Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

What do we know about the PENG block for hip surgery? A narrative review / ¿Qué conocemos del bloqueo PENG para cirugía de cadera? Una revisión narrativa

Abstract Postoperative pain management in hip surgery is classified as severe and its inadequate control leads to complications that increase patient morbidity and mortality. The PENG block is advocated as a safe, opioid-sparing analgesic technique, which provides an adequate level of analgesia. The purpose of this study is to analyze about the efficacy, safety and therapeutic appropriateness of the PENG block in hip surgery. To this end, a narrative review is conducted using various databases such as PubMed and the Cochrane library. In all of the studies analyzed, an adequate postoperative pain control was achieved using the PENG block, with reduction in pain assessment scales and opioid consumption in the first postoperative hours. Improved results were also seen as compared with other regional blocks. There were few adverse effects and none of them was classified as severe. The PENG block contributes with numerous advantages and few adverse effects for hip surgery. Further studies are needed on this block, whether alone or in combination with other regional techniques, so as to include it in analgesia protocols, developing a standardized approach and study the outcomes in more controlled settings.

Resumen El manejo del dolor posoperatorio en cirugía de cadera se cataloga como severo y su inadecuado control conduce a complicaciones que aumentan la morbimortalidad de los pacientes. El bloqueo PENG se postula como una técnica analgésica segura, ahorradora de opioides, que otorga un nivel analgésico adecuado. El objetivo de este estudio es analizar acerca de la eficacia, seguridad y el lugar terapéutico del bloqueo PENG en cirugía de cadera. Para ello, se hace una revisión narrativa utilizando distintas bases de datos como PubMed y la biblioteca Cochrane. En todos los estudios analizados se observó un adecuado control del dolor posoperatorio con el uso del bloqueo PENG, con reducción en las escalas de evaluación del dolor y en el consumo de opioides en las primeras horas del posoperatorio. También se evidenciaron mejores resultados en comparación con otros bloqueos regionales. Los efectos adversos fueron escasos, y ninguno se catalogó como grave. El bloqueo PENG aporta numerosas ventajas con escasos efectos adversos para cirugía de cadera. Es necesario continuar estudiando este bloqueo, solo o en combinación con otras técnicas regionales, e incluirlo en protocolos de analgesia, estandarizarlo y estudiar sus resultados en escenarios más controlados.

Analgesia infiltrativa del orificio de los trocares en la colecistectomia por videolaparoscopia / Infiltrative analgesia of the trocares hole in cholecystectomy by video laparoscopy

: La colecistectomía es una intervención quirúrgica que se realiza para extraer una vesícula biliar patológica. El postquirúrgico genera dolor en su periodo inmediato. La infiltración de la pared abdominal en los sitios de inserción de los trocares con anestésicos locales con aguja intramuscular al comienzo de la cirugía es una práctica que se realiza de manera rápida y segura. Lugar de Aplicación: Servicio de Cirugía General. Sala 3/5. Hospital Nacional de Clínicas. UNC. Córdoba. Material y Métodos: Se realizó un estudio entre julio del 2022 a julio 2023. Fueron operados 50 pacientes, entre 18 y 80 años de colecistectomías laparoscópicas. De ellos, 17 eran masculinos y 33 femeninos. El estudio fue comparar el dolor postquirúrgico en pacientes con infiltración y sin infiltración peritoneal. Determinar en cuantos pacientes se presentó dolor en el lugar del trocar umbilical y en zona de drenaje si se les coloco. Valorar en que tiempo del postquirúrgico inmediato es más efectiva la analgesia. Resultados: Los pacientes que sí fueron infiltrados corresponden al 44%. Estos con infiltración presentan menor proporción de dolor inmediato, y la relación entre las variables es estadísticamente significativa (p<0,05). Además, los pacientes con infiltración presentan menor proporción de dolor a la semana postquirúrgica, y menor proporción de consumo de AINES. Así mismo presentan menor proporción de dolor en trocar, como menor proporción de dolor en zona de drenaje. Conclusión: Podemos concluir que la infiltración de los orificios de trocares antes de la incisión de piel es una práctica útil que debería ser sistemática para mejorar el dolor postquirúrgico del paciente y en consecuencia su recuperación postquirúrgica más rápida

Cholecystectomy is a surgical procedure performed to remove a pathological gallbladder. The post-surgical period generates pain in its immediate period. Infiltration of the abdominal wall at trocar insertion sites with intramuscular needle local anesthetics at the beginning of surgery is a practice that is performed quickly and safely. Desing: General Surgery Service. Room 3/5. National Hospital of Clinics. UNC. Córdoba. Methods: A study was conducted between July 2022 and July 2023. 50 patients were operated on, between 18 and 80 years of laparoscopic cholecystectomies. Of these, 17 were male and 33 females. The study was to compare postoperative pain in patients with and without peritoneal infiltration. To determine how many patients had pain at the site of the umbilical trocar and in the drainage area if they were placed. To assess at what time of the immediate postoperative period analgesia is most effective. Results: The patients who were infiltrated correspond to 44%. Those with infiltration have a lower proportion of immediate pain, and the relationship between the variables is statistically significant (p<0.05). In addition, patients with infiltration have a lower proportion of pain at the postoperative week, and a lower proportion of NSAID consumption. They also have a lower proportion of pain in the trocar, as well as a lower proportion of pain in the drainage area. Conclusion: We can conclude that the infiltration of the trocar orifices before the skin incision is a useful practice that should be systematic to improve the patient's postoperative pain and consequently their faster postoperative recovery

