Preemptive kidney transplantation: why, when, and how? / Transplante renal preemptivo: por que, quando e como?

ABSTRACT Among renal replacement therapies, preemptive kidney transplantation (PKT) presents the best clinical, social, and economic results. However, it is still infrequently chosen as first therapy for patients with irreversible kidney failure. Initiatives in different parts of the world were developed to identify the reasons why PKT is still not widely used and to facilitate the access of patients with end-stage kidney disease to the advantages associated with it. This article addresses the main advantages and difficulties of PKT and discusses when it should be indicated and how to prepare potential recipients for PKT.

Resumo Entre as terapias renais substitutivas, o transplante renal preemptivo (TRP) apresenta os melhores resultados clínicos, sociais e econômicos. No entanto, ainda é raramente escolhido como primeira terapia para pacientes com falência renal irreversível. Foram desenvolvidas iniciativas em diferentes partes do mundo para identificar as razões pelas quais o TRP ainda não é amplamente utilizado e para facilitar o acesso de pacientes com doença renal em estágio terminal às vantagens associadas ao mesmo. Este artigo aborda as principais vantagens e dificuldades do TRP e discute quando ele deve ser indicado e como preparar potenciais receptores para o TRP.

Uso profiláctico de antimicrobianos fuera de la práctica quirúrgica y de procedimientos invasivos: bases conceptuales y operativas

El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.

Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.

Efficacy and safety of preemptive therapy for cytomegalovirus end-organ disease in people living with HIV: a systematic review and meta-analysis

ABSTRACT Introduction: Cytomegalovirus end-organ-disease (CMV EOD) is still a major cause of debilitating illness in people living with HIV, especially in developing countries. Objective: To evaluate the efficacy and safety of preemptive therapy against CMV EOD in HIV-positive adults with CMV viremia. Methods: Systematic review of clinical trials by searching electronic databases and clinical trial registries, screening and selection of references, data extraction and assessment of risk of bias. The results were presented in a narrative synthesis. Aggregated analyzes for dichotomous outcomes were reported as odds ratios with 95 % Confidence Intervals. Results: Four RTC were included. A reduction in the risk of CMV EOD with preemptive therapy was found OR=0.49 (95 % CI 0.31-0.76). We did not identify significant differences for all-cause mortality, adverse events, and withdrawal of the therapy secondary to adverse events. Conclusions: Preemptive therapy could be a potential option for preventing CMV EOD in people living with HIV.

Effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament reconstruction: a randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament (ACL) reconstruction.@*METHODS@#A total of 160 patients with ACL injuries who met the selection criteria and were admitted between November 2020 and August 2021 were selected and divided into 4 groups according to the random number table method (n=40). Group A began to take imrecoxib 3 days before operation (100 mg/time, 2 times/day); group B began to take imrecoxib 1 day before operation (100 mg/time, 2 times/day); group C took 200 mg of imrecoxib 2 hours before operation (5 mL of water); and group D did not take any analgesic drugs before operation. There was no significant difference in gender, age, body mass index, constituent ratio of meniscal injuries with preoperative MRI grade 3, constituent ratio of cartilage injury Outerbridge grade 3, and visual analogue scale (VAS) score at the time of injury and at rest among 4 groups (P>0.05). The operation time, hospitalization stay, constituent ratio of perioperative American Society of Anesthesiologists (ASA) grade 1, postoperative opioid dosage, and complications were recorded. The VAS scores were used to evaluate the degree of knee joint pain, including resting VAS scores before operation and at 6, 24, 48 hours, and 1, 3, 6, and 12 months after operation, and walking, knee flexion, and night VAS scores at 1, 3, 6, and 12 months after operation. The knee injury and osteoarthritis score (KOOS) was used to evaluate postoperative quality of life and knee-related symptoms of patients, mainly including pain, symptoms, daily activities, sports and entertainment functions, knee-related quality of life (QOL); and the Lysholm score was used to evaluate knee joint function.@*RESULTS@#All patients were followed up 1 year. There was no significant difference in operation time, hospitalization time, or constituent ratio of perioperative ASA grade 1 among 4 groups (P>0.05); the dosage of opioids in groups A-C was significantly less than that in group D (P<0.05). Except for 1 case of postoperative fever in group B, no complications such as joint infection, deep vein thrombosis of the lower extremities, or knee joint instability occurred in each group. The resting VAS scores of groups A-C at 6 and 24 hours after operation were lower than those of group D, and the score of group A at 6 hours after operation was lower than those of group C, and the differences were significant (P<0.05). At 1 month after operation, the knee flexion VAS scores of groups A-C were lower than those of group D, the walking VAS scores of groups A and B were lower than those of groups C and D, the differences were significant (P<0.05). At 1 month after operation, the KOOS pain scores in groups A-C were higher than those in group D, there was significant difference between groups A, B and group D (P<0.05); the KOOS QOL scores in groups A-C were higher than that in group D, all showing significant differences (P<0.05), but there was no significant difference between groups A-C (P>0.05). There was no significant difference in VAS scores and KOOS scores between the groups at other time points (P>0.05). And there was no significant difference in Lysholm scores between the groups at 1, 3, 6, and 12 months after operation (P>0.05).@*CONCLUSION@#Compared with the traditional analgesic scheme, applying the concept of preemptive analgesia with imrecoxib to manage the perioperative pain of ACL reconstruction can effectively reduce the early postoperative pain, reduce the dosage of opioids, and promote the early recovery of limb function.

