One of the fundamental pillars for optimal patient recovery after a cesarean section is pain management after a surgical intervention. For years the gold standard for analgesic management the use of intrathecal morphine due to its long-lasting effect, however adverse effects related to the use of opioids are evidenced too, Currently, with the advent of multimodal analgesia, the use of opioids and the effects associated with them have been reduced, optimizing pain management, reducing hospital stay, lower risk of postpartum depression, reducing the presence of nausea and vomiting as well as pruritus and improving mother-child relationship. An essential component of the multimodal analgesia are regional blocks like the transversus abdominis plane block and the ilioinguinal -iliohypogastric block, Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless these have a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrate better outcomes compare with intrathecal morphine.
Los pacientes críticos a menudo requieren sedación polivalente en las unidades de cuidados intensivos. Los fármacos utilizados para este fin pueden administrarse por vía intravenosa y, con menos frecuencia, por inhalación. La pandemia de COVID-19 en la actualidad nos ha traído varias consecuencias, como el agotamiento de los recursos farmacológicos, lo que nos lleva al uso no rutinario de alternativas para lograr los mismos objetivos de sedación, incluso con menos efectos adversos y mejores resultados en cuanto a la evolución de su enfermedad Se han considerado como opción los anestésicos volátiles, los mismos que se administran a través del sistema de inhalación de precipitados AnaConDa. Presentamos el caso de un paciente con diagnóstico confirmado de COVID-19, que desarrolla SDRA severo secundario y posterior necesidad de sedación profunda, proporcionándole un anestésico volátil (sevoflurano) mediante el sistema AnaConDa.
Introduction:The neuraxial technique for anesthesia in patients undergoing cesarean section is preferred by anesthesiologists due to its lower rate of complications and the advantages over the mother and the fetus, however, daily we face difficult neuraxial accesses due to changes in the of pregnancy, obesity, musculoskeletal deformations, etc., which can hinder the success of the blockade and therefore the satisfaction of the patient. The objective of this study is to validate the Vallejo position by ultrasound to achieve a successful spinal block in obstetric patients classified as difficult neuraxial access. Method: This is a descriptive, prospective cohort study, which was carried out on patients admitted for scheduled Cesarean section at Atlas Clinics, Quito-Ecuador during the month of July-August 2022. The patients were examined to classify them as NBA (Neural Axial Access Difficult) of intermediate and high difficulty who underwent ultrasonography of the lumbar spine comparing the measurement of the interspinous space L3-L4 with and without the Vallejo position. Results: 138 obstetric patients were included, of which 36 patients were classified as NBA score of intermediate difficulty and 14 patients as NBA score of high difficulty (total of 50 patients). Of the 50 patients, 5 patients achieved neuraxial blockade at the first attempt. Ultrasonography of the lumbar spine was performed on the remaining 45 patients, obtaining a mean interspinous space measurement of L3-L4 of 2.55 cm without the Vallejo position and a mean of 3.10 cm with the Vallejo position. So, the mean opening with Vallejo's position was 0.544 cm. Conclusion: The Vallejo position offers an alternative to achieve a successful neuraxial blockade in obstetric patients who have difficult access to the neuraxis.
Pain management after a surgical intervention is one of the fundamental pillars for optimal patient recovery. In obstetric patients, this management may affect the mother and the newborn. The gold standard for analgesic management is the use of intrathecal morphine due to its long-lasting effect; however, adverse effects related to the use of opioids are evidenced, whether administered intrathecally or systemically in case of contraindication to the neuraxial approach or if a long-acting opioid is not available. Cesarean sections have been associated with moderate-to-severe postoperative pain. Multimodal analgesic management seeks to minimize the undesirable effects on the mother-newborn binomial in order to increase maternal satisfaction. The most studied regional blocks for this surgery are the transversus abdominis plane block and the ilioinguinal-iliohypogastric block, which shows contradictory evidence at the time of evaluate pain where there is no significant difference compared with intrathecal morphine, but there were fewer side effects with the TAP block group when assessing pruritus, nausea, and vomiting. Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless of them having a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrates better outcomes compared with intrathecal morphine.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.