pacientes fueron distribuidas para recibir 20 mL de bupivacaína a 0,5% racémica ó 20 mL de levobupivacaína a 0,5%, ambas con 10 µg de sufentanil y vasoconstrictor. RESULTADOS: Participaron del estudio 47 pacientes, 24 en el grupo de la levobupivacaína y 23 en el grupo de la bupivacaína. Los grupos eran comparables entre sí en lo que se refiere a las características materno-fetales. Transcurridos 15 minutos después del término de la punción peridural, 62,5% de las pacientes del grupo de la levobupivacaína tenían Bromage 2 ó 3 contra 72,7% en el grupo de la bupivacaína (p = 0,83. Transcurridos veinte minutos, 66,7% de las pacientes del grupo de la levobupivacaína tenían Bromage 2 ó 3 contra 86,3% del grupo de la bupivacaína (p = 0,21. La complicación más frecuente fue la hipotensión arterial, encontrada en 16 (66,7% pacientes del grupo de la levobupivacaína y en 10 (43,5% pacientes del grupo de la bupivacaína (p = 0,11. CONCLUSIONES: La levobupivacaína y la bupivacaína fueron igualmente efectivas en el bloqueo peridural de pacientes sometidas a cesárea.BACKGROUND AND OBJECTIVES: Local anesthetic bupivacaine is found in two different enantiomers: levobupivacaine - S (- and dextrobupivacaine - R (+. Based on studies showing that S(- enantiomers are less cardiotoxic, their use has been increasing in clinical practice. This study aimed at comparing racemic bupivacaine and levobupivacaine in epidural anesthesia for elective cesarean section. METHODS: Randomized, double blind clinical trial enrolling physical status ASA I and II parturients. Patients were assigned to receive either 20 mL of 0.5% racemic bupivacaine or 20 mL of 0.5% levobupivacaine, both with 10 µg sufentanil and epinephrine 1:200,000. RESULTS: Participated in this

  12. Bloqueios nervosos guiados por ultra-som Bloqueos nerviosos guiados por ultrasonido Ultrasound-guided nerve blocks

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios nervosos guiados por ultra-som são baseadas na visualização direta das estruturas nervosas, da agulha de bloqueio e das estruturas anatômicas adjacentes. Desta maneira, é possível depositar a solução de anestésico local precisamente em torno dos nervos e acompanhar a sua dispersão em tempo real, obtendo-se, assim, um bloqueio mais eficaz, de menor latência, menor dependência de referências anatômicas, menor volume de solução anestésica e maior segurança. CONTEÚDO: O artigo revisa os aspectos relativos aos mecanismos físicos para formação de imagens, a anatomia ultra-sonográfica do neuroeixo e dos plexos braquial e lombossacral, os equipamentos e materiais empregados nos bloqueios, os ajustes do aparelho de ultra-som para melhorar as imagens, os planos de visualização das agulhas de bloqueio e as técnicas e o treinamento em bloqueios guiados por ultra-som. CONCLUSÕES: Os passos para se obter sucesso em anestesia regional incluem a identificação exata da posição dos nervos, a localização precisa da agulha, sem lesões nas estruturas adjacentes e, finalmente, a injeção cuidadosa de anestésico local junto aos nervos. Embora a neuroestimulação forneça grande auxílio na identificação dos nervos, esta não consegue, isoladamente, preencher todas essas exigências. Por isso, acredita-se que os bloqueios guiados por ultra-som serão a técnica de eleição para anestesia regional num futuro não muito distante.JUSTIFICATIVA Y OBJETIVOS: Las técnicas de bloqueos nerviosos guiados por ultrasonido se basan en la visualización directa de las estructuras nerviosas, de la aguja de bloqueo y de las estructuras anatómicas adyacentes. De esa manera, se puede depositar la solución de anestésico local precisamente en torno de los nervios y acompañar su dispersión en tiempo real, obteniéndose así, un bloqueo más eficaz, de menor latencia, menor dependencia de

  13. A COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE WITH CLONIDINE AND EPIDURAL BUPIVACAINE FOR POST OPERATIVE ANALGESIA

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    Durga Prasad

    2015-10-01

    Full Text Available BACKGROUND: Clonidine, an α 2 - adrenoreceptor agonist, administered epidurally, is gaining popularity for its analgesic, sympatholytic, hemodynamic stabilizing and sedative properties without significant side effects. METHODS: This present study “ A Comparative Study o f Epidural Bupivac aine w ith Clonidine a nd Epidural Bupivacaine f or Post - o perative Analgesia ” was conducted in 70 cases of ASA grade I and II, between the age groups of 30 - 75yrs undergoing abdominal, gynecological and orthopedic surgeries under epidural anaesthesia. At the e nd of surgery, patients were shifted to recovery room. When patients complained of pain with VAS > 4/10, they were allocated to receive either of B: Plain Bupivacaine 0.125% 10ml (n = 35. B+C: Clonidine 150 mcg (1ml + 0.125% Bupivacaine 9ml (n = 35. The following parameters were monitored: A. Onset of analgesia . B. Duration of analgesia . C. VAS and Quality of analgesia . D. ardio - respiratory effects: Pulse rate, blood pressure, respiratory rate. E. Side effects like: nausea, vomiting, pruritus, hypotensio n, sedation and respiratory depression were studied. ONSET OF ANALGESIA: The time of onset of analgesia in group (B+C was significantly less (12.7 ± 0.87 (S.D min when compared to g roup (B (16 ± 3.34 (S.D min. DURATION OF ANALGESIA: The duration of a nalgesia in group (B+C (225.2 ± 45.74 (SD min was significantly more when compared to group (B (119 ± 29.29 (SD min. VISUAL ANALOGUE SCORE: In comparison of group B and group B+C, highly significant difference in VAS was seen from 15min till 3.5hrs in between the groups. The quality of analgesia in Group B+C was VAS 3 - 4 (good to excellent pain relief, as compared to Group B, where VAS was 2 - 3 (fair to good pain relief. SEDATION: In Group B+C from 30min till 2hrs, 100% of patients were asleep (sedat ion score 3. Even in patients with sedation score 3, patients were calm, quiet and asleep but when questions were asked, they answered with

  14. Labor Epidural Analgesia and Breastfeeding: A Systematic Review.

    Science.gov (United States)

    French, Cynthia A; Cong, Xiaomei; Chung, Keun Sam

    2016-08-01

    Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively. PMID:27121239

  15. EFFICACY OF TRANSFORAMINAL EPIDURAL STEROID INJECTION IN LUMBOSACRAL RADICULOPATHY

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    Saheel

    2016-02-01

    Full Text Available BACKGROUND Lumbosacral radiculopathy is a common medical and socioeconomic problem with a lifetime prevalence estimated to be around 40%-60%. In 1930, Evans reported that sciatica could be treated by epidural injection. The use of epidural corticosteroid injection for the treatment of axial and radicular back pain was first reported in 1953. Lumbar Transforminal Epidural Steroid Injections (TFESIs are performed to provide symptomatic relief in patients with radicular pain. A transforaminal epidural steroid injection (TFESI using a small volume of local anaesthetic will anaesthetize the spinal nerve and also partially anaesthetize the dura, the posterior longitudinal ligament, the intervertebral disc and facet joint. For these reasons, fluoroscopy-guided TFESI has become the preferred approach to epidural space. AIMS AND OBJECTIVES To study the role of transforaminal epidural steroid injection in management of radiculopathy. SETTINGS AND DESIGN This prospective study was conducted in the Department of Orthopaedics, SKIMS Medical College and Hospital, Bemina, Srinagar, J and K, India, for a 2-year period from November 2012 to October 2014; 110 cases, both male and female in the age group of 20-60 years having back pain with radiculopathy of varied types and duration without neurodeficit were enrolled in the study. MATERIALS AND METHODS After selecting a patient for giving transforaminal block, we used a local anaesthetic (2% Xylocaine. Contrast media, e.g. Iohexol was used to demarcate the correct positioning of the needle. A spinal needle (20-25 gauge and 5mL syringe were used to deliver the drug. CONCLUSION Transforaminal epidural steroid injections with long acting anaesthetic is an excellent form of conservative treatment in management of low back ache with radicular pain. It is relatively safe, simple, economical and shortens the time of recovery from severe pain, avoids risks and complications of surgery and also avoids long periods of bed

  16. Asymptomatic pneumomediastinum resulting from air in the epidural space -a case report-

    OpenAIRE

    Lim, Hyun Kyoung; Cha, Young Deog; Song, Jang Ho; Park, Ji Woong; Lee, Mi Hyeon

    2013-01-01

    There are no reports regarding pneumomediastinum caused by thoracic epidural block complications. We believe that it is possible to experience an occurrence of pneumomediastinum caused by air in the epidural space after performing a thoracic epidural block using the loss of resistance (LOR) technique with air. We report a witnessed case where pneumomediastinum appeared after a thoracic epidural block. Pneumorrrhachis, paravertebral muscle emphysema, and pneumomediastinum were diagnosed by Pos...

  17. Anterior and posterior tibial anesthetic block in diabetic foot surgery. Bloqueo anestésico tibial anterior y posterior en la cirugía del pie diabético

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    Obdulio Rodríguez García

    2004-12-01

    diabético. Métodos: Estudio prospectivo realizado en el Hospital Universitario ¨Dr.Gustavo Aldereguía Lima¨ de Cienfuegos en el periodo comprendido entre enero y diciembre del 2003, en un grupo de pacientes, portadores de pie diabético, atendidos inicialmente por el Servicio de Angiologia y luego por Anestesiología al decidirse el proceder quirúrgico, a los cuales se les realizó bloqueo anterior y posterior del nervio tibial. Se midieron las siguientes variables:edad, peso, talla, tiempo quirúrgico, tipo de proceder quirúrgico, frecuencia cardiaca y presión arterial media, clasificación de los pacientes según la Asociación Americana de Anestesiología. A todos los enfermos se le aplicó la escala evaluativa del dolor en tres momentos. Resultados: Hubo predominio del sexo femenino. El bloqueo del nervio tibial posterior con lidocaína al 1 % en diferentes puntos, permitió la realización de las técnicas quirúrgicas propuestas. El proceder anestésico empleado resultó, además de favorecedor, económico por no requerir los enfermos del uso de otros analgésicos en el posoperatorio.

  18. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

    International Nuclear Information System (INIS)

    Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.)

  19. Epidural anaesthesia with levobupivacaine and ropivacaine : effects of age on the pharmacokinetics, neural blockade and haemodynamics

    NARCIS (Netherlands)

    Simon, Mischa J.G.

    2006-01-01

    Epidural neural blockade results from processes after the administration of a local anaesthetic in the epidural space until the uptake in neural tissue. The pharmacokinetics, neural blockade and haemodynamics after epidural anaesthesia may be influenced by several factors, with age as the most impor

  20. Fisiología y farmacología clínica de los opioides epidurales e intratecales Physiology and clinical pharmacology of epidural and intrathecal opioids

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    B. Mugabure

    2005-02-01

    Full Text Available La historia de la anestesia intratecal y epidural ha discurrido en paralelo al desarrollo de la anestesia general. La primera reseña publicada sobre el uso de opioides para anestesia intradural la realizó un cirujano rumano, que presentó su experiencia en 1901 en París. Ha pasado casi un siglo hasta conseguir la utilización de opioides por vía epidural. En nuestros días, el uso de opioides intradurales y epidurales constituye una práctica clínica habitual para conseguir analgesia intra y postoperatoria. En los últimos 30 años, el uso de opioides epidurales se ha convertido en rutinario para el tratamiento del dolor del trabajo del parto y del manejo tanto del dolor agudo como crónico. Ha sido ampliamente asumido que cualquier opioide depositado en el espacio epidural o intratecal producirá una analgesia altamente selectiva medular y que esta será superior a la conseguida por otras técnicas analgésicas o vías de administración. Desafortunadamente esto simplemente no es verdad. De hecho, en multitud de ocasiones, los opioides son utilizados vía perimedular a pesar de que la evidencia clínica nos demuestra que no producen un efecto específico medular, o que la analgesia producida no es superior a la conseguida tras su administración intravenosa. Para realizar un uso apropiado de los opioides espinales, debemos comprender adecuadamente la fisiología y la farmacología clínica de estos fármacos y cuál produce analgesia selectiva medular y cuál no. Las diferencias son producto de la biodisponibilidad en los receptores específicos de su biofase medular en la sustancia gris. Esta es menor para los opioides lipofílicos, ya que son aclarados hacia el plasma con mayor rapidez que los hidrofílicos, y consecuentemente producen con mayor antelación efectos adversos supramedulares y su vida media es de menor duración. La morfina es probablemente el opioide con mayor acción selectiva medular tras su administración epidural o

  1. Posterior epidural fibrotic mass associated with Baastrup’s disease

    Science.gov (United States)

    Jang, Eui-Chan; Lee, Han-Jun; Kim, Jae Yoon; Yang, Jae Jun

    2010-01-01

    A few reports have demonstrated rare cases of Baastrup’s disease that involve epidural cysts that cause dural compression. However, there have been no reports of a midline epidural fibrotic mass being associated with Baastrup’s disease. A 60-year-old man presented with neurogenic claudication that had lasted for 5 years. Radiography showed anterolisthesis at the L4–L5 level, magnetic resonance imaging demonstrated severe stenosis due to a posterior noncystic mass, and the linear fluid signal tracked into the posterior epidural space at the L4–L5 level. A cleft in the ligamentum flavum was identified by probe at surgery, and this enabled the probe to be inserted into the epidural space without excising ligamentum flavum. Histological analysis showed that the fibrotic mass consisted of a collagen matrix that had a cystic component and exhibited a peripheral inflammatory reaction. This report shows that it is possible for an extended epidural cystic mass that occurs in Baastrup’s disease to change over time through peripheral inflammation into a cyst-containing fibrotic mass. PMID:20063020

  2. Parche de lidocaína al 5% para el tratamiento del SDRC de extremidad superior por bloqueo transcutáneo del plexo braquial: Caso Clínico

    Directory of Open Access Journals (Sweden)

    M. A. Vidal

    2007-06-01

    Full Text Available El síndrome de dolor regional complejo (SDRC se manifiestan con una clínica variada que se caracteriza por dolor, impotencia funcional, trastornos vaso-sudomotores y alteraciones tróficas. Está causado por una lesión primaria o una disfunción del Sistema Nervioso Periférico, estableciéndose dos grupos: SDRC-I que sustituye al término DSR y el SDRCII en lugar del término causalgia. Caso clínico: Varón de 37 años de edad, que tras ser sometido a una artroscopia de hombro comenzó a presentar dolor en el hombro y limitación funcional importante, así como ciertos cambios vasomotores de la misma extremidad, por lo que se diagnosticó de SDRC. El paciente siguió varias pautas de tratamiento analgésico por vía oral, fue sometido a numerosas infiltraciones intraarticulares, se realizaron bloqueos del ganglio estrellado e inició tratamiento rehabilitador. Durante estos meses la evolución clínica del paciente fue tórpida, reapareciendo el dolor en todas las ocasiones y sin presentar mejoría de la movilidad. Se decidió iniciar tratamiento con parches de lidocaína al 5%, con lo que se consiguió controlar el dolor del paciente y finalizó la rehabilitación con recuperación completa. El parche de lidocaína al 5% es un analgésico tópico desarrollado para el tratamiento del dolor neuropático de origen periférico. Está aprobado en EEUU para el tratamiento de la neuralgia postherpética. Sin embargo, se está probando su utilización en otras formas de dolor neuropático, como la neuropatía diabética, el dolor crónico de espalda y el dolor miofascial. El SDRC está asociado con una actividad anormal del sistema nervioso simpático, por lo que el bloqueo simpático mediante anestésicos locales es ampliamente utilizado. En el caso concreto de los parches de lidocaína al 5% se ha publicado un caso de tratamiento de forma efectiva. Este caso es similar al que nosotros describimos, que también fue refractario al tratamiento

  3. Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

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    Venetiana Panaretou

    2012-01-01

    Full Text Available Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16 and the control group (Group B, n=14. After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO 2 levels and the calculation of regional-arterial CO 2 difference (ΔPCO 2 . Additional measurements included mean arterial pressure (MAP, cardiac output (CO, systemic vascular resistance (SVR, and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO 2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

  4. Combined general–epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Science.gov (United States)

    Panaretou, Venetiana; Siafaka, Ioanna; Theodorou, Dimitrios; Manouras, Andreas; Seretis, Charalampos; Gourgiotis, Stavros; Katsaragakis, Stylianos; Sigala, Fragiska; Zografos, George; Filis, Konstantinos

    2012-01-01

    Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional–arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results. PMID:23493852

  5. Lumbar epidural varices: An unusual cause of lumbar claudication

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    Meenakshisundaram Subbiah

    2016-01-01

    Full Text Available Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP. However as the magnetic resonance imaging (MRI in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings.

  6. Postoperative Spinal Epidural Haematoma Causing Cauda Equina Syndrome: Case Report

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    Emre Delen

    2013-08-01

    Full Text Available Cauda equina syndrome is a neurological disorder defined by urinary and/or anal sphincter dysfunction, bilateral sciatica and bilateral motor and sensory deficits. Regarding the etiology, lumbar disc disease, spinal stenosis, tumors, haematomas, fractures, infectious diseases and ankylosing spondylitis are pathologies causing this syndrome. Spinal epidural haematomas are common amongst complications after spinal surgery. However the majority of these cases are asymptomatic, thus having little clinical importance. Symptomatic postoperative spinal epidural haematomas is a serious complication, and in order to prevent permanent neurologic deficit it requires urgent surgical intervention. This article aims to present the case of a patient with a spinal epidural haematoma after spinal stenosis surgery, causing cauda equina syndrome.

  7. Continuous epidural block of the cervical vertebrae for cervicogenic headache

    Institute of Scientific and Technical Information of China (English)

    HE Ming-wei; NI Jia-xiang; GUO Yu-na; WANG Qi; YANG Li-qiang; LIU Jing-jie

    2009-01-01

    Background Cervicogenic headache (CEH) is caused by a structural abnormality in the cervical spine. Available treatments for CEH include medical therapy, local botulinum toxin injection, cervical epidural corticosteroid injection, and surgery. The objective of this study was to investigate the safety and efficacy of a continuous epidural block of the cervical vertebra.Methods Medical records were retrospectively analyzed for 37 patients diagnosed with CEH treated by a continuous epidural block of the cervical vertebra with lidocaine, dexamethasone, and saline (5 ml/min) for 3-4 weeks and triamcinolone acetonide 5 mg once weekly for 3-4 weeks. Pain was measured via the visual analogue scale (VAS) in combination with quality of life assessment. Outcome measures were patient-reported days with mild or moderate pain, occurrence of severe pain, and the daily oral dosages of non-steroidal anti-inflammatory drug use (NSAID).Results In the 3 months immediately preceding placement of the epidural catheter, the mean number of days with mild or moderate pain was 22.0±4.3. The mean occurrence of severe pain was (3.20±0.75) times and the mean oral dosage of NSAID was (1267±325) mg. During the first 6 months after epidural administration of lidocaine and corticosteroids, the mean number of days with mild or moderate pain, the mean occurrence of severe pain, and the mean daily oral dosages of NSAIDs were significantly decreased compared to 3-month period immediately preceding treatment (P <0.01). By 12 months post-treatment, no significant difference in these three outcome measures was noted.Conclusions Continuous epidural block of the cervical vertebra for patients with CEH is effective for at least six months. Further research is needed to elucidate mechanisms of action and to prolong this effect.

  8. Cerebrospinal fluid drainage through the diploic and spinal epidural veins.

    Science.gov (United States)

    Tsutsumi, Satoshi; Ogino, Ikuko; Miyajima, Masakazu; Ito, Masanori; Arai, Hajime; Yasumoto, Yukimasa

    2015-09-01

    The aim of this study was to quantitatively evaluate the function of the cranial diploic and spinal epidural veins as cerebrospinal fluid (CSF) drainage pathways by measuring lipocalin-type prostaglandin D synthase (PGDS) and cystatin C (CysC) dissolved in the blood of these veins. This was a prospective study involving 51 consecutive patients, 31 males and 20 females, who underwent 41 cranial and 10 spinal surgeries. Intraoperatively, peripheral venous blood and diploic venous blood, or peripheral venous blood and spinal epidural venous blood samples were simultaneously collected and immediately centrifuged. For all samples, dissolved albumin (for reference), PGDS and CysC were measured using an enzyme-linked immunosorbent assay. The diploic vein/peripheral vein ratios in five cranial locations and epidural vein/peripheral vein ratios were calculated and statistically evaluated for the three biomarkers. For PGDS, the diploic vein/peripheral vein ratio was significantly increased in the frontal (P = 0.011), temporal (P = 0.028), parietal (P = 0.046) and skull base (P = 0.039), while it did not reach statistical significance for CysC. For patients older than 45 years, the diploic vein/peripheral vein ratio for PGDS was significantly decreased in the frontal region (P = 0.028), and the epidural vein/peripheral vein ratio for CysC was significantly decreased (P = 0.014). These results show that the diploic veins constitute CSF drainage pathways with heterogeneous functional intensity at different cranial locations. Compared with the diploic veins, spinal epidural veins seem to drain less CSF. The cranial diploic and spinal epidural veins may jointly function as an alternative, age-related trans-dural CSF drainage system. PMID:26184099

  9. Síndrome de Tako-Tsubo em decorrência de bloqueio neuromuscular residual: relato de caso Síndrome de Tako-Tsubo como consecuencia de bloqueo neuromuscular residual: relato de caso Tako-Tsubo syndrome secondary to residual neuromuscular blockade: case report

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Tako-Tsubo é uma complicação pós-operatória rara, com mortalidade em torno de 5%. O objetivo deste relato é apresentar o bloqueio neuromuscular residual como fator desencadeante da referida síndrome, discutir sobre a mesma e alertar sobre o bloqueio neuromuscular residual. RELATO DO CASO: Paciente do sexo feminino, 61 anos, estado físico ASA I, submetida à anestesia geral associada a bloqueio paravertebral cervical para reparo artroscópico de lesão de manguito rotator. Após extubação foi evidenciado bloqueio neuromuscular residual por meio do exame clínico. Na sala de recuperação pós-anestésica evoluiu com sonolência, taquicardia, hipertensão arterial e acidose respiratória grave. Após a reintubação, evoluiu com parada cardíaca em atividade elétrica sem pulso, revertida com adrenalina e massagem cardíaca externa. Apresentou no pós-operatório elevação de segmento ST, aumento de troponina e acinesia de segmento médio-apical de ventrículo esquerdo com fração de ejeção estimada em 30%. A cineangiocoronariografia mostrou coronárias isentas de ateromatose significativa e grave comprometimento da função sistólica com acinesia inferior e ântero-septo-apical com hipercontratilidade compensatória de suas porções basais. Com o tratamento instituído houve recuperação funcional completa. CONCLUSÕES: O bloqueio neuromuscular residual associado à paralisia diafragmática e possível atelectasia pulmonar levando a insuficiência respiratória, hipercapnia e descarga adrenérgica foram os fatores desencadeantes da síndrome de Tako-Tsubo com sua grave repercussão clínica.JUSTIFICATIVA Y OBJETIVOS: El Síndrome de Tako-Tsubo es una complicación postoperatoria rara con una mortalidad en torno de un 5%. El objetivo de este relato es presentar el bloqueo neuromuscular residual como factor desencadenante del referido síndrome, discutir sobre él y alertar sobre el bloqueo

  10. Sickle cell disease with orbital infarction and epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Naran, A.D.; Fontana, L. [Dept. of Diagnostic Radiology, New York Methodist Hospital, Brooklyn, NY (United States)

    2001-04-01

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  11. Spontaneous Rapid Resolution of Acute Epidural Hematoma in Childhood

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    Ismail Gülşen

    2013-01-01

    Full Text Available Acute epidural hematoma is a critical emergency all around the world, and its aggressive diagnosis and treatment are of vital importance. Emergent surgical evacuation of the hematoma is known as standard management; however, conservative procedures are also used for small ones. Spontaneous rapid resolution of these hematomas has also been reported in eight pediatric cases. Various theories have been proposed to explain the underlying pathophysiology of this resolution. Herein, we are reporting a new pediatric case with spontaneously resolving acute epidural hematoma 12 hours after admission to the emergency room.

  12. CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA

    Institute of Scientific and Technical Information of China (English)

    Jian-qing Xu; Bo Zhu; Tie-hu Ye

    2005-01-01

    @@ SINCE the report that ropivacaine hydrochloride, a new amide local anesthetic, is of lower cardiac toxicity both in animals and humans,1 several studies have shown it to be a clinically effective local anesthetic widely used for both epidural anesthesia2-4 and analgesia5-7. Ropivacaine mesylate made in China is structurally from ropivacaine hydrochloride by substituting a mesylate group for hydrochloride group.8 This study was designed to clinically provide a double-blind comparison of ropivacaine mesylate with ropivacaine hydrochloride in epidural anesthesia and analgesia.

  13. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Energy Technology Data Exchange (ETDEWEB)

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)

    2001-07-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  14. Posterior epidural fibrotic mass associated with Baastrup’s disease

    OpenAIRE

    Jang, Eui-Chan; Song, Kwang-Sup; Lee, Han-Jun; Kim, Jae Yoon; Yang, Jae Jun

    2010-01-01

    A few reports have demonstrated rare cases of Baastrup’s disease that involve epidural cysts that cause dural compression. However, there have been no reports of a midline epidural fibrotic mass being associated with Baastrup’s disease. A 60-year-old man presented with neurogenic claudication that had lasted for 5 years. Radiography showed anterolisthesis at the L4–L5 level, magnetic resonance imaging demonstrated severe stenosis due to a posterior noncystic mass, and the linear fluid signal ...

  15. Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.

    Science.gov (United States)

    Goel, Shubhra; Burkat, Cat Nguyen

    2011-01-01

    This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner's, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  16. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

    Full Text Available This is a rare case of persistent Horner′s syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI/magnetic resonance angiography (MRA of head, neck, and chest were unremarkable. Medline search using terms Horner′s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner′s syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner′s syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner′s syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  17. Bloqueio do plexo braquial por via interescalênica: efeitos sobre a função pulmonar Bloqueo del plexo braquial por vía interescalénica: efectos sobre la función pulmonar Interscalene brachial plexus block: effects on pulmonary function

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    Alexandre Hortense

    2010-04-01

    demostrado una asociación de esa técnica con el bloqueo del nervio frénico ipsilateral. La disfunción diafragmática de resultas de esa asociación, provoca alteraciones en la mecánica pulmonar, potencialmente perjudiciales en pacientes con una limitación de la reserva ventilatoria. El objetivo del estudio fue evaluar la repercusión del bloqueo interescalénico sobre la función pulmonar por medio de la medida de la capacidad vital forzada (CVF. MÉTODO: Estudio doble ciego, con 30 pacientes, estado físico I o II (ASA, distribuidos aleatoriamente en dos grupos de 15. Se administró solución a 0,5% de ropivacaína (Grupo Ropi o bupivacaína a 0,5% con epinefrina (Grupo Bupi. El bloqueo fue realizado utilizando estimulador de nervio periférico e inyectando 30 mL de anestésico local. Cuatro espirometrías se hicieron en cada paciente: antes del bloqueo, 30 minutos, 4 y 6 horas después. Los pacientes no recibieron sedación. RESULTADOS: Un paciente del Grupo Ropi y tres pacientes del Grupo Bupi, quedaron excluidos del estudio por fallos de bloqueo. La reducción de la CVF en el Grupo Ropi se hizo máxima a los 30 minutos (25,1% y a partir de entonces, hubo una tendencia progresiva a la recuperación. Ya con la bupivacaína, la reducción de la CVF pareció ser menos acentuada en los diversos momentos estudiados; se observó una reducción adicional entre 30 minutos (15,8% y 4 horas (17,3%, siendo esa sin diferencia estadística. A partir de 4 horas, se notó una tendencia a la recuperación. En los dos grupos, después de 6 horas de bloqueo, la CVF todavía estaba por debajo de los valores previos. CONCLUSIONES: El bloqueo interescalénico reduce la CVF en la mayoría de los casos; las alteraciones fueron más acentuadas en el Grupo Ropivacaína.BACKGROUND AND OBJECTIVES: The interscalene is one of the most common approaches used in brachial plexus block. However, the association of this approach with the ipsilateral blockade of the phrenic nerve has been

  18. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Não obstante o bloqueio pleural ter sido convertido quase numa panacéia analgésica, resultados contraditórios foram publicados. O objetivo deste estudo foi observar o desempenho analgésico e espirométrico das funções pulmonares no pós-operatório imediato de 21 pacientes com o bloqueio pleural bilateral em laparotomias medianas de urgência. MÉTODO: Bloqueio pleural bilateral foi realizado em decúbito dorsal horizontal em 21 pacientes com 20 ml de bupivacaína a 0,375% com adrenalina a 1:400.000 administrados por cateter em cada hemitórax durante o pós-operatório imediato. Soluções aleatórias de bupivacaína e de solução fisiológica foram administradas por residentes ou enfermeiras que desconheciam o conteúdo das seringas, e seus desfechos analgésicos avaliados de acordo com a escala de dor Prince Henry ao comparar os valores pré e pós-bloqueio pleural bilateral. Em função da dor pós-operatória, testes espirométricos das funções pulmonares também foram determinados mediante espirômetro portátil. RESULTADOS: Analgesia pós-operatória, com duração média de 247,75 ± 75 minutos foi constatada em todos os pacientes com a bupivacaína, embora tenha persistido dor residual de menor intensidade na região suprapúbica em cinco pacientes (8% e em dois pacientes na apófise xifóide (3,2%. Nenhum efeito analgésico foi obtido com solução fisiológica. Face à dor pós-operatória, as funções pulmonares, avaliadas antes e após os bloqueios, registraram melhora com a bupivacaína na CVF (p JUSTIFICATIVA Y OBJETIVOS: No obstante el bloqueo pleural haber sido convertido casi en una panacea analgésica, fueron publicados resultados contradictorios. El objetivo de este estudio fue observar el desempeño analgésico y espirométrico de las funciones pulmonares en el pós-operatorio inmediato de 21 pacientes con el bloqueo pleural bilateral en laparotomias medianas de urgencia. M

  19. Quebra de cateter no espaço peridural Rotura de catéter en el espacio epidural Breakage of a catheter in the epidural space

    Directory of Open Access Journals (Sweden)

    Cristian Sbardelotto

    2008-12-01

    ólogo. El objetivo de este relato fue presentar un caso de rotura de catéter epidural en analgesia de parto. RELATO DEL CASO: Paciente del sexo femenino, 33 años, GII, PI, entró en la maternidad en trabajo de parto. Después de dos horas de evolución, la paciente solicitó analgesia. Al realizársele el examen, se encontraba en fase activa del trabajo de parto, con dilatación cervical de 5 cm, dinámica uterina regular, bolsa rota, con dolor clasificado por la Escala Visual Analógica - VAS 10. Se inicia la analgesia de parto por la técnica combinada con doble punción. Durante la evolución se hizo una complementación analgésica por catéter. En la retirada hubo una pequeña dificultad y su consiguiente rotura. Se optó entonces por la realización de una tomografía axial computadorizada y una radiografía de la región lumbar que no mostró la presencia del fragmento del catéter. Visto que la paciente evolucionó asintomática y clínicamente, y sin señales de irritación radicular, dolor o infección, se procedió a las debidas orientaciones y a su alta. CONCLUSIONES: Los catéteres epidurales en la región lumbar son a veces raros, difíciles de retirar. Los factores que pueden aumentar las chances de formación de nudos y el riesgo de rotura del catéter se relacionaron. En ese caso, uno de los principales factores involucrados fue la introducción excesiva del catéter epidural lumbar. Por suerte, las complicaciones neurológicas son todavía más raras y secundando las directrices de una tracción lenta y suave en la falta de parestesias en la mayoría de los casos, el catéter se retira con éxito.BACKGROUND AND OBJECTIVES: Breakage of epidural catheters during their removal is rare, but it has been described. The anesthesiologist should be aware of the complications and proper handling of those catheters. The objective of this report was to present a case of breakage of an epidural catheter in labor analgesia. CASE REPORT: A 33-year old female, gravida

  20. Epidural hematoma after ventriculoperitoneal shunt surgery: report of two cases

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    PEREIRA CARLOS UMBERTO

    1998-01-01

    Full Text Available Ventriculoperitoneal shunt operations represent the most used choice for treating hydrocephalus, although some related complications have been reported. Due to its rarity, potential dangers, and mortality rate, we present two cases of epidural hematoma following ventriculoperitoneal shunt, discussing its pathophysiology and prophylaxis.

