Revista espanola de anestesiologia y reanimacion最新文献

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New-onset chronic and neuropathic pain in survivors of severe COVID-19: A secondary analysis of the PAIN-COVID Trial 重症COVID-19幸存者的新发慢性和神经性疼痛：pain - covid试验的二次分析

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-09-23 DOI: 10.1016/j.redare.2025.501915

A. Ojeda , T. Cuñat , O. Comino-Trinidad, J. Aliaga, M. Arias, A. Calvo

Background

Survivors of critical illnesses, including COVID-19, are at risk of developing Chronic ICU-Related Pain (CIRP) and neuropathic pain (NP). This study evaluates the incidence of CIRP and NP 6 months after hospital discharge and their impact on pain intensity, functional status, and quality of life (QoL).

Methods

We performed an observational prospective cohort analysis based on a secondary analysis of data from the existing PAIN-COVID randomized controlled trial, which included adult survivors of severe COVID-19 admitted to the ICU. CIRP and NP were assessed at 6 months post-discharge using validated scales (Brief Pain Inventory [BPI] and DN4-interview). Propensity score matching was used to control for confounding factors when comparing pain intensity, functional impact, and QoL between groups.

Results

New-onset CIRP was reported by 47.7% of patients. In matched cohorts, patients with CIRP had significantly lower EQ-5D-5L index (0.705 [0.613–0.818]; p < 0.001) and VAS (72 [60–80]; p = 0.019) scores compared to those without pain. NP affected 36.5% of patients. Patients with NP showed higher BPI-intensity (5.3 [2.5–6], p=0.002) and BPI-interference scores (4.5 [1.5–6.9], p=0.025). The EQ-5D-5L index (0.68 [0.36–0.81]; p = 0.29) and VAS scores (60 [47.5–85]; p = 0.032) were lower compared to those without NP.

Conclusion

A substantial proportion of COVID-19 ICU survivors develop new-onset CIRP and NP within 6 months after discharge, resulting in significant impairment in QoL.

Trial registration

# NCT04394169, registered on 5/19/2020.

背景：包括COVID-19在内的危重疾病幸存者有发生慢性重症监护病房相关疼痛（CIRP）和神经性疼痛（NP）的风险。本研究评估出院后6个月CIRP和NP的发生率及其对疼痛强度、功能状态和生活质量的影响。方法：在对现有PAIN-COVID随机对照试验数据进行二次分析的基础上，我们进行了一项观察性前瞻性队列分析，该试验包括ICU收治的重症COVID-19成年幸存者。CIRP和NP在出院后6个月使用有效的量表（简短疼痛量表[BPI]和dn4访谈）进行评估。在比较组间疼痛强度、功能影响和生活质量时，采用倾向评分匹配来控制混杂因素。结果：新发CIRP占47.7%。在匹配的队列中，CIRP患者的eq - 5d - 5l指数显著降低(0.705 [0.613-0.818]；p结论：有相当比例的COVID-19 ICU幸存者在出院后6个月内出现新发CIRP和NP，导致生活质量明显下降。

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引用次数: 0

Postsurgical pain and ICD-11 classification: Between nosological recognition and practical constraints 术后疼痛与ICD-11分类：在疾病识别和实际限制之间。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-10-02 DOI: 10.1016/j.redare.2025.501950

A. Alcántara Montero , A. Montes Pérez

引用次数: 0

Weighing the risks: The impact of body mass index on postoperative complications in cardiac surgery 权衡风险：体重指数对心脏手术术后并发症的影响。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-10-03 DOI: 10.1016/j.redare.2025.501952

A.A. Pupiales-Dávila , R. Gopar-Nieto , G. Rojas-Velasco , D. Manzur-Sandoval

Introduction

Body mass index (BMI) is a key determinant of cardiovascular risk and may significantly impact postoperative outcomes. This study aimed to evaluate the relationship between BMI and early postoperative complications in patients undergoing cardiac surgery.