A Study to Assess the Effects of Epidural Analgesia and Parenteral Analgesia on Maternal and Neonatal Outcomes Among Parturients Experiencing Slow Progression of Labour: A Comparative Study

Introduction: Epidural analgesia however has been shown to be associated with maternal side effects like hypotension, hyperthermia and prolonged labour which are likely to have adverse effects on the fetal outcome, thus discouraging its use in clinical practice. Neonatal/fetal effect should be one of the most important determinants for choosing ideal analgesia. As there is no study which specifically has looked into the effects of labour analgesia on neonatal outcomes on augmentation of labour, it would be prudent to measure the impact of epidural analgesia in parturients requiring augmentation of labour and its effects on maternal and neonatal outcomes. Materials and Methods: The present study was carried among 60 labouring women with partographic evidence of slow progress of labour requiring augmentation in active phase of labour. The enrolled women were randomly allocated into group 1 in which epidural analgesia was established according to guidelines of department of Anesthesia and intensive care, PGIMER. Patients in group 2 received IM tramadol hydrochloride 1 mg/kg (with max. dose 400 mg / 24 hours) every 4 hours. All the women were monitored for 24 to 48 hours postpartum period for complication like hypotension, motor weakness, urinary retention, sedation, nausea or vomiting, allergy fever. The neonates were followed up till discharge from hospital. Results: Most common maternal complication in epidural group was numbness and in tramadol group was vomiting. All most all (93%) of women in epidural group were satisfied with type of analgesia and more than 77% of women reported it to be excellent. In tramadol group only 41% reported analgesia as fair and good but rest of them were dissatisfied with type of analgesia (p-0.001). Ninety three percent of women in epidural group desired to use it again in next pregnancy as compared to 20% in tramadol group. Urinary retention needing catheterization was similar in both groups. Most of neonates in both the groups had established breast feeding with in 12hrs. There was no difference between the groups in the incidence of neonatal jaundice requiring phototherapy. No neonates in either group required NICU or nursery care. Conclusion: To conclude, our study results suggest epidural analgesia might have edge over narcotic analgesics in dystocia. Neonates are more likely to get benefit. However epidural analgesia might increase second stage complications and vigilant care whenever mother on epidural analgesia is mandatory.

Shortage of perioperative supplies and drugs: Theory and practical implications / Desabastecimiento de insumos y medicamentos de uso perioperatorio: teoría e implicaciones prácticas

Abstract During the past three decades the world has been witness to an alarming increase in the shortage of drugs and biomedical products in the field of anesthesia and surgical care. This situation can be particularly challenging when there are no therapeutic alternatives available, as is the case with some supplies and drugs for perioperative use. Anesthesiologists, who play a crucial role in the preparation of the drugs they administer, are particularly aware of these shortages. The reasons for these shortages are diverse and involve problems in supply, demand and government regulation. Among the causes identified are the increase in demand, bidding systems and the sustainability challenges faced by pharmaceutical companies. It is essential to understand these causes in order to seek strategies to reduce the risk of shortages of medicines and supplies. Addressing this challenge requires improving supply chain management, fostering transparency in information on stock-outs, promoting local production of medicines, and strengthening procurement and distribution regulations and policies. The solution to this problem requires a comprehensive and collaborative approach, with multiple stakeholders working together to ensure adequate access to needed medications in the anesthesia and surgical care setting.

Resumen Durante las últimas tres décadas, en el mundo se ha observado un alarmante aumento en el desabastecimiento de medicamentos y productos biomédicos en el ámbito de la atención anestésica y quirúrgica. Esta situación puede resultar especialmente problemática cuando no existen alternativas terapéuticas disponibles, como ocurre en algunos casos de insumos y medicamentos de uso perioperatorio. Los anestesiólogos, quienes desempeñan un papel crucial en la preparación de los medicamentos que administran, son particularmente conscientes de estos fenómenos de desabastecimiento. Las causas de estos desabastecimientos son diversas e involucran problemas en la oferta, la demanda y la regulación estatal. Entre las causas identificadas se encuentran el aumento en la demanda, los sistemas de licitación y los desafíos de sostenibilidad que enfrentan las empresas farmacéuticas. Es fundamental comprender estas causas para buscar estrategias que reduzcan el riesgo de desabastecimiento de medicamentos e insumos. Para abordar este desafío se requiere mejorar la gestión de la cadena de suministro, fomentar la transparencia en la información sobre desabastecimientos, promover la producción local de medicamentos y fortalecer las regulaciones y políticas de adquisición y distribución. La solución a este problema exige un enfoque integral y colaborativo, en el que múltiples partes interesadas trabajen conjuntamente para garantizar un acceso adecuado a los medicamentos necesarios en el ámbito de la atención anestésica y quirúrgica.

