The clinical effect of multimodality analgesia after total knee arthroplasty / 中国医师杂志

Objective To compare the effect of different analgesia methods on the treatment of pain after total knee arthroplasty (TKA),and find the ideal analgesia way for peri operation period of TKA.Methods A total of 79 patients was randomly divided into three groups:cocktail,spinal,and multimodal analgesia groups.A comparative study among three groups was conducted on the postoperative visual analogue scale (VAS) of pain score,range of motion,and adverse reaction.Results The motion pain score of using multimodal analgesia patients 24 hours after operation and the resting pain scores 48 hours after operation were less than the other two groups.The postoperative joint range of motion in 1 ～ 2 weeks of multimodal analgesia group was significantly better than the other two groups.Conclusions Multimodal analgesia was an effective way to treat pain after knee arthroplasty.

Clinical observation of of postoperative analgesia in continuous interscalene brachial plexus block by different strength ropivacaine mesylate combined with sufentanil / 中国医师杂志

Objective To evaluate the efficacy and safety of postoperative analgesia in continuous Interscalene brachial plexus block by different strength ropivacaine mesylate combined with sufentanil.Methods Ninety cases of upper limb surgery in continuous peripheral nerve block (CPNB) were selected.The patients after the operation were divided randomly into three groups (A,B,and C):A group was treated with 0.158％ ropivacaine mesylate + 0.5 μg/ml sufentanil,B group with 0.238％ ropivacaine mesylate + 0.5 μg/ml sufentanil,and C group with 0.238％ ropivacaine mesylate.20 minutes before the end of surgery,controlled analgesia device was connected with infusion rate 0.05 ml/(kg · h),PCA 1 ml,and lock time 15 min.The pain visual analog score (VAS),Ramesay sedation score,and postoperative motor nerve block recovery ratings (modified Bromage classification) were recorded at the 4,8,16,32,48 h time point postoperatively.The times of using PCA and the frequency of the adverse reaction were also recorded.Results Three groups all got good analgesic effect at 4,8,16,32,48 h time point postoperatively (VAS 1.58 ± 9 ; 1.90 ± 0.8 ; 1.62 ± 0.6 ; 1.59 ± 0.7 ; 1.53 ± 0.7) (P ＞ 0.05) ; There were no significant difference among the three groups in Ramesay score,modified Bromage score,limb discomfort,nausea,vomiting,lethargy,pruritus and respiratory depression (P ＞ 0.05),but the time of using PCA in A group were significantly more than that in B or C group (P ＜ 0.05).Conclusions Sufentanil can enhance the analgesic effect significantly when the ropivacaine mesylate is in low concentrations (0.158％ ～0.238％),but when the ropivacaine mesylate concentration get up 0.238％,there will be similar analgesic efficacy and safety between ropivacaine mesylate only and ropivacaine mesylate combined with sufentanil.

Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade / Characterization of chronic pain and analgesic approaches among community-dwelling elderly

OBJETIVO: Caracterizar a dor crônica e os métodos analgésicos utilizados por idosos residentes na área de abrangência de uma Unidade Básica de Saúde (UBS), localizada na região norte da cidade de Londrina (PR). MÉTODOS: Estudo transversal descritivo com todos os indivíduos com 60 anos ou mais residentes na área de abrangência da UBS, através de inquérito domiciliar. Utilizou-se como critério de dor crônica a dor de duração mínima de seis meses. Os idosos foram questionados sobre as características da dor quanto à localização, duração, freqüência, intensidade, fatores de melhora e de piora, assim como o impacto da dor na vida do indivíduo e descrição dos métodos analgésicos utilizados. RESULTADOS: Foram entrevistados 172 idosos (101 mulheres e 71 homens). A presença de dor crônica foi observada em 107 (62,21 por cento); no sexo feminino esta prevalência foi de 69,3 por cento e no masculino 52,1 por cento (p = 0,004). Os idosos mais velhos - 80 anos ou mais - apresentaram maior referência de dor crônica (p = 0,01), assim como os idosos com depressão (p<0,001). Os locais de maior prevalência de dor foram membros inferiores e região dorsal, com 31,25 por cento cada, sendo que grande número de idosos referiam dor diária, contínua e de alta intensidade. Em relação aos métodos analgésicos, houve predomínio dos métodos farmacológicos, referidos por 86 idosos (80,37 por cento), e com maior utilização de analgésicos simples (32,6 por cento). CONCLUSÃO: Os dados mostram que há uma grande prevalência de dor crônica nessa população de idosos, principalmente nas mulheres com 80 anos ou mais e nos indivíduos depressivos.

