Codeine plus acetaminophen improve sleep quality, daily activity level, and food intake in the early postoperative period after photorefractive keratectomy: a secondary analysis / Melhora da qualidade do sono e das atividades diárias pós PRK imediato utilizando codeína com paracetamol: análise secundária de um ensaio clínico randomizado, duplo-cego e placebo-controlado

ABSTRACT Purpose: To determine whether codeine plus acetaminophen after photorefractive keratectomy (PRK) have beneficial effects on sleep quality, activity levels, and food intake, beyond their effect of pain relief. Methods: We enrolled 40 patients (80 eyes) in this randomized, double-blind, paired-eye, placebo-controlled, add-on trial. Each eye was treated 2 weeks apart, and the patients were randomly allocated to receive either the placebo or the intervention (30 mg codeine and 500 mg acetaminophen) (4 times a day for 4 days). Outcomes were sleep quality, daily activity level, and food intake within 24-72 h post-photorefractive keratectomy, as measured by the McGill Pain Questionnaire. Results: Sleep quality and daily activity level were inversely associated with pain scores within the first 48 h post-photorefractive keratectomy. During the intervention, patients were significantly more likely to score their sleep quality as good at 24 h (relative risk=2.5; 95% confidence interval 1.48-4.21, p<0.001) and 48 h compared to during placebo (relative risk=1.37; 95% confidence interval: 1.03-1.84, p=0.023). The probability of reporting good daily activity level at 24 and 72 hours post-photorefractive keratectomy was three times higher when patients received the intervention compared to the placebo (relative risk=3.0; 95% confidence interval: 1.49-6.15, p=0.006 and relative risk=1.31; 95% confidence interval: 1.02-1.67, p=0.021, respectively). No difference was observed in food intake. Conclusion: The oral combination of codeine and acetaminophen significantly improves sleep quality and daily activity level within the first 24-72 h post-photorefractive keratectomy compared to a placebo.

RESUMO Objetivo: Determinar se codeína (30 mg) mais pa­racetamol (500 mg) após ceratectomia fotorrefrativa fornece efeitos benéficos sobre a qualidade do sono, níveis de atividade e ingestão de alimentos além de seu efeito analgésico. Métodos: Quarenta pacientes (80 olhos) foram incluídos neste estudo randomizado, duplo-cego, pareado, placebo-controlado, add-on. Cada olho foi tratado com 2 semanas de intervalo, sendo aleatoriamente alocado para placebo ou intervenção (4x/dia durante 4 dias). Os resultados incluíram a qualidade do sono, atividade diária e ingestão de alimentos dentro de 24-72 horas de pós-operatório, conforme medido pelo McGill Pain Questionnaire. Resultados: A qualidade do sono e os níveis de atividade foram inversamente associados aos escores de dor nas primeiras 48 horas após o ceratectomia fotorrefrativa. Durante a intervenção, os pacientes foram significativamente mais propensos a classificar seu sono como bom em 24 horas (risco relativo=2,5, intervalo de confiança de 95%: 1,48-4,21, p<0,001) e 48 horas comparado ao placebo (risco relativo=1,37, intervalo de confiança de 95%: 1,03-1,84, p=0,023). A probabilidade de relatar bons níveis de atividade em 24 e 72 horas após ceratectomia fotorrefrativa também foi significativamente maior durante a intervenção em comparação com placebo (risco relativo=3,0, intervalo de confiança de 95%: 1,49-6,15, p=0,006 e risco relativo=1,31, intervalo de confiança de 95%: 1,02 -1,67, p=0,021, respectivamente). Nenhuma diferença foi observada entre a intervenção e placebo em relação à alimentação oral. Conclusão: A combinação de codeína e paracetamol melhorou significativamente a qualidade do sono e atividades diárias nas primeiras 24-72 horas após o ceratectomia fotorrefrativa em comparação com placebo.