  1. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    International Nuclear Information System (INIS)

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  2. Multiple remote epidural hematomas following pineal gland tumor resection

    OpenAIRE

    Jeong-Wook Lim; Seung-Hwan Yang; Jong-Soo Lee; Shi-Hun Song

    2010-01-01

    In cases of pineal tumor combined with obstructive hydrocephalus, preoperative ventriculostomy or ventriculoperitoneal shunting is typically required prior to tumor resection. The objectives of preoperative ventriculostomy are gradual reduction of intracranial pressure and consequent preoperative brain protection. Here we report a case of pineal tumor resection with preoperative ventriculostomy that was complicated by multiple epidural hematomas. While postoperative intracranial hemorrhage ma...

  3. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Han, Moon Hee; Kim, Hyun Beom [College of Medicine, Seoul National University, Seoul (Korea, Republic of)] [and others

    2000-01-01

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  4. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

    Science.gov (United States)

    Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh

    2016-01-01

    Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.

  5. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

    Science.gov (United States)

    Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh

    2016-01-01

    Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated. PMID:27695535

  6. Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas Estudio comparativo de los bloqueos intercostal e interpleural para analgesia pós-operatoria en colecistectomias abiertas Comparative study of intercostal and interpleural block for post-cholecystectomy analgesia

    Directory of Open Access Journals (Sweden)

    Antonio Mauro Vieira

    2003-06-01

    abiertas con incisión subcostal, recibieron bloqueo intercostal (Grupo IC, n=30 o bloqueo interpleural (Grupo IP, n=30, ambos con 100 mg de bupivacaína 0,5% con adrenalina, para analgesia pós-operatoria. Fueron evaluados los tiempos de analgesia y las quejas relatadas por los pacientes. RESULTADOS: La calidad de la analgesia fue considerada buena para ambas técnicas. La duración media de analgesia fue de 505 minutos en el grupo IP y 620 minutos en el grupo IC, no habiendo diferencia estadística entre ellos. Náuseas, vómitos y dolor abdominal leve fueron las quejas pós-operatorias más frecuentes. No se constató cualquier complicación pós-operatoria asociada exclusivamente a los bloqueos, así como no fue evidenciado ningún caso de pneumotórax. CONCLUSIONES: Se concluye que las técnicas promovieron analgesia satisfactoria después de colecistectomia, siendo que el bloqueo interpleural presentó mayor facilidad de ejecución.BACKGROUND AND OBJECTIVES: Postoperative analgesia is a wish of all surgical patients and has been used by most anesthesiologists. In addition to opioids, local anesthetic agents have been employed for peripheral and central blocks. The purpose of this study was to evaluate and to compare intercostal and interpleural blocks for post-cholecystectomy analgesia. METHODS: Sixty patients undergoing open cholecystectomy with subcostal incision, received either intercostal block (Group IC, n = 30 or interpleural block (Group IP, n = 30, for postoperative analgesia, both with 0.5% bupivacaine (100 mg with epinephrine. Analgesia duration and patients’ complaints were evaluated. RESULTS: Analgesia was considered satisfactory for both groups. Mean analgesia duration was 505 minutes for Group IP and 620 minutes for Group IC, with no statistical significant difference. Nausea, vomiting and mild abdominal pain were the most frequent postoperative complaints. There was no postoperative complication related to blockade and no pneumothorax was detected

  7. Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

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    Alyssa Kosturakis

    2015-01-01

    Full Text Available Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001. Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001. Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

  8. MR epidurography: distribution of injectate at caudal epidural injection

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Darra T. [Cappagh National Orthopedic Hospital, Dublin 11 (Ireland); St Paul' s Hospital, Department of Radiology, Vancouver, BC (Canada); Kavanagh, Eoin C.; Moynagh, Michael R.; Eustace, Stephen [Cappagh National Orthopedic Hospital, Dublin 11 (Ireland); Mater Misericordiae University Hospital, Dublin 7 (Ireland); Poynton, Ashley; Chan, Vikki O. [Cappagh National Orthopedic Hospital, Dublin 11 (Ireland)

    2014-08-02

    To (a) evaluate the feasibility of MR epidurography (MRE) and (b) assess the distribution of injectate using two different volumes at caudal epidural steroid injection. Twenty patients who were referred with symptomatic low back pain for caudal epidural steroid injection were assigned to have either 10 ml (9/20) or 20 ml (11/20) of injectate administered. Gadolinium was included in the injection. The patients proceeded to MRI where sagittal and coronal T1-weighted fat-saturated sequences were acquired and reviewed in the mid-sagittal and right and left parasagittal views at the level of the exit foramina. Gadolinium was observed at or above the L3/4 disc level in all 11 patients who received 20 ml (100 %), compared with only five of nine patients who received 10 ml (56 %). Injectate was seen to the L4 nerve root level in all 11 patients who received 20 ml (100 %) but only four out of nine patients who received 10 ml (44 %), not even reaching the L5 nerve root level in four further of these nine patients (44 %). Overall, there was a trend to visualize gadolinium at higher levels of the epidural space with higher volumes injected. Firstly, MR epidurography is a safe technique that allows excellent visualization of the distribution of gadolinium in the epidural space following injection via the caudal hiatus. Secondly, a volume of 10 ml is unlikely to treat L5/S1 disease in almost half of patients at caudal epidural steroid injection and at least 20 ml of injectate is likely required for any medication to reach the desired level. (orig.)

  9. Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica Estudio comparativo entre la anestesia epidural torácica y la anestesia general en mastectomia oncológica Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2008-12-01

    utiliza a menudo para procedimientos estéticos de la mama y existen pocos relatos de su uso en mastectomías con exploración axilar. El presente estudio comparó la técnica con anestesia general en operaciones oncológicas de la mama. MÉTODO: Cuarenta pacientes que se dividieron en dos grupos. En el grupo epidural (n = 20 se hizo una epidural torácica con bupivacaína y fentanil asociados a la sedación con midazolam. El otro grupo (n = 20, recibió anestesia general convencional con propofol, atracurio y fentanil y mantenimiento con O2 e isoflurano. En el intraoperatorio y durante la operación, se verificó la necesidad de complementación de la anestesia o de la sedación y variables hemodinámicas. En el postoperatorio fue registrado el tiempo para el alta de la sala de recuperación postanestésica y hospitalaria, la intensidad del dolor y el consumo de analgésicos, efectos adversos y la satisfacción con la técnica anestésica. RESULTADOS: Los grupos fueron similares y no hubo diferencia en la duración de la operación. Se hizo necesario complementar la sedación en un 100% de las pacientes que recibieron anestesia epidural y en un 15% fue complementada la analgesia con infiltración de anestésico local en la axila. Hubo una mayor incidencia de hipertensión arterial en el grupo de la anestesia general y de hipotensión entre las que recibieron epidural. Ocurrió prurito en un 55% de las pacientes con anestesia epidural. Náusea (30% y vómito (45%, fueron más frecuentes entre las que recibieron anestesia general. La analgesia postoperatoria tuvo una mejor calidad y el consumo de analgésicos fue menor en el grupo de la anestesia epidural. El período de internación también fue menor. CONCLUSIONES: La técnica epidural tiene algunas ventajas con relación a la anestesia general y puede ser considerada una opción para la anestesia en mastectomías oncológicas con vaciado axilar.BACKGROUND AND OBJECTIVES: Thoracic epidural block is frequently used for

  10. Bloqueo de los nervios iliohipogástrico e ilioinguinal para analgesia posquirúrgica en cesárea tipo Pfannenstiel realizada bajo anestesia general: ¿qué concentración del anestésico local usar? Iliohypogastric and ilioinguinal block for postsurgical analgesia after pfannenstiel cesarean section performed under general anaesthesia

    Directory of Open Access Journals (Sweden)

    Héctor Iván García García

    1998-03-01

    Full Text Available El bloqueo bilateral de los nervios Iliohipogástrico e Ilioinguinal con bupivacaína al 0.5% puede proveer analgesia luego de cesárea con incisión de Pfannenstiel aunque la cantidad de droga usada está cerca de la dosis máxima segura. Diseñamos este estudio para comparar el efecto analgésico de la bupivacaína al 0.5% y diluida al 0.25%. Se incluyeron treinta pacientes aleatoriamente asignadas a un grupo de estudio (bupivacaína 0.25%, n= 15 y uno de control (bupivacaína 0.5%, n=15. Se evaluaron las pacientes con una Escala Visual Análoga (EVA a las O, 4, 8, 12 y 24 horas posoperatorias por médicos que no sabían a qué grupo pertenecían y sólo en caso de necesidad se prescribió analgesia IM con Diclofenaco. Los puntajes de analgesia y los requerimientos de anal. gesia complementaria fueron notoriamente simila. res en ambos grupos y no hubo diferencias estadísticamente significativas. Concluimos que el bloqueo de estos nervios es una técnica analgésica efectiva (el dolor siempre estuvo en promedio por debajo de 4 en la EVA, que no es afectada por la dilución del anestésico y que además es segura pues no se presentaron complicaciones. The Iliohypogastric and Ilioinguinal bilate. ral block with 0.5% bupivacaine can provide analgesia after Pfannenstiel cesarean section although the required amount of the drug is near the maximum secure dose. We designed this study in order to compare the analgesic effect of 0.5% bupivacaine and diluted 0.25% bupivacaine. Thirty patients were included in the study and asigned in aleatory form to either a study (0.25% bupivacaine n=15 or a control group (0.5% bupivacaine n=15. They were evaluated with the Visual Analogue Scale (VAS at 0,4,8,12,24 postoperative hours by physicians who did not know the group of the patient and prescribed intramuscular analgesia with Dicofenac only if required. The analgesia scores and the complementery analgesia requirements were similar in both groups and there were

  11. Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica Estudio comparativo entre bupivacaína a 0,25% y ropivacaína a 0,2% en anestesia peridural para cirugía de tórax Comparison between 0.25% bupivacaine and 0.2% ropivacaine in epidural anesthesia for thoracic surgery

    Directory of Open Access Journals (Sweden)

    Marcus Vinícius Martins Novaes

    2001-12-01

    ventilatorios de la anestesia peridural torácica con bupivacaína a 0,25% y ropivacaína a 0,2% asociada a anestesia general en pacientes sometidos a toracotomia. MÉTODO: Participaron de este estudio prospectivo, comparativo y aleatorio, cuarenta pacientes divididos en dos grupos de veinte. Cada grupo recibió un volumen de 10 ml de anestésico local, por vía peridural torácica. Grupo B (Bupivacaína 0,25% y el Grupo R (Ropivacaína 0,2%. El bloqueo peridural fue realizado con los pacientes en decúbito lateral, punción paramediana y catéter para inyección de los fármacos A seguir, todos los pacientes recibieron anestesia general con IOT. Fueron analizados parámetros hemodinámicos y ventilatorios en 9 momentos. RESULTADOS: La presión arterial sistólica fue menor en el momento 5 y la presión arterial diastólica en los momentos 1 y 5, ambas en el grupo B. La necesidad de efedrina para corregir hipotensión arterial fue de 8/20 en el grupo B, contra 6/20 en el grupo R. La presión de pico en las vías aéreas superiores fue siempre mas elevada en el grupo R y los valores de la CAM del isoflurano fueron mas elevados en los momentos 5 y 6 también en el Grupo R. CONCLUSIONES: La técnica combinada peridural torácica y anestesia general se mostró eficaz y segura en los pacientes sometidos a toracotomia. Cuando se utilizó bupivacaína, la diminución de la presión arterial fue mayor y la presión máxima en las vías aéreas fue menor de que cuando fue utilizada ropivacaína.BACKGROUND AND OBJECTIVES: Combined general/epidural anesthesia has been used for several surgical procedures. Little has been published in the literature about its use in thoracic surgery. This study aimed to evaluate hemodynamic and ventilatory effects of combined general/epidural anesthesia with 0.25% bupivacaine and 0.2% ropivacaine in patients submitted to thoracotomy METHODS: Participated in this prospective, comparative and randomized study 40 patients divided in two groups of 20. Each

  12. Dispersión del QRS como índice de disincronía en el bloqueo de rama izquierda y de sincronía tras la terapia de resincronización cardíaca, una variable de respuesta exitosa / QRS dispersion as an index of dyssynchrony in left bundle branch block and of

    Directory of Open Access Journals (Sweden)

    Elibet Chávez González

    2015-08-01

    Full Text Available Introducción: En pacientes con insuficiencia cardíaca, el bloqueo de rama izquierda del haz de His constituye un importante marcador de mal pronóstico, en ellos la tera-pia de resincronización puede mejorar la función del ventrículo izquierdo. Objetivo: Describir variables electrocardiográficas asociadas a una mejor respuesta de la resincronización cardíaca. Método: Se estudiaron 19 pacientes, 7 mujeres y 12 hombres con bloqueo de rama izquierda y fracción de eyección ≤ 35 %. Se realizó electrocardiograma antes y des-pués de la terapia de resincronización, medición del QRS en las doce derivaciones y cálculo de su dispersión, se midieron voltajes máximos del QRS, y se realizaron eco-cardiografías antes y después del procedimiento. Resultados: La fracción de eyección se incrementó desde 29,8±4,7 hasta 41,2±10,7 % (p=0.000. La correlación lineal entre fracción de eyección y dispersión del QRS a los seis meses de seguimiento fue significativa (r=0.34 y p=0.02; las mujeres presentaron mayor dispersión del QRS (48,0±24,0 vs. 37,14±13,8 ms; p=0.04. Los voltajes del QRS fueron predominantemente negativos en aVR (-0,52±0,58 vs. 0,28±0,42 mvolt; p=0.032 y positivos en V5 (0,71±1,12 vs. -0,15±1,20 mvolt; p=0.023 para los responde-dores en relación con los no respondedores. Conclusiones: La dispersión del QRS incrementada en el electrocardiograma con blo-queo de rama izquierda y la disminución de la dispersión del QRS posresincronización demostraron correlaciones significativas con la fracción de eyección; además, el es-trechamiento del QRS tras la resincronización fue significativo para los respondedo-res. Los voltajes predominantemente positivos en aVR y negativos en V5, pudieran predecir cuáles pacientes no responderán adecuadamente a la terapia de resincroni-zación cardíaca.

  13. COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST - OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

    Directory of Open Access Journals (Sweden)

    Nagesh

    2015-02-01

    Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the

  14. Evaluation with CT scans of gas collection in the epidural space. Evaluacion mediante TC de colecciones de gas en el espacio epidural

    Energy Technology Data Exchange (ETDEWEB)

    Rebolledo Vicente, J.; Martinez San Millan, J.; Trujillo Peco, M.; Aunion Diaz, P.; Millan Juncos, J.M. (Hospital Ramon y Cajal. Departamento de Radiodiagnostico. Madrid (Spain))

    1993-01-01

    We present 9 cases of gas collection in the epidural space, revealed in CT scans of the spinal column. Five cases of herniated disc with accompanying vacuum, three of ''aerogen pseudocyst'' and a case of gas introduced iatrogenically via epidural installation catheter are included. (Author)

  15. Relación entre daño mitocondrial y producción de H2O2 en embriones bovinos producidos in vitro con alto y bajo potencial de desarrollo

    Directory of Open Access Journals (Sweden)

    Marlene Jiménez

    2001-04-01

    Full Text Available

    Los embriones producidos in vitro (EPIV presentan bloqueo en el
    desarrollo en el momento de la activación del genoma (8-16 células en bovinos, limitando la producción de blastocitos (35%. Este fenómeno ha sido relacionado con la producción de Especies Reactivas de Oxígeno (ERO. Entre las fuentes de ERO se han descrito altas tensiones de oxígeno, exposición a la luz y alteración del metabolismo oxidativo (1. Los EPIV con baja competencia para superar el bloqueo presentan fallas en la funcionalidad mitocondrial (1 y nucleolar, exhibiendo un retardo en su tasa de clivaje (2. Algunos autores han relacionado el tiempo al primer clivaje con la cantidad relativa de ciertos
    transcriptos, como Glutatión (2, un limpiador de ERO, sugiriendo que los embriones incompetentes presentan fallas  transcripcionales que les impiden defenderse contra las ERO producidas en cultivo, quizás manteniendo niveles elevados de H2O2 lo que los hace más susceptibles al daño celular.
    Hasta el presente no se ha efectuado un estudio de cinética de producción de ERO, en EPIV bovinos con alta y baja competencia durante el desarrollo temprano, ni se ha logrado esclarecer el papel de la mitocondria en la generación de ERO (como fuente o como blanco.
    Los objetivos de este estudio son determinar la cinética de producción de H2O2 en embriones con alta y baja competencia para superar el bloqueo y la relación de éstos con procesos de daño mitocondrial y mortalidad embrionaria.

     

     

  16. Bloqueio atrioventricular de 2° grau do tipo I Mobitz após aplicação de penicilina benzatina: relato de caso Bloqueo atrioventricular de 2º grado tipo Mobitz I después de la aplicación de penicilina benzatina: relato de caso Second degree atrioventricular block Mobitz type I after administration of benzathine penicillin: case report

    Directory of Open Access Journals (Sweden)

    Lúcia de Sousa Belém

    2009-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio atrioventricular de 2° grau do tipo I de Mobitz é observado como alteração transitória na presença de infarto de parede inferior ou de intoxicação medicamentosa. O objetivo desse relato foi apresentar caso de bloqueio atrioventricular de 2° grau tipo I de Mobitz após aplicação de penicilina benzatina. RELATO DO CASO: Paciente apresentou síncope e sudorese após aplicação de penicilina benzatina. Ao exame físico apresentava-se sudoreico, bradicárdico e com ritmo irregular. Foi realizado eletrocardiograma (ECG que mostrava bloqueio atrioventricular de 2° grau do tipo I de Mobitz. Administrou-se atropina 0,5 mg por via venosa. Após uma hora foi repetido o ECG que apresentava traçado normal. Paciente permaneceu seis horas assintomático e então recebeu alta. CONCLUSÕES: O bloqueio atrioventricular de 2° grau do tipo I de Mobitz surgiu após aplicação de penicilina benzatina.JUSTIFICATIVA Y OBJETIVOS: El bloqueo atrioventricular de 2° grado del tipo I de Mobitz es observado como una alteración transitoria en la presencia de infarto de la pared inferior o de intoxicación medicamentosa. El objetivo de este relato fue presentar un caso de bloqueo atrioventricular de 2° grado tipo I de Mobitz después de la aplicación de penicilina benzatina. RELATO DEL CASO: Paciente que presentó síncope y sudoración después de la aplicación de penicilina benzatina. En el examen físico sudaba, estaba bradicárdico y con ritmo irregular. Fue realizado el electrocardiograma (ECG que mostraba un bloqueo atrioventricular de 2° del tipo I de Mobitz. Se le administró atropina 0,5 mg por vía venosa. Después de una hora, fue repetido el ECG que presentaba un trazado normal. El paciente permaneció seis horas asintomático y entonces recibió el alta. CONCLUSIONES: El bloqueo atrioventricular de 2° grado del tipo I de Mobitz surgió después de la aplicación de la penicilina benzatina.BACKGROUND AND

  17. Tachyphylaxis associated with repeated epidural injections of lidocaine is not related to changes in distribution or the rate of elimination from the epidural space

    DEFF Research Database (Denmark)

    Mogensen, T; Simonsen, L; Scott, N B;

    1989-01-01

    The relationship between tachyphylaxis (measured as a decrease in the rate of regression of sensory levels of analgesia) during repeated epidural injections of lidocaine and both the distribution of lidocaine within the epidural space (as measured by spread of simultaneous injection of the tracer...... technetium-99m diethylenetriaminepentaacetate [99mTc-DTPA]) and elimination of lidocaine from the epidural space (as measured by serum concentrations of lidocaine) was investigated in 18 patients undergoing minor surgery during lumbar epidural analgesia. Twelve patients received four injections of 20 mL of 2......% lidocaine at 2-hr intervals. Epidural distribution was assessed by injection of 99mTc-DTPA diluted in saline on the preoperative day and diluted in an equal volume of 2% lidocaine on the morning before surgery and again after the fourth injection of lidocaine 6 hr later. The distribution of 99m...

  18. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Aydingoez, Ue.; Oto, A.; Cila, A. [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

    1997-12-01

    Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.) With 3 figs., 6 refs.

  19. Fluoroscope guided epidural needle insertioin in midthoracic region: clinical evaluation of Nagaro's method

    OpenAIRE

    Kim, Won Joong; Kim, Tae Hwa; Shin, Hwa Yong; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Kim, Jin Yun; Koo, Gill Hoi; Park, Sun Gyoo

    2012-01-01

    Background In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. Methods Twenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were plac...

  20. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    OpenAIRE

    Shubhra Goel; Cat Nguyen Burkat

    2011-01-01

    This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner’s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles des...

  1. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D;

    1999-01-01

    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1...... or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P ....01) but significantly lower pain scores during rest (P anaesthesia received antiemetics (13 vs five; P epidural-spinal anaesthesia...

  2. The effect of 0.5% ropivacaine on epidural blood flow

    DEFF Research Database (Denmark)

    Dahl, J B; Simonsen, L; Mogensen, T;

    1990-01-01

    Twenty patients scheduled for elective abdominal surgery received epidural analgesia with 20 ml 0.5% ropivacaine or 0.5% bupivacaine. Epidural blood flow was measured by an epidural 133Xe clearance technique on the day before surgery (no local anaesthetic) and again 1 h before surgery, 30 min after...... injection of the local anaesthetic during continuous infusion (8 ml/h). Median initial blood flow was 5.0 ml/min and 6.0 ml/min per 100 g tissue in patients receiving ropivacaine and bupivacaine, respectively. After epidural bupivacaine, blood flow increased in 8 of 10 patients to 6.9 ml/min per 100 g...

  3. Spontaneous spinal epidural hemorrhage from intense piano playing.

    Science.gov (United States)

    Chang, Hui-Ju; Su, Fang Jy; Huang, Ying C; Chen, Shih-Han

    2014-06-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation. PMID:24418452

  4. [Spinal epidural abscess as a complication of a finger infection].

    Science.gov (United States)

    Ridderikhof, M L; van den Brink, W A; van Dalsen, A D; Kieft, H

    2008-06-21

    An 81-year-old man was treated with intravenous antibiotics for a soft tissue infection in a finger. Despite adequate antibiotic treatment, he developed signs of spinal cord injury caused by a cervical spinal epidural abscess. An emergency laminectomy was performed. The neurological impairment appeared to be irreversible, and the patient died. Spinal epidural abscess is a rare and serious complication ofa bacteraemia. It is often caused by an infection of the skin or soft tissue with Staphylococcus aureus. Given the risk of rapidly progressive and irreversible neurological damage, this complication must be treated as soon as possible. The treatment of choice is surgery. Conservative management with intravenous antibiotics is an option only under strict conditions. PMID:18624007

  5. Transient bladder and fecal incontinence following epidural blood patch

    Directory of Open Access Journals (Sweden)

    Miguel Angel Palomero-Rodríguez

    2015-01-01

    Full Text Available Epidural blood patch (EBP is the currently accepted treatment of choice for postdural puncture headache because of its high initial success rates and infrequent complications. Many authors recommended a small volume (10-20 mL of blood to be delivered for an effective EBP. Here, we report an obstetric patient who developed a transient bladder and fecal incontinence after 19 mL of blood EBP at L 1 -L 2 level. Since the magnetic resonance image did not demonstrate any definitive spinal cord lesion, the exact mechanism remains unclear. We suggest that accumulation of blood performed at L 1 to L 2 level in a closed relationship with the sacral cord, may have trigger a significant pressure elevation of the epidural space at this level, resulting in a temporal spinal cord-related injury in the sacral cord.

  6. Lumbar spine osteomyelitis and epidural abscess formation secondary to acupuncture.

    Science.gov (United States)

    Godhania, Vinesh

    2016-01-01

    A 39-year-old male with no previous medical history presented with abdominal and low back pain. Based on clinical and radiological findings he was diagnosed with L1/L2 osteomyelitis and epidural abscess. Further history taking revealed recent use of acupuncture for treatment of mechanical back pain. The patient was treated conservatively with an extended course of antibiotics, monitored with repeat MRI scans and had a full recovery with no neurological deficit. This is the first reported case of epidural abscess formation and osteomyelitis after acupuncture in the UK. As acupuncture becomes more commonly used in western countries, it is important to be aware of this rare but serious complication. PMID:26976275

  7. Transient bladder and fecal incontinence following epidural blood patch

    Science.gov (United States)

    Palomero-Rodríguez, Miguel Angel; Palacio-Abinzada, Francisco J.; Campollo, Sara Chacón; Laporta-Báez, Yolanda; Mendez Cendón, Jose Carlos; López-García, Andres

    2015-01-01

    Epidural blood patch (EBP) is the currently accepted treatment of choice for postdural puncture headache because of its high initial success rates and infrequent complications. Many authors recommended a small volume (10-20 mL) of blood to be delivered for an effective EBP. Here, we report an obstetric patient who developed a transient bladder and fecal incontinence after 19 mL of blood EBP at L1 -L2 level. Since the magnetic resonance image did not demonstrate any definitive spinal cord lesion, the exact mechanism remains unclear. We suggest that accumulation of blood performed at L1 to L2 level in a closed relationship with the sacral cord, may have trigger a significant pressure elevation of the epidural space at this level, resulting in a temporal spinal cord-related injury in the sacral cord. PMID:26543470

  8. Spontaneous spinal epidural hemorrhage from intense piano playing.

    Science.gov (United States)

    Chang, Hui-Ju; Su, Fang Jy; Huang, Ying C; Chen, Shih-Han

    2014-06-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation.

  9. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

    Directory of Open Access Journals (Sweden)

    Halim Tariq

    2008-01-01

    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  10. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...... reduction in frequency. An increase in days with use of medication was found. Increased awareness of low CSF pressure headache is emphasized and a controlled larger randomized study is needed to confirm the results. However the present results, allows us to conclude that EBP in treatment-refractory low CSF...

  11. Dose de bupivacaína subaracnóidea necessária para cesariana é semelhante em mulheres obesas e com peso normal Las dosis de bupivacaína intratecal necesarias para cesáreas en mujeres obesas son similares a las usadas en mujeres con peso normal Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women

    Directory of Open Access Journals (Sweden)

    Yung Lee

    2009-12-01

    mujeres obesas y con peso normal. MÉTODO: Evaluamos embarazadas con peso normal (IMC 30 kg.m-2, con feto único a término, sometidas a cesáreas de elección. Ese fue un estudio mono ciego y de ubicación secuencial, usando el método up-down (modificado por la regla de Narayana. Todas las pacientes recibieron bloqueo combinado raquiepidural con administración intratecal de dosis variables de bupivacaína hiperbárica a 0.75% más 10 µg de fentanil y 100 µg de morfina. La primera paciente recibió 9 mg de bupivacaína. La anestesia se suplementó cuando fue necesario, a través de un catéter epidural. El éxito de la anestesia, definido como bloqueo sensitivo hasta por lo menos T6, sin necesidad de anestesia suplementaria, fue el objetivo primario. La ED95 para un resultado satisfactorio fue determinada por un modelo logístico sin transformación logarítmica de las dosis. RESULTADOS: Veinte y cuarto embarazadas con peso normal y dieciséis embarazadas obesas participaron en este estudio. La ED95 estimada para todas las pacientes fue de 12,92 mg (IC 95%: 11,49 a 34,77. La ED95 estimada para las embarazadas con peso normal y las embarazadas obesas fue similar, 12,78 mg (IC 95%: 10,75 a + infinito y 11,86 mg (CI 95%: 11,31 a 15,61, respectivamente. CONCLUSIONES: Si la anestesia raquídea con inyección única es utilizada en cesáreas, las pacientes con peso normal y obesas deben recibir dosis parecidas de bupivacaína hiperbárica. A pesar de que no fuimos capaces de determinar con exactitud la ED95 en nuestro estudio, sí que podemos afirmar que es de por lo menos 11,49 mg.BACKGROUND AND OBJECTIVES: The effect of BMI on the spread of intrathecal bupivacaine is controversial. This study assessed the ED95 of intrathecal bupivacaine for elective cesarean delivery in obese and normal weight women. METHODS: We studied normal weight (BMI 30 kg.m-2 women with singleton term pregnancies undergoing elective cesarean delivery. The study was conducted as a single blinded, up

  12. Radiographic appearance of a post-epidural headache.

    LENUS (Irish Health Repository)

    Weekes, G

    2012-02-01

    We report the case of a 35-year-old lady who presented with a 6-day history of a postural headache following an uncomplicated epidural catheter insertion. Meningitis was initially suspected and a neurology review was obtained. CT and MRI brain revealed features suggestive of meningitis. However these radiological features are also consistent with post dural puncture headache (PDPH). This case highlights the under reported and possible misleading radiographical features of PDPH.

  13. MR imaging of epidural hematoma in the lumbar spine

    International Nuclear Information System (INIS)

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk

  14. Solitary Spinal Epidural Metastasis from Prostatic Small Cell Carcinoma

    Science.gov (United States)

    Maeng, Young Hee

    2016-01-01

    Solitary, spinal epidural metastasis (SEM) that is not related to vertebral metastasis is very rare. And solitary SEM from prostatic cancer is rarely found in previously published reports. However, it is clinically significant due to the possibility of neurologic dysfunction, and it can be assessed by MRI. In this report, we show a case of solitary SEM arising from prostatic small cell carcinoma detected by MRI.

  15. MR imaging of epidural hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Dorsay, Theodore A.; Helms, Clyde A. [Duke University Medical Center, Department of Radiology, Erwin Road, Room 1504, Durham, NC 27710 (United States)

    2002-12-01

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk

  16. Lumbar spine osteomyelitis and epidural abscess formation secondary to acupuncture

    OpenAIRE

    Godhania, Vinesh

    2016-01-01

    A 39-year-old male with no previous medical history presented with abdominal and low back pain. Based on clinical and radiological findings he was diagnosed with L1/L2 osteomyelitis and epidural abscess. Further history taking revealed recent use of acupuncture for treatment of mechanical back pain. The patient was treated conservatively with an extended course of antibiotics, monitored with repeat MRI scans and had a full recovery with no neurological deficit. This is the first reported case...

