Evaluación del efecto analgésico transoperatorio del tramadol comparado con la lidocaína en caninos oncológico / Assessment of the adverse effect of tramadol compared to lidocaine in the oncologic intraoperative in canines

Introducción: El estudio y tratamiento del dolor ha sido una de las preocupaciones más importantes en los últimos 30 años en el ámbito médico mundial. Desde hace varias décadas a nivel internacional se realizan estudios sobre el efecto del tramadol y la lidocaína como analgésicos intraoperatorio, con el fin de obtener una adecuada analgesia durante el procedimiento quirúrgico y el periodo posoperatorio inmediato. Objetivo: Comparar el efecto analgésico del tramadol y la lidocaína durante el período transoperatorio en caninos programados para intervención quirúrgica. Método: Se realizó un estudio prospectivo, comparativo, con animales programados para tratamiento quirúrgico por presentar tumores periféricos. Se incluyeron 10 animales divididos en 2 grupos. El grupo control (G-C) que recibió lidocaína sin preservo (lidocaína SP) en infusión continua durante el procedimiento quirúrgico y el grupo 1 (G-1) que se le administró tramadol endovenoso previo al acto quirúrgico. Se evaluaron variables hemodinámicas y de oxigenación como indicadores indirectos de dolor transoperatorio. Resultados: La muestra fue homogénea para la edad y el sexo. El comportamiento de las variables hemodinámicas resultó más estable durante la infusión de lidocaína. La saturación periférica de oxígeno fue similar con ambos medicamentos, así como la temperatura. Conclusiones: La infusión intravenosa de lidocaína SP durante el periodo transoperatorio en caninos oncológico demostró una mejor efectividad analgésica en comparación con el tramadol aplicado preoperatoriamente, según los parámetros evaluados(AU)

Introduction: Study and treatment of pain has been one of the most important concerns in the last thirty years in the worldwide medical field. For several decades, international studies have been carried out on the effect of tramadol and lidocaine as intraoperative analgesics, in order to achieve adequate analgesia during surgical procedures and the immediate postoperative period. Objective: To compare the analgesic effect of tramadol and lidocaine during the intraoperative period in canines scheduled for surgical intervention. Method: A prospective, comparative study was carried out with animals scheduled for surgical treatment due to peripheral tumors. Ten animals were included, divided into two groups: the control group, which received lidocaine without preservation in continuous infusion during the surgical procedure, and group 1, which was administered intravenous tramadol prior to the surgical act. Hemodynamic and oxygenation variables were assessed as indirect indicators of intraoperative pain. Results: The sample was homogeneous for age and sex. The behavior of the hemodynamic variables was more stable during the lidocaine infusion. Peripheral oxygen saturation was similar in both drugs, as well as temperature. Conclusions: Intravenous infusion of lidocaine without preservation during the intraoperative period in oncological canines showed better analgesic effectiveness compared to tramadol applied preoperatively, according to the parameters assessed(AU)

Tratamiento conservador de la artrosis de cadera / Conservative treatment of hip osteoarthritis

Ante un escenario clínico de coxalgia por artrosis de cadera se planteó la necesidad de conocer los tratamientos con-servadores más seguros y efectivos para el manejo del dolor. El tratamiento de la artrosis requiere un enfoque integral e individualizado en función de las preferencias del paciente para lograr el máximo beneficio clínico. Existen numerosas estrategias útiles para el manejo del dolor en pacientes con artrosis de cadera siendo fuertemente recomendados de inicio la actividad física, los antiinflamatorios no esteroideos (AINE) orales y en ciertos casos los corticoides intraarticulares, tramadol o duloxetina, siempre asociado con la actividad física. Los ejercicios más recomendados son los aeróbicos y el Tai Chi o yoga. (AU)

Faced with a clinical scenario of coxalgia due to hip osteoarthritis, the need to know the safest and most effective conservative treatments for pain management arose. The treatment of osteoarthritis requires a comprehensive and individualised approach based on the patient's preferences to achieve maximum clinical benefit. There are numerous useful strategies for pain management in patients with hip osteoarthritis being strongly recommended from the beginning such as physical activity, oral non-steroidal anti-inflammatory drugs (NSAID) and in certain cases intra-articular corticosteroids, tramadol or duloxetine, always associated with physical activity. The most recommended exercises are aerobics and Tai Chi or yoga. (AU)

Traditional chest drainage versus drainage by thoracotomy: a prospective randomized study / Drenagem torácica tradicional versus drenagem pela toracotomia: estudo prospectivo randomizado

ABSTRACT Objective To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. Methods We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. Results The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). Conclusion Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.