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Efecto del cosedal para el alivio del dolor postoperatorio en la cirugía de hernia inguinal / Cosedal effect for the post surgery pain relief in inguinal hernia surgery

RESUMEN Introducción: la analgesia preventiva en el paciente propuesto para cirugía constituye una de las problemáticas a investigar por las ciencias médicas, específicamente por la anestesiología. Objetivo: valorar el efecto del cosedal para el alivio del dolor postoperatorio en la cirugía de hernia inguinal. Materiales y métodos: se realizó un estudio prospectivo, longitudinal en la Unidad Quirúrgica Central del Hospital "Faustino Pérez Hernández". En el mismo fueron incluidos 86 pacientes distribuidos en dos grupos de igual número integrantes. Los pacientes del Grupo I recibieron dipirona 1,2 gramos IM media hora antes de la cirugía, mientras que a los del grupo II se les administró cosedal (tableta 60 mg) VO. Todos fueron intervenidos quirúrgicamente con anestesia subaracnoidea. Se estudiaron las variables edad, género, ASA, tiempo quirúrgico, tiempo anestésico, evolución del dolor postoperatorio y necesidad de analgesia de rescate. Resultados: la intensidad del dolor postoperatorio fue 1,2 veces menor en los pacientes del Grupo II. La necesidad de analgesia de rescate fue 1,3 veces mayor en los pacientes del Grupo I. Conclusiones: los pacientes del Grupo II mostraron menor intensidad del dolor postoperatorio las primeras 6 horas de la cirugía, en ellos los requerimientos de analgesia de rescate fue inferior (AU).

ABSTRACT Introduction: preventive analgesia in patients pending to a surgery is one of the major issues to be researched by the medical sciences specifically by anesthesiology. Objective: to evaluate cosedal effect for the post-surgery pain relief in inguinal hernia surgery. Materials and methods: a prospective, longitudinal research was carried out in the Central Surgical Unit of the "Faustino Pérez Hernández" hospital. In this research 86 patients were included and distributed in two groups with the same number of members. Half an hour before the surgery, Group I patients were administered 1.2 g of intramuscular dipyrone; while Group II patients were administered oral cosedal (60 mg tablet). They all were operated with subarachnoid anesthesia. Aspects such as age, gender, ASA, surgery time, anesthetic time, post-surgery pain evolution and need of rescue analgesia need were analyzed. Results: in Group II patients the post-surgery pain intensity was 1.2 times less than in Group I patients. The need of rescue analgesia was 1.3 times greater in Group I patients. Conclusions: group II patients showed a lower post-surgery pain intensity in the first six hours after the surgery and they needed less rescue analgesia (AU).

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Eficácia analgésica da associação de 30mg do fosfato de codeína com 500mg do paracetamol após exodontias de terceiros molares inferiores impactados / Analgesic efficacy of codeine phosphate 30mg association with paracetamol 500mg after extraction of impacted lower third molars

Avaliar a eficácia analgésica da associação de 30mg do fosfato de codeína com 500mg do paracetamol após exodontias de terceiros molares inferiores impactados. Foi realizado um estudo clínico bilateral com uma amostra de 47 pacientes. Em um dos lados, todos os pacientes receberam a dosagem de 30mg do fosfato de codeína em associação com 500mg do paracetamol após exodontia (grupo teste). Para a exodontia contralateral, foi disponibilizado outro frasco contendo cápsulas idênticas, porém com a dosagem de 500mg de paracetamol (grupo controle). 100% dos pacientes do grupo teste não necessitaram utilizar a medicação resgate e não consumiram doses adicionais da medicação após as cirurgias. No grupo controle, 44,7% dos participantes relataram o uso do medicamento resgate. O consumo total de comprimidos no grupo teste foi, em média, inferior quando comparados ao lado contralateral. 80,8% dos pacientes relataram maior conforto, quanto ao critério da dor, no lado em que foi utilizado a dosagem de 30mg de fosfato de codeína associado a 500mg de paracetamol. Os efeitos colaterais estiveram mais presentes no grupo teste, sendo mais comum o relato de sonolência (34%) e tontura (31,9%), não havendo relato de abandono desta medicação por nenhum dos pacientes. Concluímos que a dosagem de 30mg do fosfato de codeína associada a 500mg de paracetamol apresentou resultados favoráveis no controle da dor e uma baixa incidência de efeitos colaterais...