  17. Spontaneous pneumomediastinum and epidural pneumatosis after oral ecstasy consumption.

    Science.gov (United States)

    Clause, A L; Coche, E; Hantson, P; Jacquet, L M

    2014-04-01

    A 19-year-old man was admitted with acute dyspnoea. Physical examination revealed subcutaneous emphysema in the cervical and thoracic area. This was further confirmed by the total body computed tomography that also demonstrated mediastinal emphysema. Epidural pneumatosis of the thoracis spine was also evident. There was no history of trauma, but well of a recent oral ecstasy consumption during a techno rave party, associated with intense dancing and jumping. Clinical course was favourable with conservative therapy.

  18. Fetal circulation during epidural analgesia for caesarean section.

    OpenAIRE

    Lindblad, A; Marsál, K; Vernersson, E; Renck, H

    1984-01-01

    Fetal blood flow was examined during epidural analgesia in six women with uncomplicated pregnancies undergoing elective caesarean section. A non-invasive, ultrasonic technique was used to measure blood flow in the fetal descending aorta and intra-abdominal part of the umbilical vein before induction of analgesia with etidocaine and bupivacaine and 15 and 30 minutes afterwards. No appreciable change in fetal blood flow was observed.

  19. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  20. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

    Directory of Open Access Journals (Sweden)

    Emine Rabia Koç

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking.

  1. Anatomical Study of Sacral Hiatus for Caudal Epidural Block

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    Dhananjay S Patil

    2012-06-01

    Full Text Available Introduction: Anatomy of the sacral hiatus is having clinical importance during caudal epidural block. Present study is aimed at determining anatomy of sacrum specially sacral hiatus for caudal epidural block, with the help of morphometric measurements of the sacrum in relation to sacral hiatus in dry sacral bones. Material & method: Total 103 complete and undamaged adult, dry sacral bones were measured with Vernier caliper (accuracy 0.1 mm and anatomical measurements were obtained. Results: Three bones were excluded because of total posterior closure defect. Agenesis of the sacral hiatus was detected in three sacral bones. Right and left superolateral sacral crests of the sacrum were taken as two points on dorsal surface of sacrum (forming the base of a triangle because posterior superior iliac spines impose on the superolateral sacral crests. The distance between the two superolateral sacral crests (base of a triangle, the distances between the right and left superolateral sacral crest and the sacral apex were on average 60.61(SD 6.71, 61.95 (11.71 and 61.4 (11.98 mm respectively.. Summary: An equilateral triangle formed between the apex of the sacral hiatus and right and left superolateral sacral crests. This equilateral triangle will help in determining the location of the sacral hiatus during caudal epidural block. [National J of Med Res 2012; 2(3.000: 272-275

  2. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

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    Rochana Girish Bakhshi

    2011-11-01

    Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

  3. The use of combined spinal-epidural technique to compare intrathecal ziconotide and epidural opioids for trialing intrathecal drug delivery.

    Science.gov (United States)

    Gulati, Amitabh; Loh, Jeffrey; Puttanniah, Vinay; Malhotra, Vivek

    2013-03-01

    SUMMARY Choosing the initial medications for intrathecal delivery is often confusing and not standardized. We describe a novel way for using a combined spinal-epidural technique to compare two first-line medications for intrathecal delivery; ziconotide and morphine (or hydromorphone). Five patients with intractable chronic or cancer pain were elected to have an intrathecal drug delivery system implanted for pain management. Each patient was given a 3-day inpatient trial with the combined spinal-epidural technique. The Visual Analog Scale, Numerical Rating Scale, short-term McGill questionnaire and opioid consumption were monitored daily. The results were used to develop a paradigm to describe how ziconotide can be used in practice. PMID:24645996

  4. Valoración de la satisfacción con el proceso asistencial de pacientes adultos afectos de patología crónica del raquis Patient satisfaction with semi-invasive medical treatments for spine pain in multidisplinary program

    Directory of Open Access Journals (Sweden)

    M. C. García Ameijeiras

    2011-08-01

    Full Text Available Objetivo: conocer la satisfacción de los pacientes después de recibir tratamiento y valoración conjunta por un equipo multidisciplinar. Material y métodos: estudio prospectivo de 47 pacientes consecutivos con patología de raquis que han sido visitados por el grupo de trabajo médico (Servicio de Rehabilitación y Unidad del Dolor. Se les ha administrado una encuesta para valorar la satisfacción con la atención recibida. Estudio estadístico mediante el programa SPSS. Resultados: el tiempo de evolución del problema de salud fue de 39,1 meses (DE 21,58. La espera para esta visita conjunta fue de 3 semanas (DE 2,1. Como diagnóstico principal el 42,6% de los pacientes presentaban estenosis de canal, 21,3% patología degenerativa, 12,7% estenosis foraminal, 2,1% hernia discal, y en 21,3% restantes se les sumaban diferentes tipos de diagnósticos principales. El EVA final fue valorado a los 3 meses de la intervención terapéutica. Las técnicas terapéuticas empleadas fueron: infiltraciones epidurales (15 casos, bloqueos foraminales (9, tratamiento farmacológico (7, bloqueos facetarios (4, electroterapia (3, y en 9 casos se requirió la utilización de más de una técnica. Se realizó una encuesta de satisfacción a los pacientes para valorar la atención recibida. El 97,9% estaban satisfechos. A estos se les pregunto qué era lo que más valoraban de la atención recibida, al 73,9% le pareció bien todos los aspectos del proceso, al 13% la atención personal, al 10,9% la técnica empleada y el poco tiempo de espera y al 2,2% la atención personalizada y la técnica empleada. Un único caso no estuvo globalmente satisfecho con la atención recibida. Conclusión: en los pacientes atendidos en este programa multidisciplinar, el grado de satisfacción por la atención recibida fue muy alto.Objective: the aim of this study was to measure patient satisfaction with semi-invasive medical treatments in a multidisciplinary program. Material and

  5. A Study of Fetomaternal Outcome of Epidural Analgesia During Labour

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    Shital H Halvadia

    2013-04-01

    Full Text Available Background: Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. This produces pain relief with minimal side effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. Objectives: This study was conducted to assess the fetomaternal outcome of epidural analgesia in labour. Methods: This study was descriptive case series study which was conducted in department of obstetrics and gynecology, GMERS medical college, Gandhinagar, Gujarat from January 2012 to December 2012. Pregnant women who received epidural analgesia during labour were involved in the study. The inclusion criteria were primi gravida patients who had gestational age of greater than 37 weeks (confirmed by ultrasound without any risk factors, in true labour (cervical dilatation >3 cm with regular uterine contraction and with vertex presentation. Results: Total number of patients was 80 with the mean age of 21.9±1.7 years. Mode of delivery was spontaneous vaginal in 46 patients (57.5%, forceps delivery in 4 patients (5%, ventouse in 14 patients (17.5% and caesarean section in 16 patients (20%. At one minute majority of the babies (n 63, 78.75% had Apgar score of more than 7, only 5 babies (6.25% had Apgar score less than 4, and 12 babies (15% had Apgar score between 4-7. At 5 minutes majority of the babies (n 74, 92.5% had Apgar score of more than 7, only one baby (1.25% had Apgar score less than 4, and 5 babies (6.25% had Apgar score between 4-7. Conclusion: Epidural anaesthesia provided excellent pain relief in majority of the patients. It can also be associated with increase duration of second stage of labour but not associated with fetal compromise in a properly managed patient. [Natl J Med Res 2013; 3(2.000: 184-186

  6. Comunicación y bloqueo institucional.- El caso de Canal 13 [de Costa Rica

    Directory of Open Access Journals (Sweden)

    Lic. William Ortiz A.

    1999-01-01

    Full Text Available institución especializada en la comunicación social puede ser estudiada de muchas maneras. El abordaje que procuramos asume una perspectiva crítica y considera la institución desde el punto de vista de la relación entre un mensaje y un sujeto receptor, es decir, se trata de la relación que vincula un conjunto de programas emitidos con un público, el cual los consume en su calidad de espectador. Pero como esta relación no se materializa si no es al interior de una sociedad, interesa situar constantemente a la institución dentro de la colectividad humana de la que forma parte y, más concretamente, dentro del estado y no dentro de la sociedad civil.

  7. Bloqueio dos nervos femoral e isquiático guiados por ultrassom em paciente anticoagulado: case reports Bloqueo de los nervios femoral e isquiático guiados por ultrasonido en paciente anticoagulado Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient: relato de casos

    Directory of Open Access Journals (Sweden)

    Leonardo Henrique Cunha Ferraro

    2010-08-01

    cada vez más en una práctica frecuente. Con la menor probabilidad de promover lesiones vasculares, el ultrasonido se convierte en un instrumento interesante en la realización de bloqueos periféricos, especialmente en los pacientes que usan anticoagulantes o con disturbios de la coagulación. El objetivo de este estudio fue relatar dos casos en que se realizaron los bloqueos isquiático y femoral guiados por ultrasonido en pacientes anticoagulados. RELATO DE LOS CASOS: En el primer caso, la cirugía realizada consistió en la amputación del pie anterior izquierdo en función de una necrosis y de señales de infección. El segundo caso, fue una limpieza quirúrgica de la rodilla izquierda. Los pacientes presentaron disturbios de coagulación con una actividad de protrombina y tiempo de tromboplastina activado por encima de los valores normales. Los dos pacientes se sometieron al bloqueo femoral e isquiático guiado por ultrasonido, evolucionando sin alteración motora o sensitiva en los territorios de esos nervios y sin hematoma en la región local de la punción. CONCLUSIONES: La anticoagulación impone ciertas restricciones a la aplicación de las técnicas anestésicas regionales clásicas. Con el avance de los equipos y métodos de ultrasonido, hoy por hoy se puede identificar con alta precisión las estructuras vasculares y neurales. Eso posibilita que la punción guiada por ultrasonido sea más exacta, tanto para alcanzar el área de interés como para minimizar los riesgos de lesión vascular accidental. Hasta el presente momento, no se recomienda la realización de bloqueo periférico en pacientes anticoagulados o portadores de coagulopatías. Sin embargo, considerando que existen pocos relatos sobre bloqueos regionales con ultrasonido en situaciones de coagulopatías, la seguridad de tal técnica en esas condiciones todavía no se ha establecido.BACKGROUND AND OBJECTIVES: The use of the ultrasound to guide the puncture in peripheral nerve blocks has become

  8. Síndrome doloroso regional complejo tipo 1: Tratamiento mediante bloqueos simpáticos y más... Complex regional pain syndrome type I: Management with sympathetic blockade and other therapies…

    Directory of Open Access Journals (Sweden)

    B. Garrido

    2005-10-01

    Full Text Available Introducción: El síndrome doloroso regional complejo tipo 1 (SDRC-I cursa con una fase aguda de inflamación neurogénica regional, que conduce a una fase crónica de desórdenes neuropáticos. La participación del sistema nervioso simpático en su génesis y mantenimiento es significativa, pero no exclusiva. De ahí la importancia de un tratamiento precoz y multifactorial, dirigido a los mecanismos fisiopatológicos. Objetivos: Estudiar el uso de los bloqueos simpáticos, asociados a otros procederes y fármacos en su tratamiento. Material y métodos: Se estudiaron 68 pacientes portadores de SDRC-I que acudieron a la Clínica del Dolor, a los que se realizó bloqueo de la cadena simpática ganglionar cervical y lumbar según la localización de la entidad. Todos los pacientes asociaron el hidromasaje en el hogar. Se administraron fármacos coadyuvantes para el control del dolor neuropático, paroxístico y persistente quemante. En los casos con trastornos de la consolidación ósea, se aplicó laserterapia local y TENS en los que presentaban mayor limitación funcional; así como técnicas de fisiatría. Se aplicó la escala análoga visual (EAV para evaluar la intensidad de la analgesia y se realizó examen físico para la valoración de los trastornos autonómicos. La función articular se consideró mediante la escala de Enneking y cols. para pacientes amputados, modificada por nosotros. Resultados: El dolor se controló en 33 pacientes y 28 descendieron su EAV a niveles álgicos tolerables, para un 89,70% de efectividad terapéutica. La función articular se recuperó en 30 pacientes y 20 quedaron con limitación leve, estos dos grupos con mejor respuesta correspondieron al 73,52% del total de los pacientes, 11 quedaron con limitación moderada y sólo 7, el 10,29% de ellos con limitación severa. Los trastornos vasomotores remitieron en la totalidad de los que presentaron respuesta favorable. Conclusiones: La intensidad de la analgesia

  9. Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

    Directory of Open Access Journals (Sweden)

    Tarek AbdElBarr

    2014-07-01

    Conclusions: Based on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia.

  10. Epidural hematoma secondary to sinusitis: a case report and review of the literature.

    Science.gov (United States)

    Aviner, Shraga; Olshinka, Noam; Cherniavsky, Evgenia; Forer, Boaz; Bibi, Haim

    2014-02-01

    Epidural hematoma is a potentially life threatening event that demands prompt diagnosis and surgical treatment, usually following head trauma. We present a case of a 9-year-old boy with no history of head trauma, and who was diagnosed with epidural hematoma secondary to frontal sinusitis; and the medical literature was reviewed. PMID:24370469

  11. Spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Bong Guk; Lee, Young Jun; Lee, Ji Young; Park, Chan Kum; Paik, Seung Sam [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Dong Woo [Dept. of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2015-07-15

    Spinal capillary hemangiomas in the epidural space are extremely rare; however, a preoperative radiological diagnosis is very important because of the risk of massive intraoperative hemorrhage. We report a case of a spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces.

  12. Spontaneous pneumomediastinum with pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis: A rare association

    OpenAIRE

    Singh, Amandeep; Kaur, Haramritpal; Singh, Gurbax; Aggarwal, Simmi

    2014-01-01

    Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax and epidural pneumotosis. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis in an 18-year-old gentleman in the absence of identifiable cause.

  13. To study the acceptance of epidural analgesia for painless labor at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Neena Gupta

    2014-08-01

    Full Text Available Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labor. Epidural analgesia is the most effective method of pain relief during labor. But unfortunately in India incidence of painless labor by epidural analgesia is very rare even in these days. The aim of our study was to study the acceptance of epidural analgesia at a tertiary care centre. Methods: The present study was conducted in department of obstetrics and gynaecology UISEMH, Kanpur over the period from May 2012 to May 2013. The study was conducted on 98 patients who were counselled regarding the adoption of epidural analgesia as painless labour and out of these 50 patients opted for epidural analgesia. Results: In our present study the acceptance was greater in primigravida (72.43% as compared to multigravida (20%. In our society social reason was the common cause for non-acceptance in primigravida (87.5%. The majority of patients belonged to middle socioeconomic status (52% and more number of educated patients opted for epidural analgesia. Conclusions: It was found that increased awareness can lead to increased acceptance of epidural analgesia. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1087-1089

  14. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

  15. Pharmacokinetics and clinical efficacy of long-term epidural ropivacaine infusion in children

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Ilett, K F; Lim, S I;

    2000-01-01

    The clinical efficacy and pharmacokinetics of long-term epidural ropivacaine infusion were investigated in 18 postoperative children aged between 0.3 and 7.3 yr. A lumbar or thoracic epidural catheter was inserted after the anaesthetic induction. Sixty minutes following a bolus dose of ropivacaine...

  16. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas

    DEFF Research Database (Denmark)

    Eriksen, Lena Mariann; Nøhr, Ellen Aagaard; Kjaergaard, Hanne

    2011-01-01

    Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between...

  17. The C2 ganglion sectioning epidural approach to craniocervical junction chordoma: A technical case report

    Directory of Open Access Journals (Sweden)

    Naoshi Hagihara

    2012-01-01

    Full Text Available In chordoma, complete surgical removal of the epidural tumor should be the first choice of treatment. Numerous surgical approaches to clival chordoma have been described: anterior approaches, lateral approaches, and posterolateral approaches. A multistaged operation with a combination of these approaches is generally performed. We used three approaches to remove a clival chordoma extending from the lower clivus anteriorly to the anterior perivertebral space and inferiorly to the C2 level. The epidural posterolateral approach through the vertebral artery (VA-C2 interval space after resection of the C2 dorsal ganglion was the most effective. To our knowledge, the epidural posterolateral approach below VA, referred to as C2 ganglion sectioning epidural approach has not been reported as an independent approach in detail. We report a two-year-old girl with a lower clival chordoma which has been excised using C2 ganglion sectioning epidural approach.

  18. Spontaneous idiopathic spinal epidural hematoma: two different presentations of the same disease Hematoma epidural espinal espontáneo: dos diferentes presentaciones clínicas de la misma enfermedad Hematoma epidural espinhal espontâneo: duas diferentes apresentações da mesma doença

    Directory of Open Access Journals (Sweden)

    Asdrúbal Falavigna

    2010-09-01

    Full Text Available We report two cases of spontaneous spinal epidural hematoma with different clinical presentations without precipitating factors and a brief review of the literature. Our case first developed acute and had progressive cervical spinal cord signs that determined emergency decompressive laminectomy. On the other hand, the second patient, who was chronic, was operated almost five months after the initial symptoms and the radiological diagnosis was a large facet cyst. Early surgical intervention is the chosen treatment for spontaneous spinal epidural hematomas. Spinal surgeons should bear in mind that spontaneous spinal epidural hematomas may have different clinical presentations according to their location in order to perform a differential diagnosis.Fueron relatados dos casos de hematoma epidural espinal espontáneo con diferentes presentaciones clínicas sin factores precipitantes, y fue hecha una breve revisión de la literatura. Nuestro caso 1 tuvo un desarrollo agudo y mostró señales progresivas en la columna cervical que determinaron una laminectomía descompresiva de emergencia. Por otro lado, el segundo paciente, crónico, fue operado casi cinco meses después de los síntomas iniciales y el diagnóstico radiológico fue de un gran quiste sinovial. La intervención quirúrgica temprana es el tratamiento de elección para hematomas espontáneos epidurales espinales. El tratamiento quirúrgico representa la forma más común de terapia para todos los tipos de presentaciones clínicas. Debemos considerar que el tratamiento conservador (o no sea más común en casos de presentación leve, principalmente en pacientes con hematoma espinal crónico. Para realizar un diagnóstico diferencial, los cirujanos deben recordar que los hematomas epidurales espinales espontáneos pueden tener distintas presentaciones clínicas según su ubicación.Os autores relatam dois casos de hematoma epidural espinhal espontâneo com diferentes apresentações cl

  19. Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior Estudio radiológico de la dispersión de diferentes volúmenes de anestésico local en el bloqueo de plexo braquial por vía posterior Radiological evaluation of the spread of different local anesthetic volumes during posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2005-10-01

    aleatoriamente en tres grupos de cinco: Grupo 1: volumen de 20 mL; Grupo 2: volumen de 30 mL; Grupo 3: volumen de 40 mL. En un paciente, sometido al bloqueo continuado del plexo braquial por la vía posterior, la administración de un volumen de 10 mL fue estudiada. En todos, el anestésico usado fue la ropivacaína a 0,375% asociada a solución radiopaca. Fueron hechas radiografías de la región cervical inmediatamente después el bloqueo que fue evaluado a través de la pesquisa de la sensibilidad térmica utilizándose algodón embebido en alcohol, treinta minutos después de su realización y en la sala de recuperación anestésica. RESULTADOS: El comportamiento radiológico y clínico del bloqueo de plexo braquial por vía posterior es muy semejante de aquél descrito con la técnica de Winnie (interescalénico. Invariablemente hay envolvimiento del plexo cervical y de las raíces más altas (C5-C7 del plexo braquial. CONCLUSIONES: Este estudio muestra que la dispersión del anestésico local en el bloqueo del plexo braquial por la vía posterior se da primariamente en las raíces responsables por la inervación del hombroBACKGROUND AND OBJECTIVES: Local anesthetic spread during interscalenic block has been thoroughly studied, however there are few studies on posterior block. This study aimed at evaluating the spread of different local anesthetic volumes during posterior brachial plexus block using contrasted X-rays. METHODS: Participated in this study 16 patients submitted to posterior brachial plexus block, 15 of whom were randomly divided in three groups of five patients: Group 1: 20 mL; Group 2: 30 mL.; Group 3 40 mL. The volume of 10 mL was studied in one patient submitted to continuous posterior brachial plexus block. All patients received 0.375% ropivacaine associated to radio-opaque solution. X-rays of the cervical region were obtained immediately after blockade that were evaluated by thermal sensitivity using cotton soaked in alcohol 30 minutes after being

  20. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  1. The knowledge and attitudes of nonanesthesia nurses regarding postoperative epidural analgesia.

    Science.gov (United States)

    Sandie, C L; Heindel, L J

    1999-10-01

    The provision of epidural analgesia for postoperative pain control offers many patient benefits and has become commonplace on many nursing units. Since nurses are responsible for the day-to-day management of patients receiving epidural analgesia, their knowledge, attitudes, and practices regarding this technique are pivotal to its success. Therefore, the purpose of the present descriptive study was to examine the knowledge base, attitudes, and clinical practice of registered nurses (N = 85) regarding postoperative epidural analgesia as managed by an acute pain service (APS). Information was obtained from a survey distributed via a convenience sample to all nurses working on 6 units in a large military teaching facility. We developed the "Epidural Knowledge and Attitude Survey" using the nursing literature on epidural analgesia. The survey consisted of a demographics section, true/false (T/F) questions, multiple choice (M/C) questions, an attitude section, and a comment section. These sections addressed the nurses' knowledge, attitudes, and practices in regard to epidural pharmacology, management, and adverse effects, as well as their general satisfaction with the APS of their facility. Data were analyzed statistically using means, standard deviations, percentages, forward step-wise linear regression, the Fisher-Irwin (exact) test, the chi 2 test, and analysis of variance with Bonferroni multiple comparisons. A P value of attitude section illustrated that 73% of nurses had "positive" attitudes toward epidural analgesia. Correct management of patients receiving epidural analgesia was being practiced by 77% of nurses. The satisfaction with the APS at this facility was 32% "very satisfied" and 62% "somewhat satisfied." The demographic characteristics that best predicted a higher score on the knowledge portion of the survey were greater years of practice as a nurse and receipt of pain education in nursing training. Nurses who had received inservice education about

  2. Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis

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    McQuay Henry J

    2006-09-01

    Full Text Available Abstract Background Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems. Methods We performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles. Results Twelve studies included 14,105 patients, of whom 5,026 (36% had vascular surgery, 4,971 (35% cardiac surgery, and 4,108 (29% thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850. There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600. Conclusion These estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding.

  3. Spinal epidural abscess: a rare complication of olecranon bursitis

    OpenAIRE

    Evans, Rhys D.R.; Moe Thaya; Ne Siang Chew; Charles E.R. Gibbons

    2009-01-01

    Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammator...

  4. Inflammation and Epidural-Related Maternal Fever: Proposed Mechanisms.

    Science.gov (United States)

    Sultan, Pervez; David, Anna L; Fernando, Roshan; Ackland, Gareth L

    2016-05-01

    Intrapartum fever is associated with excessive maternal interventions as well as higher neonatal morbidity. Epidural-related maternal fever (ERMF) contributes to the development of intrapartum fever. The mechanism(s) for ERMF has remained elusive. Here, we consider how inflammatory mechanisms may be modulated by local anesthetic agents and their relevance to ERMF. We also critically reappraise the clinical data with regard to emerging concepts that explain how anesthetic drug-induced metabolic dysfunction, with or without activation of the inflammasome, might trigger the release of nonpathogenic, inflammatory molecules (danger-associated molecular patterns) likely to underlie ERMF.

  5. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

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    Varaprasad

    2015-07-01

    Full Text Available BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of sedation were studied. RESULTS: There was no significant differ ence between the two groups in maternal satisfaction, analgesia and neonatal outcome .

  6. Abscesso epidural em paciente portador de piomiosite tropical: relato de caso e revisão da literatura Absceso epidural en paciente portador de piomiositis tropical: relato de caso y revisión de la literatura Epidural abscess in patient with tropical pyomyositis: a case report and literature review

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    Rodrigo Rezende

    2012-09-01

    Full Text Available A piomiosite é uma infecção muscular profunda subaguda que pode originar abscessos intramusculares únicos ou múltiplos. Está associada a infecções sistêmicas, diabetes mellitus, terapia imunossupressora, AIDS e mieloma múltiplo. Descrevemos um caso de piomiosite tropical com acometimento da coluna vertebral que evoluiu para abscesso epidural, em paciente com história pregressa de espondilite anquilosante em tratamento com medicações imunossupressoras e apresentou trauma direto na coxa direita previamente ao início dos sintomas. O objetivo deste trabalho é descrever o acometimento raro da coluna vertebral em pacientes com piomiosite tropical, com apenas um caso descrito na literatura mundial, destacando a necessidade dos métodos complementares na investigação diagnóstica para o adequado tratamento e as possíveis complicações dessa doença. Os pacientes imunossuprimidos com dores musculares subagudas devem ser investigados quanto à piomiosite tropical e o diagnóstico precoce é fundamental para o sucesso do tratamento.La piomiositis es una infección muscular profunda y subaguda que puede originar abscesos intramusculares únicos o múltiples. Se vincula a infecciones sistémicas, diabetes mellitus, terapia inmunosupresora, SIDA [AIDS] y mieloma múltiple. Describimos un caso de piomiositis tropical, con acometimiento de la columna vertebral, que evolucionó para absceso epidural, en paciente con historial anterior de espondilitis anquilosante en tratamiento con medicaciones inmunosupresoras y que presentó traumatismo derecho, en el muslo derecho, previamente al inicio de los síntomas. El objetivo de este trabajo es describir el acometimiento raro de la columna vertebral en pacientes con piomiositis tropical, con solamente un caso descrito en la literatura mundial, destacando la necesidad de los métodos complementarios, en la investigación de diagnóstico, para el apropiado tratamiento y las posibles complicaciones de

  7. Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents

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    Ali Alagoz

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. METHODS: After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I and fourth year (Group II according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. RESULTS: Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05. Change of needle insertion level was statistically higher in Group II (p = 0.008, whereas paresthesia was significantly higher in Group I (p = 0.007. Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p < 0.001, 0.005. CONCLUSION: Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.

  8. An Active Learning Algorithm for Control of Epidural Electrostimulation.

    Science.gov (United States)

    Desautels, Thomas A; Choe, Jaehoon; Gad, Parag; Nandra, Mandheerej S; Roy, Roland R; Zhong, Hui; Tai, Yu-Chong; Edgerton, V Reggie; Burdick, Joel W

    2015-10-01

    Epidural electrostimulation has shown promise for spinal cord injury therapy. However, finding effective stimuli on the multi-electrode stimulating arrays employed requires a laborious manual search of a vast space for each patient. Widespread clinical application of these techniques would be greatly facilitated by an autonomous, algorithmic system which choses stimuli to simultaneously deliver effective therapy and explore this space. We propose a method based on GP-BUCB, a Gaussian process bandit algorithm. In n = 4 spinally transected rats, we implant epidural electrode arrays and examine the algorithm's performance in selecting bipolar stimuli to elicit specified muscle responses. These responses are compared with temporally interleaved intra-animal stimulus selections by a human expert. GP-BUCB successfully controlled the spinal electrostimulation preparation in 37 testing sessions, selecting 670 stimuli. These sessions included sustained autonomous operations (ten-session duration). Delivered performance with respect to the specified metric was as good as or better than that of the human expert. Despite receiving no information as to anatomically likely locations of effective stimuli, GP-BUCB also consistently discovered such a pattern. Further, GP-BUCB was able to extrapolate from previous sessions' results to make predictions about performance in new testing sessions, while remaining sufficiently flexible to capture temporal variability. These results provide validation for applying automated stimulus selection methods to the problem of spinal cord injury therapy.

  9. Intraventricular Hemorrhage after Epidural Blood Patching: An Unusual Complication

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    Mohammad Sorour

    2014-01-01

    Full Text Available The authors present two cases of intraventricular hemorrhage (IVH believed to be a result of epidural blood patching. The first was a 71-year-old woman who had new onset of nontraumatic IVH on computed tomography (CT scan after undergoing an epidural blood patch (EBP. This amount of intraventricular blood was deemed an incidental finding since it was of very small volume to account for her overall symptoms. The second patient, a 29-year-old woman, was found to have nontraumatic IVH three days after undergoing an EBP. This was seen on CT scan of the head for workup of pressure-like headaches, nausea, vomiting, and absence seizures. Conservative management was followed in both instances. Serial CT scan of the head in our first patient displayed complete resolution of her IVH. The second patient did not have follow-up CT scans because her overall clinical picture had improved significantly. This highlights a potential sequel of EBP that may be observed on CT scan of the head. In the event that IVH is detected, signs and symptoms of hydrocephalus should be closely monitored with the consideration for a future workup if warranted by the clinical picture.

  10. An Active Learning Algorithm for Control of Epidural Electrostimulation.

    Science.gov (United States)

    Desautels, Thomas A; Choe, Jaehoon; Gad, Parag; Nandra, Mandheerej S; Roy, Roland R; Zhong, Hui; Tai, Yu-Chong; Edgerton, V Reggie; Burdick, Joel W

    2015-10-01

    Epidural electrostimulation has shown promise for spinal cord injury therapy. However, finding effective stimuli on the multi-electrode stimulating arrays employed requires a laborious manual search of a vast space for each patient. Widespread clinical application of these techniques would be greatly facilitated by an autonomous, algorithmic system which choses stimuli to simultaneously deliver effective therapy and explore this space. We propose a method based on GP-BUCB, a Gaussian process bandit algorithm. In n = 4 spinally transected rats, we implant epidural electrode arrays and examine the algorithm's performance in selecting bipolar stimuli to elicit specified muscle responses. These responses are compared with temporally interleaved intra-animal stimulus selections by a human expert. GP-BUCB successfully controlled the spinal electrostimulation preparation in 37 testing sessions, selecting 670 stimuli. These sessions included sustained autonomous operations (ten-session duration). Delivered performance with respect to the specified metric was as good as or better than that of the human expert. Despite receiving no information as to anatomically likely locations of effective stimuli, GP-BUCB also consistently discovered such a pattern. Further, GP-BUCB was able to extrapolate from previous sessions' results to make predictions about performance in new testing sessions, while remaining sufficiently flexible to capture temporal variability. These results provide validation for applying automated stimulus selection methods to the problem of spinal cord injury therapy. PMID:25974925

  11. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation

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    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD and ropivacaine + clonidine (RC, comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS version 10.0 for windows and value of P 0.05. Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.

  12. Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage.

    Science.gov (United States)

    Tsai, Yi-Da; Hsu, Chin-Wang; Hsu, Chia-Ching; Liao, Wen-I; Chen, Sy-Jou

    2016-03-01

    Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. A 21-year-old man visited the emergency department because of chest and back pain along with immobility of bilateral lower limbs immediately after he woke up in the morning. Complete flaccid paraplegia and hypoesthesia in dermatome below bilateral T3 level and pain over axial region from neck to lumbar region were noted. A computed tomography excluded aortic dissection. Magnetic resonance imaging revealed a fusiform lesion involving the anterior epidural space from C7 to T2 level suspected of epidural hemorrhage, causing compression of spinal cord. He started intravenous corticosteroid but refused operation concerning the surgical benefits. Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta. He underwent thoracic endovascular aortic repair uneventfully. The patient was hemodynamically stable but with slow improvement in neurologic recovery of lower limbs. Aortic coarcation can cause paralysis by ruptured vascular aneurysms with spinal hemorrhage and chest pain that mimics acute aortic dissection. A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies. Cautious and prudent evaluation and cross disciplines cares are essential for diagnosis and successful management of the disease.

