Dorsal Root Entry Zone Lesioning: Systematic Review

Introduction Dorsal root entry zone (DREZ) leasioning (DREZ-otomy) is considered an effective treatment for chronic pain due to spinal cord injuries, brachial and lumbosacral plexus injuries, postherpetic neuralgia, spasticity, and other conditions. The objective of the technique is to cause a selective destruction of the afferent pain fibers located in the dorsal region of the spinal cord. Objective To identify and review the effectiveness and the main aspects related to DREZ-otomy, as well as the etiologies that can be treated with it. Methods The PubMed, MEDLINE and LILACS databases were used as bases for this systematic review, having the impact factor as the selection criteria. The 23 selected publications, totalizing 1,099 patients, were organized in a table for systematic analysis. Results Satisfactory pain control was observed in 70.1% of the cases, with the best results being found in patients with brachial/lumbosacral plexus injury (70.8%) and the worst, in patients with trigeminal pain (40% to 67%). Discussion Most of the published articles observed excellent results in the control of chronic pain, especially in cases of plexus injuries. Complications are rare, and can be minimized with the use of new technologies for intraoperative monitoring and imaging. Conclusion DREZ-otomy can be considered a great alternative for the treatment of chronic pain, especially in patients who do not tolerate the side effects of the medications used in the clinical management or have refractory pain.

Importancia del anestesiólogo en la prevención del dolor crónico / Importance of the anesthesiologist in the prevention of chronic pain

The development of chronic pain after surgery or persistent postoperative pain is a significant public health problem that affects between 10%-56% of patients undergoing surgical intervention. It produces great restrictions of mobility, limitation of daily activities, dependence on opioids, anxiety, depression, a great alteration of the quality of life and important legal and medical-economic consequences. There is a very close correlation between acute postoperative pain, and persistent postoperative pain. For this reason, pain must be treated effectively in its acute phase to reduce the incidence of chronic pain after surgery. There are risk factors that predispose to its appearance and that must be known by the anesthesiologist. In an individualized and meticulous pre-anesthetic consultation, these risk factors can be detected, as well as the presence of surgical procedures related to chronic pain, with the purpose of the therapeutic approach of the first ones if necessary, and a good planning of the anesthetic and analgesic technique, which reduces the participation of the second, in the chronicity of acute pain. The role of the anesthesiologist in the pre-anesthetic consultation is essential for the planning of preventive and multimodal analgesia that, together with other resources, should reduce the incidence of persistent postoperative pain.

El desarrollo del dolor crónico después de la cirugía o dolor posoperatorio persistente, es un problema de salud pública significativo que afecta entre el 10%-56% de los pacientes sometidos a una intervención quirúrgica. Produce grandes restricciones de la movilidad, limitación de las actividades de vida diaria, dependencia a los opioides, ansiedad, depresión, una gran alteración de la calidad de vida e importantes consecuencias legales y médico-económicas. Hay una correlación muy estrecha entre el dolor agudo posoperatorio, y el dolor posoperatorio persistente. Por esa razón, el dolor debe ser tratado de manera eficaz en su fase aguda para disminuir la incidencia del dolor crónico posterior a la cirugía. Existen factores de riesgo que predisponen a su aparición y que deben ser conocidos por el anestesiólogo. En una consulta pre-anestésica individualizada y minuciosa, se podrán detectar estos factores de riesgo, como también la presencia de procedimientos quirúrgicos relacionados con el dolor crónico, con la finalidad del abordaje terapéutico de los primeros de ser necesario, y una buena planificación de la técnica anestésica y analgésica, que disminuya la participación de los segundos, en la cronicidad del dolor agudo. El rol del anestesiólogo en la consulta pre-anestésica, es fundamental para la planificación de la analgesia preventiva y multimodal que junto a otros recursos deberían disminuir la incidencia del dolor postoperatorio persistente.

