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Biomedical subjects

J De Andrés

Publications and source records attributed to J De Andrés.

At least 19 recordsLinked to original sources
PubMed2007

Anticlotting drugs and regional anaesthetic and analgesic techniques: comparative update of the safety recommendations.

The wide use of anticlotting drugs by patients scheduled for surgery is a challenge for the anaesthesiologist when considering a regional anaesthesia technique. This practice seems safe if there is an appropriate management based on safety intervals established according to the pharmacology of the drug and the regional technique. Some anaesthesiology societies have published recommendations for the safe practice of regional anaesthesia with the simultaneous use of anticoagulants (heparin, low molecular weight heparins, oral anticoagulants (OA), fondaparinux and others) and antiplatelet agents (aspirin, clopidogrel, ticlopidine, argatroban and others). One of the most recent guidelines has been published by the Spanish Society of Anaesthesia and Critical Care. This article reviews these recommendations and compares them with others published in the last years. The recommendations are similar, but some interesting differences can be observed and need to be considered. A European consensus in this setting would probably be necessary.

Analgesia↗
PubMed2005

[Identification of the epidural space: usual practice among Spanish anesthesiologists].

OBJECTIVE: To determine what methods are habitually used by Spanish anesthesiologists to identify the epidural space. MATERIAL AND METHODS: Spanish anesthesiologists were asked to fill in an Internet questionnaire about the methods they had learned during residency training for identifying the epidural space, the method they currently use most often, and the one they consider best for residents to learn during training. RESULTS: Responses were received from 617 anesthesiologists. The techniques the respondents had learned during training were loss of resistance to air (LOR-A), 58.5%; LOR to saline (LOR-S), 31.9%; LOR and air bubble (LOR-B), 6.1%; and the hanging drop method, 2.4%. Those who had learned the LOR-A technique had changed in 14.2% of the cases, as had 28.4% of those who learned the LOR-S procedure. LOR-A is currently used by 59.2% of the respondents, LOR-S is used by 32.4%, and LOR-B by 6%. The respondents recommended that new residents physicians learn the LOR-A (48.5%) and LOR-S (37.8%) techniques. The LOR-B is recommended by 12.6% a much larger percentage of anesthesiologists than it is habitually used by. Of those who use the LORA technique habitually, 26.4% recommend that new residents use a different procedure. CONCLUSIONS: The procedure used most often by Spanish anesthesiologists to identify the epidural space is the LOR-A technique; however, over a quarter of Spanish users of LOR-A do not recommend it.

Anesthesia, Epidural↗
PubMed2004

[Ultrasound-guided posterior approach to block the sciatic nerve at the popliteal fossa].

The recent introduction of ultrasound guidance for locating peripheral nerves and nerve plexi has allowed injection of anesthetic agents to block the sciatic nerve at the popliteal fossa proximal to division, thus preventing damage to adjacent structures, repeated punctures, and multiple nerve stimulations to verify anesthetic diffusion around the nerve. We report the case of a 23-year-old man, ASA I, who underwent reduction and osteosynthesis of a fractured right fibula. Ultrasound was used to guide the needle after identification of the sciatic nerve 10 cm from the knee fold and 3.5 cm deep. When the point of the needle was near the nerve, the nerve stimulator was switched on to 0.5 mA, and when no response was obtained the current was increased to 1.5 mA. The needle was moved slightly (1-2 mm) to produce a plantar flexion (tibial component) that persisted until stimulation had been reduced to 0.4 mA, at which time 30 mL of 1.5% mepivacaine was injected. The sonographic image during injection showed that the anesthetic had surrounded the nerve (donut sign). The motor and sensory block of the sciatic nerve was complete and no adverse events occurred during or after surgery. We conclude that the combination of ultrasound guidance and nerve stimulation allows the sciatic nerve to be located easily. The approach to the point before division of the sciatic nerve can be guaranteed so that puncture of neighboring vessels can be avoided and optimal anesthesia provided.