  13. Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage.

    Science.gov (United States)

    Tsai, Yi-Da; Hsu, Chin-Wang; Hsu, Chia-Ching; Liao, Wen-I; Chen, Sy-Jou

    2016-03-01

    Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. A 21-year-old man visited the emergency department because of chest and back pain along with immobility of bilateral lower limbs immediately after he woke up in the morning. Complete flaccid paraplegia and hypoesthesia in dermatome below bilateral T3 level and pain over axial region from neck to lumbar region were noted. A computed tomography excluded aortic dissection. Magnetic resonance imaging revealed a fusiform lesion involving the anterior epidural space from C7 to T2 level suspected of epidural hemorrhage, causing compression of spinal cord. He started intravenous corticosteroid but refused operation concerning the surgical benefits. Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta. He underwent thoracic endovascular aortic repair uneventfully. The patient was hemodynamically stable but with slow improvement in neurologic recovery of lower limbs. Aortic coarcation can cause paralysis by ruptured vascular aneurysms with spinal hemorrhage and chest pain that mimics acute aortic dissection. A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies. Cautious and prudent evaluation and cross disciplines cares are essential for diagnosis and successful management of the disease. PMID:26275629

  14. Enfermedad de Chagas en pacientes con miocardiopatía dilatada idiopática en Costa Rica

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    Oswaldo Gutiérrez-Sotelo

    2007-04-01

    Full Text Available Justificación y objetivo: Determinar la prevalencia de la enfermedad de Chagas en un grupo de pacientes con miocardiopatía dilatada, bradiarritmias y taquiarritmias ventriculares en Costa Rica. Material y métodos: Estudio observacional, descriptivo, prospectivo de una serie de casos. Se seleccionaron pacientes con diagnóstico clínico y ecocardiográfico de miocardiopatía dilatada, bloqueo atrioventricular o intraventricular documentados o con arritmia ventricular compleja, excluyéndose aquellos en quienes hubiera uno o más factores causales (enfermedad arterial coronaria o cardiopatía hipertensiva. Mediante consentimiento informado, se les realizó un estudio con 2 pruebas serológicas de diferente fuente para detectar IgG anti-Trypanosoma cruzi. Resultados: De aproximadamente 15.000 a 20.000 vistos pacientes por año en la Consulta Externa del Servicio de Cardiología del Hospital México, unos 500 se presentan con el diagnóstico de miocardiopatía dilatada. Excluidos los pacientes con causa conocida de su cardiopatía, entre febrero de 2004 y noviembre de 2005 se reclutó a 74 pacientes, 41 hombres y 33 mujeres, con edades comprendidas entre los 13 y los 87 años (promedio 47,9, de los cuales la mayoría (n=51; 68,9% tenían miocardiopatía dilatada idiopática, con una fracción de eyección promedio del 29,2%; 18 (24,33% se incluyeron por bloqueo atrioventricular y 5 por arritmia ventricular compleja. De los 78 pacientes, 5 (6,8% resultaron tener serología positiva por enfermedad de Chagas; de estos: 3 con miocardiopatía dilatada, uno con bloqueo atrioventricular completo y uno con arritmia ventricular compleja. Cabe destacar que solo uno de los 3 pacientes dilatados tiene el electrocardiograma característico de la fase crónica de la enfermedad de Chagas: bloqueo AV de primer grado, bloqueo completo de rama derecha y hemibloqueo anterior izquierdo. Conclusión: Los datos obtenidos en esta investigación revelan que la

  15. Catatonia and jaw dislocation in the postoperative period with epidural morphine

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    Satyen Parida

    2011-01-01

    Full Text Available We report a case of temporomandibular joint dislocation occurring in the postoperative period in a patient, who developed catatonia following administration of a single dose of epidural morphine. The catatonic response to epidural morphine was delayed by several hours in the postoperative period, and might have resulted from intrathecal migration of the drug, through an initial dural puncture while locating the epidural space. The temporomandibular joint dislocation was diagnosed only after reversal of the effects of morphine with naloxone, when the patient complained of inability to fully close her mouth.

  16. Combined spinal–epidural anesthesia for an elderly patient with proportionate dwarfism for laparotomy

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    Teena Bansal

    2016-01-01

    Full Text Available Anesthesia in a dwarf patient may be challenging as various anatomical anomalies make both general and regional anesthesia difficult. These patients may have atlantoaxial instability, potential for airway obstruction, and associated respiratory problems that may pose problems for general anesthesia. Spinal stenosis, osteophytes, short pedicles, or a small epidural space could complicate regional anesthesia in dwarfs which could lead to difficulties in locating the epidural space and increase the risk of dural puncture. Spinal stenosis may impair cerebrospinal fluid flow such that identification of dural puncture is difficult. This elderly dwarf patient had history of bronchial asthma with restriction of neck extension, managed successfully using combined spinal–epidural anesthesia.

  17. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  18. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

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    Joyce Leary

    2013-01-01

    Full Text Available Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues.

  19. Effects of lumbosacral epidural ketamine and lidocaine inxylazine-sedated cats : article

    OpenAIRE

    R. DeRossi; A.P. Benites; J.Z. Ferreira; J.M.N. Neto; L.C. Hermeto

    2009-01-01

    In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1) ketamine (2.5 mg/kg), (2) lidocaine (4.0 mg/kg), and (3) ketamine (2.5 mg/kg) plus lidocaine (4.0 mg/kg). Epidural injections were administered through the lumbosacral space. Analgesia, motor block...

  20. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    : Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions...... for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. CONCLUSIONS......: Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity....

  1. Pharmacokinetics and analgesic effect of ropivacaine during continuous epidural infusion for postoperative pain relief

    DEFF Research Database (Denmark)

    Erichsen, C J; Sjövall, J; Kehlet, H;

    1996-01-01

    BACKGROUND: The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. METHODS: Through an epidural...... catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was...

  2. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  3. Effect of epidural blockade and oxygen therapy on changes in subcutaneous oxygen tension after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Pedersen, U; Erichsen, C J;

    1994-01-01

    The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous...... any of the measured values. Oxygen therapy before epidural blockade increased median subcutaneous oxygen tension from 60 to 71 mmHg (P oxygen tension with oxygen therapy was 30 (15-55) min...... without epidural blockade and 15 (10-20) min with blockade (P oxygen tension with or without oxygen therapy after elective uncomplicated major abdominal surgery....

  4. PROPELLER Diffusion-Weighted Magnetic Resonance Imaging of Acute Spinal Epidural Hematoma

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    Fujiwara, H.; Oki, K.; Momoshima, S.; Kuribayashi, S. [Keio Univ. School of Medicine (Japan). Dept. of Diagnostic Radiology and Dept. of Neurology

    2005-08-01

    We present the case of an 86-year-old female with spontaneous spinal epidural hematoma. Although T1- and T2-weighted images showed the dilated posterior epidural space at the cervical spine, this finding was non-specific on conventional magnetic resonance imaging obtained 15 h after the onset of symptoms. Diffusion-weighted imaging with the use of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER), which clearly revealed the high intensity hematoma, was useful for detection and diagnosis of acute spinal epidural hematoma.

  5. Effect of epidural clonidine on somatosensory evoked potentials to dermatomal stimulation

    DEFF Research Database (Denmark)

    Lund, C; Hansen, O B; Kehlet, H

    1989-01-01

    The effect of lumbar epidural clonidine 150 micrograms on early (less than 0.5 s) somatosensory evoked potentials (SEP) to electrical stimulation of the L1 and S1 dermatomes was examined in twelve cancer patients. Epidural clonidine led to a minor but significant decrease in amplitude of two...... systolic and diastolic blood pressures decreased from 118 +/- 4/72 +/- 5 mmHg to 99 +/- 5/60 +/- 3 mmHg (P less than 0.01), respectively. It is concluded that epidural clonidine has a minor effect on the early SEPs to electrical dermatomal stimulation. Additionally, a pronounced effect on cancer pain...

  6. Medición del daño genético inducido por el basuco en linfocitos humanos empleando la prueba de micronúcleos con citocalasina b

    OpenAIRE

    Ocampo AP.; Carvajal SM.; Hoyos LS.

    2011-01-01

    El bazuco es una mezcla compleja que se deriva del proceso de extracción de la cocaína. El frecuente consumo de bazuco constituye un problema de salud pública. La prueba de micronúcleos en linfocitos humanos de sangre periférica por bloqueo de la citocinesis con Citocalasina B, es más sensible y precisa para evaluar daño  cromosómico porque permite registrar micronúcleos originados de fragmentos de cromosomas o cromosomas enteros en células que se han dividido una sola vez. El objetivo del pr...

  7. A COMPARATIVE STUDY OF EPIDURAL BUTORPHANOL AND EPIDURAL FENTANYL FOR THE RELIEF OF POST-OPERATIVE PAIN IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Ashwini

    2014-11-01

    Full Text Available BACKGROUND: Epidural anaesthesia is used extensively for both intra-operative and post-operative analgesia. This prospective randomized study was conducted using opioids epidurally for post-operative analgesia. Fentanyl is a pure opioid agonist. Butorphanol tartarate which is an agonist antagonist opioid is considered safer than pure opioid agonist. Hence, we compared epidural 4mg butorphanol and epidural 100 µg fentanyl for the relief of post-operative pain. AIMS AND OBJECTIVES: To compare the onset, duration, quality of analgesia, hemodynamic effects and side effects between the 2 study drugs. MATERIALS AND METHODS: 60 patients of either sex posted for elective lower abdominal and lower limb surgeries were randomly divided into 2 groups of 30 each. Group A received butorphanol 4mg epidurally. Group B received fentanyl 100 µg epidurally. All surgeries were done under lumbar epidural anaesthesia with catheter in situ. Post-operatively when patients complained of pain, intensity of pain was assessed using visual analogue scale [VAS]. When the VAS score was > 5, Group A received butorphanol 4mg diluted to 10 ml with NS or Group B received 100 µg fentanyl epidurally diluted to 10 ml with NS. Onset, duration, quality of analgesia, hemodynamic effects and incidence of side effects were compared between the two groups and treated accordingly. RESULTS: Demographic profile was comparable in both groups. Mean time of onset of analgesia was rapid (3.22 ±0.9 (S.D min in group B compared to group A (6.38± 1.26 (S.D min. Duration of analgesia was longer in group A (344.00 ±63.39 min compared to group B (227±38.12 min. Quality of analgesia was better with group A compared to group B. There was no significant difference in hemodynamic parameters in both groups. Sedation was the main side effect in group A. Incidence of pruritis, vomiting, hypotension and respiratory depression was more in group B. CONCLUSION: Epidural Butorphanol though has a delayed

  8. Administración epidural de lidocaína, morfina y detomidina para la resección quirúrgica de un tumor de pene en un toro joven (Epidural administration of lidocaine, morphine and detomidine for surgical removal of a tumour in a young bull penis

    Directory of Open Access Journals (Sweden)

    Castiñeiras Pérez, Eva:

    2007-04-01

    Full Text Available ResumenCon objeto de mejorar la fertilidad en las explotaciones, algunos ganaderos optan por la presencia de un toro para la monta natural. En toros jóvenes es relativamente común la aparición de fibropapilomas en el pene. Esta patología está causada por un adenovirus quepenetra a través de pequeñas heridas, dando lugar a neoplasias en la porción libre del pene. Por lo general, suelen ser de naturaleza benigna y sólo se recomienda su eliminación quirúrgica cuando dificultan la monta.1 Aunque, en los animales de producciónnunca se ha tenido muy en cuenta la analgesia intra y postoperatoria, estudios recientes muestran que el control del dolor permite una más rápida y mejor recuperación. La anestesia epidural se ha convertidoen una técnica muy utilizada para el control del dolor en diversas especies domésticas. La administración epidural de lidocaína 2% (0,2 mg/kg, morfina 2% (0,3 mg/kg y detomidina 1% (30 µg/kg en un volumen total de 14 ml, proporciona en el ganado vacuno unabuena anestesia y analgesia en ambas fosas paralumbares, abdomen,extremidades posteriores, ubre, ano, periné, vulva y vagina durante más de 100 minutos. El animal permanece de pie con mínimos efectoscardiorrespiratorios.2 La aplicación epidural antes descrita permite la exploración del aparato reproductor del animal y proporcionaanestesia y analgesia para la eliminación del tumor en el pene. Al permanecer de pie, se evitan toda una serie de problemas asociados al decúbito en el bovino (timpanismo, daños musculares y nervioso, etc..

  9. Bloqueio bilateral do nervo pudendo para hemorroidectomia em paciente acondroplásico: relato de caso Bloqueo bilateral del nervio pudendo para hemorroidectomía en paciente acondroplásico: relato de caso Bilateral blockade of the pudend nerve to hemorrhoidectomy in achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Bruno Salomé de Morais

    2006-04-01

    ética espontánea. La anestesia de esos pacientes presenta varias particularidades. El objetivo del presente relato fue el de describir un caso de paciente acondroplásico, con previo historial de intervención quirúrgica de la columna para descompresión medular, sometido a Hemorroidectomía a través de bloqueo bilateral de los nervios pudendos. RELATO DEL CASO: Paciente del sexo masculino, 47 años, acondroplásico, que fue ingresado para la realización de hemorroidectomía.Al hacérsele el examen físico presentaba el cuello acortado con extensión limitada de la cabeza, Mallampati clase IV, distancia tireomentoniana de 6 cm y abertura de la boca de 3,5 cm. La columna vertebral presentaba cifosis torácica y lordosis lumbar acentuada, además de cicatriz quirúrgica en la región lumbar. Fue realizado el bloqueo bilateral de los nervios pudendos con ropivacaina a 1%, por vía transperineal, con una aguja aislada de 0,8 mm x 100 mm 21G (Stimuplex A100 BBraun, Melsungen, Germany conectada al estimulador de nervios periféricos (Stimuplex-DIG, BBraun.El paciente fue colocado en decúbito ventral y la cirugía iniciada después de 15 minutos da administración del anestésico. Durante todo el procedimiento, el paciente permaneció consciente y no relató ningún dolor o incomodidad. Hasta el momento del alta hospitalaria (22h después de la realización del bloqueo, el paciente no refirió dolor, incomodidad, náusea, vómito, bloqueo motor, retención o incontinencia urinaria. Después del alta, evolucionó bien presentando evacuación después de 31 horas de efectuada la cirugía. CONCLUSIONES: El caso mostró el uso del bloqueo bilateral de los nervios pudendos, con el auxilio del neuroestimulador como técnica anestésica aislada para la hemorroidectomía.BACKGROUND AND OBJECTIVES: The achondroplasic dwarfism or achondroplasia is the most common form of dwarfism and occurs, in most of the cases, as a result of spontaneous genetic alteration. The anesthesia in these

  10. CLINICAL STUDY OF LOW-DOSE KETAMINE ASSOCIATING MORPHINE PATIENT CON-TROL EPIDURAL OR SUBCUTANEOUS ANALGESIA FOR MODERATE AND SEVERE LATE PHASE CANCER PAIN PATIENT%小剂量氯胺酮辅助吗啡硬膜外/皮下自控镇痛用于顽固性中、重度晚期癌痛治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    陈付强; 胡丹; 时飞; 谢平; 王昕; 艾登斌

    2009-01-01

    Objective:To observe the analgesic effects and the side effects of low-dose ketamine associa- ting morphine with patient control epidural analgesia(PCEA)and patient control subcutaneous analgesia (PCSA)for patients late cancer pain.Methods:54 cases late-phase cancer pain patients were divided in to two groups,with low-dose ketamine associating morphine PCEA Was used in the first group and low- dose ketamine associating morphine PCSA in the second group.The VAS(Visual Analogue Scale)Was used to evaluate the pain level,and the side effects in two groups.Results:The pain degrees of the two groups were alleviated significantly,the VAS at every period were no different(P>0.05),the morphine and ketamine dosage in the PCSA group was more than that in the PCEA group.The life satisfactory rate in PCEA group Was higher obviously than that in PCSA group;side effects such as the incidence of nause- a,vomiting,somnolence,itch and urine retention in the PCSA group was higher than those in the PCEA group;the incidence of respiration depression and hallucination was no different between the two groups. Conclusions:Both low-dose ketamine associating morphine with patient-control epidural analgesia (PCEA)and PCSA Call provide patient with safe and effective pain relief for moderate to severe late- phase cancer pain.PCEA is an optimas approach for moderate to severe late-phase concer pain with bet- ter pain relief and less side-effect and PCSA can serve as a complementary analgesia.%目的:观察小剂量氯胺酮辅助吗啡硬膜外或皮下自控镇痛(PCEA/PCSA)用于顽固性中、重度晚期癌痛患者的可行性及止痛效果.方法:选择54例中、重度晚期癌痛患者,均为虽经三阶梯药物治疗方案治疗未能很好地控制疼痛,同时毒副作用较大的患者.按是否可以行硬膜外穿刺置管分成两组,硬膜外自控镇痛(PCEA)组(n=28例)和皮下自控镇痛(PCSA)组(n=26例).采用硬膜外自控镇痛组,镇痛液为200ml,内含吗啡20mg

  11. How I teach evidence-based epidural information in a hospital and keep my job.

    Science.gov (United States)

    Tumblin, Ann

    2007-01-01

    A childbirth educator reveals her dilemma in teaching evidence-based practice in today's high-tech birth climate. She focuses on strategies to use when sharing epidural information with expectant parents. PMID:18769516

  12. Pure spinal epidural cavernous hemangioma: A case series of seven cases

    Directory of Open Access Journals (Sweden)

    Ignatius Ngene Esene

    2016-01-01

    Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.

  13. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen V; Bak, Marie; Christensen, Birgitte V;

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  14. A rare cause of Cauda equina syndrome: Epidural high grade primary non-Hodgkin lymphoma

    Directory of Open Access Journals (Sweden)

    Ambarish A Mathesul

    2013-01-01

    Full Text Available Cauda equina syndrome (CES may be caused by herniated disc, tumor, trauma, and spinal infections. However, CES due to epidural high-grade non-Hodgkin lymphoma (NHL is very rare. Up to our knowledge, few cases have been reported in the literature. We report a case of epidural high-grade NHL presenting as CES. A 55-year-old man presented with CES caused by extradural compression by primary NHL. The patient underwent an L4-L5 laminectomy. The operative findings were suggestive of well-demarcated epidural tumor. The final histopathological diagnosis revealed epidural high-grade NHL. NHL causing CES is rare. This report highlights the importance of keeping afresh the various causes of CES for prompt diagnosis and management.

  15. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  16. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne;

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... postoperatively compared with preoperatively (P Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....

  17. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 µg/ml, 4 ml/h. Postoperative pain......The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  18. CLINICAL EVALUATION OF EPIDURAL ADMINISTRATION OF MORPHINE, FENTANYL, METHADONE, LIDOCAINE AND LIDOCAINE WITH EPINEPHRINE IN CATTLE

    Directory of Open Access Journals (Sweden)

    A. Tabatabaei Naeine, A. Rezakhani and J. Fazlinia

    2004-01-01

    Full Text Available The purpose of this study was to determine the analgesic efficacy and clinical effects of morphine, fentanyl, methadone, lidocaine, lidocaine with epinephrine and saline (control when injected epidurally into the caudal epidural space in cattle. Epidural analgesia was achieved in five cattle on five successive occasions at weekly intervals. Analgesia was defined as a lack of response to hemostat pressure and pinprick in the skin of the perineal area and ventral aspect of the tail. The results demonstrated that while epidural lidocaine and lidocaine with epinephrine decreased the response to hemostat and pinprick compared to control, there was no reduction in response after the administration of morphine, methadone or fentanyl. Heart rate, pulse and respiratory rates were not significantly altered by any of the drugs. Neither did the drugs produce any change in the electrocardiogram (ECG of the animals.

  19. [Acute epidural hematoma with extravasation on cerebral angiogram in an infant (author's transl)].

    Science.gov (United States)

    Oseki, J; Oana, K; Kobayashi, T; Kawada, Y; Kanaya, H

    1977-03-01

    The authors recently operated on a boy four years of age with acute epidural hematoma showing an extravasation on the cerebral angiogram. The hematoma (hematoma volume 125 ml) was evacuated 7 hours after the head injury. The postoperative course was quite uneventful, and he was discharged a month after surgery without any neurologic deficits. The authors reviewed the literature and found 4 cases of acute epidural hematoma with extravasations in infants and children. In all cases the operative results were good. The age incidence and frequency of occurence overall for acute epidural hematomas, extravasations on cerebral angiograms and their mechanism, and the length of time from injury to operation were also discussed. It should be emphasized that, for acute epidural hematoma in infants and children, the early diagnosis and early surgery are essential to save the patients.

  20. A sheared Racz catheter in cervical epidural space for thirty months: a case report

    OpenAIRE

    Kang, Jae Hyuk; Choi, Hoon; Kim, Jin Sung; Lee, Min Kyu; Park, Hue Jung

    2015-01-01

    Percutaneous epidural neuroplasty may lead to complications such as hematoma, infection, epidural abscess, meningitis, hypotension, respiratory depression, urinary and fecal dysfunction, sexual dysfunction and paresthesia. Other technical complications may include shearing or tearing, misplacement, blockage and migration of the catheter. We report a case of a 41-year-old female patient, who underwent surgical removal of a sheared catheter, which was retained for 30 months after cervical Racz ...

  1. Combined Spinal Epidural Anaesthesia with BiPAP-Three Case Reports

    OpenAIRE

    Ashok Jadon; Neelam Sinha; Prashant S Agarwal

    2009-01-01

    Summary We report three cases where BiPAP (bi-level positive airway pressure) was used with CSEA (combined spinal epidural anaesthesia) to over come the hypoventilation due to preoperative poor respiratory reserves and additive effect of sedation. Combination of BiPAP with spinal, epidural and CSEA have been used successfully in patients of severe COPD (chronic obstructive pulmonary disease) for various surgical procedures. This combination provides safe alternative to conventional general an...

  2. [Labor epidural analgesia for a woman with a pityriasis versicolor in the lumbar region].

    Science.gov (United States)

    Dubar, G; Omarjee, M; Viguié, C; Barbarot, S; Mignon, A

    2011-01-01

    Epidural analgesia is usually contraindicated in case of infection at the site of needle insertion. Tinea versicolor is a benign superficial cutaneous fungal infection caused by the proliferation of a skin commensal yeast of low pathogenicity. We report the case of a pregnant woman with a tinea versicolor in the lumbar region, who benefited from a labor epidural analgesia, realised with reinforced antiseptic measures. No neurological or infectious complication occurred.

  3. Symptomatic epidural lipomatosis of the spinal cord in a child: MR demonstration of spinal cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Munoz, Alberto [Department of Radiology, Section of Neuroradiology, 505 Parnassus Av, L-371, University of California-San Francisco, CA 94143-0628 (United States); Servicio de Radiodiagnostico, Seccion de Neurorradiologia, Hospital Universitario ' ' 12 de Octubre' ' , 28040 Madrid (Spain); Barkovich, James A. [Department of Radiology, Section of Neuroradiology, 505 Parnassus Av, L-371, University of California-San Francisco, CA 94143-0628 (United States); Mateos, Fernando; Simon, Rogelio [Seccion de Neurpediatria, Servicio de Neurologia, Hospital Universitario ' ' 12 de Octubre' ' , 28041 Madrid (Spain)

    2002-12-01

    We report a case of symptomatic epidural lipomatosis in an 8-year-old girl with Cushing's syndrome secondary to longstanding high-dose steroid therapy for Crohn's disease. MR imaging of the spine revealed massive diffuse epidural fat compressing the entire spinal cord with T2 prolongation in the central gray matter of the cord suggesting ischemic myelopathy. This finding has not been previously demonstrated on imaging. A proposed mechanism underlying these findings is discussed. (orig.)

  4. Study of efficacy, safety and cardiotocographic changes during epidural analgesia with ropivacaine in labour

    OpenAIRE

    Sharma, Jyoti; Gandhi, Mansi U; Bhavsar, Mrugank M

    2013-01-01

    Background: Epidural analgesia during labour provides effective pain relief along with better maternal and neonatal outcome. Our aim of the study is to check safety and efficacy of Ropivacaine during labour analgesia. We have also compared cardiotocographic changes in labour with versus without epidural analgesia.Material & Methods: 60 Antenatal cases in between 37-41 weeks of pregnancy in active labour were selected for study. They were randomly divided into 2 groups: Study Group (Group-...

  5. The Effects of Epidural Top-Up Technique with Serum Physiological On Unilateral Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    İlkay Cömert

    2006-01-01

    Full Text Available This study was designed to investigate the influence of saline injections as epidural top-up on the sensory block duration, quality and hemodynamic effects of unilateral spinal anesthesia. The cases from ASA I-Il containing of 18-65 age group were randomly separated into three groups. For the purpose of unilateral spinal anesthesia, 6 mg 0.5% ‘heavy’ bupivacaine and for the purpose of epidural top-up, 10 mL saline were applied to the each patients of the groups. The study protocol was designed as:Ist group: Coming after the epidural catheter installation, unilateral spinal anesthesia was applied (n=20.IInd group: At first, unilateral spinal anesthesia was applied and after one minute, epidural top-up was done via the pre-installed epidural catheter (n=20.IIIrd group: At first the epidural catheter was installed and epidural top-up was applied. After one minute, unilateral spinal anesthesia was fulfilled (n=2O. Starting from the pre-anesthesic period, the hemodynamic data and following the anesthesia, the sensorial and motor block levels were recorded and evaluated.As the outcome of the inter-groups comparison of heart rate and mean arterial pressure, a statistically note-worthy differance was not determined; statistically significant but clinically acceptable hemodynamic changes were observed in intra-group evaluations, when the data was compared with control levels. The sensorial block levels were significantly higher in group II and significantly lower in group III.The application of 10 mL saline via epidural catheter 1 minute after the unilateral spinal anesthesia and remaining the patient leaning on the side of the extremity to be operated for 15 minutes improves the sensory block level of unilateral spinal anesthesia. It is determined that, for the lower extremity surgical operations with 1-1.5 hour estimated period, this method alone can be a worthwhile alternative.

  6. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

    Directory of Open Access Journals (Sweden)

    Akanksha Lamba

    2016-06-01

    Conclusions: Maternal outcome in labour analgesia is similar with 100 mg I/M tramadol and epidural ropivacaine. There is no significant difference between duration of labour, rate of LSCS, incidence of instrumental delivery and neonatal outcome in the two modes of analgesia. Analgesic efficacy with epidural ropivacaine seems to be better compared to intramuscular tramadol. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1722-1727

  7. Adolescence spinal epidural abscess with neurological symptoms: case report, a lesson to be re-learnt

    OpenAIRE

    Sales, Jafar Ganjpour; Tabrizi, Ali; Elmi, Asghar; Soleimanpour, Jafar; Gavidel, Ehsan

    2013-01-01

    Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. It promptly progresses and can cause neurologic paralysis, urinary retention or cauda equina syndrome. Compromised immune system that occurs in patients with diabetes mellitus, AIDS, chronic renal failure, alcoholism, or cancer is a predisposing factor. It mostly occurs in adults. Here we would like to report a case of spontaneous pyogenic lumbar epidural abscess with neurological deficit diagnosed ...

  8. Sympathetic activity of S-(+)-ketamine low doses in the epidural space

    OpenAIRE

    2014-01-01

    BACKGROUND AND OBJECTIVES: S-(+)-ketamine is an intravenous anaesthetic and sympathomimetic with properties of local anaesthetic. It has an effect of an analgetic and local anaesthetic when administered epidurally, but there are no data whether low doses of S-(+)-ketamine have sympathomimetic effects. The aim of this study was to determine whether low doses of S-(+)-ketamine, given epidurally together with local anaesthetic, have any effect on sympathetic nervous system, both systemic and be...

  9. Maternal and Cord Serum Cytokine Changes with Continuous and Intermittent Labor Epidural Analgesia: A Randomized Study

    OpenAIRE

    Mantha, Venkat R.; Vallejo, Manuel C.; Vimala Ramesh; Jones, Bobby L; Sivam Ramanathan

    2012-01-01

    Background. Maternal fever during labor epidural analgesia (LEA) may cause increased maternal and cord serum inflammatory cytokines. We report the effects of intermittent and continuous LEA on these cytokines. Methods. Ninety-two women were randomly assigned to continuous (CLEA) or intermittent (ILEA) groups, 46 in each. Maternal temperature was checked and blood drawn at epidural insertion (baseline) and four-hourly until 4 h postpartum (4 PP). Cord blood was drawn after placental delivery. ...

  10. Primary Epidural Peripheral Primitive Neuroectodermal Tumor of the Lumbar Spine: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Woo Jung; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Paik, Seung Sam; Jun, Young Jin [Dept. of Pathology, Hanyang University Hospital, Seoul (Korea, Republic of); Lee, Young Ho [Dept. of Pediatrics, Hanyang University Hospital, Seoul (Korea, Republic of)

    2011-05-15

    A primitive neuroectodermal tumor (PNET) is a highly malignant tumor in children and young adults, and extremely rare in the spine. We report a case of a primary epidural peripheral PNET of the lumbar spine. The present extremely rare case of primary epidural peripheral PNET of the lumbar spine illustrates the unexpected occurrence and should be included in differential diagnoses for patients with spinal tumors.

  11. Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20, 30 o 40 mL de ropivacaína en el bloqueo de plexo braquial por la vía posterior A comparative study on the postoperative analgesic efficacy of 20, 30, or 40 mL of ropivacaine in posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2007-10-01

    fue determinar cuál volumen de anestésico local en el bloqueo de plexo braquial por la vía posterior propicia analgesia postoperatoria para esas operaciones de manera más eficiente. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por vía posterior fueron divididos aleatoriamente en tres grupos de 30. Grupo 1 - volumen de 20 mL; Grupo 2 - volumen de 30 mL; Grupo 3 - volumen de 40 mL. En todos los grupos, el anestésico usado fue la ropivacaína a 0,375%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó secundando una escala numérica verbal (ENV en las primeras 24 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor promedio,tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. En el grupo de 20 mL hubo un mayor consumo de analgésicos no opioides después de la 12ª hora de postoperatorio. En los grupos de 30 y 40 mL la extensión del bloqueo fue significativamente mayor. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve analgesia eficaz para intervenciones quirúrgicas en el hombro. Los tres diferentes volúmenes estudiados promovieron analgesia similar. La mayor extensión del bloqueo con volúmenes mayores no se tradujo en una mejor analgesia.BACKGROUND AND OBJECTIVES: Arthroscopic surgeries of the shoulder are accompanied by severe postoperative pain. Among the analgesic techniques, brachial plexus block offers the best results. The objective of this study was to determine which volume of local anesthetic in the posterior brachial plexus block offers more adequate analgesia for those procedures. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided in three groups of 30 patients: Group 1 – volume of 20 mL; Groups 2 – volume of 30 m

  12. Lumbar epidural catheter placement in the presence of low back tattoos: a review of the safety concerns.

    Science.gov (United States)

    Welliver, Dawn; Welliver, Mark; Carroll, Tammy; James, Peggy

    2010-06-01

    Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. Does the placement of epidural catheters risk the introduction of tattoo pigment dyes into the epidural space through the process of coring? Are there specific risks associated with tattoo dyes and epidural needle placement? We performed a comprehensive review of the literature using multiple search databases with the intent to form guidelines for practice using a level of evidence taxonomy. The available evidence does not identify any specific risks associated with epidural catheter placement through low back tattoos, although tissue coring with tissue transport to deeper sites has been confirmed. Continued investigation is necessary before comprehensive practice guidelines regarding the practice of placing epidural needles and catheters through lumbar tattoos can be developed. We suggest avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.