Methods

This retrospective study analyzed data from 555 patients who underwent cardiac surgery at the National Institute of Cardiology from June 2022 to December 2023. Patients were categorized into 4 BMI groups: underweight, normal weight, overweight, and obese. Data on demographics, surgical procedures, postoperative complications, and hemodynamic parameters were collected and analyzed.

Results

Preoperative comorbidities, including chronic heart failure and atrial fibrillation, were more common among underweight patients. This group was also at higher risk of postcardiotomy low output syndrome (univariate OR 3.35, p = 0.03), and postoperative atrial fibrillation remained significant in multivariate analysis (OR 1.48, p = 0.01), and required increased vasopressor and inotropic support. Obese patients had a significantly increased risk of postoperative mediastinitis in both univariate (OR 2.47, p = 0.04) and multivariate analyses (OR 2.12, p = 0.03). In-hospital mortality was 14.3 % in underweight vs. 6.1 % in obese patients (p = 0.52).

Conclusions

This study highlights the significant impact of BMI on postoperative outcomes in cardiac surgery. Underweight patients exhibited higher rates of postoperative complications and mortality, likely due to underlying comorbidities and limited physiological reserves. While obesity is associated with increased cardiovascular risk, our findings suggest a potential "obesity paradox" in this cohort. Further research is needed to elucidate the underlying mechanisms and refine risk stratification models incorporating BMI and other relevant factors.

体重指数（BMI）是心血管风险的关键决定因素，并可能显著影响术后预后。本研究旨在评估心脏手术患者BMI与术后早期并发症的关系。方法：这项回顾性研究分析了2022年6月至2023年12月在美国国家心脏病研究所接受心脏手术的555名患者的数据。患者被分为4个BMI组：体重过轻、正常体重、超重和肥胖。收集和分析了人口统计学、外科手术、术后并发症和血流动力学参数的数据。结果：术前合并症，包括慢性心力衰竭和房颤，在体重过轻的患者中更为常见。这组患者出现开心术后低输出综合征的风险也较高（单因素OR为3.35,p = 0.03），在多因素分析中，术后房颤的风险仍然很高（OR为1.48,p = 0.01），需要增加血管加压剂和肌力支持。在单因素分析（OR 2.47, p = 0.04）和多因素分析（OR 2.12, p = 0.03）中，肥胖患者术后发生纵隔炎的风险均显著增加。体重过轻患者的住院死亡率为14.3%，肥胖患者为6.1% （p = 0.52）。结论：本研究强调了BMI对心脏手术术后预后的重要影响。体重过轻的患者术后并发症和死亡率较高，可能是由于潜在的合并症和有限的生理储备。虽然肥胖与心血管风险增加有关，但我们的研究结果表明，这一队列中存在潜在的“肥胖悖论”。需要进一步的研究来阐明潜在的机制，并完善纳入BMI和其他相关因素的风险分层模型。

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引用次数: 0

Chronic pain after liver transplant: A cross-sectional study 肝移植后慢性疼痛：一项横断面研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-10-03 DOI: 10.1016/j.redare.2025.501953

A. Duarte, F. Farias, V. Pires, R. Poeira, M. Canas

Introduction

Chronic post-surgical pain (CPSP) is a major concern following liver transplantation. Despite advancements in surgical and anaesthesia techniques, CPSP remains prevalent and under-researched.

Methods

This cross-sectional retrospective study was conducted at #, # in patients who underwent liver transplantation between January 2017 and December 2021. A total of 310 patients participated, exceeding the minimum sample size of 247 required for statistical significance. Data were collected from questionnaires administered over the phone – the Brief Pain Inventory Short Form (BPI-SF) and the Douleur Neuropathique en 4 Questions (DN4) – and from a review of each patient’s clinical history.