Índice de analgesia y nocicepción durante el mantenimiento anestésico en cirugía laparoscópica pediátrica / Analgesia and nociception index during anesthetic maintenance in pediatric laparoscopic surgery

Resumen: Introducción: Habitualmente el monitoreo analgésico está basado en parámetros hemodinámicos. Estas variables son insuficientes para garantizar una adecuada anestesia. La evaluación nociceptiva durante la cirugía es esencial para mejorar la recuperación postoperatoria. Objetivo: Describir el comportamiento del índice de analgesia y nocicepción (ANI) durante el mantenimiento anestésico en pacientes pediátricos sometidos a cirugía laparoscópica. Material y métodos: Serie de casos de pacientes pediátricos programados para cirugía laparoscópica con monitorización ANI. Se analizaron distintas variables en cinco momentos diferentes de la cirugía. Resultados: Se incluyeron 24 pacientes. Se observaron cambios significativos de ANI al inicio de la cirugía 58.5 ± 6.0, al neumoperitoneo 57.4 ± 6.4 y en la emersión 70.9 ± 6.3, mientras que la presión arterial media (PAM) incrementó en la emersión 74.2 ± 5.1 y la frecuencia cardíaca (FC) disminuyó al inicio de neumoperitoneo 96.3 ± 8.2 y al término de éste. La dosis de fentanilo presentó diferencias significativas al término de neumoperitoneo 0.003 ± 0.0007 y emersión 0.002 ± 0.0007. Conclusiones: No existe relación entre las variables hemodinámicas y el valor ANI, sugiriendo que dicho índice parece más sensible que la FC y la PAM para moderar la estimulación nociceptiva en pacientes pediátricos sometidos a cirugía laparoscópica.

Abstract: Introduction: Analgesic monitoring is usually based on hemodynamic parameters. These variables are insufficient to guarantee adequate anesthesia. Nociceptive assessment during surgery is essential to improve postoperative recovery. Objective: To describe the behavior of the analgesia and nociception index (ANI) during anesthetic maintenance in pediatric patients undergoing laparoscopic surgery. Material and methods: Case series of pediatric patients scheduled for laparoscopic surgery using an ANI monitor. Different variables were analyzed at 5 different moments of surgery. Results: 24 patients were included. Significant changes were observed in ANI at the beginning of surgery 58.5 ± 6.0, at the pneumoperitoneum 57.4 ± 6.4 and at emersion 70.9 ± 6.3, while the mean arterial pressure (MAP) increased at emersion 74.2 ± 5.1 and heart rate (HR) decreased at the beginning of the pneumoperitoneum 96.3 ± 8.2 and at its end. The fentanyl dose presented significant differences at the end of pneumoperitoneum 0.003 ± 0.0007 and emersion 0.002 ± 0.0007. Conclusions: There is no relationship between the hemodynamic variables and the ANI value, suggesting that this index seems more sensitive than HR and MAP to moderate nociceptive stimulation in pediatric patients undergoing laparoscopic surgery.

Evaluation of the effects of epidural labour analgesia on mode of delivery

Background: Epidural analgesia is the most effective method of pain relief during labour and the only method that provides complete analgesia without maternal or foetal adverse effects. This study aimed to assess the mode of delivery outcomes of labour in women who had received effective epidural analgesia.Methods: After ethical approval, this quasi-experimental study was carried out in Dhaka Medical College Hospital for one year, from July 2021 to June 2022. A total of 100 admitted pregnant women (37 weeks to 41 weeks) in the labour ward were included in the study according to the inclusion and exclusion criteria. Among them, 50 women were in group A (with epidural analgesia), and the other 50 were in group B (without epidural analgesia). A detailed history and thorough clinical examination were carried out on each patient. Data were collected in separate case-record forms and analyzed using SPSS 24.Results: Mean age, gestational age, parity, and body mass index were statistically similar in both group A and B. Normal vaginal delivery rate (86% vs. 90%), instrumental delivery rate (10% vs. 6%), and caesarean section rate (4% vs. 4%) were not significantly different in both groups. Besides, both group A and B had statistically similar APGAR scores at 1st (8.66±0.87 and 8.80±0.83 respectively, p=0.414) and 5th min (9.66±0.68 and 9.74±0.59 respectively, p=0.537).Conclusions: Epidural labour analgesia can be safely recommended as a method of labour analgesia, provided the prerequisites are fulfilled. It has no significant adverse effect on the mode of delivery.

A comparative study of episiotomy suturing using suture material chromic catgut versus Rapide Vicryl and its outcome

Background: Episiotomy is a surgical incision which is made in the perineum to enlarge the vaginal opening for birth, with a purpose to facilitate the completion of the second stage of labour to improve both the maternal and the neonatal outcomes. A significant number of women experience perineal trauma following vaginal deliveries which may result in perineal pain, dyspareunia and faulty healing. The type of suture material which is used, will influence these factors. Objectives were to assess the effect of suture materials (Rapide Vicryl versus catgut) used in episiotomy and evaluate the wound healing characteristics on day 2 and day 7.Methods: All the pregnant women in labour admitted in labour room of Navodaya medical college, 200 patients satisfying the inclusion and exclusion criteria were taken and were assigned in one of the groups for episiotomy and suturing was done using either of the materials-Vicryl Rapide 2-0 or chromic catgut 1-0, followed up the women in the postnatal ward on day 2 and day 7 and look for immediate complications of episiotomy like temperature, severe pain, hematoma induration, wound gapping and discharge.Results: Among a total of 200 cases, at 48 hours, there was no significant difference according to the pain measurement scores, but the median consumption of analgesics was significantly lower with fast-absorbing polyglactin 910. There was no difference in the association with dysparenia at 6 weeks after the delivery between chromic catgut (19%) compared with standard polyglactin 910 group (8%).Conclusions: Fast-absorbing form of polyglactin sutures are preferred over chromic catgut because of their non- allergic properties, increased tensile strength, lesser probability of pain and lower chances of infection.

