FacebookTwitterLinkedin

Anestesia de plexo

DETECTION OF INTRANEURAL NEEDLE PLACEMENT WITH MULTIPLE FREQUENCY BIO-IMPEDANCE
Dr. Axel R. Sauter 1,2

1 Department of Research and Development Oslo University Hospital. Oslo. Norway

2 Department of Anesthesiology and Pain Medicine lnselspital, Bern University Hospital. Bern, Switzerland


Nerve injuries related to peripheral nerve blocks can be caused by toxicity of the injectied solution or by mechanical nerve damage. In the worst cases, nerve damage can lead to persistent motor or sensory impairment and debilitating neuropathic pain 1, 2. Thus, it is highly important to avoid such iatrogenic injuries. Penetration of a nerve alone does not necessarily lead to lasting damage unless local anesthetic is injected within the nerve fascicle 3.Hence, if intraneural needle placement is identified in time, the needle could be withdrawn and nerve injury can be avoided. Ultrasound guidance 4, electrical nerve stimulation 5- 7, and injection pressure measurements 8, 9 are used to reduce the risk of intraneural needle placement and injection.

Regístrese para leer más...

ANESTESIA DE PLEXO. DEXAMETASONA COMO COADYUVANTE. ¿MEJORA DE RESULTADOS EN ANESTESIA REGIONAL?
Dr. José Manuel López González

Servicio de Anestesiología, Reanimación y Tratamiento del Dolor Hospital Universitario Lucus Augusti. Lugo

En la actualidad, la evidencia científica disponible confirma que el dolor agudo postoperatorio (DAP) continúa siendo una gran preocupación para los pacientes que se someten a cualquier tipo de cirugía. De hecho, recientes encuestas han demostrado que alrededor del 30-60% de los pacientes continúan sufriendo dolor de intensidad moderada-severa durante el periodo postoperatorio, a pesar de que los bloqueos nerviosos periféricos (BNP) están considerados como la técnica de elección para el manejo del dolor perioperatorio, sobre todo en cirugía ambulatoria . Comparado con la inyección única perineural, el bloqueo continuo del nervio periférico a través de catéteres perineurales, ha resultado ser mucho más eficaz, reduciendo el dolor hasta 48 horas tras la intervención, disminuyendo también el consumo de opioides, la incidencia de náuseas y vómitos y aumentando el grado de satisfacción del paciente. Sin embargo, estas técnicas son más costosas en material, dedicación y tiempo, en comparación con la punción única, además de que no todos los anestesiólogos disponen de la posibilidad o formación para realizarlas. Los catéteres para analgesia continua sobre nervio periférico presentan además probabilidad de desplazamiento o migración, pudiendo resultar en un bloqueo fallido o una mala calidad analgésica.

Regístrese para leer más...

THE SHAMROCK LUMBAR PLEXUS BLOCK
Dr. Axel R. Sauter

Department of Research and Development. Oslo University Hospital. Oslo. Norway

Department of Anesthesiology and Pain Medicine. lnselspital, Bern University Hospital. Bern, Switzerland

Peripheral nerve blocks (PNB) provide important benefits in the peri- and postoperative treatment of patients with lower limb surgery. Compared to the use of general, spinal, or epidural anaesthesia, improved hemodynamic stability can be maintained with PNB. Continuous nerve blocks with catheter placement are suitable for prolonged postoperative analgesia in many orthopaedic patients. This is particularly useful because the use of epidural catheters is no longer recommended for routine pain treatment after major orthopaedic surgery. Nerve supply of the lower extremity comes from two major neural pathways formed by the lumbar and sacral plexus. The lumbar plexus is formed by the ventral rami of the nerve roots L1 to L4, with a contribution from T12. The plexus is situated within the psoas mayor muscle, ventrally to the transverse processes.

Regístrese para leer más...

ROLE OF INJECTION PRESSURE MONITORING IN PLEXUS ANAESTHESIA
Andrzej Krol, MD, DEAA, FRCA, FFPMRCA

St George's University Hospitals, London, UK

Recomendations for standard monitoring during general anaesthesia and recovery has been published and well established by various anaesthesia societies including AAGBI (Association of Anaesthetists of Great Britain and Ireland), RCA (Royal College of Anaesthetists) , ESA (European Society of Anesthesiologists) , just too only mention a few. The same monitoring principle apply to any interventions under regional anesthesia, both neuraxial and peripheral plexus anaesthesia. How to monitor needle trajectory and final tip position has not been clearly defined. Anatomical landmarks and paresthesia were widely accepted end points until mid seventies when nerve stimulator was introduced into contemporary regional anaesthesia practice . Nerve stimulator introduction came not without criticism – and famous become quote “ no paresthesia no analgesia”.

Regístrese para leer más...

NEW TRENDS IN REGIONAL ANESTHESIA

Vincent WS Chan

Department of Anesthesia

University of Toronto

 

The choice of regional anesthesia to provide surgical anesthesia and postoperative analgesia has been evolving in recent years as a response to the changing practice of surgery.  The new trend in surgery favors outpatient surgery that does not involve an overnight hospital stay, minimally invasive surgery (laparoscopic technique) that causes less pain and surgery in patients of advancing age and with multiple comorbidities, e.g., hypertension, diabetes, obesity and obstructive sleep apnea. Regional anesthesia has become a very attractive option for outpatient surgery because it can offer excellent pain relief without causing nausea and vomiting, provide anesthesia with minimal hemodynamic and respiratory derangement (especially with peripheral nerve block technique) and circumvent the challenge of intubating the difficult airway.

Regístrese para leer más...