To assess the analgesic efficacy of regular dosage of codeine phosphate 30mg association with paracetamol 500mg after extraction of impacted lower third molars. We performed a bilateral clinical study analyzing a sample of 47 patients. All patients received a 30mg codeine phosphate dosage in combination with paracetamol 500mg after extraction (test group). For the contralateral tooth extraction, we had another bottle available containing identical capsules, with a 500mg paracetamol dosage (control group). 100% of the test group patients did not need to use rescue medication and did not consume additional doses of medication after surgeries. In the control group, 44.7% reported the use of rescue medication. Total consumption of pills in the test group was on average lower than the contralateral side. 80.8% of patients reported greater comfort, as the criterion of pain in the side that was used 30mg codeine phosphate dosage associated with paracetamol 500mg. The adverse effects were more present in the test group, with sleepiness being more common (34%) and dizziness (31.9%), without any patient medication abandonment. We conclude that the 30mg codeine phosphate dosage associated with paracetamol 500mg showed favorable results in controlling pain associated with a low incidence of side effects...

Tosse: neurofisiologia, métodos de pesquisa, terapia farmacológica e fonoaudiológica / Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology

Introdução: A tosse é o sintoma respiratório mais comum em crianças e adultos. Objetivo: Apresentar uma revisão sobre a neurofisiologia e os métodos para estudo do reflexo da tosse, bem como a farmacoterapia e terapia fonoaudiológica da tosse, baseada nos trabalhos publicados entre 2005 e 2010 e indexados nas bases Medline, Lilacs e Biblioteca Cochrane sob os unitermos "tosse" ou "antitussígenos". Síntese dos dados: O reflexo da tosse envolve ativação de múltiplos receptores vagais nas vias aéreas e de projeções neurais do núcleo do trato solitário para outras estruturas do sistema nervoso central. Técnicas experimentais permitem estudar o reflexo da tosse ao nível celular e molecular para desenvolver novos agentes antitussígenos. Não há evidências de que antitussígenos isentos de prescrição médica tenham eficácia superior à do placebo para o alívio da tosse. A terapia fonoaudiológica pode beneficiar pacientes com tosse crônica refratária ao tratamento farmacológico, sobretudo quando coexiste movimento paradoxal das pregas vocais. Comentários Finais: A abordagem multidisciplinar tem papel fundamental no diagnóstico etiológico e tratamento da tosse. O otorrinolaringologista deve informar os pacientes sobre os riscos dos antitussígenos de venda livre a fim de prevenir intoxicações e efeitos adversos, especialmente em crianças...

Introduction: The cough is the more common respiratory symptom in children and adults. Objective: To present a revision on the neurophysiology and the methods for study of the consequence of the cough, as well as the pharmacotherapy and phonoaudiology therapy of the cough, based on the works published between 2005 and 2010 and indexed in the bases Medline, Lilacs and Library Cochrane under them to keywords "cough" or "anti-cough". Synthesis of the data: The consequence of the cough involves activation of receiving multiples becomes vacant in the aerial ways and of neural projections of the nucleus of the solitary treatment for other structures of the central nervous system. Experimental techniques allow studying the consequence of the cough to the cellular and molecular level to develop new anti-cough agents. It does not have evidences of that anti-cough exempt of medical lapsing they have superior effectiveness to the one of placebo for the relief of the cough. The phonoaudiology therapy can benefit patients with refractory chronic cough to the pharmacological treatment, over all when paradoxical movement of the vocal folds coexists. Final Comments: The boarding to multidiscipline has basic paper in the etiological diagnosis and treatment of the cough. The otolaryngologist must inform the patients on the risks of the anti-cough of free sales in order to prevent adverse poisonings and effect, especially in children...