A comparative study of intrapartum epidural analgesia with intramuscular tramadol on labor outcome

Background: Epidural analgesia produces analgesia in labour without affecting nervous system, allows the mother to be well oriented, fully conscious and alert throughout labour. The aim of this study is to study the effect of epidural analgesia and intramuscular (IM) tramadol in different stages of labour and compare the effect of epidural analgesia with intramuscular tramadol on progress of labour and its outcome.Methods: Continuous monitoring of the haemodynamic parameters of the mother was done using multiparameter monitors. Foetal monitoring was done using continuous cardiotocography (CTG) monitor. Primigravida in spontaneous labour were randomly divided into two groups. Group I received epidural analgesia and group II received IM tramadol.Results: Duration of Ist stage of labour in group I was 167.0±47.2 min and in group II was 214.4±50.2 min. Mean duration of III stage of labour in the present group I was 7.9 min and 7.5 min in the group II. In the present study, total duration of labour is shortened by 47 min in group I compared to group II.Conclusions: Epidural analgesia during labour is a simple and effective method for painless and safe delivery. Analgesia produced by epidural route is significantly more effective than intramuscular tramadol. Epidural analgesia has favourable effect on the progress of labour. In developing nations where availability of facilities is the main limiting factor, intramuscular tramadol which is a safe and satisfactory drug for relief of labour pain, can be considered as a suitable alternative.

POLYSACCHARIDE BASED CONTROLLED RELEASE MUCOADHESIVE DRUG DELIVERY SYSTEM FOR PAIN MANAGEMENT

Mucoadhesion is one of the most extensively studied methods for the administration of medication for faster onset of action with enhanced bioavailability. Present investigation was concerned with the development and characterization of controlled release muco-adhesive drug delivery system for the drug Tramadol Hydrochloride (TRD) to extend the duration of analgesia for patients suffering from acute to chronic pain. Formulations were made using the solvent casting technique, incorporating natural polymers like Guar Gum, Xanthum Gum and Chitosan in conjunction with HPMC (hydroxy propyl methyl cellulose) to modify the drug release. The compatibility of film components were validated by Fourier Transform Infra- Red (FTIR) spectroscopy and subjected to physico-chemical evaluation parameters and ex-vivo drug diffusion study. Optimized formulation was tested for analgesic efficacy in vivo to determine extent of their suitability in therapeutic use. All the prepared formulations exhibited superior pharmaceutical qualities with respect to drug content, folding endurance, swelling index and mucoadhesion time. In ex-vivo drug diffusion study, all the films displayed a controlled release lasting longer than eight hours. Formulations containing Chitosan in combination with HPMC (F6) showed better controlled drug release over other combinations. The formulation F6 bring out remarkable in vivo analgesic efficacy with 58.10 % analgesia in contrast to the standard (61.16%). It was deduced that Tramadol hydrochloride mucoadhesive films were found to be an effective treatment for moderate to severe pain with a quick onset and a lengthy half-life.

As reações adversas frente ao uso de analgésicos e sedativos em cuidados intensivos pediátricos: implicações para a enfermagem / Adverse reactions to the use of analgesics and sedatives in pediatric intensive care: implications for Nursing

A pouca sedação em Unidades de Terapia Intensiva Pediátrica (UTIP) pode gerar estresse psicológico e físico desnecessário, além de extubação acidental. Em contrapartida, a super sedação pode provocar o uso da ventilação mecânica prolongada, levando ao maior tempo de internação dentro da UTIP, além de síndrome de abstinência, tolerância e delírio. Neste sentido, delimitou-se como objeto de estudo a identidade do cuidado de enfermagem frente às reações adversas do uso de analgésicos e sedativos nas crianças gravemente doentes. Os objetivos são: descrever as reações adversas do uso de sedativos e analgésicos identificadas pela equipe de enfermagem; analisar a prática do cuidado da equipe de enfermagem frente às reações adversas do uso de sedativos e analgésicos nas crianças; e discutir as implicações da prática do cuidado da enfermagem prestada à criança que apresenta reações adversas no uso de analgésicos e sedativos. Trata-se de um estudo de abordagem qualitativa. Foram entrevistados 15 membros da equipe de enfermagem que trabalhavam em uma UTIP de um hospital especializado em doenças crônicas e raras, utilizando-se a técnica de entrevista, o formulário de caracterização dos participantes, o diário de campo para observação não participante e a coleta de informações nos prontuários. Contou-se com o apoio do software Iramuteq para realizar a Análise Textual Discursiva. Obteve-se que as principais reações adversas identificadas pelos profissionais de enfermagem foram irritabilidade, choro e agitação. A prática do cuidado de enfermagem é desenvolvida de acordo com as reações adversas previamente identificadas e varia conforme profissional de enfermagem que atende a criança, não existindo um padrão institucional pré-estabelecido. Entre os cuidados descritos estão: banho momo, administração de doses fracionadas de sedação segundo a prescrição médica e acalento pelo familiar responsável ou pelo próprio profissional. No entanto, não foram observados registros no prontuário acerca dessas reações adversas, bem como desses cuidados relatados. Destaca-se que existe insegurança por parte da equipe de enfermagem no que tange os seus conhecimentos sobre as reações adversas relacionadas ao uso de sedativos e analgésicos e, como implicações para a prática, a falta de identidade no seu cuidado interferindo em sua autonomia e protagonismo profissional, sendo a figura do médico percebida como o mais atuante nessa temática. Conclui-se que a equipe de enfermagem reconhece alguns sinais e sintomas das reações adversas no uso de sedativos e analgésicos. Todavia, se faz necessário um aprimoramento e atualizações frente à utilização desses medicamentos, suas reações adversas e cuidados que devem ser prestados, de modo a reconhecer sua atuação e perceber sua posição dentro da equipe multiprofissional.

