Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration.
Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration.
Background and Objectives: We did not find clinical studies of the alkalization of ropivacaine in the literature. The objectives of this study were: (1) to determine the quantity of sodium bicarbonate (NaHCO 3 ), which alkalinizes 0.75% ropivacaine (with and without adrenaline); (2) to verify the physico-chemical alterations arising from this alkalization; and (3) to determine whether alkalinized ropivacaine produces a higherquality epidural block measured via sensory-motor onset, block spread and anesthesia duration.Methods: It was determined in the laboratory that 0.012 and 0.015 mEq of NaHCO 3 , respectively, alkalinized 10 mL of the 0.75% ropivacaine solutions without and with adrenaline (1:200,000). In the second phase, the study was random and double-blind and involved 60 patients divided into 3 groups of 20 (G1, G2, and G3). Via epidural lumbar blocks, these groups received, respectively, 10 mL of 0.75% ropivacaine plus 0.5 mL of 0.9% NaCl (solution A), 10 mL of 0.75% ropivacaine plus 0.0012 mEq of NaHCO 3 (solution B), and 10 mL of 0.75% ropivacaine (with adrenaline) plus 0.015 mEq of NaHCO 3 (solution C). The pH, PCO 2 (partial CO 2 pressure), and the nonionized fractions of the 0.75% ropivacaine solutions were compared before and after the addition of 0.9% NaCl or NaHCO 3 or adrenaline plus NaHCO 3 . The motor and sensory onsets, block spread, and the duration of the block were evaluated. Results:The values of the pH, PCO 2 , and nonionized fractions increased significantly in solutions B and C in relation to solution A. No differences among the groups were observed in relation to block spread and sensory-motor onset. The duration of the sensory blocks was significantly greater in the patients in groups G2 and G3.Conclusions: This study indicates that the quantity of NaHCO 3 needed to alkalize 10 mL of 0.75% ropivacaine at room temperature is 0.012 mEq. When the solution contains adrenaline 1:200,000 (mg ⅐ mL Ϫ1 ), up to 0.015 mEq of NaHCO 3 may be added. The alkalization of the 0.75% ropivacaine solution did not cause a reduction of sensory-motor onset, but did provide a significant increase in the duration of the epidural block with no significant differences between the solutions with and without adrenaline. Reg Anesth Pain Med 2001;26:357-362.
TCBC-GO 3 ; Enio Chaves de Oliveira, TCBC-GO 4 RESUMO: Objetivo: Avaliar a função pulmonar pós-colecistectomias laparoscópicas e subcostais abertas. Métodos: Tratou-se de um ensaio randomizado, onde se avaliaram espirometrias pós-operatórias de dois grupos, cada qual com 15 pacientes. O grupo GL foi submetido a colecistectomia laparoscópica. O grupo GA foi submetido a colecistectomia por via subcostal, por meio de mini-laparotomia e abreviado tempo anestésico-cirúrgico. As variáveis dos dois grupos foram comparadas entre si por meio da ANOVA. Entre um mesmo grupo, antes e depois das operações, utlizou-se do teste t-Student emparelhado. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: Todas as pacientes, dos dois grupos, apresentaram distúrbios ventilatórios restritivos pós-operatórios, com normalização espirométrica mais rápida nas pacientes operadas por laparoscopia. Grupos GL X GA, no pós-operatório imediato: Capacidade vital forçada (p < 0,001) e Volume Expiratório forçado em 1 segundo (p < 0,001). Conclusões: O prejuízo pós-operatório da função pulmonar foi significativamente menor nas colecistectomias laparoscópicas do que nas abertas, mesmo por meio de minilaparotomia e abreviado tempo anestésico-cirúrgico (Rev. Col. Bras. Cir. 2007; 34(5): 326-330). ABSTRACT Background:To evaluate pulmonary function after laparoscopic and subcostal cholecystectomies . Methods: This was a randomized study, in which postoperative spirometries in two groups of fifteen patients each were evaluated. Group GL underwent laparoscopic chlecystectomies. Group GA underwent open subcostal cholecystectomies by means of mini-laparatomy, in abbreviated anesthetic-surgical time. The two groups´ variables were compared using ANOVA. Within the same group, before and after the operations, the paired Student-t test was used. A value of p < 0.05 was considered statistically significant. Results: All patients from both groups presented restrictive postoperative ventilatory disturbances, with a faster spirometric normalization for those patients operated through laparoscopy. Groups GL vs. GA, in immediate post-operative: Forced Vital Capacity (p < 0.001) and Forced Expiratory Volume in one second (p < 0.001). Conclusion: Postoperative harm to pulmonary function was significantly less in laparoscopic than in open cholecystectomies, even with mini-laparotomies and abbreviated anesthetic-surgical time.
