Publication: Anestesia regional intravenosa bilateral con dosis bajas de lidocaína para el tratamiento de la hiperhidrosis palmar con toxina botulínica
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2017-10-30
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Universidad Complutense de Madrid
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Abstract
La hiperhidrosis palmar es una patología poco frecuente, pero que dificulta la vida de los pacientes, sus relaciones interpersonales y en algunos casos les impide realizar su trabajo. El tratamiento mediante la inyección de toxina botulínica en las palmas consigue reducir de forma muy significativa la sudoración durante meses y en algunos casos años. Para la realización de la técnica se han de dar del orden de 50 inyecciones intradérmicas. El procedimiento es muy doloroso debido a la sensibilidad de la zona palmar. Se han utilizado diferentes tipos de anestesia para llevar a cabo el procedimiento. La sedación permite realizarlo, pero requiere una profundidad anestésica importante, por lo que deberíamos considerarlo una anestesia general, con todos sus inconvenientes. Algunos pacientes no desean una anestesia general y otros presentan contraindicaciones o comorbilidades que condicionan el riesgo anestésico. También se ha utilizado la administración de crema anestésica (EMLA) o frío con resultados no siempre satisfactorios. El método preferido por los dermatólogos en la actualidad es el bloqueo de los nervios mediano y cubital. Los principales inconvenientes de este método son la duración, que es muy superior al procedimiento, y el daño ocasional de los nervios (neuropraxias), que se manifiesta en forma de dolores palmares o parestesias. En este trabajo nos proponemos utilizar una técnica alternativa que consiste en realizar una anestesia regional intravenosa con dosis bajas de lidocaína de forma secuencial e inmediata en los dos antebrazos (ARIVB)...
Palmar hyperhidrosis is a rare condition, but it makes life difficult for patients, their relationships and in some cases prevents them from doing their work. Treatment by botulinum toxin injection in the palms significantly reduces sweating for months and sometimes years. To perform the technique is to provide 50 intradermal injections. The procedure is very painful because of the sensitivity of the palmar area. Different types of anesthesia have been used to perform the procedure: Sedation is a possibility, but requires significant anesthetic depth, so we should consider it a general anesthesia, with all its drawbacks. Some patients do not want a general anesthetic and may have other contraindications or comorbidities that determine the anesthetic risk. Anesthetic cream (EMLA) or ice have also been used, not always with satisfactory results. The dermatologists preferred method is currently blocking the median and ulnar nerves. The main disadvantages of this method are the length, which is far superior to the procedure, and occasional nerve damage (neuropraxias), manifested in the form of palm pain or paresthesias. In this paper we propose to use an alternative technique witch involves making an intravenous regional anesthesia with low doses of lidocaine and sequentially in both forearms (IVBRA). Other authors have published the latter technique with good results. It allows local analgesia in the area to be treated, with a duration of action proportionate to the duration of treatment , with few side effects...
Palmar hyperhidrosis is a rare condition, but it makes life difficult for patients, their relationships and in some cases prevents them from doing their work. Treatment by botulinum toxin injection in the palms significantly reduces sweating for months and sometimes years. To perform the technique is to provide 50 intradermal injections. The procedure is very painful because of the sensitivity of the palmar area. Different types of anesthesia have been used to perform the procedure: Sedation is a possibility, but requires significant anesthetic depth, so we should consider it a general anesthesia, with all its drawbacks. Some patients do not want a general anesthetic and may have other contraindications or comorbidities that determine the anesthetic risk. Anesthetic cream (EMLA) or ice have also been used, not always with satisfactory results. The dermatologists preferred method is currently blocking the median and ulnar nerves. The main disadvantages of this method are the length, which is far superior to the procedure, and occasional nerve damage (neuropraxias), manifested in the form of palm pain or paresthesias. In this paper we propose to use an alternative technique witch involves making an intravenous regional anesthesia with low doses of lidocaine and sequentially in both forearms (IVBRA). Other authors have published the latter technique with good results. It allows local analgesia in the area to be treated, with a duration of action proportionate to the duration of treatment , with few side effects...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 28/01/2016