Inadequate sedation in Pediatric Intensive Care Units (PICU) can generate unnecessary psychological and physical stress, in addition to accidental extubating. On the other hand, oversedation can lead to the use of prolonged mechanical ventilation, leading to longer hospitalization in the PICU in addition to withdrawal syndrome, tolerance, and delirium. In this sense, the identity of nursing care in the face of adverse reactions from the use of analgesics and sedatives in seriously ill children was defined as the object of study. The objectives are to describe the adverse reactions caused using sedatives and analgesics identified by the nursing team; analyze the care practice of the nursing team in the face of adverse reactions from the use of sedatives and analgesics in children; and discuss the implications of nursing care practice provided to children who present adverse reactions to the use of analgesics and sedatives. This is a qualitative study. Fifteen members of the nursing team who worked in a PICU of a hospital specializing in chronic and rare diseases were interviewed, using the interview technique, the participant characterization form, the field diary for non-participant observation and data collection. information in medical records. The Iramuteq software was supported, and discursive textual analysis was used. It was found that the main adverse reactions identified by nursing professionals were irritability, crying and agitation. The practice of nursing care is developed according to previously identified adverse reactions and varies depending on the nursing professional who cares for the child, and there is no pre-established institutional standard. Among the care described are warm bath, administration of fractional doses of sedation according to medical prescription and comfort by the responsible family member or by the professional himself, however, no records were observed in the medical records regarding these adverse reactions, as well as this reported care. It is noteworthy that there is insecurity on the part of the nursing team regarding their knowledge about adverse reactions related to the use of sedatives and analgesics and, as implications for practice, the lack of identity in their care, interfering with their autonomy and protagonism professional, with the doctor being perceived as the most active on this topic. It is concluded that the nursing team recognizes some signs and symptoms of adverse reactions in the use of sedatives and analgesics, however, improvement and updates are necessary regarding the use of these medications, their adverse reactions and the care that must be provided to recognize their performance and understand their position within the multidisciplinary team.

Una mala sedación en las Unidades de Cuidados Intensivos Pediátricos (UCIP) puede generar estrés psicológico y físico innecesario, además de extubaciones accidentales. Por otro lado, la sobresedación puede llevar al uso de ventilación mecánica prolongada, provocando una hospitalización más prolongada en la UCIP además de síndrome de abstinencia, tolerancia y dehrio. En este sentido, se definió como objeto de estudio la identidad del cuidado de enfermería ante las reacciones adversas por el uso de analgésicos y sedantes en niños gravemente enfermos. Los objetivos son: describir las reacciones adversas provocadas por el uso de sedantes y analgésicos identificadas por el equipo de enfermería; analizar la práctica de cuidados del equipo de enfermería ante las reacciones adversas por el uso de sedantes y analgésicos en niños; y discutir las implicaciones de la práctica de los cuidados de enfermería brindados a niños que presentan reacciones adversas al uso de analgésicos y sedantes. Este es un estudio cualitativo. Se entrevistó a quince miembros del equipo de enfermería que trabajaban en una UCIP de un hospital especializado en enfermedades crónicas y raras, utilizando la técnica de la entrevista, la ficha de caracterización participante, el diario de campo para la observación no parficipante y la recolección de información en historias clínicas. Se apoyó el software Iramuteq y se utiliz6 análisis textual discursivo. Se encontró que las principales reacciones adversas identificadas por los profesionales de enfermería fueron irritabilidad, llanto y agitaci6n. La práctica del cuidado de enfermería se desarrolla según reacciones adversas previamente identificadas y varía dependiendo del profesional de enfermería que atiende al niño, no existiendo un estándar institucional preestablecido. Entre los cuidados descritos se encuentran: baño tibio, administración de dosis fraccionadas de sedación según prescripción médica y confort por parte del familiar responsable o por el propio profesional, sin embargo, no se observaron registros en las historias clínicas respecto a estas reacciones adversas, así como estos ínformamn cuidados. Se destaca que existe inseguridad por parte del equipo de enfermería respecto de su conocimiento sobre las reacciones adversas relacionadas al uso de sedantes y analgésicos y, como implicaciones para la práctica, la falta de identidad en su cuidado, interfiriendo en su autonomía y protagonismo profesional, siendo el médico el más activo en este tema. Se concluye que el equipo de enfermería reconoce algunos signos y síntomas de reacciones adversas en el uso de sedantes y analgésicos, sin embargo, es necesario mejorar y actualizar respecto al uso de estos medicamentos, sus reacciones adversas y los cuidados que se deben brindar para reconocer su desempeño y comprender su posición dentro del equipo multidisciplinario.