The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty

Abstract Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain. Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use. Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc (n = 31), and the control group received 6 cc 0.9% NaCl (n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1st, 3rd, 6th, 12th, and 24th hours. Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1st, 3rd, 12th, and 24th hours were 4.03 ± 3.08 (0-10); 3.42 ± 2.39 (0-8); 2.97 ± 2.22 (0-8); 2.87 ± 2.61 (0-9); and 1.94 ± 2.06 (0-9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1st, 3rd, 12th, and 24th hours were 4.12 ± 2.7 (0-10); 3.45 ± 2.4 (0-10); 2.94 ± 2.7 (0-10); 2.79 ± 2.34 (0-10); and 1.5 ± 1.8 (0-6), respectively. The statistical analysis revealed no significant difference among the groups. Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

Analgesia preemptiva em cirurgias de implantes dentais: (i) revisão sistemática e meta-análise; (ii) ensaio clínico triplo-cego, paralelo, randomizado e controlado por placebo / Preemptive analgesia in dental implant surgery: (i) systematic review and meta analysis; (ii) triple-blind, parallel, randomized and placebo-controlled clinical trial

Não existem evidências suficientes, para recomendar um regime analgésico específico, para o controle da dor em analgesia preemptiva, após cirurgia de implante dentário. Isto sinaliza a necessidade de estudos adicionais. Esta pesquisa apresenta dois estudos com objetivos distintos: (1) avaliar a eficácia da analgesia preemptiva em cirurgias de implantes dentais por meio de uma revisão sistemática e meta-análise de ensaios clínicos randomizados. (2) avaliar e comparar por meio de um ensaio clínico randomizado (ECR), paralelo, controlado por placebo, a efetividade da analgesia preemptiva em cirurgias de implantes dentais unitários, buscando identificar dentre os analgésicos e anti-inflamatórios não esteroidais (AINES) [eterocoxibe (ETERO), ibuprofeno (IBU), nimesulida (NIME) e acetaminofeno (ACETA)], qual possui maior eficácia no alívio da dor pós-operatória e na redução do uso da medicação de resgate comparados ao uso do placebo. Esta revisão sistemática com meta-análise seguiu as diretrizes PRISMA e foi registrada no PROSPERO (CRD42020168757). Cinco estudos foram incluídos na revisão e quatro foram incorporados à meta-análise. Uma meta-análise de efeito randômico comparou a eficácia da medicação preventiva em comparação ao placebo. Para a interpretação dos resultados utlizamos a certeza da evidência usando a abordagem Grading of Recommendations, Assessment, Development and Evaluation (GRADE) e a magnitude do efeito, de acordo com as diretrizes do GRADE. Todos os estudos demonstraram que a medicação preemptiva contribuiu para uma melhora significativa da dor pós-operatória. No entanto, o desvio médio padrão (DMP) geral agrupado mostrou, que, a medicação preventiva teve um efeito pequeno em comparação com o placebo, na redução da dor (DMP: -0,43; IC: -0,71; -0,15), com baixa certeza da evidência. Essa metanálise mostrou que a magnitude do efeito foi maior seis a oito horas após a cirurgia (efeito grande), comparada ao tempo de uma a duas horas, após a cirurgia (efeito pequeno). Concluiu-se que a analgesia preventiva pode ter um efeito positivo na redução da dor em comparação ao não uso de medicação preemptiva. No entanto, as evidências são ainda insuficientes. O ECR com inserção de implante dental unitário envolveu 135 indivíduos, com média de idade de 57,1 (±11,2), de ambos os gêneros alocados em 5 grupos (ETERO, IBU, NIME, ACETA e placebo). A ocorrência, tempo e a intensidade da dor foram analisados por meio testes de teste Qui-quadrado, Exato de Fisher, ANOVA e modelos de equações de estimativas generalizadas quando adequados. Todos os medicamentos testados proporcionaram um efeito benéfico da analgesia preemptiva. Isso foi demonstrado pela redução da dor pós-operatória e do menor uso de medicação de resgaste. O grupo IBU apresentou significativamente maiores escores de dor que os outros três grupos testes (IBU>ETERO=NIME=ACETA), que foram equivalentes entre si. Apesar da ocorrência de significância estatística, do ponto de vista da relevância clínica, a diferença entre os grupos foi pequena e todos os grupos apresentaram baixos escores de dor. Assim, sugerimos que a tomada de decisão em relação à escolha do medicamento deve considerar, também, a relação de custo-benefício, efeitos adversos e características individuais dos pacientes. Em adição, estudos futuros em cirurgias implantodônticas extensas (maior número de implantes inseridos e com enxertos ósseos/gengivais) apresentando alto rigor metodológico, ainda se faz necessário. (CAEE 83534618.5.0000.5149)