Consideraciones en pacientes con dolor crónico sometidos a cirugía / Considerations in chronic pain patients that will undergo surgery

Resumen El dolor crónico es una condición cada vez más prevalente, que afecta aproximadamente a un 32% de la población nacional. Estos pacientes poseen características particulares que complejizan un óptimo cuidado perioperatorio, sobre todo en términos de analgesia, efectos adversos de los distintos fármacos y complicaciones postquirúrgicas. El objetivo de esta revisión es exponer el creciente problema que involucra el manejo de los pacientes con dolor crónico no oncológico sometidos a una cirugía, y destacar algunas consideraciones que se deben tener en su cuidado. Dentro de los aspectos más relevantes están una adecuada caracterización del dolor y un buen esquema analgésico a ser utilizado en el perioperatorio, prefiriendo un enfoque multimodal ajustado acorde a las necesidades del paciente. Se debe tener especial consideración en pacientes usuarios crónicos de opioides, aquellos con dolor neuropático y aquellos con fibromialgia. Un adecuado seguimiento de estos grupos permitirá ajustar los esquemas de acuerdo con sus necesidades y lograr un mejor manejo analgésico perioperatorio.

Chronic pain is an increasingly prevalent condition, estimated in approximately 32% of the Chilean population. These patients have characteristics that make optimal perioperative care more complex, especially in terms of analgesia, adverse effects of the different drugs, and post-surgical complications. The aim of this publication is to expose the growing problem involved in the management of patients with chronic pain undergoing surgery, and to highlight some considerations that must be taken. Among the most relevant aspects are an adequate characterization of pain and a good analgesic scheme to be used in the perioperative period, preferring a multimodal analgesia approach adjusted according to the patient's needs. Special consideration should be given to patients with chronic opioids use, those with neuropathic pain and those with fibromyalgia. An adequate follow-up of these groups will allow adjusting the schemes according to their needs and achieve a better perioperative analgesic management.

Síndrome de dolor crónico postmastectomía: ¿qué podemos hacer en el período perioperatorio para disminuir su incidencia? / Postmastectomy chronic pain syndrome: what can we do to reduce the incidence?

El síndrome de dolor crónico postmastectomía es frecuente en pacientes sometidas a cirugía por cáncer de mamas, llegando a ser invalidante en casos severos. Existen distintos factores de riesgo para que éste se presente, siendo el dolor agudo postoperatorio el único en el cual podemos intervenir. La importancia de implementar estrategias de prevención en el periodo perioperatorio es fundamental. En la mantención de la anestesia general, la utilización de propofol se asocia con menor incidencia de dolor agudo postoperatorio. El uso de anestésicos locales, ya sea por vía tópica, subcutánea y sistémica, ha demostrado su beneficio para disminuir el dolor agudo. No obstante, solo el uso tópico y endovenoso ha sido útil para reducir el dolor hasta 3 meses postcirugía. Técnicas de analgesia regional, como el bloqueo PEC I y II, bloqueo paravertebral y bloqueo del erector de la espina han demostrado ser útiles para reducir el dolor agudo; pero solo el bloqueo paravertebral ha demostrado su utilidad en reducir el dolor hasta 1 año postcirugía. El uso de gabapentina, pregabalina y ketamina desde el periodo preoperatorio disminuyen la incidencia de dolor agudo postoperatorio. En tanto, la venlafaxina y dexmedetomidina demostraron su utilidad para reducir el dolor crónico.

Postmastectomy chronic pain syndrome is common in patients undergoing surgery for breast cancer, becoming invalidating in severe cases. There are different risk factors for this to occur, with acute post-operative pain being the only one in which we can intervene. The importance of implementing prevention strategies in the perioperative period is essential. In the maintenance of general anesthesia, the use of propofol is associated with a lower incidence of acute post-operative pain. The use of local anesthetics, whether topically, subcutaneously and systemically, has shown its benefit in reducing acute pain. However, only topical and endovenous use has been useful to reduce pain up to 3 months after surgery. Regional analgesia techniques, such as PEC I and II block, paravertebral block, and spinal erector block have been shown to reduce acute pain; but only the paravertebral block has shown its usefulness in reducing pain up to 1 year after surgery. The use of gabapentin, pregabalin and ketamine from the preoperative period reduce the incidence of acute postoperative pain. Meanwhile, venlafaxine and dexmedetomidine proved useful in reducing chronic pain.