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62. percent) of these 69.3 percent were female and 52.1 percent male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2 percent each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4 percent) and simple analgesic (32.6 percent) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Analgesia y sedación en procedimientos ortopédicos dolorosos en la sala de urgencias pediátricas

Resumen Antecedentes: cada vez es más frecuente el uso de sedación-analgesia para procedimientos dolorosos en áreas de urgencias pediátricas, pero esta conducta todavía no es generalizada. No existe consenso sobre la asociación más eficaz y segura de fármacos a utilizar en estos procedimientos. Objetivo: evaluar eficacia y seguridad de la sedación-analgesia para procedimientos ortopédicos dolorosos en niños, efectuados en un área de urgencia pediátrica y comparar tres diferentes regímenes terapéuticos. Material y métodos: ensayo clínico prospectivo, aleatorizado, con pacientes ambulatorios en un Departamento de Urgencia Pediátrica, en el período comprendido desde 11 de diciembre de 2001 al 4 de enero de 2003. Se compararon tres protocolos: midazolam/fentanilo (M-F), lidocaína/propofol/fentanilo (L-P-F) y atropina/midazolam/ketamina (A-M-K). La eficacia se evaluó a través del grado de analgesia y sedación intraprocedimiento, necesidad de reiterar dosis de fármacos, grado de dolor postprocedimiento, grado de reducción del dolor y amnesia del procedimiento. La seguridad se evaluó por los siguientes efectos adversos: disminución de SatO2, apnea, bradicardia, hipotensión arterial y alucinaciones durante el procedimiento, y cambios de conducta posteriores. Resultados: fueron incluidos 61 niños: 20 (M-F), 21 (L-P-F), 20 (A-M-K), que resultaron comparables en edad, sexo, peso, tipo de lesión y grado de dolor previo. No hubo diferencias en el grado de analgesia y sedación entre las tres cohortes comparadas, obteniéndose un nivel muy satisfactorio con los tres protocolos, con 98,4% de amnesia del procedimiento. Se produjo disminución de la SatO2 en el 16,4% de los casos, predominando en el grupo L-P-F. El grupo A-M-K registró el menor número de efectos adversos (p: 0,02 - riesgo relativo de 0,19; rango 0,03 a 1,34; intervalo de confianza de 95%). Éstos se solucionaron con medidas de soporte vital básico. Conclusiones: los tres protocolos mostraron un alto nivel de eficacia y seguridad y no se observaron diferencias significativas entre ellos.

Summary Introduction: the use of analgesia and sedation in pain treatment is increasing in the Pediatric Emergency Department, however it has not been overexposed yet. There is no agreement about which drug association is more effective and safer to use. Objective: to evaluate safeness and efficacy of three different therapies for painful orthopedic procedures performed in children at the emergency department. Methods: a prospective, randomized clinical trial was done with patients between December 2001 and January 2003 at the emergency department.Three different therapies were compared: midazolam/fentanyl (M-F), lydocaine/propofol//fentanyl (L-P-F) and atropine/midazolam/ketamine (A-M-K). The efficacy was assessed by comparing sedation-analgesia degrees during the procedure, the need to repeat doses, pain scores post-procedure, pain reduction scores and amnesia of the procedure. Safety was assessed by considering the following adverse effects: SatO2 decrease, apnea, bradycardia, arterial hypotension, intra-procedure hallucinations and behavioral changes after procedure. Results: sixty-one patients were included in the study and randomly distributed into three groups: 20 M-F, 20 A-M-K and 21 in L-P-F. Age, gender and weight distribution along with the kind of injury and pain scores done previously to the procedure were comparable. High sedation-analgesia scores were obtained with all the protocols with no differences found between them. 98,4% of the patients did not recall the procedure. SatO2 decrease was observed in 16,4% of the cases prevailling in the L-P-F group. The A-M-K group had the lowest number of adverse effects (p: 0,02-RR 0,19; [0,03 to 1,34]; IC 95%). In all cases adverse effects were overcome with basic support measures. Conclusions: the three protocols were highly effective and safe. No difference was observed between them.