  13. EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS

    Institute of Scientific and Technical Information of China (English)

    Li Changgen; Peng Xiaoyun; Xu Mingyu; Wang Zhongcheng

    2001-01-01

    Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods:33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n = 11), acupoint-skin electrical stimulation combined with epidural anesthesia (B) group (n= 11 ) and simple epidural anesthesia (C) group (n= 11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2~3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before,NE of group A and B lowered in comparison with pre-operation, particularly group A (P <0.01), while in group C,plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre-operation (P levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint-skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effec t has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. C_onclusion:Acupuncture or acupoint-surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.

  14. Effects of lumbosacral epidural ketamine and lidocaine in xylazine-sedated cats.

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    DeRossi, R; Benites, A P; Ferreira, J Z; Neto, J M N; Hermeto, L C

    2009-06-01

    In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1) ketamine (2.5 mg/kg), (2) lidocaine (4.0 mg/kg), and (3) ketamine (2.5 mg/kg) plus lidocaine (4.0 mg/kg). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate and arterial oxygen saturation were measured. Rectal temperature was compared before and after sedation as well as after epidural administration of the drugs. Epidural administration of the ketamine/lidocaine combination induced prolonged analgesia extending from the coccygeal to the T13-L1 dermatomes, leading to severe ataxia. Cardiovascular effects were significant in all treatments: heart rate decreased, but there was a minimal reduction in arterial pressure. It was concluded that adding a dose of ketamine to epidural lidocaine in cats is feasible and effective. PMID:19831267

  15. Effects of lumbosacral epidural ketamine and lidocaine inxylazine-sedated cats : article

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    R. DeRossi

    2009-05-01

    Full Text Available In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1 ketamine (2.5 mg/kg, (2 lidocaine (4.0 mg/kg, and (3 ketamine (2.5 mg/kg plus lidocaine (4.0 mg/kg. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate and arterial oxygen saturation were measured. Rectal temperature was compared before and after sedation as well as after epidural administration of the drugs. Epidural administration of the ketamine/lidocaine combination induced prolonged analgesia extending from the coccygeal to the T13-L1 dermatomes, leading to severe ataxia. Cardiovascular effects were significant in all treatments: heart rate decreased, but there was a minimal reduction in arterial pressure. It was concluded that adding a dose of ketamine to epidural lidocaine in cats is feasible and effective.

  16. Caudal epidural analgesia using lidocaine alone or in combination with ketamine in dromedary camels (Camelus dromedarius

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    Omid Azari

    2014-02-01

    Full Text Available This study was performed to investigate the analgesic effect of lidocaine and a combination of lidocaine and ketamine following epidural administration in dromedary camels. Ten 12–18-month-old camels were randomly divided into two equal groups. In group L, the animals received 2% lidocaine (0.22 mg/kg and in group LK the animals received a mixture of 10% ketamine (1 mg/kg and 2% lidocaine (0.22 mg/kg administered into the first intercoccygeal (Co1–Co2 epidural space while standing. Onset time and duration of caudal analgesia, sedation level and ataxia were recorded after drug administration. Data were analysed by U Mann-Whitney tests and significance was taken as p < 0.05. The results showed that epidural lidocaine and co-administration of lidocaine and ketamine produced complete analgesia in the tail, anus and perineum. Epidural administration of the lidocaine-ketamine mixture resulted in mild to moderate sedation, whilst the animals that received epidural lidocaine alone were alert and nervous during the study. Ataxia was observed in all test subjects and was slightly more severe in camels that received the lidocaine-ketamine mixture. It was concluded that epidural administration of lidocaine plus ketamine resulted in longer caudal analgesia in standing conscious dromedary camels compared with the effect of administering lidocaine alone.

  17. Anaesthetists' experiences with the early labour epidural recommendation for obese parturients: a qualitative study.

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    Va, Eley; Lk, Callaway; Aaj, van Zundert; J, Lipman; C, Gallois

    2016-09-01

    Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015. Leximancer™ text analysis software applied a validated algorithm to the data to identify themes and concepts. The major themes were explored by the first author to answer the research question. Three major themes were identified: the demands associated with caring for obese women; concern regarding the anaesthetic technique used in obese women; and the importance of communication with obstetric staff. Disagreement regarding interpretation and application of early epidural analgesia was identified within this group of anaesthetists. These anaesthetists were inconsistent in how they interpreted and applied early epidural analgesia for obese parturients, with some questioning the validity of the practice. The combination of uncertainty, urgency and technical difficulty presented by obese parturients provoked anxiety in these clinicians, particularly the anticipation of unplanned general anaesthesia. Consistent anaesthetic practice could improve the implementation of early epidural analgesia in obese parturients. PMID:27608347

  18. Controversy of the use of epidural analgesia in labour

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    Enrique Ramón Arbués

    2008-11-01

    Full Text Available During last years, it was thought that free-pain labour was a big advance for woman. Recently, ideological patrons such as ecofeminism have feed a critical mind in the woman who is going to give birth. In this bibliographic review we don’t approach a reliable and definitive conclusion, due to the bias and lack of scientific rigour of some studies and the doubtful methodological reliability and generalization of others.This way, we conclude the need to make a tolerant effort on the part of everyone, just as researching and assuming on the services portfolio (if needed alternative techniques such as combined spinal-epidural analgesia, sterile water injections, water immersion, acupuncture, hypnosis, etc.

  19. Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis

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    Adriano Bonfim Carregaro

    2010-07-01

    Full Text Available A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural, CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma, CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1 e CON (anestesia epidural com lidocaína 2%. Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur.Ketamine has demonstrated analgesic effects in subanesthetic doses, besides the maintenance of stability of physiological parameters. The study aimed to evaluate the cardiorespiratory effects and the post operative analgesia of ketamine via epidural

  20. Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo Analgesia controlada por el paciente con fentanil o sufentanil en el pós-operatorio de reconstrucción de ligamentos de la rodilla: estudio comparativo Patient controlled analgesia with fentanyl or sufentanil in the postoperative period of knee ligament reconstruction: comparative study

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    Marcelo Negrão Lutti

    2002-04-01

    diferença entre os grupos. CONCLUSÕES: O fentanil ou o sufentanil contínuos em bolus acionados pelo paciente, por via peridural, nas doses utilizadas neste estudo, apresentaram excelente analgesia pós-operatória. No entanto, o sufentanil apresentou efeitos colaterais mais intensos que o fentanil.JUSTIFICATIVA Y OBJETIVOS: Los opioides han sido utilizados por vía peridural asociados o no a anestésicos locales para analgesia pós-operatoria de forma continua y/o en bolus controlado por el paciente. El objetivo de este estudio fue comparar la analgesia pós-operatoria entre el fentanil y sufentanil en infusión continua y en bolus por vía peridural, en pacientes sometidos a la reconstrucción de ligamento de la rodilla. MÉTODO: Participaron del estudio 70 pacientes con edad entre 16 y 47 anos, estado físico ASA I y II, divididos aleatoriamente en dos grupos: Grupo F (fentanil y Grupo S (sufentanil. Todos los pacientes fueron sometidos a anestesia peridural con bupivacaína a 0,5% (100 mg con epinefrina 1:200.000 asociada a fentanil (100 mg. Al final de la cirugía, los pacientes recibieron fentanil (Grupo F o sufentanil (Grupo S por vía peridural en régimen de infusión continua más bolus liberados por el paciente. En el Grupo F fue utilizada solución fisiológica (85 ml conteniendo fentanil 500 µg (10 ml y bupivacaína (5 ml a 0,5%. En el Grupo S fue utilizada solución fisiológica (92 ml conteniendo sufentanil 150 µg (3 ml y bupivacaína (5 ml a 0,5%. Para los dos grupos la bomba de infusión fue programada inicialmente en 5 ml.h-1, con dosis de 2 ml en bolus liberado por el paciente en un intervalo de 15 minutos. Fueron comparados los siguientes parámetros: dolor, número de bolus accionados, consumo de opioides, bloqueo motor, sedación y efectos colaterales. RESULTADOS: No hubo diferencia significativa entre los grupos cuanto la calidad de la analgesia, siendo la mayoría de buena calidad (EAV 0 a 2. Hubo diferencia significativa cuanto al número de

  1. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS: a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

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    Friedly Janna L

    2012-03-01

    Full Text Available Abstract Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone. Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization

  2. Effects of thoracic epidural analgesia with morphine or bupivacaine on lower oesophageal motility--an experimental study in man.

    Science.gov (United States)

    Thorén, T; Carlsson, E; Sandmark, S; Wattwil, M

    1988-07-01

    Lower oesophageal peristalsis and lower oesophageal sphincter (LOS) pressure during thoracic epidural analgesia (TEA) were studied in 20 healthy volunteers. After oesophageal manometric baseline recordings, 10 volunteers received 4 mg epidural morphine. The other ten received 0.5% bupivacaine epidurally in sufficient amounts to block the sympathetic innervation of the oesophagus. Thereafter oesophageal manometry was repeated. During epidural morphine oesophageal peristalsis, resting LOS pressure and the contraction of LOS after swallowing did not change, but the relaxation of the LOS in response to swallowing decreased significantly (P less than 0.01). Following TEA with bupivacaine, neither distal oesophageal peristalsis nor LOS pressure changed. PMID:3414347

  3. A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non-cancer pain.

    Science.gov (United States)

    Glynn, C; Dawson, D; Sanders, R

    1988-08-01

    In a randomised double-blind study of 20 patients with chronic pain, epidural morphine 5 mg in 5 ml of saline was compared with epidural clonidine 150 micrograms in 5 ml of saline. Thirteen patients had a clinical and radiological diagnosis of arachnoiditis, 6 had low back pain and 1 had post-operative scar pain. There were 18 females and 2 males with an average age of 52 years, range 22-76 years. There was no difference found between the 2 solutions in the resultant analgesia measured by the visual analogue scale for pain, pain relief or the pain word score during the 3 h period of the study. No difference was found in the patient's mood which was also measured with the visual analogue scale. Two patients had no analgesia from either injection, 2 patients did not obtain any relief from clonidine and another 2 obtained no relief from morphine. Six patients reported that clonidine was better than morphine, 5 reported that morphine and clonidine were the same and 3 reported that morphine was better than clonidine. The duration of analgesia from the clonidine varied from 6 h to 1 month; the duration of analgesia from morphine varied from 6 to 24 h. Clonidine was associated with sedation and a fall in blood pressure of greater than 20 mm Hg in all patients, 1 patient required ephedrine to treat hypotension. Twelve patients had pruritus, 7 nausea and 2 vomiting following the morphine. Statistically there was no difference found between morphine and clonidine for short-term (3 h) analgesia in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Anestesia do tronco encefálico após bloqueio retrobulbar extraconal: é possível evitar? Relato de caso Anestesia del tronco encefálico después de bloqueo retrobulbar extraconal: ¿se puede evitar? Relato de caso Brainstem anesthesia after extraconal retrobulbar block: can it be avoided? Case report

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    Haroldo Maciel Carneiro

    2007-08-01

    bloqueios anestésicos realizados em oftalmologia. Ressalta-se a importância do conhecimento desta e de outras complicações pela equipe cirúrgica, com necessidade de preparo e de monitorização adequada para que se diagnostique a possível complicação e se instale prontamente o tratamento, objetivando riscos mínimos para o paciente.JUSTIFICATIVA Y OBJETIVOS: El CEROF-HC es una institución pública especializada en oftalmología. La realización de bloqueos anestésicos para intervenciones quirúrgicas oftálmicas es una práctica común y eficiente. Como técnica no está exenta de riesgos, existe la posibilidad de perforación de meninges y la inyección de anestésico local (AL en la región del sistema nervioso central (SNC. El objetivo de este relato fue mostrar un caso de anestesia del tronco encefálico como complicación del bloqueo oftálmico y destacar la profilaxis del accidente y el tratamiento de las complicaciones. RELATO DE CASO: Paciente del sexo femenino, 60 años, ASA II, con diagnóstico de catarata grado II, indicada para facectomía con implante de lente intraocular en el ojo derecho. Hoja clínica de hipertensión arterial y antecedente de vitrectomía. Exámenes físicos, laboratoriales y cardiológicos normales. Fue realizado bloqueo retrobulbar extraconal con anestésico local (lidocaína y bupivacaína e hialuronidasis (volumen total de 5 mL. Inmediatamente después, la paciente presentó apnea y pérdida de la conciencia. Fue tratada con intubación traqueal (IOT y ventilación mecánica, manteniéndose estable. Se realizó la operación. Empezó a moverse 30 minutos después del IOT, recuperándose totalmente sin presentar ninguna secuela. CONCLUSIONES: El bloqueo oftálmico, a pesar de seguro, no está exento de riesgos. El principal factor de riesgo es la inadecuada realización de la técnica anestésica. El anestésico local (AL, en el bloqueo oftálmico, puede alcanzar el SNC por punción inadvertida de la arteria oftálmica o por

  5. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

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    Sukhen Samanta

    2016-01-01

    Full Text Available Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001 regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.

  6. SUMMARY OF CLINICAL STUDY ON ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA FOR CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    秦必光; 刘颖涛; 李长根; 任亚川; 张兰英; 艾中立; 彭小云; 白占勇

    2001-01-01

    Objective: To study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of smadose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n=66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4~11. Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C ( P < 0. 001 ). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3.75 % higher than group A and B respectively ( P < 0. 001 ), suggesting that acupuncture or acu-point-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.

  7. CONSERVATIVE THERAPY VERSUS EPIDURAL STEROID INFILTRATION IN MANAGEMENT OF CHRONIC LOW BACK ACHE

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    Vivian Roshan D

    2015-11-01

    Full Text Available BACKGROUND: Sciatica due to lumbar intervertebral disc herniation is one of the most common causes of radicular pain in an adult working population. This study aims at studying the effectiveness of conservative management of lumbar disc herniation as an alternative to surgical measures. METHODS: A prospective study of 100 patients with lumbar disc herniations who were treated conservatively were followed up at intervals of 1 month, 6 months and 1 year. Patients planned for conservative treatment were treated with pharmacological therapy, rest and physiotherapy. Those planned for epidural steroid injections were administered a single dose of steroid one level higher than the lesion in the epidural space. The collected data was analyzed by Chi square. RESULTS: Our results showed that in both genders, epidural steroid infiltration yielded better results than conservative treatment. Occupation had no discernible effect on the magnitude of disc herniation. People with sedentary lifestyle recovered better with epidural steroid infiltration as compared to the heavy physical labor group. Irrespective of disc bulge, protrusion or extrusion, the epidural steroid injection group showed significant improvement in symptoms as compared to conservative treatment. Smokers tended to show delay in the recovery as compared with the non-smoker group. The amount of disc herniation is not directly proportional to the outcome of treatment. CONCLUSIONS: Epidural steroid infiltration showed significant improvement in symptoms of lumbar intervertebral disc herniation thereby avoiding disc surgery. Conservative management for atleast 4 to 6 weeks can be recommended followed by epidural steroid in those patients without improvement. Cessation of smoking should be an integral part of the treatment.

  8. Effect of epidural saline washout on regression of sensory and motor block after epidural anaesthesia with 2% lidocaine and fentanyl in elderly patients.

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    Park, E Y; Kil, H K; Park, W S; Lee, N-H; Hong, J-Y

    2009-03-01

    Seventy elderly males received lumbar epidural anaesthesia with 12 ml of 2% lidocaine containing fentanyl 50 mug. At the end of transurethral surgery, the washout group (n = 33) received an epidural bolus of 30 ml saline while the control group (n = 34) did not. Mean (SD) times to 1-grade (17.2 (11.9) vs 32.7 (11.3) min) and 2-grade regression (23.8 (12.2) vs 56.0 (23.9) min) of motor block, 3-dermatomal sensory regression (31.4 (11.6) vs 42.2 (14.4) min for cold and 30.8 (15.6) vs 40.6 (14.2) min for pinprick), and regression to S1 (57.7 (16.1) vs 76.2 (20.2) min for cold and 56.8 (17.3) vs 69.2 (16.2) min for pinprick) were significantly shorter in the washout group than the control group. There were no differences in postoperative pain scores and side effects between the two groups. We concluded that epidural washout facilitates regression of both motor and sensory block following epidural anaesthesia without reducing the postoperative analgesic benefit.

  9. Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: "la buena sufridora" Analysis of rejection of epidural analgesia during labor in Andalusian women: "the silent sufferer"

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    L. Biedma Velázquez

    2010-02-01

    Full Text Available Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Conclusiones: Las características sociales, económicas y culturales que definen el rechazo, es decir, el "tipo" de mujer que rehúsa la epidural, coinciden con el esquema de "mujer tradicional" estudiado por otros autores (que se caracteriza por tener escasos

  10. Lisis de adherencias epidurales (Parte 1: Fisiopatología y clínica Percutaneous Epidural lysis of adhesions

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    G. Racz

    2012-12-01

    Full Text Available Según estudios epidemiológicos toda la población tiene altas probabilidades de sufrir dolor lumbar en algún momento de su vida. Este cuadro suele ser reconocido como lumbalgia o lumbociática. En su forma clínica más común se observa mejoría rápida y solo presentan síntomas persistentes 5-10% de los casos (1. En la década de 1990 en EEUU, el sector salud registró costes estimados en miles de millones de dólares destinados al tratamiento del dolor lumbar, y teniendo en cuenta la tendencia a la búsqueda de una mayor expectativa de vida de la población, solo se puede esperar que los costes aumenten (2,3. El tratamiento comienza generalmente con medidas conservadoras, tales como medicación oral y terapia física, y puede incluir múltiples opciones intervencionistas invasivas para controlar el dolor. En ciertas ocasiones es necesario recurrir a cirugía para los pacientes que tienen déficit neurológico progresivo o para aquellos que están refractarios a otras terapéuticas. A veces el médico se encuentra frente a un dilema, después de una primera cirugía, con respecto a si se debería repetir la cirugía o intentar otra técnica alternativa. Este es el principal problema en el cual la liberación epidural de adherencias puede permitir "evitar cirugías". Se ha demostrado que esta técnica libera los nervios y disminuye la formación de cicatrices, lleva los anestésicos locales y los corticoides a sitios específicos y reduce el edema al usar hialuronidasa y solución salina hipertónica (15,16. La liberación epidural de adherencias ha demostrado eficacia para provocar reducción del dolor y de los síntomas neurológicos sin incurrir en los altos costes y el ocasionalmente largo periodo de recuperación que implica la repetición de la cirugía. En muchos casos previene la necesidad de una primera intervención quirúrgica (6,10. La liberación epidural de las adherencias ha sido calificada con un alto nivel de evidencia, que

  11. ROLE OF EPIDURAL INJECTIONS IN THE MANAGEMENT OF ACUTE LUMBAR DISCOGENIC PAIN

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    Srinivas

    2015-05-01

    Full Text Available INTRODUCTION: The use of epidural injections in the cervical , thoracic and lumbo sacral spine for both diagnostic and therapeutic purposes has developed as an important part of a comprehensive interdisci plinary approach to spinal pain . (1, 2 It is well known that structural abnormalities see n on CT or MRI scans do not always cause pain and diagnostic injections often can help correlate abnormalities on imaging studies with associated pain complaints. Therapeutically , epidural injections can provide significant pain relief during which , time r ecovery of disc and nerve root injuries can occur and patients also can progress their level of physical activity. In acute disc injury with or without radiculopathy , therapeutic injections can help and manage the patient ’ s pain without reliance on oral analgesics. Epidural cortico steroid injections with physical therapy is recommended in conjunction . (1 Mechanism of pain relief is due to potent and anti - inflammatory properties of the cortico steroids . ( 3,2 Aim to know the effic acy and results of the epidural steroid injection in acute lumbar discogenic pain . ( 2 MATERIALS AND METHODS: I have treated 800 patients with lumbar epidural injections for 3 weeks ( W eekly interval since 2005 at Sri Venkata Hospital and pain management ce ntre SP Nagar , Kukatpally , Hyderabad , Telangana. F or the management of Lumbar Discogenic Pain till 2014. RESULTS: E xcellent in 90% of patients and no patient complained of recurrence of symptoms and reached their normal activities without surgery after epidural injection treatment. Lumbar Epidural steroid injection is usually performed in about 6 weeks after the onset of low back pain or radicular pain. Lumbar Epidural steroid injection is appropriate for an outpatient setting provided all necessary resu scitative equipment is available i.e. O 2 , intubation equipment , emergency drugs , IV access and we can avoid the hospitalization . DISCUSSION: LESIs

  12. Estudo comparativo entre bupivacaína a 0,5%, mistura enantiomérica de bupivacaína (S75-R25 a 0,5% e ropivacaína a 0,75% associadas ao fentanil em anestesia peridural para cesarianas Estudio comparativo entre bupivacaína a 0,5%, mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y ropivacaína a 0,75% asociadas al fentanil en anestesia peridural para cesáreas Comparative study between 0.5% bupivacaine, 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 0.75% ropivacaine, all associated to fentanyl, for epidural cesarean section anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Figueiredo Côrtes

    2003-04-01

    en función de menor cardiotoxicidad. Este estudio visó evaluar la calidad de la anestesia y las repercusiones maternas y fetales con el empleo de la bupivacaína a 0,5%, con la mezcla enantiomérica de la bupivacaína (S75-R25 a 0,5% y con la ropivacaína a 0,75% asociadas al fentanil, por vía peridural en cesáreas. MÉTODO: Fueron evaluadas 90 gestantes sometidas a cesáreas electivas bajo anestesia peridural y divididas en 3 grupos: en el grupo I recibieron 23 ml de bupivacaína a 0,5% con epinefrina; en el grupo II recibieron 23 ml de la mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% con epinefrina y en el grupo III recibieron 23 ml de ropivacaína a 0,75%. Se asociaron 2 ml de fentanil a los anestésicos locales. Fueron evaluados: tiempo de latencia, duración de la analgesia, grado de bloqueos motor y sensitivo, tiempos de histerotomia y delibramiento, relajamiento muscular y calidad de la anestesia, alteraciones hemodinámicas y respiratorias maternas, presencia de efectos colaterales y vitalidad de los recién-nacidos a través del índice de Apgar y de la gasometria del cordón umbilical. RESULTADOS: No he habido diferencia entre los grupos, excepto en la calidad de la anestesia. En los grupos con predominancia de la fracción levógira fue clínicamente inferior, habiendo necesidad de complementación de la anestesia en 3 casos. La duración de la analgesia fue mayor en el grupo de la ropivacaína. CONCLUSIONES: La mezcla enantiomérica (S75-R25 de la bupivacaína a 0,5% y la ropivacaína a 0,75% por vía peridural proporcionaron buenas condiciones, tanto cuanto a la bupivacaína a 0,5%, para la realización del acto anestésico quirúrgico. Las repercusiones en los neonatos, mostraron que los agentes anestésicos fueron igualmente seguros.BACKGROUND AND OBJECTIVES: Clinical trials with local anesthetic levo-enantiomers have shown higher safety due to lower cardiotoxicity. This study aimed at evaluating quality of anesthesia and maternal

  13. Portable optical epidural needle-a CMOS-based system solution and its circuit design.

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    Cihun-Siyong Alex Gong

    Full Text Available Epidural anesthesia is a common anesthesia method yet up to 10% of procedures fail to provide adequate analgesia. This is usually due to misinterpreting the tactile information derived from the advancing needle through the complex tissue planes. Incorrect placement also can cause dural puncture and neural injury. We developed an optic system capable of reliably identifying tissue planes surrounding the epidural space. However the new technology was too large and cumbersome for practical clinical use. We present a miniaturized version of our optic system using chip technology (first generation CMOS-based system for logic functions. The new system was connected to an alarm that was triggered once the optic properties of the epidural were identified. The aims of this study were to test our miniaturized system in a porcine model and describe the technology to build this new clinical tool. Our system was tested in a porcine model and identified the epidural space in the lumbar, low and high thoracic regions of the spine. The new technology identified the epidural space in all but 1 of 46 attempts. Experimental results from our fabricated integrated circuit and animal study show the new tool has future clinical potential.

  14. Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy

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    Sandeep Kundra

    2014-01-01

    Full Text Available Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use. Materials and Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests. Results: Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg as compared to group II (24.80 ± 6.009 mg. Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P 0.01. Conclusion: Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.

  15. High thoracic epidural anesthesia in cardiac surgery: risk factors for arterial hypotension.

    Science.gov (United States)

    Casalino, Stefano; Mangia, Fabio; Stelian, Edmond; Novelli, Eugenio; Diena, Marco; Tesler, Ugo F

    2006-01-01

    There is an interest in the use of high thoracic epidural anesthesia in cardiac surgery, because experimental and clinical studies have suggested that central neuroaxial blockade attenuates the response to surgical stress and improves myocardial metabolism and perioperative analgesia-thus enabling earlier extubation and a smoother postoperative course. Matters of major concern in the adoption of high thoracic epidural anesthesia in cardiac surgery are neurologic injury secondary to neuroaxial hematoma and hypotension secondary to sympatholysis. The risk associated with possible neuraxial hematoma caused by high thoracic epidural anesthesia has been thoroughly investigated and largely discounted, but scant attention has been devoted to the onset of hypotensive episodes in the same setting. We analyzed the hypotensive episodes that occurred in a series of 144 patients who underwent on-pump cardiac surgery procedures. Among the patient variables that we tested in a multivariate logistic-regression model, only female sex was found to be significantly correlated with hypotension. In order to decrease the incidence and severity of hypotensive episodes resulting from anesthetic blockade, anesthesiologists need to monitor, with special care, women patients who are under high thoracic epidural anesthesia. Further studies are needed in order to determine why women undergoing open heart surgery under high thoracic epidural anesthesia are at a relatively greater risk of hypotension. PMID:16878616

  16. Saline as the Sole Contrast Agent for Successful MRI-guided Epidural Injections

    Energy Technology Data Exchange (ETDEWEB)

    Deli, Martin, E-mail: martin.deli@web.de [University of Witten/Herdecke, Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT) (Germany); Fritz, Jan, E-mail: jfritz9@jhmi.edu [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States); Mateiescu, Serban, E-mail: mateiescu@microtherapy.de; Busch, Martin, E-mail: busch@microtherapy.de [University of Witten/Herdecke, Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT) (Germany); Carrino, John A., E-mail: jcarrin2@jhmi.edu [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States); Becker, Jan, E-mail: j.becker@microtherapy.de; Garmer, Marietta, E-mail: garmer@microtherapy.de; Groenemeyer, Dietrich, E-mail: dg@microtherapy.de [University of Witten/Herdecke, Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT) (Germany)

    2013-06-15

    Purpose. To assess the performance of sterile saline solution as the sole contrast agent for percutaneous magnetic resonance imaging (MRI)-guided epidural injections at 1.5 T. Methods. A retrospective analysis of two different techniques of MRI-guided epidural injections was performed with either gadolinium-enhanced saline solution or sterile saline solution for documentation of the epidural location of the needle tip. T1-weighted spoiled gradient echo (FLASH) images or T2-weighted single-shot turbo spin echo (HASTE) images visualized the test injectants. Methods were compared by technical success rate, image quality, table time, and rate of complications. Results. 105 MRI-guided epidural injections (12 of 105 with gadolinium-enhanced saline solution and 93 of 105 with sterile saline solution) were performed successfully and without complications. Visualization of sterile saline solution and gadolinium-enhanced saline solution was sufficient, good, or excellent in all 105 interventions. For either test injectant, quantitative image analysis demonstrated comparable high contrast-to-noise ratios of test injectants to adjacent body substances with reliable statistical significance levels (p < 0.001). The mean table time was 22 {+-} 9 min in the gadolinium-enhanced saline solution group and 22 {+-} 8 min in the saline solution group (p = 0.75). Conclusion. Sterile saline is suitable as the sole contrast agent for successful and safe percutaneous MRI-guided epidural drug delivery at 1.5 T.

  17. Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis

    Science.gov (United States)

    Jebaraj, B; Khanna, P; Baidya, DK; Maitra, S

    2016-01-01

    Background: Dexamethasone is a potent anti-inflammatory, analgesic, and antiemetic drug. Individual randomized controlled trials found a possible benefit of epidural dexamethasone. The purpose of this meta-analysis is to estimate the benefit of epidural dexamethasone on postoperative pain and opioid consumption and to formulate a recommendation for evidence-based practice. Materials and Methods: Prospective, randomized controlled trials comparing the analgesic efficacy of epidural local anesthetic and dexamethasone combination, with local anesthetic alone for postoperative pain management after abdominal surgery, were planned to be included in this meta-analysis. PubMed, PubMed Central, Scopus, and Central Register of Clinical Trials of the Cochrane Collaboration (CENTRAL) databases were searched for eligible controlled trials using the following search words: “Epidural”, “dexamethasone”, and “postoperative pain”, until February 20, 2015. Results: Data from five randomized control trials have been included in this meta-analysis. Epidural dexamethasone significantly decreased postoperative morphine consumption (mean difference −7.89 mg; 95% confidence interval [CI]: −11.66 to −3.71) and number of patients required postoperative rescue analgesic boluses (risk ratio: 0.51; 95% CI: 0.41-0.63). Conclusion: The present data shows that the addition of dexamethasone to local anesthetic in epidural is beneficial for postoperative pain management. PMID:27375389

  18. Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T V;

    1993-01-01

    patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated...

  19. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

    DEFF Research Database (Denmark)

    Iversen, Trond; Solberg, Tore K; Romner, Bertil;

    2011-01-01

    To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks).......To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks)....

  20. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M. [University of Arkansas for Medical Sciences, Pediatric Radiology, Little Rock, AR (United States)

    2016-01-15

    Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

  1. Continuous positive airway pressure breathing increases cranial spread of sensory blockade after cervicothoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Eerd, M.J. van; Seventer, R. van; Gielen, M.J.M.; Giele, J.L.P.; Scheffer, G.J.

    2007-01-01

    BACKGROUND: Continuous positive airway pressure (CPAP) increases the caudad spread of sensory blockade after low-thoracic epidural injection of lidocaine. We hypothesized that CPAP would increase cephalad spread of blockade after cervicothoracic epidural injection. METHODS: Twenty patients with an e

  2. COMPA RATIVE EVALUATION OF INTRATHECAL, EPIDURAL AND INTRAVENOUS BOLUS SUFENTANIL FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY

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    Sudhakar

    2015-06-01

    Full Text Available In clinical experience sufentanil is more effective when given epidurally than intrathecally and intravenously. To test this hypothesis we compare the analgesic characteristic of 10μgm of epidural, intrathecal and intravenous single shot sufenta nil for pain relieve after elective lower limb surgeries. A randomized double blind trial was conducted on 60 patients who were under - going elective lower limb surgery in epidural anesthesia with bupivacaine. In recovery room as soon as pain score higher than 3 on the scale of 10 on visual analogue score was reported 10μgm intravenous, intrathecal and epidural was given respectively. We concluded that epidural sufentanil is better as compared to intrathecal and intravenous in terms of duration of pain reli ef, vital complications and side effects for post - operative pain relief.