Summary: Ramos GC -Relevant Aspects of Coronary Artery Disease in Candidates for Non-Cardiac Surgery. Background and objectives:Due to its prevalence, coronary artery disease (CAD) represents the main cause of morbidity and mortality in elective surgeries, which justifies this review, whose objective was to establish preoperative conducts based on rules and directive to minimize peri-and postoperative morbidity and mortality of patients with CAD.
InTRODUÇÃOProcedimentos cirúrgicos tendem a promover hipoxemia tardia 70 e distúrbios ventilatórios restritivos pós-operatórios, especialmente após operações abdominais 2 . Dessa maneira, o maior comprometimento é observado depois de operações de andar superior do abdome, seguido de operações torácicas, vindo a seguir procedimentos de abdome inferior 1. Assim, os pulmões tornam-se os mais importantes órgãos-alvos relacionados à morbi-mortalidade pós-operatória 1 . O objetivo do presente estudo é fazer retrospecto histórico da espirometria e da pressão arterial de oxigênio (PaO2), e da relação dessas variáveis com operações abdominais. Por outro lado determinar as causas das disfunções pulmonares pós-operatórias e formas de minimizá-las, o que pode reduzir complicações pulmonares pós-operatórias. MÉTODOForam utilizadas a bases de dados do Pubmed (www. ncbi.nlm.nih.gov/pubmed/) para revisão da literatura internacional (palavras-chave: postoperative pulmonary complications, pulmonary function, blood gas, spirometry) e do Lilacs (www.bireme.br) (palavras-chave: complicações pulmonares pós-operatórias, gases sanguineos, espirometria, função pulmonar) para revisão da literatura médica nacional/latino americana. Alguns artigos históricos foram selecionados a partir de citações da literatura levantada. Espirometria É a prova de função pulmonar de mais simples execução e a mais importante na prática clínica. É obtida por um espirômetro, por meio do qual pode-se determinar volumes (estáticos e dinâmicos) e capacidades pulmonares (soma de dois ou mais volumes ABCDDV/639Ramos GC, Pereira E, Gabriel-Neto S, Oliveira EC. Aspectos históricos da pressão arterial de oxigênio e espirometria relacionados à operação abdominal ABCD Arq Bras Cir Dig 2009;22(1):50-6 RESUMO -Introdução -Operações, principalmente de abdome superior, cursam no pós-operatório com hipoxemia e distúrbios ventilatórios restritivos. O objetivos da presente revisão foram: a) fazer retrospecto histórico das técnicas espirométricas e da avaliação laboratorial da hipoxemia, por meio da pressão arterial de oxigênio (PaO2) e, b) rever os principais fatores responsáveis pelas alterações da função pulmonar pós-operatória. Métodos -Fez-se revisão histórica sobre os principais aspectos espirométricos e da medida da PaO2, correlacionando esses exames como aferidores da função pulmonar, após operações abdominais. Conclusões -Operações em andar superior do abdome podem cursar com hipoxemia e distúrbios ventilatórios restritivos, cuja principal causa é a disfunção diafragmática, que pode ser minimizada por meio de laparoscopia e um eficaz tratamento da dor pós-operatória. DESCRITORES -Operações abdominais. Função pulmonar. Pós-operatório.
The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifi es the present review (Part II). The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the fi rst part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.
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