There is insufficient evidence to recommend a specific analgesic regimen for pain management in preemptive analgesia after dental implant surgery, signaling the need for further studies. This research presents two studies with different objectives: (1) to evaluate the effectiveness of preemptive analgesia in dental implant surgeries through a systematic review and meta-analysis of randomized clinical trials. (2) to evaluate and compare, through a randomized clinical trial (RCT), parallel, controlled by placebo, the effectiveness of preemptive analgesia in single dental implant surgeries, seeking to identify among analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) [ eterocoxib (ETERO), ibuprofen (IBU), nimesulide (NIME) and acetaminophen (ACETA)], which is more effective in relieving postoperative pain and reducing the use of rescue medication compared to the use of placebo. The systematic review with meta-analysis was conducted by PRISMA guidelines and registered in PROSPERO (CRD42020168757). Five studies were included in the review and four were incorporated into the meta-analysis. A random-effect meta- analysis compared the effectiveness of preventive medication compared to placebo. The interpretation of the results followed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach together with the magnitude of the effect according to the GRADE guidelines. All studies demonstrated that preemptive medication contributed to a significant improvement in postoperative pain. However, the pooled overall mean standard deviation (SMD) showed that preventive medication had a small effect compared with placebo in reducing pain (SMD: -0.43; CI: -0.71; -0.15) with low certainty of evidence. Our meta-analysis showed that the magnitude of the effect was greater six to eight hours after surgery (large effect), compared to one to two hours after surgery (small effect). It was concluded that preventive analgesia can have a positive effect in reducing pain compared to not using preemptive medication, but the evidence is still insufficient. The RCT with single dental implant insertion involved 135 individuals, with a mean age of 57.1 (±11.2), of both genders allocated into 5 groups (ETERO, IBU, NIME, ACETA and placebo). The occurrence, duration and intensity of pain were analyzed using Chi- square, Fisher's Exact, ANOVA and generalized estimating equation models when appropriate. All drugs tested provided a beneficial effect of preemptive analgesia demonstrated by reduced postoperative pain and reduced use of rescue medication. The IBU group had significantly higher pain scores than the other three test groups (ETERO, NIME and ACETA), which were equivalent to each other. Despite the occurrence of statistical significance, from the point of view of clinical relevance, the difference between the groups was small and all had low pain scores. Thus, we suggest that the decision making regarding the choice of medication should also consider the cost-benefit ratio, adverse effects and individual characteristics of patients. In addition, future studies in extensive implant dentistry surgeries (greater number of implants inserted and with bone/gingival grafts) presenting high methodological rigor are still necessary. (CAEE 83534618.5.0000.5149)

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar hypomineralization: a triple-blind randomized clinical trial

Abstract Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia. Objective: This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity. Methodology: Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher's exact test, and t-test. Results: Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure. Conclusion: Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity.

Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials

This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including "grey literature." The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The "Joanna Briggs Institute for Randomized Controlled Trials" tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure.

Effects of preemptive nasogastric tube placement on improving nutrition and feeding status of infants with congenital heart disease / 中国实用护理杂志