RESUMO Objetivo Comparar a drenagem torácica pela mesma intercostotomia à drenagem tradicional em pacientes submetidos à toracotomia poupadora lateral. Métodos Foram avaliados 40 pacientes maiores de 18 anos submetidos a toracotomias poupadoras laterais eletivas. Eles foram separados em dois grupos de 20 pacientes cada, sendo um submetido à drenagem torácica pelo mesmo espaço intercostal da toracotomia e o outro à drenagem tradicional. Resultados No grupo da drenagem pela mesma intercostotomia, a mediana de tempo de internação em unidade de terapia intensiva foi de 1,5 dia (1,0 a 2,0 dias) e de 2,0 dias (1,25 a 3,0 dias) na drenagem tradicional (p=0,060). As medianas do tempo de internação (p=0,527) e de drenagem (p=0,547) foram ambas de 4 dias, no primeiro grupo, e de 2 e 5,5 dias, no grupo com drenagem tradicional. As doses utilizadas de dipirona e de tramadol não apresentaram diferenças estatísticas entre os grupos (p=0,201 e p=0,341). As médias da escala de dor foram 4,24 no primeiro dia pós-operatório do grupo com a drenagem proposta e 3,95 nos drenados da forma tradicional (p=0,733); no terceiro pós-operatório, foi de 3,18 para o grupo drenado pela incisão e de 3,11 nos drenados da forma tradicional (p=0,937). No 15º dia após a cirurgia, a drenagem pela incisão foi de 1,53 e a tradicional de 2,11 (p=0,440); no 30º pós-operatório, foi de 0,71 e 0,84, respectivamente, para a incisão e a forma tradicional (p=0,787). Em relação às complicações, os grupos foram semelhantes, com 30% na drenagem proposta e 25% na drenagem tradicional (p=0,723). Conclusão A drenagem pelo mesmo espaço intercostal foi exequível e não apresentou inferioridade à técnica tradicional no período pós-operatório estudado de 30 dias.

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.

Factors associated to potential drug interactions in one Intensive Care Unit: a cross-sectional study / Factores asociados a interacciones medicamentosas potenciales en un Centro de Terapia Intensiva: estudio transversal / Fatores associados a interações medicamentosas potenciais em um Centro de Terapia Intensiva: estudo transversal

ABSTRACT Objective: to identify the factors associated to Potential Drug Interactions with High Alert Medications in the Intensive Care Unit of a Sentinel Hospital. Methods: a cross-sectional, retrospective study using a quantitative approach carried out at a Sentinel Hospital in Rio de Janeiro. The research was based on the analysis of the prescriptions of patients hospitalized in the Intensive Care Unit of the Hospital, in a period of one year, in order to identify the drug interactions related to high alert medications in these prescriptions. Results: Of the 60 prescriptions analyzed, 244 were selected. In these prescriptions, 846 potential drug interactions related to high alert medications and 33 high alert medications were identified. Of the 112 types of potential drug interactions identified, some were more recurrent: tramadol e ondansetron, midazolam and omeprazole, regular insulin and hydrocortisone, fentanyl and midazolam, and regular insulin and noradrenaline. The variables polypharmacy, length of hospital stay, and some specific medications were associated with drug interactions with high alert medications. Conclusion and Implications for practice: It is important to strengthen strategies to reduce adverse drug events. Therefore, the relevance of studies that investigate the origin of these events is highlighted. Drug interactions can represent medication errors. It's indispensable to work with strategies to better manage the medication system.