Adult↗
PubMed1998

Intra-articular analgesia after arthroscopic knee surgery: comparison of three different regimens.

One hundred and three patients ASA grades I-II, 16-80 years of age scheduled for arthroscopic meniscectomy were prospectively studied, and randomly allocated to one of four groups: group 1 (n = 25): 0.25% bupivacaine (50 mg) intra-articular (IA), group 2 (n = 27): 1 mg of 0.1% preservative free morphine chloride in saline, group 3 (n = 26): 1 mg of 0.1% preservative free morphine chloride in 0.25% bupivacaine and group 4 (n = 25): normal saline (0.9%). The volume given was always 20 mL. Ketorolac [Toradol, 30 mg intramuscularly (i.m.)] was used as rescue medication; analgesia was assessed using a visual analogue scale (VAS), a verbal rating scale (VRS), supplemental analgesic consumption post-operatively (SAC) and the presence of side effects. Verbal rating scale and visual analogue scale scores showed better pain control in group 1, 20 min after surgery, and in groups 1 and 2 at 4 h and 10 h as well as in the global VAS. In multifactorial analysis no significant differences among groups or side effects was found, pH analysis of the substances used showed no alterations in the basal pH range. The analgesic efficacy of 20 mL of bupivacaine 0.25% is similar to that of 1 mg of morphine in 20 mL of saline 0.9%. The morphine-bupivacaine mixture was no more efficacious than bupivacaine or morphine alone.

Adolescent↗
PubMed1997

A controlled, randomized, double-blind study of ketorolac for postoperative analgesia after plastic surgery.

The present study was designed to evaluate the efficacy and safety of ketorolac compared with metamizol (Nolotil) in the control of pain after plastic surgery. Almost no literature exists on postoperative pain control in this specialty. A multiple-dose, randomized, double-blind study of parallel design was carried out. One hundred patients received either ketorolac 30 mg intramuscularly (IM) every 8 hours or metamizol 2 g IM every 8 hours for postoperative analgesia during the first 48 postoperative hours. Pain severity was assessed using a visual analog scale. Adverse events were recorded. There were no significant differences between the groups in terms of pain scores or frequency of adverse events throughout the study. Two postoperative hemorrhages were recorded in the ketorolac group. Ketorolac and metamizol were found to be equally safe and effective in reducing postoperative pain after plastic surgery. It should be noted that 52% of patients in the ketorolac group and 48% in the metamizol group considered their postoperative analgesia to be very good. Nevertheless, for surgical procedures or for patients in whom postoperative hematoma formation is a particular concern, ketorolac probably should not be used.

Adolescent↗
PubMed1993

A comparative study of analgesia after knee surgery with intraarticular bupivacaine, intraarticular morphine, and lumbar plexus block.

Following arthroscopic surgery of the knee, 60 ASA I-II patients were randomly allocated to three different groups (n = 20 each) in an attempt to establish the best postoperative analgesic protocol: 20 ml of bupivacaine (0.25%; 50 mg) intra-articularly (IA) (Group 1); continuous three-in-one lumbar plexus block using a catheter to administer 0.25 ml/kg of bupivacaine (0.25%; single-shot) plus continuous pump infusion of the same drug (0.03 ml.kg-1 x h-1 of 0.25% bupivacaine for 24 h) (Group 2); or 1 mg of morphine with 20 ml of saline IA (Group 3). The results were appraised in a double-blind manner, and the degree of postoperative pain was evaluated by visual analog scale (VAS) at constant hourly intervals for the first 24 h, by the incidence of secondary effects, and by the need for complementary analgesia. Group 2 (three-in-one) VAS values were lower 16 and 24 h after surgery and also globally (P < 0.05), with respect to the other two groups. Five patients in Groups 1 and 3 required complementary analgesia, while three patients in Group 1 suffered nausea. No other secondary effects were observed. We conclude that all three analgesic methods proved efficient, as reflected by the scant requirements for additional analgesics and the degree of expressed patient satisfaction. However, lumbar plexus block (three-in-one) with continuous bupivacaine infusion was most effective, and, although it constitutes an added technique, its scant complications and easy performance make its use advisable.

