Prescripción de analgésicos no opioides en un Servicio de Ortopedia / Prescription of non-opioid analgesics in an Orthopedics Service

Introducción: El dolor asociado a las alteraciones del sistema musculoesquelético debe ser tratado frecuentemente por los especialistas en Ortopedia. Los analgésicos no opioides se ubican dentro de los fármacos que más se prescriben en este Servicio, aunque no siempre de modo adecuado, según los principios de la prescripción racional. Objetivo: Caracterizar el uso de analgésicos no opioides en el servicio de Ortopedia del Hospital Dr. Salvador Allende. Material y Métodos: Estudio descriptivo de utilización de medicamentos del tipo prescripción-indicación y esquema terapéutico. Se revisaron las historias clínicas de 70 pacientes ingresados en el Servicio de Ortopedia del Hospital Dr. Salvador Allende, durante el período comprendido desde septiembre de 2018 hasta enero de 2019. Resultados: Predominó el sexo femenino y la media de edad de 71,3 años en los pacientes estudiados con una desviación estándar de 22.2 años. Los analgésicos más prescritos fueron dipirona, diclofenaco y paracetamol, en indicaciones aprobadas donde destacaron las fracturas, la celulitis y la seudoartrosis. En la totalidad de los casos, las dosis empleadas fueron adecuadas, no así los intervalos de administración ni la duración del tratamiento. Conclusiones: Es alentador el predominio de la prescripción de analgésicos no opioides con buena relación beneficio-riesgo. No obstante, la presencia de prescripciones irracionales en cuanto a intervalos de administración y duración del tratamiento, indica un déficit en la práctica de la terapéutica analgésica que no debe ser ignorado(AU)

Introduction: The pain associated with alterations of the musculoskeletal system should be frequently treated by the specialist in Orthopedics. Non-opioid analgesics are the most prescribed drugs in this medical service although they are not always used appropriately according to the principles of national prescription. Objective: To characterize the use of non-opioid analgesics in the orthopedics service of the Dr. Salvador Allende Hospital. Material and Methods: A descriptive study of the use of prescription-indication medications and therapeutic scheme was conducted. Medical records of 70 patients admitted to the orthopedics service of the Dr. Salvador Allende Hospital during the period between September 2018 and January 2019 were reviewed. Results: The female sex and a mean age of 71.3 years with standard deviation of 22,2 years predominated in the study. The most frequently used analgesics, which were indicated in the treatment of fractures, cellulitis and pseudarthrosis, were dipyrone, diclofenac and paracetamol. In all cases, the doses used were adequate, but not the administration intervals or the duration of treatment. Conclusions: The predominance of the prescription of non-opioid analgesics with a good benefit-risk ratio is encouraging. However, the presence of irrational prescriptions regarding administration intervals and duration of treatment indicates a deficit in analgesic therapy that should not be ignored(AU)

Analgésicos no opioides / Non-opioid analgesics

Resumen La analgesia multimodal es una recomendación universal para el control del dolor postoperatorio en situaciones clínicas diversas. Esta recomendación está avalada por la Sociedad Americana del Dolor (APS), la Sociedad Americana de Anestesia Regional y Medicina del Dolor (ASRA) y la Sociedad Americana de Anestesiólogos (ASA). La terapia analgésica multimodal se individualiza y ajusta de acuerdo con la edad, el tipo de dolor e intensidad, el procedimiento quirúrgico específico, las morbilidades asociadas y los efectos adversos de los fármacos. La escalera analgésica propuesta por la Organización Mundial de la Salud fue adaptada por la Federación Mundial de Sociedades y Asociaciones de Anestesiólogos (1997) para el abordaje del dolor agudo perioperatorio. Los analgésicos no opioides son la piedra angular para una terapia perioperatoria exitosa; entre los cuales se encuentran el paracetamol, los antiinflamatorios no esteroideos no selectivos y los COX-2, así como los coadyuvantes (para ver el artículo completo visite http://www.painoutmexico.com).

Abstract: Multimodal analgesia is an universal recommendation for the control of postoperative pain in diverse clinical situations. This recommendation is endorsed by the American Pain Society (APS), the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the American Society of Anesthesiologists (ASA). Multimodal analgesic therapy is individualized and adjusted according to age, type of pain and intensity, specific surgical procedure, associated morbidities and adverse effects of drugs. The analgesic ladder proposed by the World Health Organization was adapted by the World Federation of Societies and Associations of Anesthesiologists (1997) for the management of acute perioperative pain. Non-opioid analgesics are the cornerstone for a successful perioperative therapy, among which are paracetamol, non-selective and COX-2, also include adjuvants (full version visithttp://www.painoutmexico.com ).