Objective:To evaluate the effectiveness and safety of preemptive nasogastric tube placement for improving nutritional status and clinical outcomes in hospitalized infants with congenital heart disease.Methods:Children from 0 to 12 months with congenital heart disease hospitalized in cardiovascular center of Children's Hospital of Fudan University from February to July 2018 were selected as control group through continuous sampling. Children hospitalized were selected from September 2018 to February 2019 as intervention group. The control group followed the current feeding method, the intervention group used preemptive nasogastric tube placement. The nutritional indicators, feeding indicators and clinical outcomes of the two groups were compared to evaluate the intervention effect.Results:The serum albumin and prealbumin of the children in the intervention group were (36.81±4.59) g/L and (162.74±48.17) g/L, which were higher than those in the control group (34.80±5.21) g/L and (142.98± 33.96) g/L, the difference between the two groups was statistically significant ( t values were -2.721, -3.169, both P<0.05); the daily enteral intake, calorie intake and single enteral calorie intake of children in the intervention group were (124.93±27.97) ml·kg -1·d -1, (376.48±88.53) kj·kg -1·d -1, (48.39±9.13) kj·kg -1·time -1, higher than the control group (114.74±30.63) ml·kg -1·d -1, (330.01±90.75) kj·kg -1·d -1, (44.24±13.31) kj·kg -1·time -1, the difference between the two groups was statistically significant ( t values were -2.511, -3.750, -2.382, all P<0.05). the incidence of feeding difficulties in the intervention group was 4.95% (5/101) lower than 14.68% (16/109) of the control group, the difference between the two groups was statistically significant ( χ2 value was 5.513, P<0.05); the proportion of children in the intervention group reaching the target feeding amount when discharged from the hospital was 97.03% (98/101), higher than 84.40% (92/109) of the control group, the difference between the two groups was statistically significant ( χ2 value was 9.699, P<0.05). Conclusions:Preemptive nasogastric tube placement is safety and effectively for patients with congenital heart disease in clinical infants. but it still needs a large sample for a long time to confirm its effectiveness.

Comparative study between electroacupuncture at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery / 中国针灸

OBJECTIVE@#To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery.@*METHODS@#Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T@*RESULTS@#The MAP at T@*CONCLUSION@#The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.

Avaliação da eficácia de diferentes protocolos de analgesia preemptiva em cirurgias odontológicas / Evaluation of the effectiveness of different preemptive analgesia protocols in dental surgery

A analgesia preemptiva tem como princípio a administração de fármacos antes do início dos estímulos dolorosos, a fim de reduzir ou prevenir a dor pós-operatória. Apesar da sua importância, os efeitos da analgesia preemptiva em cirurgias odontológicas reportados na literatura ainda são conflitantes. Assim, o objetivo deste estudo foi avaliar a eficácia clínica de diferentes classes de medicamentos para analgesia preemptiva, em 2 propostas de investigação 1) cirurgias para exodontia de terceiros molares impactados; 2) cirurgias periodontais a retalho. Para tal, foram realizados ensaios clínicos randomizados placebo-controlados onde os participantes recebiam, 1 hora antes da cirurgia, o medicamento teste e o placebo em cirurgias distintas, em um desenho boca-dividida. Na primeira proposta de investigação, de um total de 376 pacientes com necessidade de exodontia de terceiros molares inferiores classe IIB, foram selecionados 100 pacientes, com idade entre 18 - 30 anos (22,4±2,9), alocados em 5 grupos (n = 20 por grupo), sendo: 1) paracetamol; 2) cetoprofeno; 3) ibuprofeno; 4) nimesulida; 5) dexametasona). Através de escala visual analógica, dor pós-operatória foi avaliada nos tempos 1h, 6h, 12h, 24h, 48h e 72h e edema foi avaliado nos tempos baseline, 24h, 48h, 72h e 7 dias pós-operatórias. As diferenças entre o medicamento de teste e o placebo foram determinadas como a variável de resposta. Um modelo de Equação de Estimativa Generalizada foi ajustado para cada variável desfecho e os grupos foram comparados pelo teste de Tukey. O ibuprofeno e a nimesulida apresentaram efeitos preemptivos gerais mais altos no controle de dor ao longo do tempo, sem diferenças entre eles (p = 0,557). O paracetamol mostrou efeitos gerais mais baixos no controle do edema ao longo do tempo, quando comparado aos outros medicamentos em teste, que mostraram efeitos semelhantes (p<0,05). Também foram observados melhores resultados na quantidade de medicamentos de resgate para o ibuprofeno e a nimesulida, sem diferenças entre eles (p = 0,999). Ibuprofeno e a nimesulida mostraram melhores efeitos preemptivos gerais nas cirurgias de terceiros molares inferiores impactados e assim devem ser considerados caso a caso como medicamentos de escolha em analgesia preemptiva. Na segunda proposta de investigação, de um total de 360 indivíduos com necessidade de cirurgias a retalho, foram selecionados 40 pacientes, com idade entre 18 a 60 anos (43,40 ± 11,91), alocados em 2 grupos (n = 20 por grupo), sendo 1) ibuprofeno; 2) nimesulida. Através da escala visual analógica, dor pós-operatória foi avaliada nos tempos 1h, 6h, 12h, 24h, 48h e 72h. As diferenças entre medicamento teste e placebo foram determinadas como a variável de resposta. Um modelo de Equação de Estimativa Generalizada separado foi ajustado para cada variável desfecho e os grupos foram comparados pelo teste de Tukey. O uso de medicação de resgate foi menor e o tempo pós-operatório foi maior nos grupos teste ibuprofeno e nimesulida em comparação ao placebo (p<0,001). E o grupo nimesulida apresentou escores de EVA mais baixos nos tempos T12, T24, T72 horas (p<0,001; p<0,001; p<0,007), mostrando-se um coadjuvante benéfico para o controle da dor pós-operatória em cirurgias periodontais a retalho.