Results

CPSP was identified in 20.0% of patients, with a higher prevalence in women (27.6%) conpared to men (17.0%) (odds ratio: 1.85; 95% confidence interval: 1.03–3.33; p = 0.019). Acute postoperative pain and female gender were significant independent predictors. Neuropathic pain characteristics were present in 25.8% of cases. We found that CPSP significantly interfered with daily activities, but despite its high incidence, only 24.2% of patients were receiving treatment for their pain.

Discussion

Our findings highlight the impact of CPSP on liver transplant recipients and the need for improved pain management. The study underscores the importance of addressing acute postoperative pain to prevent the development of CPSP and calls for heightened awareness and better treatment protocols to enhance outcones.

Conclusion

This study provides insights into the prevalence and impact of CPSP among liver transplant patients, and identifies acute postoperative pain and female gender as risk factors. The results show the need to improve pain management practices in order to mitigate the long-term effects of CPSP.

慢性术后疼痛（CPSP）是肝移植术后的主要问题。尽管手术和麻醉技术取得了进步，但CPSP仍然普遍存在，研究不足。方法：在2017年1月至2021年12月期间接受肝移植的患者中进行了横断面回顾性研究。共有310例患者参与，超过了统计意义所需的最小样本量247例。数据收集自通过电话进行的问卷调查——简短疼痛调查表（BPI-SF）和双神经病变4个问题（DN4）——以及对每位患者的临床病史的回顾。结果：20.0%的患者确诊为CPSP，其中女性（27.6%）高于男性（17.0%）（优势比：1.85；95%可信区间：1.03-3.33;p=0.019）。术后急性疼痛和女性性别是显著的独立预测因素。25.8%的病例存在神经性疼痛特征。我们发现CPSP明显干扰日常活动，但尽管发病率很高，但只有24.2%的患者接受了治疗。讨论：我们的研究结果强调了CPSP对肝移植受者的影响以及改善疼痛管理的必要性。该研究强调了解决急性术后疼痛的重要性，以防止CPSP的发展，并呼吁提高认识和更好的治疗方案，以提高结果。结论：本研究揭示了肝移植患者CPSP的患病率及其影响，并确定了术后急性疼痛和女性性别为危险因素。结果表明，需要改善疼痛管理实践，以减轻CPSP的长期影响。

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引用次数: 0

Macklin effect in critically COVID-19 patients: Observational single-center analysis COVID-19危重症患者的麦克林效应：观察性单中心分析

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-10-03 DOI: 10.1016/j.redare.2025.501930

G. Melegari , F. Arturi , G. Vaccari , F. Gazzotti , E. Bertellini , L. Astore , G. Della Casa , A. Pecchi , A. Barbieri

Objective

To analyze the incidence and impact of the Macklin effect (ME) in critically ill COVID-19 patients and its correlation with pneumothorax (PNX), spontaneous pneumomediastinum (SP), and barotraumatic complications (BC).

Design

Observational single-center study.

Setting

Intensive Care Unit (ICU) of a single Italian hospital.

Patients or participants

Critically ill COVID-19 patients aged ≥18 years, with at least one chest computed tomography (Ch-CT) scan and undergoing mechanical ventilation. Patients with pre-existing PNX, SP, or tracheal lesions at ICU admission were excluded.

Interventions

Retrospective analysis of Ch-CT scans to detect ME.

Main variables of interest

ME incidence, its correlation with barotrauma development and mortality.

Results

Among 138 patients, ME was detected in 5.80% (8 cases) on the first Ch-CT scan and in 10.87% (15 cases) at any time during ICU stay. PNX occurred in 17.39% (24 cases) and subcutaneous emphysema in 14.49% (20 cases), with a total BC incidence of 23.91% (33 cases). ME presence on the first Ch-CT scan was significantly associated with PNX (OR 5.5, p = 0.012), SP (OR 12.77, p < 0.001), and BC (OR 11.44, p = 0.004). ME detection on the first Ch-CT scan showed a hazard ratio (HR) of 5.91 (CI 2.41–14.50, p < 0.001) for BC development.