Adolescent↗
PubMedDate not supplied

Subarachnoid anesthesia in young patients: a comparative analysis of two needle bevels.

BACKGROUND AND OBJECTIVES: This prospective, randomized, double-blind study compares the efficacy of two spinal needles in terms of their performance characteristics and associated perioperative complaints in young patients. METHODS: ASA I and II patients aged from 20 to 40 years undergoing lower limb orthopedic surgery were included during a 12-month period. After application of the protocol, 158 patients were recruited. The patients were randomized to two groups: group I: 26-gauge Atraucan (n = 79) and Group II: 27-gauge Whitacre (n = 79). A study was made of the demographic parameters, technical characteristics, and peri- and postoperative complications. RESULTS: No significant differences were found in the technical handling of the needles, number of attempts made to achieve the puncture, or the time required to perform the technique. No technical failures (spinal anesthesia inadequate for the planned surgery) were reported, and the frequency of complications during the procedure was identical in both groups. Frequency of postdural puncture headache (3.8%) or severity and duration showed no difference between the two groups. The overall assessment of postoperative complications revealed similar scores for both needles. CONCLUSIONS: Technical handling (ease with which block was performed) of the needles analyzed was extremely easy, showing a high success rate which associated with the similar incidence of complications. Type of bevel does not appear to be a determining factor in the quality or morbidity associated with subarachnoid block when fine-gauge needles are used in young patients.

Adult↗
PubMedDate not supplied

Continuous spinal anesthesia: a comparative study of standard microcatheter and Spinocath.

BACKGROUND AND OBJECTIVES: This prospective, randomized study evaluated the advantages and disadvantages of a new subarachnoid catheter. METHODS: Sixty ASA I-IV patients aged 40-70 years, scheduled for total knee arthroplasty, were randomly distributed into group 1 (Spinocath; Braun Melsungen, Germany) and group 2 (Intralong; Pajunk, Germany). The study tabulated details of subarachnoid catheter insertion, dural puncture, time to free cerebrospinal fluid (CSF) flow, anesthesia onset time, surgery anesthesia time, the upper level of sensory block reached, the anesthesiologist-evaluated degree of difficulty with the technique, and the quality of analgesia obtained and complications. At the end of surgery, all the catheters were removed, and their patency was checked. RESULTS: Spinocath insertion required 6.3 +/- 3.2 minutes in group 1 versus 3.9 +/- 1.2 minutes in group 2 (P < .01) with similar difficulties with catheter introduction. Perception of dural puncture was better in group 1 (P < .05). There were significant intergroup differences in time to free flow of CSF through the catheter. In group 2, correct catheter positioning had to be confirmed by aspiration in 80% of cases (P < .05). At the end of surgery, the catheters were removed, and there were no significant differences between groups. The anesthetic blocks were similar with both systems. Patient opinion of the technique did not differ between groups, and regression analysis did not show any differences between groups or correlation to any incident during performance of the technique. Globally, the anesthesiologists participating in the study considered both systems to be easy to use and adequate for continuous spinal anesthesia. With respect to the advantage afforded by a directional needle in orientating the catheter within the spinal canal, the Spinocath system-with a longer technique performance time than the standard approach-involves a success rate and incidence of technical problems similar to that of the conventional technique.

Adult↗
PubMedDate not supplied

Management of progressive pain in a patient with intramedullary chordoma of the spine.