Fascitis plantar. Criterios y experiencias sobre la infiltración con anestésicos locales y corticoesteroides / Plantar fasciitis Criteria and experiences on infiltration with local anesthetics and corticosteroids

Introducción: Dentro del grupo de las enfermedades del sistema osteomioarticular la fascitis plantar (FP) es una de las causas más frecuente de dolor crónico del pie. Objetivo: aportar criterios sobre el empleo de la infiltración de anestésicos locales y corticoesteroides para el tratamiento de la fascitis plantar. Desarrollo: se seleccionaron las infiltraciones de corticoesteroides y de anestésicos locales que se realizan con mayor frecuencia en la práctica clínica, se analizó su efectividad según la evidencia en la literatura internacional y a partir de ahí se contrastaron los resultados encontrados con los criterios y experiencias de los autores de este trabajo. Conclusiones: Las consideraciones realizadas en este estudio apuntan a que el uso de los corticoides mediante infiltraciones en patologías ortopédicas es un medio valioso para mejorar la inflamación de los tejidos y para el alivio de los dolores, tanto cuando se emplea en las articulaciones como en las partes blandas(AU)

Introduction: within the group of diseases of the osteomioarticular system, plantar fasciitis (FP) is one of the most frequent causes of chronic foot pain. Objective: to provide criteria on the use of infiltration of local anesthetics and corticosteroids for the treatment of plantar fasciitis. Development: the infiltrations of corticosteroids and local anesthetics that are performed more frequently in clinical practice were selected, their effectiveness was analyzed according to the evidence in the international literature and from there the results were contrasted with the criteria and experiences of the patients authors of this work. Conclusions: the considerations made in this study suggest that the use of corticosteroids through infiltrations in orthopedic pathologies is a valuable means to improve inflammation of the tissues and for the relief of pain, both when used in the joints and in the joints and soft parts(AU)

Dolor crónico en el paciente reumático / Chronic pain in the rheumatic patient

Introducción: el dolor en el paciente reumático puede presentarse, en forma de dolor agudo o crónico, de carácter más complejo, de mayor duración (a partir de 3 meses) o que permanece una vez solucionada la lesión. Objetivo: precisar algunas regularidades sobre este tipo de dolor en el paciente reumático. Desarrollo: es de alta significación considerar en la evaluación del enfermo con dolor crónico el rol de las vías de afrontamiento. Conclusiones: el carácter del manejo del dolor es multifactorial, lo que obliga a implementar intervenciones multifactoriales complejas para perfeccionar el tratamiento apropiado(AU)

Introduction: the pain in the rheumatic patient can present, in the form of acute or chronic pain, more complex nature, of greater duration (from 3 months) or that remains after the injury has been resolved. Objective: to focus on some regularities on this type of pain in the rheumatic patient. Development: it is highly significant to consider in the evaluation of the patient with chronic pain the role of the coping ways. Conclusions: the character of pain management is multifactorial, which requires the implementation of complex multifactorial interventions to perfect the appropriate treatment(AU)

Influence of tramadol on functional recovery of acute spinal cord injury in rats

Abstract Purpose: To evaluate the influence tramadol on functional recovery of acute spinal cord injury in rats. Methods: Ten rats were divided into two groups (n = 5). All animals were submitted by a laminectomy and spinal cord injury at eighth thoracic vertebra. In control group, the rats didn't receive any analgesic. In tramadol group, the rats received tramadol 4mg/Kg at 12/12h until 5 days by subcutaneous. Animals were following by fourteen days. Was evaluated the Basso, Beattie, Bresnahan scale (locomotor evaluation) and Rat Grimace Scale (pain evaluation) at four periods. Results: There no difference between the groups in locomotor evaluation in all periods evaluated (p>0.05) and in both groups there was a partial recover of function. The tramadol group show a lower pain levels at the first, third and seventh postoperatively days when comparing to the control group. Conclusion: The tramadol as an analgesic agent don't influence on functional recovery of acute spinal cord injury in rats

Relación entre el adecuado manejo del dolor agudo perioperatorio e incidencia de dolor crónico no oncológico / Relationship between the adequate management of perioperative acute pain and Incidence of non-oncologic chronic pain

El adecuado manejo perioperatorio del dolor agudo y la elección de la técnica anestésica influyen en la incidencia de complicaciones a corto, mediano y largo plazo, encontrándose en este grupo el desarrollo de dolor crónico no oncológico (DCNO). debido al aumento de la prevalencia de dolor crónico no oncológico y su relación con un manejo inadecuado o insuficiente del dolor agudo en el periodo perioperatorio, hemos realizado una revisión de su fisiopatología, los factores de riesgo y las técnicas preventivas que permitirían mitigar y/o disminuir su incidencia.