Preemptive analgesia has as its principle the administration of drugs before the start of painful stimuli, in order to reduce or prevent postoperative pain. Despite its importance, the effects of preemptive analgesia in dental surgeries reported in the literature are still conflicting. Thus, the objective of this study was to evaluate the clinical efficacy of different classes of drugs for preemptive analgesia, in 2 different research proposals: 1) surgeries for extraction of impacted third molars; 2) periodontal flap surgeries. To this end, randomized placebo-controlled clinical trials were carried out where the participants received, 1 hour before surgery, the test drug and the placebo in different surgeries, in a mouth-divided design. In the first research proposal, from a total of 376 patients in need of extraction of lower third molars, class IIB, 100 patients were selected, aged between 18 - 30 years (22.4 ± 2.9), allocated in 5 groups ( n = 20 per group), being: 1) acetaminophen; 2) ketoprofen; 3) ibuprofen; 4) nimesulide; 5) dexamethasone). Through a visual analog scale, postoperative pain was assessed at 1h, 6h, 12h, 24h, 48h and 72h and edema was assessed at baseline, 24h, 48h, 72h and 7 postoperative days. Differences between test drug and placebo were determined as response variable. A separate Generalized Estimation Equation model was separated for each outcome variable and the groups were compared using the Tukey test. Ibuprofen and nimesulide higher overall preemptive sinks in pain controls over time, with no differences between them (p = 0.557). Paracetamol general effects resulting from lower control of edema over time, when compared to other drugs under test, which affect other similar effects (p <0.05). Better results were also observed in the quantity of rescue drugs for ibuprofen and nimesulide, with no differences between them (p = 0.999). It was concluded that ibuprofen and nimesulide are the main general preemptive effects in impacted lower third molar surgeries. Thus, in the decision-making process for preemptive analgesia, ibuprofen and nimesulide should be considered case by case as the drugs of choice. In the second research proposal, from a total of 360 individuals in need of retail surgery, 40 patients were selected, aged between 18 and 60 years (43.40 ± 11.91) years, allocated in 2 groups (n = 20 per group), being 1) ibuprofen; 2) nimesulide. Through the visual analog scale, postoperative pain was assessed at 1h, 6h, 12h, 24h, 48h and 72h. The differences between the test drug and the placebo were determined as the response variable. A separate Generalized Estimation Equation model was separated for each outcome variable and the groups were compared using the Tukey test. The nimesulide group had lower complementary EVA scores at times T12, T24, T72 hours (p <0.001; p <0.001; p <0.007). The use of rescue medication was less secondary and the postoperative time was longer in the ibuprofen and nimesulide test groups compared to placebo (p <0.001). Thus, nimesulide can be considered a beneficial adjunct to the control of postoperative pain in periodontal flap surgeries.

Efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery: a systematic review and meta-analysis / Eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica de hombro: una revisión sistemática y metanálisis

Abstract: Objective: To assess the efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery. Material and methods: A PRISMA-compliant systematic review and meta-analysis was conducted in PubMed, Cochrane Library and ScienceDirect databases. Randomized Controlled Trials (RCTs) comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing shoulder arthroscopic surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score at 24 hours and cumulative morphine consumption at 24 hours. The secondary outcomes were complications of nausea/vomiting, sedation and dizziness. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary. Results: Five clinical studies (gabapentin group n = 4 and pregabalin group n = 1) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 24 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea/vomiting. There were no significant differences in the occurrence of sedation and dizziness. Conclusions: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following arthroscopic shoulder surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after shoulder surgery.

Resumen: Objetivo: Evaluar la eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica del hombro. Material y métodos: Se llevó a cabo una revisión sistemática y metaanálisis conforme a PRISMA en las bases de datos PubMed, Cochrane Library y ScienceDirect. Se recuperaron ensayos controlados aleatorios (RCT) que comparaban los gabapentinoides (gabapentina y pregabalina) con placebo en pacientes sometidos a cirugía artroscópica del hombro. El punto final principal fue la puntuación de la escala analógica visual (VAS) a las 24 horas y el consumo acumulado de morfina a las 24 horas. Los resultados secundarios fueron complicaciones de náuseas/vómitos, sedación y mareos. Después de realizar pruebas de sesgo de publicación y heterogeneidad entre los estudios, se agregaron datos para modelos de efectos aleatorios cuando fue necesario. Resultados: En última instancia, se incluyeron en el metaanálisis cinco estudios clínicos (grupo de gabapentina n = 4 y grupo de pregabalina n = 1). Los gabapentinoides se asociaron con puntuaciones de dolor reducidas a las 24 horas. Del mismo modo, los gabapentinoides se asociaron con una reducción en el consumo acumulado de morfina a las 24 horas. Además, los gabapentinoides pueden reducir significativamente la aparición de náuseas/vómitos. No hubo diferencias significativas en la ocurrencia de sedación y mareos. Conclusiones: El uso preoperatorio de gabapentinoides fue capaz de reducir el dolor postoperatorio, el consumo total de morfina y las complicaciones relacionadas con la morfina después de la cirugía artroscópica del hombro. Otros estudios deben determinar la dosis óptima y si la pregabalina es superior a la gabapentina en el control del dolor agudo después de la cirugía de hombro.