Conclusions

Early ME detection in critically ill COVID-19 patients is crucial, as it is significantly associated with PNX, SP, and BC. Recognizing ME could play a role in improving clinical management and outcomes.

目的：分析新冠肺炎危重症患者麦克林效应（Macklin effect， ME）的发生率、影响及其与气胸（PNX）、自发性纵隔气肿（SP）、气压创伤并发症（BC）的相关性。设计：观察性单中心研究。环境：意大利一家医院的重症监护室（ICU）。患者或参与者：年龄≥18岁的COVID-19危重患者，至少进行一次胸部计算机断层扫描（Ch-CT）并进行机械通气。排除入院时已存在PNX、SP或气管病变的患者。干预措施：回顾性分析Ch-CT扫描检测ME。主要感兴趣的变量：ME发病率，其与气压创伤发展和死亡率的相关性。结果：138例患者中，首次ct扫描ME检出率为5.80%（8例），ICU住院期间任何时间ME检出率为10.87%（15例）。PNX发生率为17.39%（24例），皮下肺气肿发生率为14.49%（20例），BC总发病率为23.91%（33例）。首次Ch-CT扫描ME的存在与PNX （OR 5.5, p = 0.012）、SP （OR 12.77, p）显著相关。结论：危重患者早期ME检测至关重要，因为它与PNX、SP和BC显著相关。认识ME可以在改善临床管理和结果方面发挥作用。

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引用次数: 0

A complicated tale of a cited complication! 一个被引用的复杂的故事！

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-09-05 DOI: 10.1016/j.redare.2025.501898

R. Magoon , V. Suresh

引用次数: 0

Single-puncture ultrasound-guided sciatic, femoral, and obturator injection (SP-SFO): Spread of dye in cadavers 单穿刺超声引导坐骨、股、闭孔注射（SP-SFO）：染色在尸体中的扩散。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-10-02 DOI: 10.1016/j.redare.2025.501951

S. Diwan , V. Sathe , A. Sabnis , P. Mane , A. Gupta

Background

The terminal nerves of the lumbar plexus, the femoral and obturator nerves, and the sciatic nerve are situated in different fascial planes on the medial side of the thigh. Attempts have been made to approach these nerves using a single puncture from the anterior and medial aspect of the thigh. The previously described SOFT block requires multiple transducer positions, needle redirections, and punctures. We attempted a novel single-puncture, single-position approach to all 3 nerves in different fascial planes in 6 soft embalmed cadavers that provided a total of 12 specimens.

Methods

Six fresh human cadavers left at room temperature for a minimum of 6 h were positioned supine, and an ultrasound-guided single puncture technique was used to target branches of the sciatic, femoral, and obturator nerves (SP-SFO) and inject 0.1% methylene blue dye. Cross-sections were obtained with a band saw in all cadavers at the level of the SP-SFO injections to observe the spread of the dye in various planes.

Results

Cadaver cross-sections showed the spread of the dye in all respective planes. The dye infiltrated the femoral and obturator nerves, while in 4 specimens it reached the sciatic nerve and the paraneural tissue.

Conclusion

This single puncture for branches of the sciatic, femoral, and obturator nerves block (SP-FSO block) can be used to successfully target all these nerves.