  3. Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Mahadevan, Anand, E-mail: amahadev@bidmc.harvard.edu [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Floyd, Scott [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Wong, Eric; Jeyapalan, Suriya [Department of Neuro-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Groff, Michael; Kasper, Ekkehard [Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel)

    2011-12-01

    Purpose: When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials: SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy Multiplication-Sign 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results: The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions: SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.

  4. MRI findings in spinal subdural and epidural hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Braun, Petra [Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0.5, 12540 Vila-real (Castello) (Spain)], E-mail: PetraBraun@gmx.de; Kazmi, Khuram [Department of Radiology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (United States); Nogues-Melendez, Pablo; Mas-Estelles, Fernando; Aparici-Robles, Fernando [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)

    2007-10-15

    Background: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. Patients and Methods: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. Results: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. Discussion: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.

  5. Congenital neuroblastoma with symptoms of epidural compression at birth.

    Science.gov (United States)

    Gigliotti, A R; De Ioris, M A; De Grandis, E; Podda, M; Cellini, M; Sorrentino, S; De Bernardi, B; Paladini, D; Gandolfo, C

    2016-03-01

    The occurrence of congenital neuroblastoma presenting at birth with symptoms of epidural compression secondary to spinal canal invasion is rare. Almost all cases reported in the literature have survived from the tumor but suffer severe sequelae, with the exception of the 2 most recently described whose birth was anticipated. The 3 cases of this article have been followed for a minimum of 5 years with the aim to describe their definitive late complications. In none of these cases had the routine ultrasound scan performed in third trimester of pregnancy discovered a tumor mass, nor had it shown abnormal fetal movements. All had leg hypotonia detected on the first day of life. In all, both primary and intraspinal tumors responded well to chemotherapy. All survive with motor deficit and severe bladder dysfunction despite early physiotherapy. Scoliosis has developed in the case with the longest follow-up. The description of these patients enforces the importance of early diagnosis of tumor masses in late pregnancy. Neonatologists should be aware of this rare clinical entity and take it into account in the differential diagnosis with other conditions of early-onset hypotonia. On the other hand, obstetric sonologists should be aware of the possibility to detect such rare tumors in late pregnancy, as anticipation of delivery may reduce the risk of late sequelae. PMID:26901768

  6. Vértigo con nistagmo vertical por administración de morfina intratecal y reversión con naloxona

    Directory of Open Access Journals (Sweden)

    Jorge De All

    2011-10-01

    Full Text Available La anestesia regional combinada es utilizada frecuentemente como herramienta para el tratamiento del dolor postoperatorio. Los efectos secundarios de los opioides utilizados por esta vía son similares a los que se presentan luego de la administración sistémica. La aparición de vértigo con nistagmo vertical es un efecto adverso muy pocas veces descripto con el uso de morfina por vía intratecal, epidural o endovenosa. Comunicamos el caso de un paciente que presentó esta complicación en el postoperatorio de una nefrectomía parcial, luego de la administración de morfina intratecal, con resolución completa mediante el uso de naloxona endovenosa.

  7. Estudo comparativo entre ultrassom e neuroestimulação no bloqueio do plexo braquial pela via axilar Estudio comparativo entre ultrasonido y neuroestimulación en el bloqueo del plexo braquial por la vía axilar A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2009-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O uso do ultrassom em Anestesia Regional vem crescendo. Existem poucos estudos comparando o uso do ultrassom com a neuroestimulação. O objetivo deste estudo foi comparar a execução do bloqueio do plexo braquial pela via axilar guiado por neuroestimulação com dupla injeção e guiado por ultrassonografia em procedimentos cirúrgicos na mão. Para isto, foram comparados o tempo de realização, a taxa de sucesso e complicações. MÉTODO: Após a aprovação do Comitê de Ética em Pesquisa do Hospital Governador Celso Ramos foram selecionados 40 pacientes escalados para operações eletivas na mão com bloqueio de plexo braquial via axilar. Os pacientes foram distribuídos aleatoriamente eletronicamente em dois grupos de 20 pacientes: Grupo Neuroestimulação (NE e Grupo Ultrassonografia (US. Foram comparados tempo de realização, taxa de sucesso e taxa de complicações. RESULTADOS: As taxas de bloqueio completo, falha parcial e falha total não apresentaram diferença estatística significativa entre os grupos US e NE. O tempo médio para realização do procedimento no grupo US (354 segundos não apresentou diferença estatística significativa quando comparado ao grupo NE (381 segundos. Pacientes do grupo NE apresentaram maior taxa de punção vascular (40% quando comparados ao grupo US (10%, p JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido en Anestesia Regional ha venido creciendo. Existen pocos estudios comparando el uso del ultrasonido con la neuroestimulación. El objetivo de este estudio, fue comparar la ejecución del bloqueo del plexo braquial por la vía axilar, guiado por neuroestimulación con doble inyección y guiado por ultrasonido en procedimientos quirúrgicos en la mano. Para eso, se compararon el tiempo de realización, la tasa de éxito y las complicaciones. MÉTODO: Después de la aprobación por parte del Comité de Ética en Investigación del Hospital Governador Celso Ramos, se

  8. Do antenatal education classes decrease use of epidural analgesia during labour? – a Danish RCT

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg;

    on whether to implement the NEWBORN program in a clinical setting also depend upon the trial effect on psycho-social outcomes which will be analysed in near future. Main messages (max 200 anslag): 1. No effect of antenatal education in small groups on use of epidural analgesia as pain relief during labour......Background: Epidural analgesia is widely used as pain relief during labour but has negative side effects, such as prolonged labour and increased risk of obstetric interventions. Antenatal education in small groups may increase trust in own ability to cope at home in the early stages of labour......, and reduce fear during birth which in turn may decrease use of pain relief. Few randomised trials have examined the effect of attending antenatal education in small groups on use of epidural analgesia and among these conclusions are conflicting. The objective of this study was therefore to examine the effect...

  9. A Rare Case: Isolated Testicular and Epidural Abscess Associated with Brucellosis

    Directory of Open Access Journals (Sweden)

    Tugce Kalayci

    2014-08-01

    Full Text Available Coincidence of isolated testicular abscess and epidural-paravertebral abscess is a rare complication of brucellosis. A 24-year-old male patient was admitted to our clinic with 2 months ongoing back pain, night sweats and left scrotal pain. Septal cystic lesion with dense content in the left testis was considered to isolated testicular abscess in scrotal Doppler examination. Multiple spinal epidural and right paraspinal abscess were detected in the spinal magnetic resonance imaging. The patient was treated with drainage of abscess and oral antibiotics. The rare combination of spinal epidural and testicular abscess should be kept in the mind if a patient presented with low back pain and scrotal pain in regions where brucellosis was endemic.

  10. Emergency surgery for epidural abcess secondary to sacral fistula after laparoscopic proctectomy

    Science.gov (United States)

    Zeitoun, Jeremie; Menahem, Benjamin; Fohlen, Audrey; Lebreton, Gil; Lubrano, Jean; Alves, Arnaud

    2016-01-01

    A 61-year-old man presented via the emergency department with a few days history of abdominal and colic occlusion symptoms. He presented signs of sepsis, midline lumbar spine tenderness and reduced hip flexion. Computer tomography of the abdomen and pelvis showed a presacral collection contiguous with the posterior part of the colo-rectal anastomosis, and MRI lumbar spine revealed abscess invation into the epidural space. He underwent a laparotomy with washout of the presacral abscess and a colostomy with a prolonged course of intravenous antibiotic therapy. At 3 weeks after initial presentation he had made a full clinical recovery with progressive radiological resolution of the epidural abscess. The objective of the case report is to highlight a unique and clinically significant complication of a rare post-operative complication after rectal surgery and to briefly discuss other intra-abdominal sources of epidural abscess. PMID:27421299

  11. Influência da procainamida sobre o bloqueio neuromuscular produzido pelo rocurônio e investigação sobre o mecanismo de ação da procainamida na junção neuromuscular Influencia de la procainamida sobre el bloqueo neuromuscular producido por el rocuronio e investigación sobre el mecanismo de acción de la procainamida en la junción neuromuscular Influence of procainamide on the neuromuscular blockade caused by rocuronium and investigation on the mechanism of action of procainamide on the neuromuscular junction

    Directory of Open Access Journals (Sweden)

    Thalita Duque Martins

    2007-02-01

    el bloqueo neuromuscular producido por la d-tubocurarina ya está comprobada, pero sin embargo el mecanismo es controvertido. El objetivo del estudio fue el de evaluar la influencia de la procainamida en el bloqueo neuromuscular producido por el rocuronio e investigar los mecanismos de esa interacción. MÉTODO: Se utilizaron 15 ratones (250 a 300 g en preparación descrita por Bülbring. Se formaron los siguientes grupos (n = 5 cada: procainamida - 20 µg.mL-1 (Grupo I; rocuronio - 4 µg.mL-1 (Grupo II y rocuronio - 4µg.mL-1 y procainamida - 20µg.mL-1 (Grupo III. Se evaluó: 1 la amplitud de las contracciones musculares bajo la estimulación indirecta en cada grupo, antes y después de la adición de los fármacos; 2 los potenciales de placa terminal en miniatura (PPTM; 3 la eficacia de la 4-aminopiridina en la reversión del bloqueo neuromuscular. El mecanismo de la interacción se estudió en Biventer cervicis (n = 5 y diafragma de ratón desnervado (n = 5, observándose la influencia de la procainamida en la respuesta a la acetilcolina antes y después de la adición de la procainamida. RESULTADOS: De forma aislada, la procainamida no alteró las respuestas neuromusculares. El bloqueo producido con el Grupo III fue de 68,6% ± 7,1%, con una diferencia significativa (p = 0,0067 con relación al Grupo II (10,4% ± 4,5%, revertido por la 4-aminopiridina. La procainamida ocasionó un aumento en la frecuencia de los PPTM, seguido de bloqueo revertido por la 4-aminopiridina. En Biventer cervicis, la procainamida aumentó la respuesta a la acción de contracción de la acetilcolina, resultado no observado con el diafragma desnervado. CONCLUSIONES: La procainamida potenció el bloqueo producido por el rocuronio. Las alteraciones observadas con PPTM y Biventer cervicis identificaron una acción presináptica. El antagonismo de la 4-aminopiridina sobre el bloqueo de los PPTMs sugirió la desensibilización de los receptores por la procainamida.BACKGROUND AND OBJECTIVES

  12. Bloqueio isquiático-femoral guiado por ultra-som para revisão de coto de amputação: relato de caso Bloqueo isquiático-femoral guiado por ultrasonido para revisión de muñón de amputación: relato de caso Ultrasound-guided sciatic-femoral block for revision of the amputation stump: case report

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2008-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O emprego da ultra-sonografia na anestesia regional vem se tornando cada vez mais difundido pelo seu papel facilitador e pela sua eficácia. A visualização direta por meio da ultra-sonografia permite que se identifiquem os nervos periféricos, independentemente da capacidade de se obter estimulação sensitiva ou motora. RELATO DO CASO: Paciente submetido à revisão de coto de amputação no nível do joelho sob bloqueio isquiático-femoral guiado por ultra-som com 40 mL de ropivacaína a 0,5%, promovendo bloqueio sensitivo completo e anestesia cirúrgica de excelente qualidade. CONCLUSÕES: A assistência ultra-sonográfica é capaz de ampliar o espectro de utilização dos bloqueios periféricos nas intervenções cirúrgicas sobre membros amputados em situações em que a neuroestimulação não pode ser utilizada.JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido en la anestesia regional se ha venido convirtiendo cada vez más en algo muy difundido por su rol de facilitador y por su eficacia. La visualización directa a través del ultrasonido permite que se identifiquen los nervios periféricos, independientemente de la capacidad de poder obtenerse una estimulación sensitiva o motora. RELATO DEL CASO: Paciente sometido a revisión de muñón de amputación al nivel de la rodilla bajo bloqueo isquiático-femoral guiado por ultrasonido con 40 mL de ropivacaína a 0,5%, promoviendo bloqueo sensitivo completo y anestesia quirúrgica de excelente calidad. CONCLUSIONES: La asistencia ultra sonográfica es capaz de ampliar el espectro de utilización de los bloqueos periféricos en las intervenciones quirúrgicas sobre miembros amputados en situaciones en que la neuro estimulación no puede ser utilizada.BACKGROUND AND OBJECTIVES: The use of ultrasound in regional blocks has become increasingly used because its role as a facilitator and its efficacy. Direct ultrasound visualization allows the identification of

  13. Combined Spinal Epidural Anaesthesia with BiPAP-Three Case Reports

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2009-01-01

    Full Text Available We report three cases where BiPAP (bi-level positive airway pressure was used with CSEA (combined spinal epidural anaesthesia to over come the hypoventilation due to preoperative poor respiratory reserves and additive effect of sedation. Combination of BiPAP with spinal, epidural and CSEA have been used successfully in patients of severe COPD (chronic obstructive pulmonary disease for various surgical procedures. This combination provides safe alternative to conventional general anaesthesia, as it avoids need for postoperative ventilatory support and its deleterious effects.

  14. Traumatic spinal epidural hematoma in a 1-year-old boy.

    Science.gov (United States)

    Tarbé de Saint Hardouin, A-L; Grévent, D; Sainte-Rose, C; Angoulvant, F; Chéron, G

    2016-07-01

    Traumatic spinal epidural hematoma is uncommon in children, making rapid diagnosis difficult. In this report, we present a case of traumatic cervical epidural hematoma in a 1-year-old boy, diagnosed with computed tomography scanning and magnetic resonance imaging (MRI). Management was conservative and the lesion regressed spontaneously. The presentation in childhood is often nonspecific. MRI is the imaging modality of choice for diagnosing these lesions. Conservative treatment has to be considered in cases with a benign clinical course and provided that the patient is followed up neurologically with repeated MRI. PMID:27266638

  15. Posterior epidural migration of lumbar ruptured disc: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Deug Hee; Lee, Sang Ho; Park, Hyeon Seon; Park, Jy Young; Chung, Seung Eun; Jo, Byung June [Wooridul Spine Hospital, Seoul (Korea, Republic of)

    2006-02-15

    Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.

  16. Conservative treatment of lumbar disc herniation. Epidural steroid injection and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ohmura, Munehisa; Sakanaka, Hideki; Wada, Eiji; Inaoka, Masahiro; Yonenobe, Sakuo [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)

    1996-01-01

    A study was made on the efficacy of the epidural injection of steroids in 65 patients of lumbar disc herniation. It was recognized that epidural steroids were effective in 49 cases (75 percent) and the effect was closely correlated with the prognosis of lumbar disc herniation. On follow-up MRI studies, a definite decrease in the size of the herniated nucleus pulposus was observed in six patients of the sequestration type: disappearance in five. No definite change was observed except for one patient in the protrusion type. (author).

  17. Septic arthritis in a lumbar facet joint: a rare cause of an epidural abscess

    Energy Technology Data Exchange (ETDEWEB)

    Heenan, S.D. [Dept. of Neuroradiology, Atkinson Morley`s Hospital, London (United Kingdom); Britton, J. [Dept. of Neuroradiology, Atkinson Morley`s Hospital, London (United Kingdom)

    1995-08-01

    A 10-year-old boy presented with a 7-day history of back pain and pyrexia. MRI showed an epidural abscess arising from septic arthritis in a lumbar facet joint. To our knowledge, there are only two previously reported cases of septic arthritis of a facet joint leading to an epidural abscess. This case illustrates how infection in a synovial joint may extend into the extradural space and might be the route of infection in more cases than has previously been recognised. (orig.)

  18. Cardiovascular and ventilatory responses to electrically induced cycling with complete epidural anaesthesia in humans

    DEFF Research Database (Denmark)

    Kjaer, M; Perko, G; Secher, N H;

    1994-01-01

    Cardiovascular and ventilatory responses to electrically induced dynamic exercise were investigated in eight healthy young males with afferent neural influence from the legs blocked by epidural anaesthesia (25 ml 2% lidocaine) at L3-L4. This caused cutaneous sensory anaesthesia below T8-T9...... with epidural anaesthesia [93 +/- 3 (rest) to 95 +/- 5 mmHg (exercise)]. As there is ample evidence for similar cardiovascular and ventilatory responses to electrically induced and voluntary exercise (Strange et al. 1993), the present results support the fact that the neural input from working muscle is crucial...

  19. Avaliação do bloqueio neuromuscular residual e da recurarização tardia na sala de recuperação pós-anestésica Evaluación del bloqueo neuromuscular residual y de la recurarización tardia en la sala de recuperación pós-anestésica Evaluation of residual neuromuscular block and late recurarization in the post-anesthetic care unit

    Directory of Open Access Journals (Sweden)

    Maria Cristina Simões de Almeida

    2004-08-01

    fase de recuperação, quando foi usada a neostigmina não se seguiu de "recurarização", sugerindo que esse fenômeno não tenha significado clínico quando o paciente não apresenta sinais de falência de órgãos ou comorbidades que alteram a transmissão neuromuscular.JUSTIFICATIVA Y OBJETIVOS: El bloqueo neuromuscular residual altera la patencia de las vías aéreas aumentando el riesgo de graves complicaciones en el pós-operatorio. En los pacientes que reciben el anticolinesterásico, la transmisión neuromuscular es incrementada por el acumulo de acetilcolina en la placa motora, más que, una vez concluido el efecto de la neostigmina, teoricamente es posible una "recurarización", visto que el agente antagonista no desloca el bloqueador neuromuscular de su local de acción. Fue objetivo de este trabajo cuantificar el grado de parálisis residual en la Sala de Recuperación Pós-Anestésica (SRPA y averiguar si los pacientes que recibieron neostigmina presentan fenómeno de "recurarización" tardia. MÉTODO: Fueron estudiados en la SRPA 119 pacientes adultos que recibieron bloqueadores neuromusculares para diferentes tipos de procedimientos. Al llegar a la SRPA, la transmisión neuromuscular fue cuantificada a través de un monitor por método acelerográfico. Los electrodos estimuladores fueron instalados en el trayecto del nervio ulnar en el puño, y se utilizó la secuencia de 4 estímulos, con corrientes de 30 mA, en la periodicidad de 15 hasta 120 minutos. En esta pesquisa se consideró como residuo de bloqueo neuromuscular una relación T4/T1 abajo de 0,9. En el tiempo de permanencia de la SRPA fueron igualmente registrados los síntomas clínicos sugestivos de bloqueo neuromuscular residual y aferidos los señales vitales. Para análisis estadística fueron utilizadas medidas descriptivas tales como media y frecuencia absoluta. RESULTADOS: Los pacientes que recibieron pancuronio presentaron mayor incidencia de residuo de bloqueo neuromuscular

  20. The lucid interval associated with epidural bleeding: evolving understanding.

    Science.gov (United States)

    Ganz, Jeremy C

    2013-04-01

    The aim of this paper was to elucidate the evolution of our understanding of the term "lucid interval." A number of texts were reviewed to assess their suitability for analysis. The primary requirement was that the text contain detailed descriptions of a series of patients. Details of the clinical course, the findings and timing of surgery, and, when relevant, the time of death and postmortem findings were required. Books written by Henri-François Le Dran, Percival Pott, and James Hill fulfilled these criteria. Surgical findings included the presence and type of fractures, changes in the bone, separation of periosteum, malodorous or purulent material, tense brain, and hematoma. Postmortem findings supplemented and/or complemented the surgical findings. The courses of the patients were then tabulated, and the correlation between different clinical and operative findings was thereby determined. Our understanding of a lucid interval began in the early 18th century with the work of Henri-François Le Dran and Percival Pott in London. They did not, however, demonstrate an interval without symptoms between trauma and deterioration in patients with epidural hematomas (EDHs). The interval they described was longer than usually expected with EDHs and occurred exclusively in patients who had a posttraumatic infection. In 1751, James Hill, from Dumfries, Scotland, described the first hematoma-related lucid interval in a patient with a subdural hematoma. The first case of a lucid interval associated with an EDH was described by John Abernethy. In the 19th century, Jonathan Hutchinson and Walter Jacobson described the interval as it is known today, in cases of EDH. The most recent work on the topic came from studies in Cincinnati and Oslo, where it was demonstrated that bleeding can separate dura mater and that hemorrhage into the epidural space can be shunted out via the veins. This shunting could delay the accumulation of a hematoma and thus the rise in intracranial pressure

  1. Rol de la mitocondria y el estrés oxidativo en el bloqueo del desarrollo de embriones bovinos producidos in vitro Mitochondrial rol and oxidative stress in the developmental blockade of in vitro produced bovine embryos

    Directory of Open Access Journals (Sweden)

    AM Tarazona

    2010-01-01

    Full Text Available Uno de los mayores obstáculos en la producción de embriones in vitro con fines de investigación básica, comerciales, o de conservación, es el detenimiento temprano del clivaje que ocurre de forma específica en una etapa del desarrollo. Para explicar este fenómeno se han postulado diferentes factores causales como: desórdenes en la cromatina, rearreglos del citoesqueleto, estrés oxidativo y daños mitocondriales. Esta última propuesta ha recibido gran atención, debido a que la mitocondria es fuente de especies reactivas de oxígeno (EROs y el estrés oxidativo es un mediador crítico de procesos fisiológicos y estados patológicos. Durante los últimos años se ha demostrado que el peróxido de hidrógeno (H2O2 es una molécula pivotante capaz de desencadenar muerte celular por diferentes mecanismos que pueden involucrar o no a los factores de transcripción: NFκB - p53, y es ejecutado por caspasas efectoras. Se cree que la mitocondria podría estar jugando un papel importante como productora o como blanco del H2O2, y como mediadora en la muerte por apoptosis de los embriones. El objetivo de esta revisión es mostrar el estado del arte en cuanto a la apoptosis desencadenada por estrés oxidativo y mediada por la mitocondria en los embriones bovinos producidos in vitro, como parte de la explicación del bloqueo del clivaje y la baja eficiencia que aún se tiene en este proceso.One of the biggest obstacles in the in vitro embryo production for basic research, commercial purposes, or conservation, is the blockade of the early cleavage, which occurs on a species-specific manner in a particular stage of development. To explain this phenomenon some causative factors have been postulated such as: disturbances in chromatin, cytoskeleton rearrangement, oxidative stress and mitochondrial damage. The latter has received considerable attention because mitochondrion is a source of reactive oxygen species (ROS, and oxidative stress is a critical

  2. Analgesia epidural com clonidina ou romifidina em cães submetidos à cirurgia coxofemoral Epidural analgesia with clonidine or romifidine in dogs submitted to coxofemoral surgery

    Directory of Open Access Journals (Sweden)

    J.T. Brondani

    2004-04-01

    Full Text Available Avaliaram-se as alterações cardiorrespiratórias e a analgesia da administração epidural de clonidina ou romifidina em cães submetidos à cirurgia coxofemural. Foram utilizados 14 cães distribuídos em dois grupos: o grupo Cloni recebeu 150µg de clonidina e o grupo Romi, 20µg/kg de romifidina. A indução anestésica foi realizada com propofol e a anestesia cirúrgica mantida com halotano e O2 em respiração espontânea. A punção do espaço epidural foi feita logo após a indução. Antes da indução e a cada 10 minutos foram avaliadas as freqüências cardíaca e respiratória, a pressão arterial sistólica, a saturação de oxigênio da hemoglobina e a concentração de halotano. Após indução e ao término do procedimento cirúrgico coletou-se sangue arterial para avaliação gasométrica de pH, PaCO2, PaO2, SaO2, BE e HCO3-. Foi realizada avaliação pós-operatória do grau de analgesia (intensa, pouco intensa e inadequada nas primeiras duas horas após término da cirurgia. Os animais do grupo Romi apresentaram bradicardia, bradiarritmias e hipertensão. A freqüência cardíaca e a pressão arterial sistólica no grupo Cloni mantiveram-se dentro da faixa de variação fisiológica para a espécie. A analgesia trans-operatória foi considerada intensa nos dois grupos. A administração epidural de clonidina ou romifidina produziu intensa analgesia transcirúrgica sem depressão respiratória e pouco intensa analgesia pós-operatória por duas horasCardiovascular alterations and analgesia in 14 dogs submitted to epidural administration of clonidine or romifidine to enable coxofemoral surgery were evaluated. Dogs were separated in two groups: Cloni group received 150µg of clonidine and Romi group, 20µg/kg of romifidine. Anesthetic induction was performed using propofol (8mg/kg and maintenance using halothane and O2 in spontaneous breathing. The puncture of epidural space was performed just after anesthetic induction. Heart

  3. Medición del daño genético inducido por el basuco en linfocitos humanos empleando la prueba de micronúcleos con Citocalasina B

    Directory of Open Access Journals (Sweden)

    Ocampo AP.

    2001-06-01

    Full Text Available El bazuco es una mezcla compleja que se deriva del proceso de extracción de la cocaína. El frecuente consumo de bazuco constituye un problema de salud pública. La prueba de micronúcleos en linfocitos humanos de sangre periférica por bloqueo de la citocinesis con Citocalasina B, es más sensible y precisa para evaluar daño  cromosómico porque permite registrar micronúcleos originados de fragmentos de cromosomas o cromosomas enteros en células que se han dividido una sola vez. El objetivo del presente estudio fue evaluar el daño genético, inducido por el bazuco en linfocitos humanos in vitro empleando la prueba de micronúcleos con Citocalasina B.

  4. Efficacy of low-dose epidural anaesthesia in surgery of the anal canal--a randomised controlled trial.

    Science.gov (United States)

    Kausalya, R; Jacob, R

    1994-04-01

    The aim of the study was to compare in terms of patient comfort, surgical requirements and anaesthetic safety, the difference between epidural and general anaesthesia in patients undergoing surgery of the anal canal. The study was undertaken on 50 adult patients undergoing anal surgery. By random allocation 25 were given a general anaesthetic while 25 were given a low-dose epidural using 0.375% bupivacaine. Advantages and disadvantages of both methods were noted in the study. It was concluded that low-dose epidural is a more effective means of providing analgesia, while maintaining adequate sphincter tone for surgery on the anal canal, than general anaesthesia. PMID:8210019

  5. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred...

  6. Effect of epidural 0.25% bupivacaine on somatosensory evoked potentials to dermatomal stimulation

    DEFF Research Database (Denmark)

    Lund, C; Hansen, O B; Kehlet, H

    1989-01-01

    The effect of lumbar epidural analgesia with similar volumes (about 25 ml) of 0.25% and 0.5% bupivacaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients. Level of sensory...

  7. Effects of etidocaine administered epidurally on changes in somatosensory evoked potentials after dermatomal stimulation

    DEFF Research Database (Denmark)

    Lund, C; Hansen, O B; Kehlet, H;

    1991-01-01

    The effect of lumbar epidural anesthesia with similar volumes (approximately 20 ml) of 1% and 1.5% etidocaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients in a...

  8. Parietal osteomyelitis and epidural abscess: A delayed complication of fetal monitoring

    International Nuclear Information System (INIS)

    Infected cephalohematomas are extremely rare. In this report an infant of 14 weeks developed an infected cephalohematoma, osteomyelitis of the parietal bone and an epidural abscess after fetal monitoring with scalp electrodes. Streptococcus pneumoniae was isolated from the purulent aspirate. (orig.)

  9. Epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion

    Institute of Scientific and Technical Information of China (English)

    Yang Zhizhou; Zhu Xiaodong; Li Ming

    2009-01-01

    Objective: To investigate epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion. Methods: Medical records were selected randomly from 30 patients whose diagnoses were consistent with the inclusion criteria of the study. Thickness of bilateral fat, the longest length of posterior fat, thickness of bilateral yellow ligament and thehernial distance of lumbar discs were measured by MRI at L3/L4, L4/L5 and LS/S 1 levels. According to clinical symptoms of lumbar intervertebral disc protrusion, the patients were divided into two groups at all space levels. All data were analyzed by statistical software. Results: The longest length of posterior epidural fat at the symptomatic levels was shorter than that at the non-symptomatic levels in each disc space. The symptomatic levels had no effect on the whole thickness of the lateral fat and lateral yellow ligaments. Conclusion: Epidural fat distribution in patients with lumbar intervertebral disc protrusion is different from that in normal adults. It is affected by the hernial distance of lumbar discs. The diagnostic criteria for spinal epidural lipomatosis in normal adults may therefore prove to be inappropriate for patients with lumbar intervertebral disc protrusion.

  10. Surgery on spinal epidural metastases (SEM) in renal cell carcinoma : a plea for a new paradigm

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Coppes, Maarten H.; Vergeer, Rob A.; Kuijlen, Jos M. A.; Groen, Rob J. M.

    2014-01-01

    BACKGROUND CONTEXT: Prediction models for outcome of decompressive surgical resection of spinal epidural metastases (SEM) have in common that they have been developed for all types of SEM, irrespective of the type of primary tumor. It is our experience in clinical practice, however, that these model

  11. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine

    Directory of Open Access Journals (Sweden)

    Tanmoy Ghatak

    2010-01-01

    Full Text Available For treatment of intra and postoperative pain, no drug has yet been identified that specifically inhibits nociception without associated side effects. Magnesium has antinociceptive effects in animal and human models of pain. The current prospective randomised double-blind study was undertaken to establish the effect of addition of magnesium or clonidine, as adjuvant, to epidural bupivacaine in lower abdominal and lower limb surgeries. A total of 90 American Society of Anesthesiology (ASA grade I and II patients undergoing lower abdominal and lower limb surgeries were enrolled to receive either magnesium sulphate (Group B or clonidine (Group C along with epidural bupivacaine for surgical anaesthesia. All patients received 19 ml of epidural bupivacaine 0.5% along with 50 mg magnesium in group B, 150 mcg clonidine in Group C, whereas in control group (Group A, patients received same volume of normal saline. Onset time, heart rate, blood pressure, duration of analgesia, pain assessment by visual analogue score (VAS and adverse effects were recorded. Onset of anaesthesia was rapid in magnesium group (Group B. In group C there was prolongation of duration of anaesthesia and sedation with lower VAS score, but the incidence of shivering was higher. The groups were similar with respect to haemodynamic variables, nausea and vomiting. The current study establishes magnesium sulphate as a predictable and safe adjunct to epidural bupivacaine for rapid onset of anaesthesia and clonidine for prolonged duration of anaesthesia with sedation.

  12. Paraplegia after thoracotomy under combined general and epidural anesthesia in a child.

    NARCIS (Netherlands)

    Allison, C.E.; Aronson, D.C.; Geukers, V.G.; Berg, R. van den; Schlack, W.S.; Hollmann, M.W.

    2008-01-01

    A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and

  13. [Acute epidural hematoma of the posterior fossa in a case of von Willebrand's disease].

    Science.gov (United States)

    Takenaka, N; Mine, T; Ikeda, E; Iwai, H; Kusano, S

    1988-01-01

    A rare case of acute epidural hematoma of the posterior fossa associated with von Willebrand's disease is reported. A 9-year-old boy fell down and hit his occipital region against a floor. Soon after he came home and slept, but three hours later he began to vomit and became drowsiness. He visited our hospital and his Glasgow Coma Scale showed 13 points. CT scan on admission showed acute epidural hematoma of left posterior fossa and contusional hematoma in the right temporal lobe. The bleeding time was over 18 minutes. He had been suspected to be suffering from von Willebrand's disease two years ago. Then fresh blood, fresh frozen plasma and anti-hemophilic globulin were prepared. Ten hours after injury, the operation was begun. Fresh epidural hematoma existed as a clot beyond transverse sinus. During the procedure of dural tenting suture, diffuse bleeding from bone, muscle, subcutaneous tissue and dura occurred and it was difficult to stop the bleeding. By using fresh blood and anti-hemophilic globulin, the bleeding was controlled, and then the operation was achieved. In the postoperative course a new epidural hematoma was found in the left temporal region and a new but asymptomatic retinal hemorrhage was found in his right eye. He was discharged without any neurological deficits 25 days after operation.

