ANESTESIA REGIONAL GUIADA POR ULTRASONIDO (ULTRASOUND-GUIDED REGIONAL ANESTHESIA, UGRA) EN URGENCIAS ORTOPÉDICAS: ¿DISMINUYE SEDACIÓN PROCEDIMENTAL Y EVENTOS ADVERSOS?
Palabras clave:
Anestesia regional, ultrasonografía, Servicio de urgencias, Fracturas óseas, Analgesia, sedación conscienteResumen
DOI: https://doi.org/10.46296/yc.v10i18.0868
Resumen
El dolor intenso en fracturas y luxaciones atendidas en urgencias suele manejarse con opioides y, para algunos procedimientos, con sedación procedimental; ambos recursos son eficaces, pero pueden acompañarse de hipoxemia, hipotensión, náuseas, delirio y prolongación de la estancia. Esta revisión crítica narrativa, elaborada con una búsqueda estructurada en PubMed/MEDLINE entre 2016 y 2026, analiza si la anestesia regional guiada por ultrasonido reduce la necesidad de sedación y los eventos adversos en urgencias ortopédicas. La evidencia más sólida favorece su uso temprano en fractura de cadera para disminuir dolor, consumo de opioides y efectos indeseables relacionados; la evidencia más directa sobre sustitución de la sedación procedimental proviene de reducciones de fracturas de antebrazo y, en menor medida, luxación glenohumeral. La seguridad global es favorable en series multicéntricas, aunque la heterogeneidad metodológica y la subcaptura de complicaciones tardías limitan inferencias definitivas. Los mayores beneficiarios son pacientes frágiles, con riesgo respiratorio o con procedimientos dolorosos que podrían evitar sedación.
Palabras claves: Anestesia regional, ultrasonografía, Servicio de urgencias, Fracturas óseas, Analgesia, sedación consciente.
Abstract
Severe pain from fractures and dislocations treated in the emergency department is commonly managed with opioids and, for some procedures, procedural sedation; both are effective, but they may be accompanied by hypoxemia, hypotension, nausea, delirium, and longer length of stay. This critical narrative review, based on a structured PubMed/MEDLINE search from 2016 to 2026, examines whether ultrasound-guided regional anesthesia reduces the need for procedural sedation and adverse events in orthopedic emergencies. The strongest evidence supports early use in hip fracture to decrease pain, opioid exposure, and related side effects; the most direct evidence for replacing procedural sedation comes from forearm fracture reductions and, to a lesser extent, shoulder dislocation. Overall safety appears favorable in multicenter series, although methodological heterogeneity and possible underdetection of delayed complications limit definitive inferences. The patients most likely to benefit are frail individuals, those at respiratory risk, and those undergoing painful manipulations that might otherwise require sedation.
Keywords: Regional anesthesia; Ultrasonography; Emergency Service, Hospital; Fractures, Bone; Analgesia; Conscious Sedation.
Información del manuscrito:
Fecha de recepción: 09 de febrero de 2026.
Fecha de aceptación: 15 de abril de 2026.
Fecha de publicación: 13 de mayo de 2026.
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