Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jul 2015
[Bilateral subdural hematoma secondary to accidental dural puncture].
We report the case of a 25-year-old woman, who received epidural analgesia for labour pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.
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Rev Bras Anestesiol · Jul 2015
[Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane - a systematic review].
The transverse abdominal plan blockade (TAP) is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that according to the descriptions carried out and the prospective studies would make it possible to utilize the TAP in different surgical interventions; however, the results obtained in randomized clinical trials (RCTs) are inconsistent. ⋯ The TAP have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in RCT are not conclusive, and as a result, it is necessary to develop new and well designed RCT, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.
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Rev Bras Anestesiol · Jul 2015
[Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus].
The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. ⋯ Ondansetron does not inhibit subarachnoid morphine-induced pruritus.
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Rev Bras Anestesiol · May 2015
[Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound].
The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block (ABPB). ⋯ This study demonstrated that ultrasound guided ABPB can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.