The adequate perioperative management of acute pain and the correct choice of the anesthetic technique influence the incidence of complications in the short, medium and long term, being in this group the development of chronic non-oncological pain (CNOP). due to the increase in the prevalence of non-oncological chronic pain and its relation with an inadequate or insufficient management of acute pain in the perioperative period, we have carried out a review of its pathophysiology, risk factors and preventive techniques that would allow mitigating and/or decrease its incidence.

Importancia de las co-morbilidades en la insuficiencia cardiaca / Importance of the co morbidities in the heart failure

La insuficiencia cardíaca afecta aproximadamente a 5.1 millones de adultos en los Estados Unidos de América, con expectativas de alcanzar a casi 8 millones de adultos para 2030. Los pacientes portadores de insuficiencia cardiaca están en mayor riesgo de sufrir una mayor morbilidad y mortalidad que la población en general; además, existen co-morbilidades que pueden complicar el cuidado de estos pacientes. La diabetes mellitus, el dolor crónico y la depresión son diagnósticos que muy a menudo coexisten con la insuficiencia cardiaca. Los medicamentos con que normalmente se tratan estas co-morbilidades pueden inducir o empeorar los síntomas de la insuficiencia cardiaca, así que determinar la terapia apropiada es de vital importancia. Los médicos deben entender la relación que existe entre estas medicaciones y la insuficiencia cardiaca para mejorar la asistencia, aumentar la seguridad del paciente y reducir la morbilidad y mortalidad. Este trabajo analiza la asociación entre ciertos medicamentos usados para el tratamiento de estas co-morbilidades y su relación con la insuficiencia cardiaca. El propósito de este artículo es proporcionar una orientación farmacológica donde las opciones de tratamiento tengan especial consideración con un aumento de la supervisión médica, para evitar la descompensación o aparición de la insuficiencia cardiaca en los pacientes portadores de diabetes mellitus, dolor crónico y depresión (AU).

Heart failure affects approximately 5.1 million adults in the USA, with expectations of a rise to nearly 8 million adults by 2030. Patients with heart failure are at increased risk for morbidity/mortality, and co-morbidities can further complicate care for these patients. Diabetes mellitus, chronic pain, and depression are diagnoses that often coexist with heart failure. Medications commonly used to treat these co-morbidities may induce or worsen heart failure symptoms, so determining appropriate drug therapy is important. Healthcare providers must understand the relationship between these medications and heart failure in order to improve prescribing practices to increase patient safety and reduce morbidity and mortality. This manuscript discusses the association between certain medications used to treat the aforementioned diagnoses and their relationship to heart failure. The purpose of this article is to provide guidance on which pharmacologic options require special consideration, increased monitoring, or complete avoidance in heart failure patients with diabetes mellitus, chronic pain, and/or depression (AU).

Quadratus lumborum block in chronic pain after abdominal hernia repair: case report / Bloqueio do quadrado lombar em dor crônica pós-hernioplastia abdominal: relato de caso

Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL) and depot (vial) methylprednisolone (20 mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Resumo Justificativa e objetivos: O bloqueio da fáscia do músculo quadrado lombar foi descrito por R. Blanco nas suas duas abordagens (I e II). A deposição de anestésico local nessa localização pode conferir bloqueio dos dermátomos T6-L1. Os autores fizeram esse bloqueio de fáscia, guiado por ultrassom, para tratamento de uma dor crônica neuropática da parede abdominal. Relato de caso: Paciente do gênero masculino, 61 anos, 83 kg, com antecedentes de trombocitopenia por hepatopatia alcoólica, entre outros, apresentava dor crônica da parede abdominal após hernioplastias abdominais múltiplas havia um ano e meio, com má resposta ao tratamento com neuromoduladores e opioides. No exame clínico, apresentava uma dor neuropática, com predomínio de alodinia ao toque, que abrangia toda a parede abdominal anterior, desde os dermátomos T7 a T12. Optou-se pela realização de um bloqueio do quadrado lombar tipo II bilateral, guiado por ultrassom, com administração de 25 mL de ropivacaína 0,2% e 20 mg de metilprednisolona depot (ampola) em cada um dos lados. O procedimento conferiu alívio imediato da sintomatologia e, após seis meses, o paciente mantinha redução significativa da alodinia, sem compromisso da qualidade de vida. Conclusões: Os autores consideram que a realização do bloqueio do quadrado lombar tipo II foi uma opção analgésica relevante no tratamento de um paciente com dor crônica pós-hernioplastia abdominal e salientaram os efeitos da dispersão do anestésico local até o espaço paravertebral torácico. A técnica mostrou ser segura e bem tolerada. É desejável a publicação de mais casos clínicos que reproduzam a eficácia desse bloqueio no contexto de dor crônica.

Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment / Dor crônica persistente pós-operatória: o que sabemos sobre prevenção, fatores de risco e tratamento?

Abstract Background and objectives: Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. Content: This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively. Conclusion: Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.

Resumo Justificativa e objetivos: A dor crônica persistente pós-operatória (DCPO) constitui um grave problema de saúde, incapacitante, mina a qualidade de vida dos pacientes acometidos. Apesar de mais estudos e pesquisas terem sido desenvolvidos a respeito dos possíveis mecanismos da evolução da dor aguda para dor crônica pós-operatória, ainda não existem dados consistentes a respeito de seus fatores de risco e prevenção. Este artigo se propõe a trazer o que há no panorama da literatura atual disponível. Conteúdo: Esta revisão descreve a definição, os fatores de risco e os mecanismos da DCPO, sua prevenção e seus tratamentos. Os principais medicamentos e técnicas são expostos de forma compreensiva. Conclusão: A dor crônica persistente pós-operatória é uma entidade complexa e de etiologia ainda não esclarecida, que interfere intensamente na vida do sujeito. A dor neuropática decorrente do trauma cirúrgico ainda é a expressão mais comum dessa entidade. Técnicas que evitem a lesão de nervos estão recomendadas e devem ser usadas sempre que possível. Apesar dos esforços para entender e selecionar os pacientes de risco, o manuseio e a prevenção dessa síndrome continuam desafiantes e inapropriados.

Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study / Efeito da gabapentina pré-operatória na intensidade da dor e desenvolvimento de dor crônica após o tratamento cirúrgico da síndrome do túnel do carpo em mulheres: estudo randomizado duplo-cego controlado com placebo

ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period), incidence of postoperative neuropathic pain (over a six-month period), need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4) questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome) were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg) did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

RESUMO CONTEXTO E OBJETIVOS: Analgesia pós-operatória eficaz é importante para reduzir a incidência de dor crônica. Este estudo avaliou o efeito da gabapentina pré-operatória na analgesia pós-operatória e na incidência de dor crônica em pacientes submetidos à cirurgia para tratamento da síndrome do túnel do carpo. DESENHO E LOCAL: Randomizado, duplo cego, Universidade Federal de São Paulo. MÉTODOS: Os 40 pacientes com 18 anos ou mais de idade foram distribuídos aleatoriamente em dois grupos: o Grupo Gabapentina recebeu 600 mg de gabapentina no pré-operatório uma hora antes da cirurgia, e o Grupo Controle recebeu placebo. Todos os pacientes receberam anestesia regional intravenosa com lidocaína a 1%. Midazolam foi utilizado para sedação, se necessário. Paracetamol foi administrado para analgesia pós-operatória, conforme necessário, e codeína, se o paracetamol fosse insuficiente. Foram avaliados: a intensidade da dor pós-operatória (durante seis meses), a incidência de dor neuropática pós-operatória (durante seis meses), a necessidade de sedação intra-operatória e o uso de paracetamol e codeína no pós-operatório. A presença de dor neuropática foi estabelecida utilizando-se o questionário DN4 (dor neuropática 4). Síndrome de dor regional complexa foi diagnosticada através do questionário Budapeste. RESULTADOS: Não foram observadas diferenças na necessidade de sedação, no controle da dor pós-operatória e na incidência de síndromes dolorosas crônicas (neuropáticas ou síndrome de dor regional complexa). Não foram observadas diferenças no consumo de paracetamol e codeína. CONCLUSÕES: Gabapentina pré-operatória (600 mg) não melhorou o controle da dor pós-operatória e não reduziu a incidência de dor crônica em pacientes submetidos à cirurgia para tratamento da síndrome do túnel do carpo.