Consideraciones para el uso de tramadol en dolor crónico no oncológico en atención primaria de salud (APS)

Introducción: tramadol es un analgésico opioide usado frecuentemente para el manejo del dolor crónico no oncológico (DCNO). En Chile, es parte del arsenal farmacológico de los centros de atención primaria para el tratamiento de patologías como artrosis de cadera y rodilla. Es considerado seguro y efectivo, sin embargo, existen reportes de efectos adversos serios por polimorfismos hepáticos, interacciones farmacológicas, intoxicaciones, adicción y muerte. La dosis óptima de tramadol es paciente dependiente. Por esto, es necesario contar con orientaciones específicas para prescribir tramadol de manera segura y eficaz según las características de cada paciente. Materiales y métodos: se revisaron guías actualizadas, revisiones sistemáticas y guías de sociedades internacionales sobre el uso de opioides en DCNO y el uso de tramadol en patologías de DCNO como artrosis, lumbago crónico, dolor neuropático y fibromialgia. Resultados: tramadol no está indicado en el tratamiento de cuadros de dolor primario como fibromialgia y en DCNO secundario es un fármaco de segunda línea o no está recomendado. En dolor crónico neuropático (DCN) es segunda línea de tratamiento. En osteoartritis de cadera, rodilla y mano, se reporta efecto analgésico modesto. Sopesar riesgos versus beneficios en estos pacientes. En artritis reumatoide y lumbago crónico se desaconseja su uso. Conclusiones: tramadol es un medicamento seguro y efectivo si se indica, administra, supervisa y descontinúa adecuadamente. Sin embargo, puede asociarse a interacciones farmacológicas, efectos secundarios serios, conductas de abuso y usos ilícitos, por lo que es necesario conocer y manejar adecuadamente su farmacología e indicaciones.

Introduction: Tramadol is an opioid pain medicine commonly used for chronic non-cancer pain (CNCP) management. In Chile, it is part of the pharmacological arsenal available in primary care centers for treating specific CNCP pathologies, such as hip and knee arthrosis. Tramadol is considered a safe and effective drug. Nevertheless, there are reports of serious adverse effects of tramadol, such as poisoning, addiction, and death, probably caused by liver polymorphisms and drug interaction. The optimal dose of tramadol is patient-specific. Specific knowledge is needed to prescribe tramadol in a safe and effective way according to the patient's medical backward. Methods: We review updated guidelines, systematic reviews, and guidelines from international societies about the use of opioids and tramadol in CNCP pathologies such as osteoarthritis, chronic low back pain, neuropathic pain, and fibromyalgia. Results: Tramadol has no role in primary pain treatment, such as fibromyalgia, but is a second-line drug for chronic neuropathic pain (CNP) and some secondary pain syndromes. Tramadol has a modest analgesic effect in osteoarthritis patients. Clinicians should always weigh the risks and benefits before prescribing tramadol. Tramadol use is discouraged in rheumatoid arthritis and chronic lumbago. Conclusions: Tramadol is a safe and effective drug if correctly indicated, administered, supervised, and discontinued. However, it may be associated with pharmacological interactions, serious side effects, abuse behaviors, and illicit uses, and it is necessary that clinicians know and manage its pharmacology and indications appropriately.

Bloqueo interescalénico en desarticulación de miembro torácico derecho por liposarcoma pleomórfico, para prevención de dolor de miembro fantasma. Reporte de caso / Interscalene block in right thoracic limb disarticulation due to pleomorphic liposarcoma, for the prevention of phantom limb pain. Case report

Resumen: El liposarcoma pleomórfico es una neoformación de tejidos blandos, que afecta principalmente las extremidades. Los pacientes que los presentan son candidatos a resección amplia o incluso amputación del miembro afectado. Como parte de una técnica anestésica integral y multimodal, destaca la utilización de bloqueos ecoguiados que disminuirán los requerimientos de opioides, teniendo un impacto importante en la preservación de la inmunidad del paciente oncológico, lo que le permitirá aumentar la tasa de supervivencia y su período libre de enfermedad; adicionando además un alfa 2 agonista, el cual nos brinda una adecuada analgesia postoperatoria, y realizando los bloqueos previos a la amputación, tenemos mayor tasa de éxito en la prevención del dolor y síndrome de miembro fantasma.

Abstract: Pleomorphic liposarcoma is a neoformation, which mainly affects the extremities. Being the patient candidate to perform a wide resection or even amputation of the affected limb. As part of a multimodal anesthetic technique, the use of ultrasound-guided blocks are useful, reducing opioid requirements, having an important impact on the preservation of the cancer patient's immunity, also adding an alpha 2 agonist, which provides adequate postoperative analgesia, and performing the blocks prior to amputation, we have a higher success rate in the prevention of pain and phantom limb syndrome.

Efecto de la musicoterapia en signos vitales y dolor posoperatorio inmediato / Effect of music therapy on vital signs and immediate postoperative pain

Resumen Objetivo: Evaluar el efecto de la musicoterapia en los signos vitales y el dolor posoperatorio inmediato en pacientes hospitalizados. Metodología: Estudio prospectivo, con una muestra de 80 pacientes divididos en dos grupos (grupo control y grupo de intervención). Al grupo de intervención se le brindo terapia musical a base de música tipo zen en un periodo de 20 minutos, después de una hora se realizó el registro de signos vitales y el resultado de la escala análoga del dolor. Prueba estadística T de Student con significancia estadística. Resultados: Al realizar la comparación entre ambos grupos de estudio se observó una t=0.3 para la frecuencia cardiaca, t=0.9 para la frecuencia respiratoria, presión arterial media con t=0.4 y una Z=0.7 para la escala análoga del dolor. Limitaciones: Preferencia musical en los participantes del estudio. Originalidad: Aplicación clínica en el dolor. Conclusiones: Existe un efecto benéfico en los signos vitales y el dolor posoperatorio inmediato con el empleo de musicoterapia, sin embargo, no se demostró diferencia estadísticamente significativa al comparar ambos grupos de estudio debido probablemente al buen control de la terapia analgésica indicada al paciente.