Effectiveness of pre-emptive thoracic epidural analgesia for acute post thoracotomy pain relief: a randomised blinded study

Background: Thoracotomy is one of the most damaging surgical insults on respiratory mechanics and management of post-thoracotomy pain is a challenge. This study was conducted to compare intensity of postoperative pain, measured by VAS, in patients receiving Pre-emptive TEA compared to patients receiving epidural analgesia during surgical closure.Method: Group A comprised of patients receiving Pre-emptive TEA with 0.1%Ropivacaine and 2 μg/ml fentanyl, 20 minutes before incision. Group B comprised of patients receiving the same drug, during surgical closure.Results: Demographic profile was comparable between both groups. Both groups offered good analgesia, but pre-emptive group took an upper hand upto4th postoperative hour (p<0.05), both at rest and coughing. Beyond 4thhour, analgesic efficacy of both groups was comparable.Conclusion: Pre-emptive technique offered better analgesia over the postoperative technique up to 4th postoperative hour, both at rest and coughing.

To Compare Analgesic Effect Of Two Different Doses Of Oral Pregabalin As Premedication In Patients Undergoing Abdominal Hysterectomy Under Spinal Anaesthesia

Background-In preemptive analgesia, the analgesic treatment is started before and is operational during the surgical procedure so that the physiological consequences of nociceptive transmission are reduced. Because of this protective effect on nociceptive pathways, preemptive analgesia decreases the incidence of hyperalgesia and allodynia after surgery.Methods-This Hospital based, prospective, randomized, double blind, comparative study was conducted in Department of Anaesthesiology, Sawai Man Singh Medical College after obtaining approval from Institutional Ethics Committee and Research Review Board and written informed consent from all the patients.Results- The mean duration of analgesic was 4.97 ± 2.98 hrs in group Aafter which first rescue analgesic was required in group A, 6.49±2.98 hrs in group B and 7.26±2.51 hrs in group C. The mean duration of analgesia after which second rescue analgesic was required was 9.77±1.95 hrs for group A, 13.36±5.21 hrs for group B and 13.13±4.15 hrs for group C. The mean duration of analgesia after which third rescue analgesic was required was 15.43±3.58 hrs for group A, 15.94±3.42 hrs for group B and 17.25±0.35 hrs for group C.Conclusion-We conclude that pregabalin 75 mg is better drug for preemptive analgesia and it can be used safely as a part of multoimodal analgesia regimens.

Effect of preoperative intervention of electroacupuncture at point on postoperative complications of procedure for prolapsed and hemorrhoids / 中国针灸

OBJECTIVE@#To explore effective treatments that can alleviate postoperative complications in patients with procedure for prolapsed and hemorrhoids (PPH).@*METHODS@#Sixty patients with pre-mixed hemorrhoids PPH were randomly divided into a simple operation group and a preoperative electroacupuncture intervention group, 30 cases in each group. PPH routine treatment was given in the simple operation group. Electroacupuncture (EA) was applied at point 30 min before PPH in the preoperative electroacupuncture intervention group, and EA was applied at Ciliao (BL 32) and Xialiao (BL 34) for 30 min. The scores of anus pendant, pain degree and persistent time and first urination time were compared within 24 h after operation between the two groups.@*RESULTS@#The scores of anal pendant and pain degree in the 6 h, 12 h, 18 h, the persistent time of anal pendant and pain degree within 24 h and first urination time were better in the preoperative electroacupuncture intervention group than those in the simple operation group, and there were statistically significant differences (all <0.05).@*CONCLUSION@#Electroacupuncture at point 30 min before PPH can not only decrease the degrees of anal pendant and pain in the 6 h, 12 h, 18 h, but also shorten the persistent time of anal pendant and pain within 24 h after surgery and promote the first urination.