Avaliação da dor crônica em idosos institucionalizados / Evaluacion del dolor cronico en ancianos institucionalizados / Evaluation of chronic pain in the institutionalized elderly

Objetiva-se com esta pesquisa avaliar a dor e caracterizar os idosos institucionalizados segundo as variáveissociodemográficas e clínicas. Trata-se de estudo descritivo realizado com 124 idosos residentes nas Instituiçõesde Longa Permanência para Idosos de Minas Gerais. Para a obtenção dos dados, realizou-se entrevista, bem comoavaliação clínica. Utilizou-se estatística descritiva com análise univariada dos dados. Verificou-se a predominânciado sexo feminino, com hipertensão arterial sistêmica referida, solteiros e com filhos, média de idade 76,2 anos eIMC médio 23,1 kg/m². A dor crônica, a adoção de tratamento medicamentoso e a não realização de atividade físicaregular foram referidas pela maioria dos idosos. Os principais fatores de melhora e piora referidos foram o repouso ea movimentação física, respectivamente. A dor crônica e a não realização de atividade física regular são vivenciadaspela maioria dos idosos institucionalizados. Espera-se que novas medidas de monitoramento, prevenção e controleda dor sejam implementadas nessas instituições.

This study objective was to evaluate the pain in institutionalized elderly as well as characterize this group accordingto socio-demographic and clinical variables. It is a descriptive study with 124 elderly people living in long-term carefacilities (LTCF) in the state of Minas Gerais, Brazil. Data were obtained via interview and clinical assessment. Descriptivestatistics with univariate data were used. There was predominance of women with systemic arterial hypertension, singleand with children. The mean age was 76.2 years, and the median BMI was 23.1 kg / m². Chronic pain, the medicationtreatment and the lack of physical activity were reported. Key fators for improvement and worsening of health were thephysical rest and physical activity, respectively. Results indicated that chronic pain and lack of regular physical activityare experienced by most of the institutionalized elderly. New measures for monitoring, preventing and controlling thepain should be implemented in these institutions.

El objetivo del presente estudio fue evaluar el dolor y caracterizar ancianos institucionalizados en función de variablesdemográficas y clínicas. Se trata de un estudio descriptivo de 124 ancianos hospedados en establecimientos delarga permanencia de Minas Gerais. Llevamos a cabo entrevistas y evaluación clínica para obtener datos. Se utilizóestadística descriptiva con los datos de una variable. Los resultados indican que hay predominio de individuos delsexo femenino, hipertensos, solteros y con hijos. Edad promedio de 76,2 años y promedio de IMC de 23,1 kg / m².Dolor crónico, tratamiento con fármacos y falta de actividad física regular fueron mencionados por la mayoría de losancianos. Principales fatores de mejora y empeoramiento fueron reposo y actividad física, respectivamente. Llegamosa la conclusión que la mayoría de los ancianos vive con dolor crónico y falta de actividad física regular. Se espera quesean implementadas nuevas medidas de control, prevención y control del dolor en estas instituciones.

Analgesia preventiva: parte del pasado / Preventive analgesia: is that in the past

La analgesia preventiva se constituye como un área de desarrollo dentro del estudio del dolor. Numerosos autores y estudios multicéntricos han tratado de avalar o descartar el uso de la analgesia preventiva previo al acto quirúrgico, con el fin de evitar o modular el desarrollo tanto del dolor agudo postoperatorio como del dolor crónico. A través de este artículo, otorgamos una revisión de los conceptos incluidos en la analgesia preventiva y el dolor postoperatorio, dando a conocer los trabajos recientes publicados al respecto. Se analizan, además, las distintas modalidades de analgesia preventiva actualmente en uso y se establece que este tipo de manejo analgésico constituye un desafío actual que debe motivarnos a realizar nuevos estudios donde se integren los conceptos aprendidos y se establezca una estrategia analgésica que nos permita optimizar los resultados perioperatorios.

Preventive analgesia is a development area within the greater area of pain study. Numerous authors and Studies have intended to support or rule out the use of preventive analgesia prior to surgery in order to avoid or modulate both postoperative acute pain and chronic pain. In this article we review the concepts in preventive analgesia and postoperative pain, discussing the most recent publications. In addition, we analyze different types of preventive analgesia presently in use and establish that this type of analgesia management is a current challenge that should motivate us into exploring new ideas to integrate the concepts we have learnt and establish an analgesia strategy that allows us to optimize perioperative results.