A Randomized, Open Label, Multicentre Study to Evaluate the Safety and Efficacy of Cough Mixture CS1 (Pholcodeine and Promethazine - Tixylix) Versus CS2 (Noscapine, Ammonium Chloride, Sodium Citrate) in Treatment of Children with Dry Cough.

The objective of this study was to compare the efficacy and safety of cough mixture containing pholcodeine and promethazine - Tixylix (CS1) to a cough mixture which has noscapine, ammonium chloride, and sodium citrate (CS2) as its constituents in treatment of children suffering from dry cough. A total of 208 patients were enrolled at 4 sites. Of these, 179 (94 receiving CS1 and 99 receiving CS2) completed the study. Results of this study suggest that both the cough mixtures were comparable as per evaluation of their primary parameters. According to global assessment for efficacy and tolerability by parents on Day 7, Group CS1 performed better than CS2. It was also observed that no AE was reported in Group CS1 as compared to 2 AEs in Group CS2. To conclude, cough mixture combination of pholcodeine and promethazine - Tixylix exhibited efficacy and safety that was comparable with cough mixture which has noscapine, ammonium chloride, and sodium citrate. It was proven to be efficacious, safe and well tolerated in the select population.

Protocolos laxativos para o controle da constipaçäo intestinal em doentes com dor oncológica / Laxative protocol for constipation management in oncological pain patients

O estudo objetivou analisar a efetividade de um protocolo para manejo da constipaçäo intestinal relacionada ao uso de opiáceos e a adesäo dos doentes a esse protocolo. O protocolo constou de recomendaçöes de uso diário de fibras (40gr de farelo de trigo, que equivale a aproximadamente 17gr de fibra), líquido (6 a 8 copos), emoliente (10ml) e de supositórios e enemas, quando näo houvesse evacuaçäo por um período de 3 dias. Participaram 50 doentes oncológicos em início de protocolo analgésico e laxativo. Os doentes foram acompanhados por um período de 2 meses e submetidos a 6 avaliaçöes. A maior parte dos doentes evacuou, em média, a cada 1 ou 2 dias (78 porcento), apresentando fezes de consistência dura (74 porcento). O índice médio de constipaçäo durante a tratamento avaliado pela escala de McMillan (escores de 0 a 16), foi de 6,6, compatítvel com constipaçäo moderada e superior ao índice observado no início do protocolo. O protocolo foi efetivo pleno (quando a evacuaçäo ocorreu com uso de fibra, líquido e óleo mineral) em 8 porcento do doentes; efetivo parcial (quando a evacuaçäo ocorreu com uso de fibra, líquido, óleo mineral e supositório) de em 64 porcento e pouco efetivo (quando a evacuaçäo ocorreu com uso de fibra, líquido, óleo mineral, supositório e enema) em 28 porcento dos doentes. A maior parte dos doentes apresentou adesäo plena ao farelo de trigo (84 porcento), adesäo parcial ao líquido (74 porcento) e adesäo insuficiente ao óleo (54 porcento). Näo se observaram relaçöes entre a efetividade do protocolo e a adesäo ao farelo de trigo (p=0,370), ao consumo de líquidos (p=0.177) e ao uso de emoliente (p=0.991). Observou-se que a maior parte dos doentes utilizou supositório de glicerina para evacuar. Tal fato sugere que o supositório possa ser incluído no protocolo padräo