Effects of preemptive analgesia by nalbuphine combined with flurbiprofen on pain and platelet activity in patients with decompensated cirrhosis / 吉林大学学报(医学版)

Objective: To observe the influence of preemptive analgesia by nalbuphine combined with flurbiprofen in the platelet activity indexes of the patients with decompensated cirrhosis, and to explore its quality of analgesia in the patients with decompensated cirrhosis. Methods: A total of 120 patients with decompensated cirrhosis were randomly divided into combination group (40 cases, given nalbuphine combined with flurbiprofen before anesthesia), nalbuphine group (40 cases, given nalbuphine before anesthesia) and flurbiprofen group (40 cases, given flurbiprofen before anesthesia). The postoperative patient-controlled intravenous analgesia (PCIA) was carried out with sufentanil in all the patients. The indexes of visual analog score (VAS), PCIA compression number, sufentanil consumption, Ramsay score, thrombelastogram (TEG) indexes (R value, K value, a angle, MA value and CI value) and the maximum aggregation rate by arachidonic acid (MARAA) and β-endorphin (β-EP) level, recovery time, and agitation occurrence rate of the patients in various groups were recorded 12 h and 24 h after operation. Results: The indexes of VAS, PCIA compression number, sufentanil consumption and 3-EP level of the patients in combination group were lower than those in the other groups 12 and 24 h after operation (P0. 05). The Ramsay scores of the patients in three groups had no differences at 12 and 24 h after operation (P>0. 05). Compared with nalbuphine group, the R values and K values of the patients in combination group and flurbiprofen group at 12 and 24 h after operation were increased (P 0. 05). The recovery time of the patients among three groups had no significant difference (F=2. 054, P=0. 102). The agitation occurrence rate during recovery period of the patients in case group was the highest (F=5. 624, P= 0. 001), and there was no significant difference in the agitation occurrence rate during recovery period of the patiens between nalbuphine group and flurbiprofen group (χ2 =3. 020, P=0. 091). Conclusion: Combination of nalbuphine and flurbiprofen in the patients with decompensated cirrhosis before analgesia can improve the quality of postoperative analgesia and can' t inhibit the activity of platelet obviously.

Effect of preemptive electroacupuncture on pain reactions in primiparous parturients during vaginal delivery / 针刺研究

OBJECTIVE: To investigate the effect of preemptive electroacupuncture (EA) plus epidural block (EB) on pain reactions and stress hormone levels in primiparous parturients during labor. METHODS: A total of 104 primiparous parturients undergoing vaginal delivery were randomly divided into PA group (n=31), sham EA group (n=36) and EA group (n=37). EA (2 Hz/100 Hz, a tolerable strength) was applied to bilateral Hegu (LI4) and Sanyinjiao (SP6) beginning from the latency of the 1st birth process when the orifice of uterus was opened to about 1 cm wider till the active stage when the orifice of the uterus opened about 3 cm wider. Patients in the sham EA group received shallow acupuncture needle stimulation (without cutaneous penetration of the needle tip, and without stimulation electric current output). All the patients of the 3 groups were given EB (1% Lidocaine, 0.05% Sufentanil and 0.1% Ropivacaine) and patient-controlled epidural analgesia (PCEA) when the orifice of the uterus opened about 3 cm wider. The pain severity was assessed by using Visual Analogue Scale (VAS) at time-points of immediately after EA, 1 h after EA, 2 h after EA, immediately after EB, 1 h after EB, 2 h after EB and full open of the uterus orifice. The contents of serum adrenocorticotrophic hormone (ACTH) and cortisol (COR) were assayed by using ELISA. RESULTS: There was no significant difference in the VAS score at the immediate time of post-EA among the three groups (P>0.05). Compared with the EB group, the VAS scores at all time-points except the immediate time of post-EA were significantly decreased in the EA group (P<0.05). One and 2 h after EB, and after full open of the uterus orifice, the VAS scores in the 3 groups were all evidently decreased (P<0.05), and those of the EA group were significantly lower than those of the sham EA and EB groups (P<0.05). The three groups had a significant increase in the levels of serum ACTH and COR at time-points of 1 and 2 h after EA, immediately after EB, and when the orifice of the uterus was fully opened (P<0.05), presenting a gradual increase of their level during the course of labor. Compared with the EB group, the levels of serum ACTH and COR contents were considerably decreased in the EA group (rather than in the sham EA group) (P<0.05). The dosages of Ropivacaine and Sufentanil, the total pressing times and the effective pressing times of PCEA pump were significantly lower in the EA group than those in the EB and sham EA groups (P<0.05). CONCLUSION: EA plus epidural analgesia, given during the latency period of labor, can effectively alleviate pain, inhibit stress response and reduce the dosage of anesthetics in primiparous parturients throughout the labor process.

