Browsing by Author "Leyton, Patricio A."
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Publication Continuous peripheral nerve blocks for pain control after orthopaedic surgery(2025) Espinoza, Ana María; Leyton, Patricio A.; Robles, Marcia; Vargas, Javiera; Muñoz, Loreto A.BACKGROUND Continuous peripheral nerve blocks (CPNB) provide an opioid-free alternative for pain control after orthopaedic surgery. However, postdischarge ambulatory patient care and follow-up concerns have prevented CPNB use at home. OBJECTIVE To address physicians’ concerns about the outpatient use of CPNB. DESIGN Prospective, cohort, observational study. SETTING Single centre, teaching private hospital in Santiago, Chile, between July 2016 and March 2020. PATIENTS We included patients aged at least 18 who underwent orthopaedic surgery using CPNB for postoperative pain management. Patients scheduled simultaneously for non-orthopedic surgery on the same event were excluded. MAIN OUTCOME MEASURES Pain scores, opioid use, and complication rates at both in-hospital and at-home sites. RESULTS CPNB were provided as an analgesia plan in 497 patients who met inclusion criteria, and 387 (77.87%) were discharged home with this continuous analgesia. At 48 h, 70% of the patients reported no-worse-than-mild pain. Less than 3.1% of patients reported an episode of severe pain, and less than 13% of the patients required opioid rescue medication. Transient neurological symptoms were observed in 13% (95% confidence interval (CI), 10.4 to 16.1) of the patients. No long-term or severe complications were observed. High rates of satisfaction were reached among patients. CONCLUSION In-hospital and at-home use of CPNB supervised by a pain service team provides a feasible and safe alternative after orthopaedic surgery, pain control with a low requirement of opioids.Publication Early extubation in COVID-19 pneumonia patients and temporal changes in the lactate dehydrogenase profile(2022) Rojas, Mariana; Gignon , Lucile; Díaz, Fernando; Florea M., Andrei; Leyton, Patricio A.; Abarca Z. , Juan; Vargas Z., JavieraObjective: Since the beginning of the 2019 global pandemic of Coronavirus Disease, using invasive mechanical ventilation as support therapy has been a critical treatment of acute respiratory failure. In the context of a collapsed health system, having an early extubation predictor becomes a useful way of supporting clinical management, by enabling to anticipate the availability of mechanical ventilators. Hence, we assessed the relationship between the progression of lactate dehydrogenase and early extubation in patients with COVID-19. Design: A retrospective study. Setting: A single private hospital in Chile. Patients: Adults aged 18 or older diagnosed with COVID-19 pneumonia and requiring mechanical ventilation, having been admitted to an ICU during the study period. Interventions: None. Measurements and Main Results: Fifty two individuals, 73% males, were included with a median age of 47.1 years old and a median body mass index of 29. Individuals extubated within the first 5 days of mechanical ventilation, early extubation group, amounted to 34.6%. The average decrease in serum lactate dehydrogenase levels was 27.5 UI/L per day (p < 0.01) in the early extubation group compared to 14.7 UI/L per day (p < 0.01) in the late extubation group (individuals extubated after day 5). During the first 48 hours, the average daily decrease was 56.7 UI/L in the early extubation group compared to 13.2 UI/L per day in late extubation group (p < 0.01). Conclusions: Serum lactate dehydrogenase daily level decrease during the first days of mechanical ventilation is associated with earlier patient extubation.