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Vol. 30. Issue 5.
Pages 222-227 (September - October 2019)
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Vol. 30. Issue 5.
Pages 222-227 (September - October 2019)
Clinical Research
DOI: 10.1016/j.neucie.2019.05.001
Evaluation of temporal muscle trophism in relation to the manipulation time and infiltration of 0.5% isobaric bupivacaine through a pterional approach
Evaluación del trofismo del músculo temporal posquirúrgico en relación con el tiempo de manipulación y la infiltración transoperatoria de bupivacaína isobárica al 0,5% en pacientes sometidos a craneotomía pterional
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Heberseleth Valdivia-Chiñasa, María Elena Córdoba-Mosquedaa,
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dramaelenacmosqueda@gmail.com

Corresponding author.
, Erika Fabiola Cruz-Cruzb, Diego Ochoa-Caciquea, Óscar Medina-Carrilloa, Ulises García-Gonzáleza
a Departamento de Neurocirugía, Hospital Central Sur de Alta Especialidad de PEMEX, Mexico City, Mexico
b Departamento de Anestesiología, Hospital Central Sur de Alta Especialidad de PEMEX, Mexico City, Mexico
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Tables (3)
Table 1. Intraoperative periods in patients with pterional approach and infiltration of 0.5% bupivacaine.
Table 2. Correlation of intraoperative times with the difference in thickness of the temporal muscle in the postoperative period at 90 days.
Table 3. Comparison between dysfunction indices in the preoperative and postoperative period of patients with pterional approach infiltrated with 0.5% bupivacaine.
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Abstract
Introduction

There are different techniques for the reconstruction of the temporal muscle (TM) in the pterional approach (PA) in order to avoid and reduce atrophy, it has not been able to avoid it in its entirety.

The administration of bupivacaine generates regeneration of muscle fibres. There are no studies in the medical literature that evaluate the time of TM manipulation and the use of bupivacaine for the treatment of atrophy after pterional approach, the present investigation aim is to describe the effects of these variables.

Patient and methods

Longitudinal study, including patients from 18-80 years old with pterional approach at 2016–2017. We evaluated the effects of the TM manipulation times and the administration of 0.5% bupivacaine on the trophism and function of TM.

Results

Twenty-nine patients underwent a PA; 16(55.17%) count with criteria for 0.5% bupivacain infiltration.

We found a negative correlation between manipulation times and trophism, with no statistically significance (p>.05).

We evaluated presurgical and postsurgical index of Helkimo and Fonseca's index, finding an increase of disfunction with statistically significance (p<.05).

In patients who were infiltrated with 0.5% bupivacaine we observed a mean difference in the TM's trophism of 0.275±1.18mm, in contrast with no infiltrated which was 2.39±1.30mm (t[27]=−5.118, p=.0001).

Conclusions

The manipulation of the TM during a pterional approach conditioned an impact on the quality of life according to the disfunction indexes, due to atrophy. This investigation exhibits that de administration of 0.5% bupivacaine during surgery offers a decrease in the TM atrophy.

Keywords:
Bupivacaine
Temporal muscle
Atrophy
Pterional approach
Resumen
Introducción

Existen diferentes técnicas para reconstrucción del músculo temporal (MT) en el abordaje pterional (AP) con el objetivo de evitar y disminuir la atrofia, hasta el momento ninguna ha logrado evitarla en su totalidad.

La administración de bupivacaína genera regeneración de fibras musculares. Aún no existe en la literatura médica estudios que evalúen el tiempo de manipulación del MT y que den uso a la bupivacaína para el tratamiento de la atrofia después de un abordaje pterional, el presente estudio pretende describir los efectos de estas variables.

Pacientes y métodos

Estudio longitudinal, incluyendo pacientes de 18-80 años y sometidos a abordaje pterional en los años 2016-2017. Evaluamos los efectos de la manipulación del MT y la administración de bupivacaína al 0,5% sobre el trofismo y la función del MT.

Resultados

Veintinueve pacientes fueron sometidos a AP; 16(55,17%) contaron con criterios para infiltración con bupivacina al 0,5%.

Se encontró una correlación negativa entre los tiempos de manipulación y el trofismo, no estadísticamente significativo (p>0,05).

Se evalúo los índices de disfunción de Helkimo y Fonseca prequirúrgicos y posquirúrgicos encontrándose un incremento estadísticamente significativo en la disfunción (p<0,05).

En pacientes infiltrados con bupivacaína al 0,5% se observó una diferencia media del espesor de MT de 0,275±1,18mm, en contraste con los no infiltrados de 2,39±1,30mm (t[27] = -5,118, p=0,0001).

Conclusiones

La manipulación del MT durante el abordaje pterional, condiciona un impacto sobre la calidad de vida de acuerdo con los índices de disfunción, debido a la atrofia. Esta investigación presenta que la administración de bupivacaína al 0,5% durante la cirugía ofrece una disminución en la atrofia del MT.

Palabras clave:
Bupivacaína
Músculo temporal
Atrofia
Craneotomía pterional

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