Lysine clonixinate vs. paracetamol / codeine in postepisiotomy pain

This study conducted to compare the analgesic action of Lysine Clonixinate (LC) vs Paracetamol/Codeine association (PC) in the treatment of postepisiotomy pain in primiparae women: 131 primiparous patients with moderate-to-severe postepisiotomy pain were enrolled in a double blind dummy design study and randomly allocated to either treatment with fixed doses of LC 125 mg or Paracetamol 500 mg+Codeine 30 mg 6 qh during 24 hours. Intensity of spontaneous pain and pain on walking was assessed according to a visual analog scale (VAS) and patientÝs assessment before receiving treatment and after 1, 2, 6 and 24 hours. Intensity of spontaneous pain was reduced in 24 hours from 4.28+2.11 to 1.73+1.46 (P<0.0001) in the LC group and from 4.78+2.08 to 1.90+1.72 in the PC- treated group (p<0.0001); with no significant differences between treatments. 54 percent of the patients treated with LC and 55 percent of those receiving PC showed onset of analgesic action 30 minutes following dose administration. PatientÝs final global assessment revealed that 95 percent of LC-treated patients and 96 percent of the PC group showed total or partial pain relief during the first treatment day. No sleep disturbances were seen during the night in 75 percent of patients. Only one patient reveiving LC showed nausea not requiring treatment discontinuation. It is concluded that both treatments are equally effective to relieve moderate-to-severe postepisiotomy pain.

Traumatismos articulares e osteomusculares agudos em atletas analgesia com associaçäo paracetamol-codeína / Acute articular and muscolosketal traumatic injuries in athletes: analgesia with paracetamol plus codeine combination

Os traumatismos em atletas sempre vistos com preocupaçäo pelas agremiaçöes as quais pertencem. A dor está sempre presente e funciona como mecanismo de defesa, limitando a movimentaçäo. O alívio da dor é sempre desejado lançando-se mäo de medidas auxiliares e medicamentosas. Avaliou-se neste estudo a rapidez de açäo da associaçäo paracetamol 500mg/codína 30mg em 50 atletas com traumatismos tipo contusäo, entorse, luxaçäo e fratura. Com a utilizaçäo de um comprimido, 46% dos atletas estavam sem dor ou com dor leve após 30 minutos; após quatro horas, 72% dos atletas estavam nessa categoria. Na avaliaçäo da 24§ hora após tomadas de um a dois comprimidos, a cada quatro horas, 84% dos atletas estavam sem dor ou com dor leve. A porcentagem de reduçäo dos índices indicativos de dor em relaçäo a dor inicial foi de 54% aos 30 minutos, e 75% após quatro horas obteve-se uma reduçäo de 84%, na avaliaçäo da 24§ hora. Näo foram relatadas reaçöes adversas até cinco horas após a utilizaçäo de um comprimido. Após doses múltiplas nove atletas relataram sonolência e sete distúrbios gástricos entre as horas 5 e 24. Nenhum atleta interrompeu a medicaçäo. A associaçäo paracetamol 500mg/ codeína 30 mg pode ser considerada como uma importante alternativa para o rápido alívio da dor provocada por traumatismos articulares e osteomusculares agudos, em atletas

Avaliaçäo da atividade analgésica e da tolerância da associaçäo paracetamol/codeína no controle de dores desencadeadas por patologias reumáticas / Evaluation of analgesic activity and tolerance of the paracetamol/codeine combination in the control of pains induced by rheumatic diseases

Em estudo multicêntrico, aberto e näo comparativo, reumatologistas brasileiros avaliaram a eficácia, a tolerabilidade e a duraçäo do efeito analgésico da associaçäo paracetamol 500mg/codeína 30mg, quando empregada na terapêutica de manifestaçöes dolorosas agudas de distintas afecçöes reumáticas (algias vertebrais, doença reumatóide, espondilite anquilosante, osteoartrose e reumatismos de partes moles). Foram observados 143 adultos, geralmente internados, durante dois dias (48 horas). Os resultados evidenciaram que no final das primeiras quatro horas, após uma única dose da associaçäo medicamentosa, 63,7% dos casos apresentaram significativo alívio da dor. O efeito analgésico após 48 h de avaliaçäo foi considerado excelente ou bom em 58% e em 53,2% dos casos, pelos médicos e pelos pacientes, respectivamente. Quanto à tolerância ela foi considerada boa em 69,5% dos enfermos e os efeitos indesejáveis, quando ocorreram, foram, geralmente, leves e transitórios. Concluem os autores que a associaçäo paracetamol 500mg/codeína 30mg, utilizada na dose média de 2 a 4 comprimidos/dia, pode ser considerada uma opçäo terapêutica viável no alívio de dores agudas desencadeadas por patologias reumáticas