Abstract Objective: To evaluate the effect of music therapy on vital signs and immediate postoperative pain in hospitalized patients. Methodology: Prospective study, with a sample of 80 patients divided into two groups (control group and intervention group), the intervention group was given musical therapy based on Zen-type music in a period of 20 minutes, 1 hour after Vital signs were recorded and the result of the pain analog scale, Student's t statistical test with statistical significance. Results: When making the comparison between both study groups, a t=0.3 was observed for heart rate, t=0.9 for respiratory rate, mean arterial pressure with t=0.4 and a Z=0.7 for the analog scale of pain. Limitations: Musical preference in study participants. Originality: Clinical application in pain. Conclusions: There is a beneficial effect on vital signs and immediate postoperative pain with the use of music therapy, however, no statistically significant difference was demonstrated when comparing both study groups, probably due to the good control of the analgesic therapy indicated to the patient.

Efficacy and safety of intravenous paracetamol versus intravenous tramadol for labour analgesia

Background: An effective labour analgesia improves maternal and perinatal outcome and improves the course of labour.Methods: This was a prospective, randomised study done to compare effectiveness and safety of intravenous infusion of paracetamol with tramadol when used for labour analgesia. Group A (25 parturients) received paracetamol 1000 mg and group B (25 parturients) received tramadol 1mg/Kg at 4 to 6 cm cervical dilatation. Visual analogue score for pain was assessed at the baseline, 1 hour and 3 hours of drug administration and was compared between the two groups along with various maternal and fetal outcomes.Results: The difference in mean Visual Analogue Score (VAS) just before the drug administration was not statistically significant. However, at 1 hour of drug administration, mean VAS was significantly lower in the Group A (4.60) in comparison to Group B (5.82). The mean VAS at 3 hours was slightly lower in group A (6.35) in comparison to group B (6.65), though statistically there was no significant difference. Nausea, vomiting and sedation were found to be more in the tramadol group as compared to paracetamol group. The mean 1 and 5 minute apgar scores were found to be comparable in both the groups.Conclusions: So, it can be concluded from our study that intravenous paracetamol may be preferred over intravenous tramadol as it is associated with better analgesic efficacy and less maternal side effects. Although both the drugs were found to have good neonatal outcome.

Uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos / Clinical Use of Intravenous Lidocaine for Management of non-Oncologic Neuropathic Pain in Adults

El dolor neuropático es común en la práctica clínica. Se estima que afecta entre el 2 y 3 % de la población a nivel global. Una cantidad considerable de pacientes presentan dolor refractario a tratamientos existentes, volviéndolo un reto diagnóstico y terapéutico. El objetivo de este estudio es describir el uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos. La búsqueda de información se realizó consultando las bases de datos HINARI, SciELO y PubMed. Se seleccionaron artículos en inglés y español de 2017 a 2021. Se utilizaron artículos originales, ensayos clínicos, revisiones bibliográficas y metaanálisis. Las causas de dolor neuropático en las que ha sido utilizada la lidocaína son la neuralgia posherpética, neuropatía diabética y neuralgia del trigémino. El uso de lidocaína intravenosa demostró que disminuye la intensidad del dolor; sin embargo, al compararlo con otros fármacos de primera línea no hay diferencias a largo plazo. La mayoría de efectos secundarios se presentan en el sistema nervioso, gastrointestinal y cardiovascular. La lidocaína intravenosa como monoterapia para manejo de dolor neuropático no oncológico, si bien fue eficaz a corto plazo con dosis de 3-5 mg/Kg, no tuvo un efecto persistente y duradero

Neuropathic pain is common in clinical practice; it is estimated that 2 to 3 % of the global population is affected; a considerable number of patients present pain refractory to existing treatments, making it a diagnostic and therapeutic challenge. The objective of this study is to describe the clinical use of intravenous lidocaine for the management of non-cancer neuropathic pain in adults. The information search was performed by consulting the HINARI, SciELO and PubMed databases. Articles with an obsolescence of no more than five years, both in English and Spanish, were selected. Original articles, clinical trials, bibliographic reviews and meta-analyses were used. The causes of neuropathic pain in which lidocaine has been used were postherpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia. The use of intravenous lidocaine has been shown to decrease pain intensity; however, when compared with other first line drugs, there are no long-term differences. Most side effects occur in the nervous, gastrointestinal, and cardiovascular systems. Intravenous lidocaine as monotherapy for the management of non-cancer neuropathic pain, although effective in the short term with doses of 3-5 mg/Kg, does not have a persistent and long-lasting effect

Effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical ICU patients / 中国药房

OBJECTIVE To investigate the effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical intensive care unit （ICU） patients. METHODS Forty cases of mechanically ventilated non-surgical patients in the ICU of our hospital from February 1st， 2023 to July 31st， 2023 were selected and randomly divided into control group and esketamine （S-K） group using grouping method with opaque envelopes， with 20 cases in each group. Control group was given sufentanil， and S-K group was infused with Esketamine hydrochloride injection at a constant rate of 0.2 mg/（kg·h）+ sufentanil. The treatment period length， analgesic compliance rate， sedation level， analgesic and sedative consumption， and gastric motility indexes were compared between the two groups. RESULTS There was no statistically significant difference in the treatment period length， analgesic compliance rate， sedation level， or the consumption of propofol and midazolam between the two groups （P＞0.05）. The consumption of sufentanil in the S-K group was significantly less than control group （P＜ 0.05）. Compared with 1 h after randomization， the antral contraction frequency， antral contraction amplitude and antral motility index of patients in the S-K group were significantly higher at 72 h after randomization and were significantly higher than control group （P＜0.05）. CONCLUSIONS Esketamine may reduce opioid consumption and improve gastric motility in mechanically ventilated non-surgical ICU patients while ensuring a level of analgesic sedation.