  14. Epidural ropivacaine combined with fentanyl or in combination with clonidine in infraumblical surgeries: a comparative study

    Directory of Open Access Journals (Sweden)

    Rakesh Bahadur Singh

    2015-10-01

    Conclusions: So this study re-established the fact, that the fentanyl and clonidine when added as adjuvant to epidural ropivacaine, significantly prolongs the analgesic duration without causing significant hemodynamic and respiratory changes. [Int J Res Med Sci 2015; 3(10.000: 2740-2744

  15. Epidural volume extension: A novel technique and its efficacy in high risk cases.

    Science.gov (United States)

    Tiwari, Akhilesh Kumar; Singh, Rajeev Ratan; Anupam, Rudra Pratap; Ganguly, S; Tomar, Gaurav Singh

    2012-01-01

    We present a unique case series restricting ourselves only to the high-risk case of different specialities who underwent successful surgery in our Institute by using epidural volume extension's technique using 1 mL of 0.5% ropivacaine and 25 μg of fentanyl. PMID:25885627

  16. Acute intracranial epidural haematoma in a basketball player: a case report.

    OpenAIRE

    Datti, R; Gentile, S L; Pisani, R.

    1995-01-01

    A 35-year-old basketball player suffered a serious double head injury during a match. An acute left temporal epidural haematoma, which necessitated surgical drainage, developed. The exceptional circumstances of the trauma are discussed and the literature concerning basketball-related injuries is reviewed.

  17. Spinal Epidural Hematoma Following Cupping Glass Treatment in an Infant With Hemophilia A.

    Science.gov (United States)

    Fruchtman, Yariv; Dardik, Rima; Barg, Assaf Arie; Livnat, Tami; Feldman, Zeev; Rubinstein, Marina; Grinberg, Gahl; Rosenberg, Nurit; Kenet, Gili

    2016-06-01

    A 6 months old infant, diagnosed with a rare mutation causing severe hemophilia A, presented with spinal epidural hematoma. Parents later admitted the infant had glass cupping therapy performed within 2 weeks of the onset of symptoms. The rare mutation, rare bleeding complication, and the eventual course of therapy applied in this case will be discussed in our case report.

  18. Estudo comparativo entre clonidina associada à bupivacaína e bupivacaína isolada em bloqueio de plexo cervical para endarterectomia de carótida Estudio comparativo entre la clonidina asociada a la bupivacaína y la bupivacaína aislada en bloqueo de plexo cervical para endarterectomía de carótida A comparative study between bupivacaine and clonidine associated with bupivacaine in cervical plexus block for carotid endarterectomy

    Directory of Open Access Journals (Sweden)

    Walter Pinto Neto

    2009-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio de plexo cervical permite avaliação neurológica durante a endarterctomia, além de manter analgesia pós-operatória. A clonidina é agonista alfa2 com efeito analgésico em diferentes bloqueios. O objetivo deste estudo foi comparar o efeito analgésico da clonidina com bupivacaína em relação à bupivacaína isolada em bloqueio de plexo cervical. MÉTODO: Foram avaliados 30 pacientes de forma aleatória e duplamente-encoberta divididos em dois grupos: G1 recebeu 1,5 mg.kg-1 de bupivacaína a 0,375% associados a 150 ¼g de clonidina (2 mL e G2, 1,5 mg.kg-1 de bupivacaína a 0,375% associados à solução fisiológica (2 mL. Foram avaliados: frequência cardíaca e pressão arterial nos momentos 0 (bloqueio, 30, 60, 90 e 120 minutos; necessidade de complementação anestésica; momento para primeira complementação analgésica; quantidade de analgésico usada e intensidade da dor nos momentos 0 (término da operação, 30, 60, 120, 240 e 360 minutos. RESULTADOS: A complementação anestésica com lidocaína foi de 3,8 mL no G1 e 3,6 mL no G2 sem diferença estatística significativa. O momento para a primeira complementação foi de 302,6 ± 152,6 minutos no G1, e de 236,6 ± 132,9 minutos no G2, sem diferença significativa. Não houve diferença na dose de dipirona e tramadol usada. Não houve diferença na intensidade da dor entre os grupos. CONCLUSÃO: A associação de 150 ¼g de clonidina à bupivacaína em bloqueio de plexo cervical para endarterectomia de carótida não promoveu melhora significativa do efeito analgésico avaliado por intensidade da dor, primeira complementação analgésica e quantidade de analgésico complementar.JUSTIFICATIVA Y OBJETIVOS: El bloqueo de plexo cervical permite la evaluación neurológica durante la endarterectomía, además de mantener la analgesia postoperatoria. La clonidina es agonista alfa-2 con un efecto analgésico en diferentes bloqueos. El objetivo de

  19. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

    Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

  20. Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient

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    Jamil S Anwari

    2015-01-01

    Full Text Available Background: Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox™ analgesia as bridging analgesia for epidural placement. Materials and Methods: Sixty-four laboring women who requested epidural analgesia with pain score of ≥7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction cycle, pain, Richmond Agitation Sedation Scale (RASS, nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded. Results: The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001, and continued to decrease significantly over the study period (P < 0.0001. The RASS scores continuously improved after each cycle (P < 0.0001. Only 1 parturient from the cohort became lightly sedated (RASS = −1. Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment. Conclusion: Penthrox™ provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient.

  1. Effects of epidural lidocaine analgesia on labor and delivery: A randomized, prospective, controlled trial

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    Nafisi Shahram

    2006-12-01

    Full Text Available Abstract Background Whether epidural analgesia for labor prolongs the active-first and second labor stages and increases the risk of vacuum-assisted delivery is a controversial topic. Our study was conducted to answer the question: does lumbar epidural analgesia with lidocaine affect the progress of labor in our obstetric population? Method 395 healthy, nulliparous women, at term, presented in spontaneous labor with a singleton vertex presentation. These patients were randomized to receive analgesia either, epidural with bolus doses of 1% lidocaine or intravenous, with meperidine 25 to 50 mg when their cervix was dilated to 4 centimeters. The duration of the active-first and second stages of labor and the neonatal apgar scores were recorded, in each patient. The total number of vacuum-assisted and cesarean deliveries were also measured. Results 197 women were randomized to the epidural group. 198 women were randomized to the single-dose intravenous meperidine group. There was no statistical difference in rates of vacuum-assisted delivery rate. Cesarean deliveries, as a consequence of fetal bradycardia or dystocia, did not differ significantly between the groups. Differences in the duration of the active-first and the second stages of labor were not statistically significant. The number of newborns with 1-min and 5-min Apgar scores less than 7, did not differ significantly between both analgesia groups. Conclusion Epidural analgesia with 1% lidocaine does not prolong the active-first and second stages of labor and does not increase vacuum-assisted or cesarean delivery rate.

  2. Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: "la buena sufridora"

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    L. Biedma Velázquez

    2010-02-01

    Full Text Available Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Conclusiones: Las características sociales, económicas y culturales que definen el rechazo, es decir, el "tipo" de mujer que rehúsa la epidural, coinciden con el esquema de "mujer tradicional" estudiado por otros autores (que se caracteriza por tener escasos

  3. Modulación de la muerte de monocitos infectados con Mycobacterium tuberculosis: papel del Ca Ca2+ 2+ 2+, , IL-10 y de PLA2 y correlación con el crecimiento intracelular de la micobacteria

    Directory of Open Access Journals (Sweden)

    Luis Fernando García

    2003-01-01

    Full Text Available En macrófagos murinos infectados con Mycobacterium tuberculosis
    (Mtb el balance entre TNFa e IL-10 modula la apoptosis (1,2. Además, la infección activa flujos de calcio responsables del
    daño mitocondrial y la regulación dependiente de cAMP (3. En
    nuestro laboratorio se ha observado que el PPD y el Mtb inducen
    apoptosis y necrosis en monocitos de pacientes tuberculosos, mientras que en monocitos de controles sólo apoptosis, indicando que los mecanismos de muerte podrían asociarse con la patogénesis de la enfermedad y con el control de la infección. Ensayos de bloqueo muestran que ambos tipos de muerte celular pueden ser modulados por TNFa e IL-10; el anti-TNFa inhibe la apoptosis y la anti-IL-10 la aumenta disminuyendo la necrosis; sin embargo, los mecanismos moduladores de la necrosis son desconocidos. En este proyecto hemos postulado que en presencia de las señales antiapoptóticas de la IL-10, un segundo factor, probablemente el calcio, podría activar otras vías como lipasas y proteasas diferentes a caspasas, que llevan a la muerte celular independiente de la apoptosis.

  4. Diagnosis of epidural hematoma by brain scan and perfusion study: case report. [/sup 99m/Tc tracer techniques

    Energy Technology Data Exchange (ETDEWEB)

    Buozas, D.J.; Barrett, I.R.; Mishkin, F.S.

    1976-11-01

    By using the arterial and venous phases of an anterior cerebral perfusion study, which showed downward displacement of the sagittal sinus, and the finding of a rim on the delayed scans, the specific diagnosis of epidural hematoma was established.

  5. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Blemmer, T;

    1993-01-01

    Thirty-one patients scheduled for elective cholecystectomy performed through a mini-laparotomy, were randomized to received either combined thoracic epidural anaesthesia/light general anaesthesia and postoperative balanced analgesia with continuous epidural bupivacaine 10 mg.h-1 and morphine 0.2 mg.......h-1 for 38 h after surgery plus systemic ibuprofen 600 mg x 8 h-1 (N = 15) or general anaesthesia and postoperative analgesia with systemic morphine and ibuprofen 600 mg x 8 h-1 (N = 16). During postoperative epidural infusion sensory blockade to pinprick was Th4 to L1, and analgesia at rest...... lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group...

  6. Assessment of the implication of epidural steroid injection versus other conservative measures in the management of lumbar disc herniation

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    Amal F Soliman

    2016-01-01

    Conclusion Epidural injection could be a preferable choice in managing low back and radicular pain due to LDH. It was a clinically useful mode of treatment that is cost-effective and could offset the need for surgery.

  7. Epidural spinal cord compression as initial clinical presentation of an acute myeloid leukaemia: case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Dominique N'Dri Oka; Alpha Boubacar Bah; André Valentin Tokpa; Louis Derou

    2016-01-01

    Epidural localization of myeloid leukaemia is rarely reported.Spinal cord compression as an initial presentation of acute myeloid leukaemia is extremely rare.This is a report of a 17-year-old black boy who presented to emergency department with neurological symptoms of spinal cord compression.Imaging modalities showed multiple soft tissue masses in the epidural space.After surgical treatment,histopathological examination of the epidural mass showed myeloid leukaemia cells infiltration.Literature review on Medline and "scholar Google" database was done.The characteristics and management of extra-medullary leukaemia are discussed.Granulocytic sarcoma,myeloid sarcoma or chloroma with acute myeloid leukaemia should be considered as part of epidural spinal cord compression.Therefore surgery is indicated on an emergent basis.

  8. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  9. Comparative evaluation of the effect of silicone and teflon in prevention of epidural fibrosis after laminectomy in rat

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    Sheikh Rezaei A

    2001-08-01

    Full Text Available There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and histologic studies after 6 weeks. Silicone decreased intermuscular scar, deep scar, dural adhesion and collagen fiber density in epidural space. Teflon decreased dural adhesion and collagen fiber density but did not decrease intermuscular and deep scar formation in epidural space.

  10. Effectiveness of epidural versus alternate analgesia for pain relief after radical prostatectomy and correlation with biochemical recurrence in men with prostate cancer

    Directory of Open Access Journals (Sweden)

    Mir MC

    2013-10-01

    Full Text Available Maria C Mir,1 Binoy Joseph,1 Rona Zhao,1 Damien M Bolton,1 Dennis Gyomber,1 Nathan Lawrentschuk1,21University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, VIC, Australia; 2Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, VIC, AustraliaObjectives: Our objectives were to analyze the effectiveness of epidural anesthesia in patients who underwent open retropubic radical prostatectomy (RRP at our institution over the past decade, and to examine subsequent oncologic outcomes, comparing those receiving with those not receiving epidural anesthesia.Methods: A comprehensive database of all patients undergoing RRP from November 1996 to December 2006 was analyzed; 354 patients underwent RRP at our institution and were divided into those receiving or not receiving an epidural. An independent pain management team scoring technical success found epidural technique to be consistent. Oncological outcome was an endpoint of our study, comparing both analysis groups. We classed prostate-specific antigen (PSA recurrence after RRP as a serum PSA ≥ 0.2 ng/mL at any stage of postoperative follow-up. Complications were recorded to 30 days using the modified Clavien system, and full statistical analyses were undertaken.Results: Records were available for 239 men; we observed a decreased trend in the use of epidural for pain management, along with a decrease in average hospital stay and an overall epidural success rate of 64%. When dividing data into RRP with and without epidural, we found a median hospital stay of 7 days for patients receiving an epidural compared with 6 days for those not receiving an epidural. The differences were statistically significant (P < 0.048 and remained so after adjusting for complications (P < 0.0001. Regarding oncological outcome, PSA recurrence was further analyzed in this cohort. Percentage of recurrence was higher (14.8% for patients receiving an epidural than for the non-epidural group (4.8%. The

  11. Comparative evaluation of the effect of silicone and teflon in prevention of epidural fibrosis after laminectomy in rat

    OpenAIRE

    Sheikh Rezaei A; Fakhr Tabatabaei SA; Khoshnevisan A; Marzban H; Nikbakht M; Barbarestani M; Asadi F; Alavi Naeini M

    2001-01-01

    There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon) in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and hi...

  12. Efficacy of caudal epidural injection of lidocaine, xylazine and xylazine plus hyaluronidase in reducing discomfort produced by electroejaculation in bulls

    OpenAIRE

    PAGLIOSA, Ronaldo C.; DEROSSI, Rafael; COSTA, Deiler S.; FARIA, Fabio J.C.

    2015-01-01

    To test the hypothesis that epidural administration of lidocaine, xylazine or xylazine plus hyaluronidase provides reduced pain and stress during electroejaculation in bulls, eight 30-month-old Nellore bulls received saline solution (control), 2% lidocaine, 2% xylazine or 2% xylazine plus hyaluronidase injected into the first intercoccygeal (Co1–Co2) epidural space in randomized order. Heart rate, respiratory rate, mean arterial pressure, analgesia, animal behavior and motor blockade were eva...

  13. Epidural anesthesia for laparoscopic cholecystectomy in a patient with sickle cell anemia, beta thalassemia, and Crohn's disease -A case report-

    OpenAIRE

    Baş, Sema Şanal; Özlü, Onur

    2012-01-01

    A 37-year-old woman diagnosed with sickle cell anemia (SCA), beta (+) thalassemia, Crohn's disease, and liver dysfunction was scheduled for laparoscopic cholecystectomy (LC) due to acute cholecystitis with gall bladder. Regional anesthesia was performed. An epidural catheter was inserted into the 9-10 thoracal epidural space and then 15 ml of 0.5% bupivacaine was injected through the catheter. The level of sensorial analgesia tested with pinprick test reached up to T4. Here we describe the fi...

  14. Bloqueo del receptor del factor de crecimiento semejante a la Insulina Tipo I utilizando oligodeoxinucleótidos antisentido en cáncer de mama experimental Type I insulin-like growth factor receptor antisense strategies in experimental breast cancer

    Directory of Open Access Journals (Sweden)

    Mariana Salatino

    2004-04-01

    Full Text Available Evaluamos el efecto del bloqueo de la expresión del receptor del factor de crecimiento semejante a la insulina tipo I (IGF-IR sobre el crecimiento in vivo de cáncer de mama empleando una estrategia "antisentido". Utilizamos el adenocarcinoma mamario murino progestágeno-dependiente C4HD. La administración intratumoral o sistémica de oligodeoxinucleótidos antisentido fosfotiolados al ARNm del IGF-IR (AS[S]ODN inhibió el crecimiento tumoral. El efecto antitumoral fue específico debido a su dosis-dependencia y a la falta de efecto en ratones tratados con el S[S]ODN "sentido". Los tumores obtenidos de ratones tratados con AS[S]ODN mostraron: disminución en la expresión de IGF-IR y en la fosforilación del sustrato del receptor de insulina-1, inhibición de la activación de PI-3K/Akt, p42/p44MAPK y ErbB-2, mientras que la expresión y activación del receptor de progesterona no se afectó. Es la primera demostración que el crecimiento de cáncer de mama puede ser inhibido por la administración in vivo de AS[S]ODN al IGF-IR.We addressed the effect of targeting type I insulin-like growth factor receptor (IGF-IR, with antisense strategies in in vivo growth of breast cancer cells. We used C4HD tumors from an experimental model of hormonal carcinogenesis in which medroxyprogesterone acetate induced mammary adenocarcinomas in Balb/c mice. Intratumor or systemic administration of phosphorothiolated antisense oligodeoxynucleotides (AS[S]ODN to IGF-IR mRNA resulted in a significant inhibition of C4HD tumor growth. The antitumor effect was specific since inhibition of tumor growth was dose-dependent and no effect was observed in mice treated with sense S[S]ODN. Tumors from AS[S]ODN-treated mice showed a decrease in IGF-IR expression and in insulin receptor substrate-1 tyrosine phosphorylation. Activation of PI-3K/Akt, p42/p44 MAPK and ErbB-2 was abolished in tumors treated with AS[S]ODN. Progesterone receptor expression or activity remained

  15. [Pressure Ulcer Caused by Long-term Keeping of the Same Body Position during Epidural Labour Analgesia].

    Science.gov (United States)

    Naruse, Satoshi; Uchizaki, Sakiko; Mimura, Shinichiro; Taniguchi, Mizuki; Akinaga, Chieko; Sato, Shigehito

    2016-06-01

    We report the case of a 34-year-old woman (height: 153 cm, weight : 62.4 kg, non-pregnant weight : 52 kg, uniparous) without underlying diseases who developed pressure ulcer due to keeping a similar body position during long-term epidural delivery. Induction of childbirth was started in gestational week 40, causing reduction of fetal heart rate, which improved after adoption of a right lateral recumbent position. Severe contractions occurred and epidural labour analgesia was started. The fetal heart rate decreased again and induction of childbirth was suspended, but the right lateral recumbent position was maintained. Epidural administration was continued due to persistent contractions. Next morning, induction of childbirth was restarted and birth occurred in approximately 6 hours. The right lateral recumbent position was maintained for approximately 20 hours. At childbirth, a pressure ulcer was present in the intertrochanteric part of the right femur. The causes included insufficient knowledge of medical staff about the risk of pressure ulcer during epidural delivery, and no position change. A decreased sensation and blocked motor nerve caused by epidural anesthesia might have accelerated pressure ulcer development. This case suggests that preventive measures against pressure ulcer are required in epidural anesthesia in pregnant women. PMID:27483666

  16. Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1% no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20 mL de ropivacaina a 0,5, 0,75 ó 1% en el bloqueo de plexo braquial por la vía posterior Comparative study for the postoperative analgesic efficacy of 20 mL at 0.5, 0.75, and 1% ropivacaine in posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2008-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operatória de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual concentração de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória mais prolongada para essas operações. MÉTODO: Noventa pacientes submetidos ao bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1: 20 mL de ropivacaína a 0,5%; Grupo 2: 20 mL de ropivacaína a 0,75%; Grupo 3: 20 mL de ropivacaína a 1%. O bloqueio foi avaliado por meio da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV nas primeiras 48 horas. RESULTADOS: Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. CONCLUSÕES: Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Utilizando-se 20mL de ropivacaína, as três diferentes concentrações estudadas promovem analgesia similar.JUSTIFICATIVA Y OBJETIVOS: Las intervenciones quirúrgicas por vía artroscópica en el hombro se relacionan con el dolor postoperatorio de gran intensidad. Entre las técnicas de analgesia, el bloqueo del plexo braquial es la que ofrece los mejores resultados. El objetivo de este estudio fue determinar cuál concentración de anestésico local en el bloqueo de plexo braquial por la vía posterior, propicia analgesia postoperatoria más prolongada para esas operaciones. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por la v

  17. Sympathetic activity of S-(+-ketamine low doses in the epidural space

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    Slobodan Mihaljevic

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: S-(+-ketamine is an intravenous anaesthetic and sympathomimetic with properties of local anaesthetic. It has an effect of an analgetic and local anaesthetic when administered epidurally, but there are no data whether low doses of S-(+-ketamine have sympathomimetic effects. The aim of this study was to determine whether low doses of S-(+-ketamine, given epidurally together with local anaesthetic, have any effect on sympathetic nervous system, both systemic and below the level of anaesthetic block. METHODS: The study was conducted on two groups of patients to whom epidural anaesthesia was administered to. Local anaesthesia (0.5% bupivacaine was given to one group (control group while local anaesthesia and S-(+-ketamine were given to other group. Age, height, weight, systolic, diastolic and mean arterial blood pressure were measured. Non-competitive enzyme immunochemistry method (Cat Combi ELISA was used to determine the concentrations of catecholamines (adrenaline and noradrenaline. Immunoenzymometric determination with luminescent substrate on a machine called Vitros Eci was used to determine the concentration of cortisol. Pulse transit time was measured using photoplethysmography. Mann-Whitney U-test, Wilcoxon test and Friedman ANOVA were the statistical tests. Blood pressure, pulse, adrenaline, noradrenaline and cortisol concentrations were measured in order to estimate systemic sympathetic effects. RESULTS: 40 patients in the control group were given 0.5% bupivacaine and 40 patients in the test group were given 0.5% bupivacaine with S-(+-ketamine. Value p < 0.05 has been taken as a limit of statistical significance. CONCLUSIONS: Low dose of S-(+-ketamine administered epidurally had no sympathomimetic effects; it did not change blood pressure, pulse, serum hormones or pulse transit time. Low dose of S-(+-ketamine administered epidurally did not deepen sympathetic block. Adding 25 mg of S-(+-ketamine to 0

  18. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Rong Lin

    Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

  19. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Background and Aims: Opioids as epidural adjunct to local anesthetics (LA have been in use since long and α-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. Methods: A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist (ASA physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine (RD and Ropivacaine + Fentanyl (RF, comprising 50 patie nts each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 μg/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P<0.05 is considered significant and P<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 (7.12±2.44 vs 9.14±2.94 and establishment of complete motor blockade (18.16±4.52 vs 22.98±4.78 was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group (366.62±24.42 and consequently low dose consumption of local anaesthetic LA (76.82±14.28 vs 104.35±18.96 during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on

  20. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

    OpenAIRE

    Liu, E H C; Sia, A T H

    2004-01-01

    Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women.

  1. Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Hansen, B L;

    1992-01-01

    In a double-blind, randomized study, epidural infusions of low-dose morphine (0.2 mg/h) combined with low-dose bupivacaine (10 mg/h) were compared with epidural infusions of low-dose morphine (0.2 mg/h) alone for postoperative analgesia at rest and during mobilization and cough in 24 patients after...... mobilization from the supine into the sitting position 12 and 30 h after surgical incision and during cough 8, 12, and 30 h after surgical incision (P less than 0.05). We conclude, that low-dose epidural bupivacaine potentiates postoperative low-dose epidural morphine analgesia during mobilization and cough...

  2. Cuidados con el anciano con tos productiva.

    OpenAIRE

    Costa de Moura, María Lucia

    2005-01-01

    A partir de las informaciones y con la motivación para hacer un estudio dirigido a los cuidados con el anciano, sigue la necesidad del desarrollo de acciones pertinentes para la práctica de cuidar, o sea, la asistencia de enfermería prestada directamente al anciano, principalmente a aquellos que llegan a la unidad de salud quejándose de tos. El objeto de este estudio es la asistencia de enfermería basándome en las cuestiones que rodean la percepción del enfermero y cómo el...

  3. Parche de lidocaína al 5% para el tratamiento del SDRC de extremidad superior por bloqueo transcutáneo del plexo braquial: Caso Clínico Licodocaíne patch for the treatment of CRPS in the arm by transcutaneous block of the brachial plexus: Clinical case

    Directory of Open Access Journals (Sweden)

    M. A. Vidal

    2007-06-01

    Full Text Available El síndrome de dolor regional complejo (SDRC se manifiestan con una clínica variada que se caracteriza por dolor, impotencia funcional, trastornos vaso-sudomotores y alteraciones tróficas. Está causado por una lesión primaria o una disfunción del Sistema Nervioso Periférico, estableciéndose dos grupos: SDRC-I que sustituye al término DSR y el SDRCII en lugar del término causalgia. Caso clínico: Varón de 37 años de edad, que tras ser sometido a una artroscopia de hombro comenzó a presentar dolor en el hombro y limitación funcional importante, así como ciertos cambios vasomotores de la misma extremidad, por lo que se diagnosticó de SDRC. El paciente siguió varias pautas de tratamiento analgésico por vía oral, fue sometido a numerosas infiltraciones intraarticulares, se realizaron bloqueos del ganglio estrellado e inició tratamiento rehabilitador. Durante estos meses la evolución clínica del paciente fue tórpida, reapareciendo el dolor en todas las ocasiones y sin presentar mejoría de la movilidad. Se decidió iniciar tratamiento con parches de lidocaína al 5%, con lo que se consiguió controlar el dolor del paciente y finalizó la rehabilitación con recuperación completa. El parche de lidocaína al 5% es un analgésico tópico desarrollado para el tratamiento del dolor neuropático de origen periférico. Está aprobado en EEUU para el tratamiento de la neuralgia postherpética. Sin embargo, se está probando su utilización en otras formas de dolor neuropático, como la neuropatía diabética, el dolor crónico de espalda y el dolor miofascial. El SDRC está asociado con una actividad anormal del sistema nervioso simpático, por lo que el bloqueo simpático mediante anestésicos locales es ampliamente utilizado. En el caso concreto de los parches de lidocaína al 5% se ha publicado un caso de tratamiento de forma efectiva. Este caso es similar al que nosotros describimos, que también fue refractario al tratamiento

  4. Influência da freqüência de estímulos na instalação do bloqueio neuromuscular produzido pelo rocurônio e pancurônio: avaliação pelo método acelerográfico Influencia de la frecuencia de estímulos en la instalación del bloqueo neuromuscular producido por el rocuronio y pancuronio: evaluación por el método acelerográfico Influence of stimulation frequency on rocuronium and pancuronium-induced neuromuscular block onset: acceleromyography evaluation

    Directory of Open Access Journals (Sweden)

    Derli da Conceição Munhóz

    2004-02-01

    entre os grupos. As condições de intubação traqueal foram satisfatórias em 117 pacientes (97,5% e insatisfatórias em 3 (2,5%. CONCLUSÕES: O início de ação e o tempo para obtenção do bloqueio neuromuscular total no músculo adutor do polegar, produzidos pelo rocurônio e pelo pancurônio, são mais curtos quando há emprego de maiores freqüências de estímulos.JUSTIFICATIVA Y OBJETIVOS: Factores relacionados al paciente y al bloqueador neuromuscular (BNM, así como otros inherentes a la monitorización de la función neuromuscular pueden influenciar en la instalación del bloqueo neuromuscular. El objetivo de este estudio fue evaluar la influencia de dos frecuencias diferentes de estímulos sobre el tiempo de instalación del bloqueo producido por el pancuronio y por el rocuronio. MÉTODO: Fueron incluidos en el estudio 120 pacientes, estado físico ASA I y II, sometidos a cirugías electivas bajo anestesia general, distribuidos aleatoriamente en dos grupos, de acuerdo con la frecuencia de estímulo empleada, para la monitorización del bloqueo neuromuscular: Grupo I - 0,1 Hz (n = 60 y Grupo II - 1 Hz (n = 60. En cada grupo se formaron dos subgrupos (n = 30 de acuerdo con el bloqueador neuromuscular empleado: Subgrupo P (pancuronio y Subgrupo R (rocuronio. La medicación pre-anestésica consistió de midazolam (0,1 mg.kg-1 por vía muscular, 30 minutos antes de la cirugía. La inducción anestésica fue obtenida con propofol (2,5 mg.kg-1 precedido de alfentanil (50 µg.kg-1 y seguido de pancuronio o rocuronio. Los pacientes fueron ventilados bajo máscara con oxígeno a 100% hasta la obtención de reducción de 75% o más en la amplitud de la respuesta del músculo aductor del pulgar, cuando fueron realizadas las maniobras de laringoscopia e intubación traqueal. La función neuromuscular fue monitorizada con aceleromiografia. Fueron evaluados: tiempo de inicio de acción del pancuronio y del rocuronio; tiempo para instalación del bloqueo total y

  5. [Effect of the continuous epidural saline infusion for patients with postdural puncture headache after pulmonary resection].

    Science.gov (United States)

    Katayama, Tatsuya; Hirai, Shinji; Hamanaka, Yoshiharu; Fukui, Takayuki; Itou, Shimon; Hatooka, Shunzou; Mitsudomi, Tetsuya

    2011-11-01

    The dual puncture is one of the diseaseful complications at the induction of the epidural anesthesia, which causes severe symptoms of intracranial hypotension such as headache and nausea. The clinical courses of 3 patients with the dual puncture symptoms after pulmonary resections were retrospectively reviewed, and the effect of the continuous epidural saline infusion treatment (CESI) for the dual puncture was evaluated. Pneumococcal empyema developed in 1 patient who had been treated with conservative management. In contrast, the symptoms of the others who were treated with the CESI were quickly recovered or were effectively prevented. This report strongly suggested that the CESI was convenient and effective treatment for dual punctune symptoms by suppressing the cerebrospinal fluid leakage by elevation of the fluid pressure in the extradural space. PMID:22187867

  6. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Nygård, Eigil; Sørensen, Lars H; Hviid, Lamia B;

    2004-01-01

    OBJECTIVE: This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG). DESIGN AND SETTING......: The study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university. PARTICIPANTS: One hundred sixty-three patients scheduled for coronary artery bypass graft surgery. INTERVENTIONS: In this 2 x 2 factorial-designed study the patients were...... randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single...

  7. Plasma concentration and cardiovascular effects of lidocaine during continuous epidural administration in dogs anesthetized with isoflurane.

    Science.gov (United States)

    Sakonju, Iwao; Maeda, Kenichi; Karasawa, Koichi; Tadokoro, Toshiyuki; Kakuta, Tomoko; Takase, Katsuaki

    2011-03-01

    The cardiovascular effects of continuous epidural administration (CEA) of lidocaine were investigated in anesthetized dogs. Loading epidural injections of 2, 4, or 6 mg/kg of lidocaine were followed by CEA with 1, 2, or 3 mg/kg/hr lidocaine, respectively, for 2 hr under 2.0% isoflurane anesthesia. Heart rate, direct blood pressure, cardiac index, and stroke volume decreased dose-dependently during CEA, whereas systemic vascular resistance did not significantly differ with dose, and no characteristic changes were observed in any groups. Plasma lidocaine concentration reached a steady state during CEA and increased in a dose-dependent manner. Circulatory suppression caused by lidocaine CEA was not attributable to peripheral vasodilation, but rather to the direct cardiac action of systemic lidocaine absorption from the peridural space. PMID:21048393

  8. Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

    Directory of Open Access Journals (Sweden)

    A. L. M. J. van der Knijff-van Dortmont

    2016-01-01

    Full Text Available SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

  9. Evaluation of a segmented rectal probe and caudal epidural anesthesia for electroejaculation of bulls

    OpenAIRE

    Etson, Cathy J.; Waldner, Cheryl L.; Barth, Albert D.