Analgesia preemptiva do cetoprofeno e do parecoxibe em cirurgia para remoção de terceiros molares inclusos / Preemptive analgesia of the ketoprofen and parecoxib in the surgery to removal of impacted third molar teeth

Este trabalho prospectivo, duplo-cego randomizado, avaliou o efeito da analgesia preemptiva do cetoprofeno e do parecoxibe. Sessenta pacientes foram submetidos à cirurgia para remoção de terceiros molares inferiores bilaterais inclusos, sendo operado um lado de cada vez. O paciente foi seu próprio controle. Os pacientes foram separados em dois grupos de 30 pacientes. No grupo parecoxibe, na primeira operação foi usado o parecoxibe ou placebo, endovenoso, 30 minutos antes da cirurgia e imediatamente após a operação foi feita a administração do placebo ou parecoxibe, garantindo ao paciente receber parecoxibe antes ou após a operação. O lado oposto foi operado após duas semanas da primeira cirurgia e o paciente que havia recebido parecoxibe antes e placebo depois da operação recebeu placebo antes e parecoxibe depois da operação e o que havia recebido placebo antes e parecoxibe depois recebeu parecoxibe antes e placebo depois. Nos 30 pacientes do grupo cetoprofeno, o modelo foi o mesmo, substituindo-se apenas o parecoxibe pelo cetoprofeno. O paciente pôde utilizar como medicação resgate a dipirona, sempre que necessário para controlar a dor pós-operatória. Após a operação foi fornecido para todos os pacientes um questionário, contendo a escala analógica visual (EAV), a escala descritiva de dor (EDD) e uma tabela para informar o consumo de medicação resgate. Foi avaliada a dor pós-operatória por meio da EAV, da EDD e pelo consumo de medicação resgate. Não houve diferença estatisticamente relevante quanto a intensidade da dor com o uso do parecoxibe ou do cetoprofeno antes ou depois do procedimento cirúrgico. Ao comparar a analgesia proporcionada pelo cetoprofeno e pelo parecoxibe os resultados mostraram que o parecoxibe administrado antes do procedimento cirúrgico foi mais eficaz do que o cetoprofeno no controle da dor na quarta hora do pós-operatório (p=0,041), mas foi menos eficaz após 24h (p=0,003). Quando se comparou a analgesia proporcionada por esses...

This is a prospective, double-blind randomized, cross over experiment, to evaluate the effect of the preemptive analgesia of ketoprofen and parecoxib. Sixity patients who had gone though surgery for removal of the impacted mandibular bilateral third molar teeth, having one side operated each time, were evaluated. The patients were separated in groups of 30, in the parecoxib group (P). On the first operation parecoxib or placebo were used 30 minutes before the surgery. Immediately after the operation, placebo or parecoxib were administred, so that the patient who had received parecoxib before the operation or after it. The opposite side was operated two weeks after the first surgery and the patients who received parecoxib before and placebo after operation received placebo before and parecoxib after operation and patients who received placebo before and parecoxib after received parecoxib before and placebo after, under the same method. In the group C (n= 30), the model was the same, using ketoprofen instead parecoxib. The patient could use dipyrone as rescue medication, in the event of postoperative pain. A questionnaire was provided to the patient after each surgery, containing a visual analogic scale, a descriptive pain scale and a table to inform the consum of rescue medication. The postoperative pain was evaluated by visual analogic scale, descriptive pain scale and rescue medicine consum. There was no statistically relevant difference as pain intensity with use of parecoxib or ketoprofen before or after the surgical procedure. Comparing ketoprofen analgesia against parecoxib analgesial, the results shown that the administration of parecoxib before the surgical procedure had a major efficacy than ketoprofen in pain control by the fourth hour post operatory (p=0,041), but was less efficient after 24 hours (p=0,003). When comparing the analgesic effect of both drugs after the operation, parecoxib was more effective than ketoprofen six and eight hours after...