Clinical Profile And Outcome Of Paraquat Poisoning Induced Acute Kidney Injury

Paraquat poisoning is one of the causes of AKI, the mechanism of toxicity being the production of reactive oxygen species,thereby causing toxicity at the cellular level. The aim of this study is to determine the requirement of haemodialysis and the severity of toxicity, depending upon the amount ingested.It is found that in Paraquat poisoning, the intervention with pre–emptive haemodialysisis not useful in decreasing the mortality. Ingestion under the influence of alcohol has higher mortality.Amount of poison ingested has a great impact and is directly proportional to the mortality. Oral ulcers, hepatic involvement, ARDS and MODS all reflected grave prognosis ultimately leading to death. The overall mortality in the study is 51%.

Eficacia de la Analgesia Preoperatoria con Antiinflamatorios no Esteroidales (Aines) en Cirugía de Terceros Molares. Revisión de la Literatura / Efficacy of Preemptive Analgesia with Nonsteroidal Anti-Inflammatory Drugs (Nsaids) in Third Molar Surgery. Literature Review

RESUMEN: El manejo del dolor postoperatorio en cirugía de desinclusión de terceros molares es fundamental. El uso de antiinflamatorios no esteroidales (AINES), son considerados como una excelente alternativa para el manejo del dolor, siendo administrados tanto postoperatorios, como preoperatorios. El propósito de la presente revisión bibliográfica fue establecer la eficacia y seguridad de la analgesia preoperatoria con antiinflamatorios no esteroidales en desinclusiones quirúrgicas de terceros molares en las que hubiera remoción parcial o total de hueso. Se realizó una búsqueda en las bases de datos: PubMed, EBSCO, Cochrane Library y Scielo; usando las palabras claves: Preemptive Analgesia, NSAID, Oral Surgery. Trece artículos fueron seleccionados, sumando un total de 875 pacientes evaluados. Si bien varios autores consideraron la analgesia preoperatoria con AINES, como un método eficaz, hacen falta más estudios que demuestren su eficacia en cirugía oral.

SUMMARY: The management of postoperative pain in third molar surgery is fundamental. The use of nonsteroidal antiinflammatory drugs (NSAIDs) are considered an excellent alternative for pain management, administered both, postoperative and preoperative. The purpose of this review is to establish the efficacy and safety of preemptive analgesia with nonsteroidal antiinflammatory drugs in surgical disinclusions of third molars, in which at least partial bone was removed. We conducted a search in databases like: PubMed, EBSCO, Cochrane Library and Scielo; using the key words: Preemptive Analgesia, NSAID, Oral Surgery. Thirteen articles were selected, in total of 875 patients evaluated in the selected articles. Although several authors considered preemptive analgesia with NSAIDs as an effective method, more standardized studies are needed to demonstrate its effectiveness in oral surgery.

Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft

Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student's t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.

Resumo Este estudo avaliou o efeito preventivo e pós-operatório de dexametasona e ibuprofeno na prevenção da dor, desconforto, edema e interferência na vida diária, em pacientes submetidos ao recobrimento radicular associado a enxerto de tecido conjuntivo subepitelial (CAF + CTG). Vinte pacientes foram divididos aleatoriamente: Grupo AINES: Ibuprofeno 400 mg 60 min antes da cirurgia + Ibuprofeno 400 mg no período pós-operatório e Grupo AIES: 4 mg de dexametasona 60 min antes da cirurgia + Dexametasona 4mg no pós-operatório. A medicação pós-operatória foi administrada 8 e 16 horas pós-cirurgia. Cada paciente recebeu questionários com base na escala numérica NRS-101 (101 pontos numéricos) e perguntas de múltipla escolha (VRS-4) sobre dor / desconforto no período transoperatório, de hora em hora durante 8 h e uma vez por dia durante três dias após a cirurgia. A Escala Visual Analógica (VAS) para análise de edema e interferência na vida diária também foi respondida no 1º, 2º, 3º e 7º dia após a cirurgia. O grau de ansiedade foi estatisticamente avaliado pelo teste do Qui-quadrado. Mann-Whitney e Friedman foram utilizados para os demais questionários. Para o tempo de cirurgia e o número de analgésicos consumidos, o teste t de Student foi aplicado. Os pacientes que utilizaram dexametasona apresentaram uma tendência para menores níveis de dor quando comparados aos indivíduos que ingeriram ibuprofeno, com diferença significativa observada 3 h após o procedimento cirúrgico (p<0,05). A utilização de dexametasona também promoveu menores níveis de edema até ao segundo dia e menor interferência na vida diária no terceiro dia, quando comparada com o ibuprofeno (p<0,05). Concluiu-se que a utilização de dexametasona como medicamento preventivo e pós-operatório mostra ser mais adequado como protocolo medicamentosos para cirurgias de recobrimento radicular com associação de enxerto de tecido conjuntivo.