OBJECTIVES: The case here presented adequately reflects the difficulties involved in the treatment of pain in patients where the neuropathic component of pain predominates, and shows the different therapeutic steps that may be taken-from surgery and radiotherapy, to the administration of different drugs via the spinal route, to, finally, the presently little-used option of a direct intraventricular access. CONCLUSIONS: Spinal tumors are infrequent, but pose great difficulties for the management and control of the pain they cause. The utility of the spinal route as an early approach for the provision of adequate analgesia seems clear. However, it also appears to lose efficacy with time, and dose incrementing and/or the addition of drugs that enhance the analgesic action of morphine are not always effective. In such selected cases, the intraventricular route may constitute a useful alternative, allowing improved symptoms control with lower morphine doses, and the use of the system previously implanted for intrathecal spinal infusion.

Analgesics↗
PubMedDate not supplied

Use of botulinum toxin in the treatment of chronic myofascial pain.

BACKGROUND: Myofascial pain syndrome (MPS) is defined as acute or chronic pain with sensory or motor autonomic symptoms, referred from active myofascial triggering points with associated dysfunction. Previous studies have suggested the usefulness of botulinum toxin A (BTX-A) in the treatment of MPS since it is capable of controlling muscular spasms, as well as other alternative mechanisms of action. OBJECTIVES: To analyze the efficacy of BTX-A treatment and its effect on daily life activities assessing pain reduction using a visual analogue scale (VAS); degree of improvement in physical impairment and disability scoring in the Oswestry low back pain questionnaire; and psychologic status using the Hospital Anxiety and Depression Scale (HAD), in patients suffering from MPS. METHOD: An open-label interventional prospective trial was conducted in 77 patients diagnosed of refractory MPS (defined as the presence of muscle spasm with pain on mobilization or stretching, plus the existence of trigger points with associated referred pain), resistant to both conservative management and to physical therapy. The BTX-A dosages for the different muscles were chosen according to a standardized protocol. Electromyographic guidance was used to localize the motor end plate prior to injection in superficial muscles; while fluoroscopic guidance was employed to evidence intramyofascial spread of the contrast solution within deep muscles. The assessment of treatment efficacy was based on a pain VAS applied before enrollment, at 15, 30, and 90 days and upon completion of the study; the Lattinen test to establish a relationship between pain intensity and its corresponding impact on daily living; and the HAD scale to assess psychologic stress, performed both before treatment and at the end of the study; and the Oswestry Questionnaire was used to evaluate patients' ability to carry out daily life activities according to their degree of physical impairment and disability scores. RESULTS: The global analysis revealed a positive correlation between the VAS score prior to treatment and the scoring at 15, 30, and 90 days. This correlation was maintained when analyzing independently for superficial or deep muscles. The correlation coefficients for HAD scores and the Lattinen test values showed a significant association between pre- and post-treatment findings. No adverse events were recorded for 83.1% of the cases. CONCLUSIONS: The results of this study are consistent with other studies showing the efficacy of BTX-A for treating pain in MPS. The evaluation of the psychologic dimension of this disorder and its associated disability can provide valuable information for the adequate management of these patients and for assessing treatment outcome.

Adult↗
PubMedDate not supplied

Repeated subarachnoid catheter displacement as a complication of spinal infusion using an internal infusion pump.

OBJECTIVE: To present and analyze the case of a woman receiving chronic spinal opioid therapy using an implanted infusion pump who experienced repeated displacement of the subarachnoid catheter despite the use of standard techniques for anchoring the catheter. The solution devised to avoid the problem is described. CASE REPORT: A 53-year-old woman was diagnosed with transverse myelitis 10 years earlier and she developed T7-T10 spinal cord atrophy, and pain below the T7 segment. After unsuccessful noninvasive pharmacological treatment, a spinal opioid infusion protocol was begun. On 3 occasions during the course of therapy, despite the use of standard measures for anchoring the system, catheter displacement into the subcutaneous pouch of the pump occurred. After the last such episode, a specially designed technique was used, anchoring the catheter by means of a silicone piece, and the injection of 2.5 mL of fibrin glue in the epidural space. CONCLUSIONS: The application of fibrin glue (Tissucol; Immuno AG, Vienna, Austria) may be considered as an adjuvant for the fixation of subarachnoid catheters used for intraspinal infusions.

Analgesics, Opioid↗