    2004-01-01

    Changes in concentrations of cortisol and progesterone in serial blood samples were used to quantify a stress response to different methods of electroejaculation in 10 Hereford bulls. Treatments included restraint (control), and electroejaculation using rectal probes with segmented electrodes or conventional nonsegmented electrodes, with or without lidocaine caudal epidural anesthesia. A subjective scoring system was used to assess behavioral responses to the different methods of electroejacu...

  10. EPIDURAL ANESTHESIA FOR CESAREAN SECTION IN ATRIAL SEPTAL DEFECT WITH PULMONARY HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Rashmi

    2015-07-01

    Full Text Available Pregnant patients with atrial septal defect (ASD with pulmonary hypertension , occasionally present for anaesthesia . These patients are considered high risk for anaesthesia due to increased chances of per i operative cardiovascular complications . Anaesthesia requires intensive cardiovascular mo nitoring and maintenance of stable pulmonary and systemic haemodynamics . Here is a case of second gravida for LSCS which was managed under epidural anaesthesia successfully

  11. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    OpenAIRE

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D; Porath, Martina; Berg, Hans J. van den; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A.H.M.; Logtenberg, Sabine L M

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an intermediate to high obstetric risk with an intention to deliver vaginally. To exclude a clinically relevant difference in satisfaction with pain relief of more than 10%, we needed to include 1136 women....

  12. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

    OpenAIRE

    Akanksha Lamba; Priya Sardana; Ramanjeet Kaur

    2016-01-01

    Background: The pain of childbirth is one of the most severe types of pain that a woman experiences in her lifetime. Adequate analgesia during labour has a positive influence on the course of labour. For labor analgesia several non-pharmacologic and pharmacologic methods are adopted. The objective of the study is to compare parenteral tramadol and epidural ropivacaine with regard to maternal and labour outcome. Methods: This prospective, comparative, interventional clinical study was condu...

  13. A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats.

    Science.gov (United States)

    Lawal, F M; Adetunji, A

    2009-12-01

    A mixture of 2% lignocaine (LIG) and 0.5% bupivacaine (BUP), at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP), was compared to LIG (4 mg/kg) and BUP (1 mg/kg) for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg) and ketamine hydrochloride (10 mg/kg). Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR), respiratory frequency (fR) and rectal temperature (RT) were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 +/- 0.7 min), LIG (3.9 +/- 1.0 min) and BUP (5.0 +/- 1.0 min) was similar. Duration of analgesia with LIG-BUP (49.4 +/- 4.5 min) was significantly (P<0.05) longer than with LIG (40.2 +/- 1.0 min) but shorter than with BUP (79.4 +/- 6.3 min). There were no significant differences in times to standing with LIG-BUP (26.3 +/- 6.4 min), LIG (20.4 +/- 4.7 min) and BUP (22.6 +/- 10.3 min). Minimal changes were observed in HR, fR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP. PMID:20458866

  14. A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats

    Directory of Open Access Journals (Sweden)

    F.M. Lawal

    2009-05-01

    Full Text Available A mixture of 2% lignocaine (LIG and 0.5% bupivacaine (BUP, at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP, was compared to LIG (4 mg/kg and BUP (1 mg/kg for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg and ketamine hydrochloride (10 mg/kg. Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR, respiratory frequency (ƒR and rectal temperature (RT were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 ± 0.7 min, LIG (3.9 ± 1.0 min and BUP (5.0 ± 1.0 min was similar. Duration of analgesia with LIG-BUP (49.4 ± 4.5 min was significantly (P < 0.05 longer than with LIG (40.2 ± 1.0 min but shorter than with BUP (79.4 ± 6.3 min. There were no significant differences in times to standing with LIG-BUP (26.3 ± 6.4 min, LIG (20.4 ± 4.7 min and BUP (22.6 ± 10.3 min. Minimal changes were observed in HR, ƒR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP.

  15. Lumbar Discectomy of a Patient of Mitral Stenosis with Chronic Atrial Fibrillation Under Epidural Anaesthesia

    Directory of Open Access Journals (Sweden)

    Vinaya R Kulkarni

    2008-01-01

    Full Text Available A 60-year-old female patient posted for discectomy of lumbar region L 3 -L 4 was accidently diagnosed to have chronic atrial fibrillation of rheumatic aetiology.This is a case report of this patient of critical mitral stenosis with mild mitral regurgitation with chronic atrial fibrillation managed successfully under lower thoracic epidural anaesthesia,in prone position without any compli-cation.

  16. Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor

    Directory of Open Access Journals (Sweden)

    Veena Chatrath

    2015-01-01

    Full Text Available Background: Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome. Materials and Methods: A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 μg fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ≥ 4. Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome. Results: Patients in Group II had significantly prolonged analgesia (145 ± 9 minutes than in Group I (95 ± 7 minutes. Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent. Conclusions: Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects.

  17. [The characteristics of epidural analgesia during the removal of lumbar intervertebral disk hernias].

    Science.gov (United States)

    Arestov, O G; Solenkova, A V; Lubnin, A Iu; Shevelev, I N; Konovalov, N A

    2000-01-01

    Epidural analgesia (EA) was used in 29 patients undergoing surgical removal of lumbar discal hernia. Marcain EA with controlled medicinal sleep and non-assisted breathing allowed to perform the whole operation in 27 patients. EA may be ineffective in combination of sequestrated disk hernia with scarry adhesive process. The technique of the operation demands a single use of the anesthetic drug which is potent enough to make blockade throughout the operation up to the end. PMID:10738758

  18. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    BACKGROUND: Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. RESULTS......: Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions...

  19. Evaluation of prostaglandin D2 as a CSF leak marker: implications in safe epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Kondabolu S

    2011-07-01

    Full Text Available Sirish Kondabolu, Rishimani Adsumelli, Joy Schabel, Peter Glass, Srinivas PentyalaDepartment of Anesthesiology, School of Medicine, Stony Brook Medical Center, Stony Brook, New York, USABackground: It is accepted that there is a severe risk of dural puncture in epidural anesthesia. Of major concern to anesthesiologists is unintentional spinal block. Reliable identification of cerebrospinal fluid (CSF from the aspirate is crucial for safe epidural anesthesia. The aim of this study was to determine whether prostaglandin D2 could be clinically used as a marker for the detection of CSF traces.Methods: After obtaining Institutional Review Board approval and patient consent, CSF was obtained from patients undergoing spinal anesthesia, and blood, urine, and saliva were obtained from normal subjects and analyzed for prostaglandin D2 (PGD. CSF (n=5 samples were diluted with local anesthetic (bupivacaine, normal saline and blood in the ratios of 1:5 and 1:10. PGD levels in the CSF samples were analyzed with a PGD-Methoxime (MOX EIA Kit (Cayman Chemicals, MI. This assay is based on the conversion of PGD to a stable derivative, which is analyzed with antiserum specific for PGD-MOX. Results: Different concentrations of pure PGD-MOX conjugate were analyzed by EIA and a standard curve was derived. PGD levels in CSF and CSF with diluents were determined and the values were extrapolated onto the standard curve. Our results show a well-defined correlation for the presence of PGD both in straight CSF samples and in diluted CSF (dilution factor of 1:5 and 1:10. Conclusion: Prostaglandin D2 was reliably identified in CSF by enzyme-linked immunosorbent assay when diluted with local anesthetic, saline, and serum, and can be used as a marker to identify the presence of CSF in epidural aspirates.Keywords: epidural, cerebrospinal fluid, leak, marker, prostaglandin D2

  20. Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative patients

    Energy Technology Data Exchange (ETDEWEB)

    Simao, Marcelo Novelino, E-mail: marcelo_simao@hotmail.com [Central de Diagnostico Ribeirao Preto (CEDIRP), Ribeirao Preto, SP (Brazil); Helms, Clyde A. [Radiology, Musculoskeletal Section, Duke University Medical Center, Durham, NC (United States); Richardson, William J. [Orthopedic Surgery, Spine Surgery Section, Duke University Medical Center, Durham, NC (United States)

    2012-07-15

    Objective: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. Materials And Methods: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. Results: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. Conclusion: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified. (author)

  1. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589

  2. Epidural ropivacaine hydrochloride during labour: protein binding, placental transfer and neonatal outcome.

    LENUS (Irish Health Repository)

    Porter, J M

    2012-02-03

    This study was undertaken: (i) to quantify the effects of labour and epidural analgesia on plasma alpha1-acid glycoprotein concentration, (ii) to examine the effects of changes in plasma alpha1-acid glycoprotein concentration on plasma protein binding and placental transfer of ropivacaine, and (iii) to examine the association between umbilical venous ropivacaine concentration and neurobehavioural function in the neonate. Multiparous patients undergoing induction of labour received a continuous epidural infusion of 0.1% ropivacaine following an epidural bolus. A significant association was demonstrated between maternal plasma alpha1-acid glycoprotein concentration and 1\\/free fraction of ropivacaine 60 min after starting ropivacaine administration (r(2) = 0.77) but not at delivery. No significant correlation was demonstrable between maternal unbound ropivacaine concentration and either neonatal (cord) ropivacaine concentration or UV\\/MV (a measure of placental transfer). Thirty minutes after delivery, 9\\/10 neonates had neurological and adaptive capacity scores < 35, whereas only three infants had scores < 35 at 2 h. All scores exceeded 35 16 h after delivery. No association between mean (SD) umbilical venous ropivacaine concentration [0.09 (0.08) mg x l(-1)] and neurological and adaptive capacity scores was demonstrated.

  3. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

    Directory of Open Access Journals (Sweden)

    Amitabh Sagar

    2010-01-01

    Full Text Available We present a case of a 42-year-old male, an old case of deep vein thrombosis on warfarin and other drugs like quetiapine, aspirin, diclofenac sodium, fenofibrate, atorvastatin, propanolol and citalopram for concurrent illnesses, who presented with widespread mucocutaneous bleeding and epidural spinal hematoma. The epidural bleed presented clinically as a nontraumatic, rapidly improving myeloradiculopathy. Magnetic resonance imaging (MRI of the spine revealed an epidural hematoma at D12-L1 level. The case was managed conservatively due lack of neurosurgical facilities. The patient gained full neurological recovery on conservative management alone. This case highlights the problem of drug interaction on warfarin therapy and also an unusual spontaneous recovery of spinal hematoma. Our case was anticoagulated in the recommended therapeutic INR range of 2.2 to 2.4. Most of the similar cases reported in literature were also anticoagulated in the therapeutic range. Thus intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient on anticoagulant agents who complains of local or referred spinal pain associated with neurological deficits. Drug interactions with warfarin are common. High suspicion and immediate intervention are essential to prevent complications from intraspinal hemorrhage.

  4. Decoding the rat forelimb movement direction from epidural and intracortical field potentials

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    Slutzky, Marc W.; Jordan, Luke R.; Lindberg, Eric W.; Lindsay, Kevin E.; Miller, Lee E.

    2011-06-01

    Brain-machine interfaces (BMIs) use signals from the brain to control a device such as a computer cursor. Various types of signals have been used as BMI inputs, from single-unit action potentials to scalp potentials. Recently, intermediate-level signals such as subdural field potentials have also shown promise. These different signal types are likely to provide different amounts of information, but we do not yet know what signal types are necessary to enable a particular BMI function, such as identification of reach target location, control of a two-dimensional cursor or the dynamics of limb movement. Here we evaluated the performance of field potentials, measured either intracortically (local field potentials, LFPs) or epidurally (epidural field potential, EFPs), in terms of the ability to decode reach direction. We trained rats to move a joystick with their forepaw to control the motion of a sipper tube to one of the four targets in two dimensions. We decoded the forelimb reach direction from the field potentials using linear discriminant analysis. We achieved a mean accuracy of 69 ± 3% with EFPs and 57 ± 2% with LFPs, both much better than chance. Signal quality remained good up to 13 months after implantation. This suggests that using epidural signals could provide BMI inputs of high quality with less risk to the patient than using intracortical recordings.

  5. Insidious Onset of Tetraparesis due to Cervical Epidural Abscess from Enterococcus faecalis

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    Konstantinos Chr. Soultanis

    2013-01-01

    Full Text Available We report a case of cervical epidural abscess from Enterococcus faecalis, which caused an insidious onset of tetraparesis. This 53-year-old female with a history of diabetes mellitus and chronic renal failure under hemodialysis presented with pain and progressive weakness of upper and lower extremities without fever. Although a recent MRI she did at the beginning of symptoms showed no significant pathologies, except for a cervical disc herniation and adjacent spinal degeneration, and stenosis that confused the diagnostic procedure, newer imaging with CT and MRI, which was performed due to progression of tetraparesis, revealed the formation of a cervical epidural abscess. Surgical drainage was done after a complete infection workup. The patient showed immediate neurological improvement after surgery. She received antibiotics intravenously for 3 weeks and orally for another 6 weeks. The patient was free from complications 24 months after surgery. A high index of suspicion is most important in making a rapid and correct diagnosis of spinal epidural abscess. The classic clinical triad (fever, local pain, and neurologic deficits is not sensitive enough for early detection. Continuous clinical, laboratory, and imaging monitoring are of paramount importance. Early diagnosis and surgical intervention could optimize the final functional outcome.

  6. [Effects of epidural analgesia combined with general anesthesia on hemodynamics during neck surgery].

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    Arakawa, M; Amemiya, N; Nagai, K; Kato, S; Goto, F

    1993-10-01

    The aim of the present study was to investigate the effect of epidural analgesia combined with general anesthesia on hemodynamics. Thirty patients undergoing surgery for the treatment of cancer of the neck were studied. The patients were divided into two groups of those who received epidural analgesia combined with general anesthesia group (Group 1) and those with general anesthesia alone (Group 2). Blood pressure was not different between the groups. But heart rate and rate pressure products in Group 1 were significantly lower than those of Group 2. CVP in Group 1 increased significantly to 10.1 +/- 2.9 mmHg during surgery from 6.8 +/- 1.8 mmHg at the beginning of the surgery. There was no difference in intraoperative blood loss and the amount of fluid infused between the two groups. These results suggest that epidural anesthesia combined with general anesthesia is effective to stabilize hemodynamics during cervical surgery, but we have to be careful about using local anesthetics during long cervical procedures, because it increases CVP which might result from the depression of cardiac function. PMID:8230698

  7. [Temperature changes and thermoregulatory responses during epidural anesthesia in women undergoing cesarean delivery].

    Science.gov (United States)

    Negishi, C; Ozaki, M; Suzuki, H; Ohno, T

    1996-05-01

    Eleven healthy pregnant women were studied to determine temperature changes after induction of epidural anesthesia during cesarean delivery. Epidural anesthesia was induced by 2% lidocaine 15-20 ml (T 5 level) at 25 degrees C ambient temperature. Tympanic membrane and skin surface temperature, skin-temperature gradients (forearm-fingerchip, calf-toe), thermal perception (1-10 scale VAS) and the presence or absence of shivering were measured. Sixty minutes after induction, tympanic temperature decreased for 0.52 +/- 0.26 degrees C and average skin temperature increased for 0.56 +/- 0.17 degrees C. Central hypothermia and shivering did not produce a cold sensation. Temperature gradients of upper limb increased to 2.0 +/- 3.7 degrees C (50 minutes after induction) and the lower limbs decreased to -1.4 +/- 0.55 degrees C (30 minutes after induction). Shivering occurred in 3 patients. We conclude that epidural anesthesia impaired thermoregulatory control and induced redistribution hypothermia as in nonpregnant individuals.

  8. Spine epidural and sacroiliac joints injections – when and how to perform

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    D’Orazio, Federico, E-mail: federico.dorazio@gmail.com; Gregori, Lorenzo Maria, E-mail: lollog@hotmail.it; Gallucci, Massimo, E-mail: massimo.gallucci@cc.univaq.it

    2015-05-15

    Highlights: • Image guided interventions focused to administer drugs inside the epidural space are effective in reducing the perceived spinal pain, but their efficacy seems to be limited in time. • To treat spinal pain with image guided interventions is safe and repeatable. • Sacroiliac dysfunction is a common cause of sciatica-like pain which can be treated with CT-guided interventions (both steroids and pulsed RF denervation). - Abstract: Objectives: To review the state-of-the-art of image – guided techniques used to treat painful syndromes of the lower back, their indications, how they should be performed, their related risks and the expected results. Methods: We describe the actual standards about image-guided infiltrative therapies both on spine and on sacroiliac joints. Results: Both spinal epidural and sacroiliac injections appear useful in a large percentage of treated patients to get control of the perceived pain. Performing these therapies under CT or fluoroscopic guidance is the best and safest way to obtain satisfactory results because it is possible to target the use of drugs directly to the involved painful structures. Conclusions: Image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time but considering the low associated risk when performed by trained personnel, they can be easily repeated.

  9. Learned self-regulation of the lesioned brain with epidural electrocorticography

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    Alireza eGharabaghi

    2014-12-01

    Full Text Available Introduction: Different techniques for neurofeedback of voluntary brain activations are currently being explored for clinical application in brain-related disorders. One of the most frequently used approaches is the self-regulation of oscillatory signals recorded with electroencephalography (EEG. Many patients are, however, not in a position to use such tools. This could be due to the specific anatomical and physiological properties of the patient's brain after the lesion, as well as to methodological issues related to the technique chosen for recording brain signals.Methods: A patient with extended ischemic lesions of the cortex was unable to gain volitional control of sensorimotor oscillations when using a standard EEG-based approach. We provided him with a neurofeedback set-up with which his brain activity could be recorded from the epidural space by electrocorticography (ECoG.Results: Ipsilesional epidural recordings of field potentials facilitated learned self-regulation of brain oscillations in an online closed-loop paradigm and allowed swift and reliable neurofeedback training for a period of four weeks on a daily basis.Conclusion: Epidural implants may decode and train brain activity even when the cortical physiology is distorted following severe brain injury. Such practice would allow for reinforcement learning of preserved neural networks and may well provide restorative tools for those patients who are worst afflicted.

  10. Chlorhexidine Gluconate Dressings Reduce Bacterial Colonization Rates in Epidural and Peripheral Regional Catheters

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    Klaus Kerwat

    2015-01-01

    Full Text Available Introduction. Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. Methods. In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. Results. A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. Conclusion. CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.

  11. The Effect of Dexmedetomidine on Lumbar Epidural Injection for Failed Back Surgery Syndrome

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    Ashraf Eskandr

    2016-01-01

    Full Text Available Purpose. Failed back surgery syndrome is a chronic pain condition requiring rapid, effective, and efficient management. This study evaluates the effect of adding dexmedetomidine to lumbar epidural steroids in patients with failed back surgery syndrome. Methods. Fifty patients suffering from failed back surgery syndrome were randomly assigned to one of two groups, receiving an epidural injection of 20 mL of either a mixture of betamethasone (14 mg and bupivacaine 0.5 mg (group C or a mixture of betamethasone (14 mg, bupivacaine 0.5 mg, and dexmedetomidine (0.5 μg/kg (group D adjusted to the volume with normal saline. The effect was evaluated using visual analogue scale (VAS, analgesic requirement, and Oswestry disability index 2 weeks, 4 weeks, 8 weeks, and 12 weeks after injection. Results. VAS and ibuprofen consumption showed a significant reduction in group D. The Oswestry disability index was significantly improved in group D. There were no records of hypotension, bradycardia, sedation, or hypoxemia in both groups. Conclusion. The present study demonstrated potential safe and effective usage of adding dexmedetomidine to epidural steroid to control pain in patients with failed back surgery syndrome.

  12. Spinal epidural haematoma: report of 11 cases and review of the literature

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    Boukobza, M. (Dept. of Neuroradiology and Therapeutic Angiography, Hopital Lariboisiere, Paris (France)); Guichard, J.P. (Dept. of Neuroradiology and Therapeutic Angiography, Hopital Lariboisiere, Paris (France)); Boissonet, M. (Dept. of Neurosurgery, Hopital Lariboisiere, Paris (France)); George, B. (Dept. of Neurosurgery, Hopital Lariboisiere, Paris (France)); Reizine, D. (Dept. of Neuroradiology and Therapeutic Angiography, Hopital Lariboisiere, Paris (France)); Gelbert, F. (Dept. of Neuroradiology and Therapeutic Angiography, Hopital Lariboisiere, Paris (France)); Merland, J.J. (Dept. of Neuroradiology and Therapeutic Angiography, Hopital Lariboisiere, Paris (France))

    1994-08-01

    Spinal epidural haematomas (SEH) are rare; most are caused by trauma, anticoagulant therapy, vascular anomalies, hypertension, blood dyscrasias, epidural anaesthesia or, rarely, spinal surgery. We report 11 cases and review the literature (16 cases). The clinical picture is that of acute spinal cord compression. MRI characteristics are quite specific. On sagittal sections, the SEH appears as a biconvex mass, dorsal to the thecal sac, clearly outlined and with tapering superior and inferior margins. The dura mater is seen as curvilinear low signal separating the haematoma from the cord. Within 24 h of onset, the haematoma is isointense with the cord on T1-weighted images and heterogeneous on T2-weighted images. Later, it gives high signal on both T1- and T2-weighted images. Differential diagnosis must include subdural haematoma, epidural neoplasm and abscess. Complete neurological recovery rapidly follows laminectomy and removal of the clot. In three of our cases, the haematoma resolved spontaneously. MRI is the best examination for diagnostic and follow-up. (orig.)

  13. Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery

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    Gaurav Jain

    2012-01-01

    Full Text Available Background: To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA using lignocaine (1%, bupivacaine (0.25% and ropivacaine (0.5% for thyroid surgery. Methods: In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications. Results: Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups. Conclusion: We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine.

  14. Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases

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    Chiapparini, L.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milano (Italy); Sghirlanzoni, A.; Pareyson, D. [Department of Neurology, Istituto Nazionale Neurologico, Milano (Italy)

    2000-08-01

    We reviewed the clinical and neuroradiological features in 16 patients with serious neurological complications of lumbar epidural anaesthesia. We observed acute, transient or permanent and delayed complications. Four patients had symptoms immediately after the procedure. One patient developed a subacute flaccid paraparesis. Two other patients had infectious spondylodiscitis at lumbar puncture level. Eight patients had a delayed progressive spastic paraparesis and were found to have subarachnoid cysts and irregularities of the surface of the spinal cord consistent with arachnoiditis; six of them had an extensive, complex syrinx within the cord. One patient had a severe lumbar polyradiculopathy, and MRI showed adhesive arachnoiditis involving the cauda equina. Although epidural anaesthesia is generally considered safe, rare but severe complications, such as radiculopathy, infectious disease, myelopathy from ischemia and arachnoiditis with a syrinx may occur. The patients with arachnoiditis had a relentless progression of the disease and a poor outcome: five are confined to a wheelchair, one is bedridden. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia may be ignored or underestimated when they appear after a delay. Awareness of the possibility of delayed complications is important. (orig.)

  15. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

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    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.

  16. Treatment of degenerative chronic low back pain with fluoroscopically guided epidural procaine-corticosteroid injection

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    Ćulafić Slobodan

    2008-01-01

    Full Text Available Background/Aim. Low back pain is one of the most common painful conditions in the modern age. Therefore, it is very important to establish the most effective protocol for the treatment of this condition. The aim of this study was to find out if fluoroscopically, guided epidural procainecorticosteroid injection is effective in the treatment of degenerative chronic low back pain. Methods. This prospective cohort study was performed in the Military Medical Academy from September 2005 to June 2006 and included 60 patients of both sexes, 34-85 years of age. Degenerative changes of lumbosacral spine were determined by magnetic resonance imaging. The intensity of low back pain was evaluated by subjective (Roland's scale and objective parameter (Lazarevic sign. Epidural procaine-corticosteroid injection was applied in the patients with low back pain not responding to conservative therapy. After the application of injection, effects of the therapy were followed up. Results. In 92% of the patients there was a reduction of pain intensity for three months, in 4.8% a reduction for a month, but after another injection they felt pain reduction for the next three months. One patient (2.3% had pain reduction for one month. Conclusion. In the treatment of degenerative chronic low back pain, not responding to conservative therapy with nonsteroidal anti-inflammatory drugs, epidural procaine-corticosteroid injection have a satisfactory short-term as well as a long-term analgesic effect.

  17. Cervical Transforaminal Epidural Steroid Injection (Taffies): Role of MR Imaging and Epidurography

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    Choi, Soo Jung; Ahn, Jae Hong; Kim, Chung Hwan; Jung, Seung Moon; Ryu, Dae Sik; Park, Man Soo; Lee, Jong Hyeog [GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of); Song, Jae Seok [University of Kwandong College of Medicine, Goyang (Korea, Republic of)

    2011-01-15

    To evaluate the relationship between MR/epidurographic findings and the clinical outcome after a fluoroscopy-guided transforaminal epidural steroid injection (TFESI) in patients with cervical radicular pain. Forty-five patients who had taken a cervical TFESI in our department were included in this study. We retrospectively reviewed MR and epidurographic findings to see if there was a relationship between these methods and the amount of pain relief, by way of a multiple regression analysis. On MR imaging, there was significant relationship between the amount of pain relief and location of herniated intervertebral disc (HIVD, central: 54.4%, lateral recess: 69.4%, foraminal: 59%: p = 0.048). There was no significant difference regarding the other MR findings. On epidurographic findings, there was significant difference in the amount of pain relief with the extent of the contrast (epidural and epineural space, 65.3%: epineural space only, 64.2%: p = 0.03) and location of the needle tip (in the foramen, 59.4%: outside the foramen, 68.4%: p = 0.002). The results indicate that TFESI could be more useful in patients with cervical HIVD in lateral recess rather than another location. Contrast spread into epidural reflux appears to be a favorable injection pattern. Needle tip location is recommended outside the foramen rather than in the foramen

  18. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

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    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  19. Effect of epidural analgesia with 0.075% ropivacaine versus 0.1%ropivacaine on the maternal temperature during labor:a randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    YUE Hong-li; SHAO Liu-jiazi; LI Jin; WANG Ya-nan; WANG Lei; HAN Ru-quan

    2013-01-01

    Background A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever.Recently,evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever.The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1%ropivacaine on the maternal temperature during labor.Methods Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine.Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 μg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine,and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia.The measurements included the maternal oral temperature,visual analog scale pain scores,labor events and neonatal outcomes.Results Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1%ropivacaine.Moreover,0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes.Conclusion Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

  20. Dual renin-angiotensin system blockade plus oral methylprednisone for the treatment of proteinuria in IgA nephropathy Doble bloqueo del sistema renina-angiotensina más metilprednisona oral para el tratamiento de la proteinuria en la nefropatía por IgA

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    Hernán Trimarchi

    2007-10-01

    Full Text Available Renin-angiotensin system inhibition is a widely accepted approach to initially deal with proteinuria in IgA nephropathy, while the role of immunosuppressants remains controversial in many instances. A prospective, uncontrolled, open-label trial was undertaken in patients with biopsy-proven IgA nephropathy with proteinuria > 0.5 g/day and normal renal function to assess the efficacy of a combination treatment of angiotensin converting enzyme inhibitors plus angiotensin receptor blockers enalapril valsartan coupled with methylprednisone to decrease proteinuria to levels below 0.5 g/day. Twenty patients were included: Age 37.45 ± 13.26 years (50% male; 7 patients (35% were hypertensive; proteinuria 2.2 ± 1.86 g/day; serum creatinine 1.07 ± 0.29 mg/dl; mean follow-up 60.10 ± 31.47 months. IgA nephropathy was subclassified according to Haas criteria. Twelve patients (60% were class II; seven (35% were class III and one (5% class V. All patients received dual reninangiotensin system blockade as tolerated. Oral methylprednisone was started at 0.5 mg/kg/day for the initial 8 weeks and subsequently tapered bi-weekly until the maintenance dose of 4 mg was reached. Oral steroids were discontinued after 24 weeks (6 months of therapy but renin-angiotensin inhibition remained unchanged. At 10 weeks of therapy proteinuria decreased to 0.15 ± 0.07 g/day (P El doble bloqueo del sistema renina-angiotensina con inhibidores de la enzima convertidora de angiotensina junto a bloqueadores del receptor tipo I de angiotensina II es aceptado como tratamiento en la proteinuria de la nefropatía por IgA, ya que el rol de los inmunosupresores continúa siendo controvertido. Estudio prospectivo, no controlado, abierto para pacientes con nefropatía por IgA con proteinurias >0.5 g/día y creatininas séricas <1.4 mg/dl, para evaluar la eficacia de tratamiento de enalapril más valsartán asociado a metilprednisona vía oral para disminuir las proteinurias a <0.5 g

  1. Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

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    Manchikanti L

    2012-08-01

    Full Text Available Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati,1 Ramsin Benyamin3,41Pain Management Center of Paducah, Paducah, KY; 2University of Louisville, Louisville, KY; 3Millennium Pain Center, Bloomington, IL; 4University of Illinois, Urbana-Champaign, IL, USAAbstract: Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures, the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management

  2. Effect of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits

    Institute of Scientific and Technical Information of China (English)

    LIU Li-min; SONG Yue-ming; DUAN Hong; DING Yong-li; LU Bing

    2006-01-01

    Objective: To determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits.Methods: Twenty-four apanese white rabbits underwent laminectomy (including the attached ligaments)at L2 and Ls. After laminectomy at L5, polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at L2 , nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12weeks. Then the operated spine was observed grossly,histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intracellular structure of fibroblasts.Results: The glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group,which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group.However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in

  3. Influencia de la analgesia epidural sobre la incidencia de taquiarritmias en el postoperatorio de la cirugía pulmonar Influence of epidural analgesia on the incidence of tachyarrhythmia during pulmonary surgery postoperative

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    A. Gutiérrez-Guillén

    2004-02-01

    Full Text Available Objetivos: Valorar la influencia del uso de analgesia epidural torácica (AET intra y postoperatoria sobre la presentación de taquiarritmias en el postoperatorio de las resecciones pulmonares. Material y métodos: Se han analizado, de forma retrospectiva, los cursos postoperatorios de 200 pacientes consecutivos intervenidos de resecciones pulmonares mayores (lobectomías, bilobectomías y neumonectomías en nuestro hospital durante el periodo comprendido entre octubre de 1998 y junio de 2002. En este tiempo se ha introducido progresivamente en nuestro Servicio la AET como parte de la técnica anestésica en cirugía pulmonar. Se ha analizado la influencia del empleo de AET en la presentación de episodios de taquiarritmia supraventricular en las primeras 48 horas de postoperatorio. Resultados: Se empleó AET para el manejo anestésico y control del dolor postoperatorio en el 49,5% de los casos (99/200. No existen diferencias significativas entre los grupos de pacientes con y sin AET en cuanto a edad, sexo, riesgo ASA, duración de la intervención y tipo de resecciones practicadas. Presentaron crisis de taquiarritmia el 9,5% de los pacientes (19/200, tratándose, en todos los casos, de fibrilación auricular paroxística. Entre los pacientes que no recibieron AET la tasa de arritmias fue del 13,86% (14/101, mientras que en aquellos en los que se empleó AET como parte de la téc