Analysis of Analgesic Efficacy of the Non-Opioid Analgesics in Patients Following Abdominal Hysterectomy at a Tertiary Care Centre

Background: Women undergoing procedures or surgeriesrelated to infertility experience pain, which is often treated withopioid medication. Hence; the present study was undertakenfor assessing analgesic efficacy of the non- opioid analgesic inpatients following abdominal hysterectomy at a tertiary carecenter.Materials and Methods: A total of 30 patients scheduled toundergo abdominal hysterectomy were enrolled in the presentstudy. All the patients underwent abdominal hysterectomyunder the hands of skilled clinicians. All the patients weredivided broadly into three study groups: Group 1: Patients weregiven placebo Group 2: Patients were given metamizol 1 g,and Group 3: Patients were given paracetamol 1 g. The drugswere dissolved in 100 mL normal saline and given via IVinfusion over 15 minutes. Patients in the placebo groupreceived only 100 mL of normal saline. All the postoperativedata in all the patients was recorded. All the results wereanalyzed by SPSS software.Results: In the present study, a total of 30 patients wereanalyzed. Mean age of the patients of the study group 1, 2 and3 was 42.8 years, 40.1 years and 43.8 years respective. MeanBMI of the patients of the study group, 2 and 3 was 27, 25.9and 26.1 Kg/m2respectively. In the present study, whilecomparing the Frequency of Patient controlled analgesia bolusdemands among the four study groups, non-significant resultswere obtained.Conclusion: Both metamizol and paracetamol can be usedwith equal efficacy in patients following abdominalhysterectomy.

The research progress on the effect of Non⁃opioid anesthetic drugs on the growth and metastasis of cancer cells / 医学研究生学报

Anesthesia drugs are closely related to metastasis and recurrence of tumors. In recent years, it is believed that anesthetics have important effects on proliferation, migration of tumor cells. Most studies suggest that opioids, mainly morphine, promote tumor growth and metastasis, while the clinical effects of different anesthetic drugs on different types of tumors and different subtypes of the same tumor are vaied. At present, non⁃opioid anesthesia drugs have potential advantages in postoperative metastasis and recurrence of tumor patients. Compared with opioid drugs, they have broad application prospects. This article reviews the progress of general anesthetics, local anesthetics and non⁃opioid analgesics.

Designing the ideal perioperative pain management plan starts with multimodal analgesia / 대한마취과학회지

Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to tailor to the individual patient. Elements of this protocol may include opioids, non-opioid systemic analgesics like acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, and local anesthetics administered by infiltration, regional block, or the intravenous route. While implementation of multimodal analgesic protocols perioperatively is recommended as an intervention to decrease the prevalence of long-term opioid use following surgery, the concurrent crisis of drug shortages presents an additional challenge. Anesthesiologists and acute pain medicine specialists will need to advocate locally and nationally to ensure a steady supply of analgesic medications and in-class alternatives for their patients’ perioperative pain management.

Conocimiento básico de los riesgos del uso de analgésicos no opioides en pacientes ambulatorios / Basic knowledge of risks for non-opioid analgesics (NOA) in ambulatory patients

OBJETIVO: Evaluar el conocimiento básico de los pacientes acerca de los analgésicos no opioides (ANOP) e identificar los posibles factores relacionados con la falta de información sobre este tipo de analgésicos. MATERIAL Y MÉTODOS: Participaron 629 pacientes >50 años con síndrome doloroso de origen no oncológico y que recibieron ANOP. Se analizaron sus características generales, la información recibida y su conocimiento sobre ANOP. La variable dependiente fue la falta de conocimiento básico (FCB) sobre ANOP. Se realizó análisis descriptivo y bivariado. RESULTADOS: Del total de participantes, 64.2 por ciento tuvo FCB; 28 por ciento desconocía la forma correcta de tomar ANOP y 48 por ciento sabía que ocasionan trastornos gastrointestinales. Factores asociados con la FCB: no recibir información sobre ANOP (RM= 2.22; IC95 por ciento 1.32-3.70), escolaridad < 7 años (RM= 1.87; IC95 por ciento 1.33-2.63) y duración del dolor < 4 años (RM=1.70; IC95 por ciento 1.22-2.37). CONCLUSIONES: Los pacientes carecen de conocimiento y reciben poca información acerca de ANOP. Es indispensable promover acciones para solucionar este problema.

OBJECTIVE: To describe patients’ knowledge of non-opioid analgesics (NOA) and to identify factors associated with patients’ lack of basic knowledge (LBN) on this type of medication. MATERIAL AND METHODS: A total of 629 ambulatory patients older than 50 years of age, with non-malignant pain syndrome, attended to two family medicine clinics and received seven day prescriptions for NOA. The data on patients’ general characteristics, the information they received and their actual knowledge of NOA were analyzed using descriptive statistics and bivariate analysis. RESULTS: A total of 64.2 percent had LBN; 28 percent did not know how to take NOA properly, and 48 percent knew that these drugs cause gastrointestinal adverse effects. The factors significantly associated with LBN on NOA included: failure to receive information on NOA (OR:2.22, 95 percentCI 1.32-3.70), education <7 years (OR:1.87, 95 percentCI 1.33-2.63) and pain duration <4 years (OR:1.70, 95 percentCI 1.22-2.37). CONCLUSION: Patients lack knowledge and receive little information on NOA. It is important to encourage actions to tackle this problem.