背景：腰丛末梢神经、股神经和闭孔神经、坐骨神经分布于大腿内侧不同的筋膜平面。已经尝试通过从大腿前部和内侧穿刺来接近这些神经。先前描述的SOFT块需要多个换能器位置，针重定向和穿刺。我们尝试了一种新颖的单穿刺、单位置入路，在不同的筋膜平面上所有3条神经，在6具软防腐尸体上提供了总共12个标本。方法：将6具室温下放置至少6小时的新鲜人尸体平卧，采用超声引导单针穿刺技术瞄准坐骨神经、股神经和闭孔神经（SP-SFO）分支，注射0.1%亚甲基蓝染料。在所有尸体的SP-SFO注射水平上用带锯获得横截面，观察染料在各个平面上的扩散。结果：尸体横切面显示染料在各个平面上的扩散。染色浸润股神经和闭孔神经，4例到达坐骨神经和神经旁组织。结论：单次穿刺坐骨、股、闭孔神经分支阻滞（SP-FSO阻滞）可成功靶向所有神经。

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引用次数: 0

Acute coronary syndrome due to compression by giant sinus of Valsalva aneurysm Valsalva动脉瘤巨窦压迫所致急性冠状动脉综合征。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-09-24 DOI: 10.1016/j.redare.2025.501876

B. Segura-Méndez, R. Bernal-Esteban, N. Arce-Ramos, Y. Carrascal

引用次数: 0

Anaesthesia management of endovascular aortic arch repair using the NEXUS TRE™ stent graft: A case report 使用NEXUS TRE™支架修复血管内主动脉弓的麻醉管理：1例报告。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 Epub Date: 2025-09-08 DOI: 10.1016/j.redare.2025.501914

J.A. Rodenas-Rubio , J. Guillén-Perales , M. Vintimilla-Izquierdo

Endovascular aortic arch surgery is an evolving field that offers less invasive alternatives to open surgery. The emergence of new devices and their implantation imply new considerations in the management by the anaesthesiologist during the procedure. An example of this is the NEXUS TRE™ stent, designed to preserve the patency of the supra-aortic trunks without the need for extra-anatomic bypass. We present the case of a 75-year-old man diagnosed with an aortic arch aneurysm with accelerated growth and risk of rupture, who underwent endovascular repair of the aortic arch and its three branches with the NEXUS TRE™ stent. This is one of the first cases carried out in Europe, specifically in Spain.

血管内主动脉弓手术是一个不断发展的领域，为开放手术提供了侵入性较小的选择。新器械的出现及其植入意味着麻醉医师在手术过程中的管理需要新的考虑。NEXUS TRE™支架就是一个例子，它的设计目的是保持主动脉上干的通畅，而不需要解剖外搭桥。我们报告了一例75岁的男性主动脉弓动脉瘤患者，其生长加速且有破裂风险，他接受了NEXUS TRE™支架对主动脉弓及其三个分支的血管内修复。这是在欧洲，特别是在西班牙实施的首批病例之一。

引用次数: 0

Perineural botulinum toxin in the management of post-traumatic headache: A case report 神经周肉毒杆菌毒素治疗创伤后头痛1例。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI: 10.1016/j.redare.2025.501903

L. Arce Gálvez , J.M. Mancera Álzate

Post traumatic headache is a common condition that can be managed with pharmacologic interventions or analgesic procedures; however, most evidence is derived from patients with mild trauma, leaving a large gap with regard to patients with moderate or severe trauma who present complex pain. Botulinum toxin plays an increasingly important role in pain management. This neurotoxin acts on different receptors, ranging from TRPV1 (transient receptor potential vanilloid type 1) to CGRP (calcitonin gene-related peptide). This is the first case report of the use of perineural botulinum toxin in a patient with moderate post-traumatic headache who responded poorly to standard interventional measures.

创伤后头痛是一种常见疾病，可通过药物干预或镇痛程序加以控制；然而，大多数证据来自轻度创伤患者，对于出现复杂疼痛的中度或重度创伤患者，存在很大的差距。肉毒杆菌毒素在疼痛管理中扮演着越来越重要的角色。这种神经毒素作用于不同的受体，从TRPV1（瞬时受体电位1型香草素）到CGRP（降钙素基因相关肽）。这是首例使用神经周肉毒杆菌毒素治疗中度创伤后头痛患者的病例报告，该患者对标准干预措施反应不佳。

引用次数: 0

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