Anti-nociceptive effect and mechanism of madecassic acid / 中国药科大学学报

@#Abstract: To date, the investigation of the functional composition of Centella asiatica (L.) Urban has been mainly focused on the triterpenoid saponins, with little research on the other compositions. The acetic acid-induced writhing, Eddy's hot plate and formalin tests were employed to investigate the anti-nociceptive effects of madecassic acid (MA). The experiment was divided into normal control group, acetylsalicylic acid (ASA) group, and the MA groups of low (10 mg/kg), medium (20 mg/kg) and high (40 mg/kg) dosage. Meanwhile, the anti-nociceptive effect of MA on the acetic acid and formalin-induced nociceptive models in the absence and presence of NAL (naloxone hydrochloride) was evaluated. To have an insight into the anti-nociceptive mechanisms of MA, the capsaicin- and glutamate-induced paw licking tests were also employed to evaluate the involvement of the vanilloid and glutamatergic systems, respectively. Results showed that MA exhibited good anti-nociceptive activity in the acetic acid-induced writhing test and the second phase of formalin test; the anti-nociceptive effect of MA in both the acetic acid and formalin-induced nociception was not effectively removed by NAL; MA (20 mg/kg and 40 mg/kg) effectively reduced the duration of biting/licking the capsaicin-injected paw with inhibition rates of 29.5% and 64.4%, respectively; MA (20 mg/kg and 40 mg/kg) distinctly shortened the time spent in biting/licking the glutamate-injected paw by 30.9% and 56.1%, respectively. In summary, MA induces significant peripheral anti-nociceptive effect, and the anti-nociceptive activities probably involve the modulation of glutamatergic systems and vanilloid systems (TRPV1) instead of the opioidergic system.

Comparison of the early analgesic efficacy of three different drugs after anterior cruciate ligament reconstruction / 北京大学学报(医学版)

Objective:The pain-relieving effect and safety of compound aminopyrine phenacetin tab-lets,tramcontin(tramadol hydrochloride sustained-release tablets)and dolantin in the early stage of au-tologous tendon reconstruction of the anterior cruciate ligament(ACL)of the knee joint were compared.Methods:Retrospective analysis of postoperative pain and drug analgesia in 45 patients performed by the same group from November 2018 to February 2019.The random area group design was divided into two groups according to whether ACL rupture was combined with meniscal injury,group A was 24 patients with ACL reconstruction of knee joint and group B was 21 patients with ACL fracture combined with me-niscus injury.The two groups were divided into three subgroups respectively according to the actual treat-ment of postoperative analgesic drugs received by the patients,including 4 cases of compound aminopy-rine phenacetin tablets,11 cases of oral tramcontin,9 cases of intramuscular dolantin combined with phenergan in group A;3 cases of compound aminopyrine phenacetin tablets,10 cases of oral tramcontin,and 8 cases of intramuscular dolantin combined with phenergan in group B.When the early postoperative patients complain about pain and actively ask for analgesia.When the patients complained about pain af-ter the operation and actively asked for analgesia,they were randomly given painkillers,tramcontin or do-lantin combined with phenergan to relieve pain.Pain visual analogue scale(VAS)was used to evaluate pain relief and observe the occurrence of adverse reactions.Results:There were no significant dif-ferences in gender,age,body mass index,and time of hospital stay between the two groups of patients(P＞0.05).In the patients who used tramcontin and dolantin combined with phenergan to relieve pain judging by VAS score before and 1 h after taking the drug,it was found that the pain situation of the pa-tient was significantly relieved,and the difference before and after taking the drug had statistical signifi-cance(P＜0.05).Pairwise comparisons of the three drugs applied in the two groups showed significantly greater pain relief in the dolantin combined with phenergan group than in the remaining two drugs.There was no significant difference(P＞0.05).Dolantin was prone to nausea and vomiting,but the application of phenergan was also used to reduce side effects.In terms of adverse reactions,only 1 case of nausea oc-curred in the tramcontin group for simple ACL reconstruction,and none of the patients in the other groups showed serious complications and allergic reactions.Conclusion:Whether in cruciate ligament recon-struction alone or combined with meniscus molding or suture,compound aminopyrine phenacetin tablets,tramcontin,dolantin combined with phenergan can effectively relieve pain.Among the three drugs,do-lantin caused the largest pain relief.At the same time,the combination of phenergan effectively reduced the adverse reactions,such as vomiting and nausea,and increased the drug safety.

Study advances in analgesic management in severe patients after neurosurgery / 重庆医学

Analgesia is an important link in the treatment of severe patients after neurosurgery and plays a vital role in improving the prognosis of the patients.Understanding the status quo and influencing fac-tors of pain in severe patients after neurosurgery helps to predict the occurrence of pain,which is crucial for determining the new pain assessment methods and auxiliary analgesic methods and developing novel analgesic drugs.This paper reviews the pain status,pain evaluation and analgesic methods of severe patients after neuro-surgery in recent years so as to understand the pain management current status of the patients with severe neurological conditions and provide reference for the medical staff to implement the analgesic programs.