RESUMEN Objetivo: identificar los puntos asociados a las Interacciones Medicamentos Potenciales con Medicamentos de alta vigilancia en un Centro de Cuidados Intensivos de un Hospital de Guardia. Métodos: estudio transversal, retrospectivo, de abordaje cuantitativo, realizado en un hospital de guardia en Rio de Janeiro. Esta investigación se basó en el análisis de las prescripciones medicamentosas de pacientes internados en un Centro de Cuidados Intensivos de un hospital, en un período de 1 año, con el objetivo de identificar las interacciones medicamentosas relacionadas con Medicamentos de alta Vigilancia recurrentes en las mismas. Resultados: de los informes analizados, se seleccionaron 244 prescripciones medicamentosas. En las 244 prescripciones de medicamentos, se pudieron identificar 846 Interacciones de Medicamentos Potenciales (IMP) relacionados a Medicamentos de Alta Vigilancia y 33 Medicamentos de Alta Vigilancia. De los 112 tipos de interacciones de medicamentos potenciales identificados, algunos han sido más recurrentes; a saber: tramadol y ondansetrón, midazolam y omeprazol, insulina regular e hidrocortisona, fentanilo y midazolam, insulina regular y noradrenalina. Las variables polifarmacia, tiempo de internación y algunos medicamentos específicos se asociaron a las interacciones medicamentosas potenciales con Medicamentos de Alta Vigilancia. Conclusión e Implicaciones para la práctica: es importante fortalecer las estrategias para reducir los eventos adversos relacionados con medicamentos. Por lo tanto, se destaca la relevancia de los estudios que plantean la naturaleza de estos eventos. Las interacciones medicamentosas pueden provocar errores de medicación. Es imprescindible trabajar con estrategias para administrar mejor el sistema de medicación.

RESUMO Objetivo: Identificar os fatores associados às Interações Medicamentosas Potenciais com Medicamentos de alta vigilância em Centro de Terapia Intensiva de um Hospital Sentinela. Métodos: Estudo transversal, retrospectivo, de abordagem quantitativa, realizado em um hospital sentinela no Rio de Janeiro. A pesquisa apoiou-se na análise das prescrições de pacientes internados no setor, com recorte temporal de 1 ano, a fim de identificar as interações medicamentosas relacionadas a medicamentos de alta vigilância recorrentes nas mesmas. Resultados: Dos 60 prontuários analisados, selecionaram-se 244 prescrições. Nelas identificaram-se 846 interações medicamentosas potenciais, relacionadas aos medicamentos de alta vigilância e 33 medicamentos de alta vigilância. Dos 112 pares de interações identificadas, foram mais recorrentes: tramadol e ondansetrona, midazolam e omeprazol, insulina regular e hidrocortisona, fentanil e midazolam, e insulina regular e noradrenalina. As variáveis polifarmácia, tempo de internação e alguns medicamentos específicos foram associadas às interações com medicamentos de alta vigilância. Conclusão e Implicações para a prática: É importante fortalecer as estratégias para reduzir os eventos adversos relacionados a medicamentos. Portanto, destaca-se a relevância de estudos que levantem a natureza desses eventos. As interações medicamentosas podem configurar erros de medicação. Portanto, é indispensável que se trabalhe com estratégias para melhor manejar o sistema de medicação.

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

A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering / Estudo prospectivo randômico, duplo-cego e controlado comparando tramadol, clonidina e dexmedetomidina para tremores pós-raquianestesia

Abstract Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1 mg.kg-1, Group C getting clonidine 1 mcg.kg-1 and Group D patients receiving dexmedetomidine 0.5 mcg.kg-1. The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable.

Resumo Introdução O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós-raquianestesia e observar seus efeitos adversos. Métodos Este estudo prospectivo, randômico, controlado e duplo-cego foi feito com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 mg.kg-1 de tramadol (Grupo T), 1 mcg.kg-1 de clonidina (Grupo C) e 0,5 mcg.kg-1 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) do que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor do que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão Dexmedetomidina foi melhor do que tramadol e clonidina para o controle de tremores devido ao seu início de ação mais rápido e à taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis.

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.

Incidência de flebite e flebite pós-infusional em adultos hospitalizados / Incidencia de flebitis y flebitis después de la infusión en adultos hospitalizados / Incidence of phlebitis and post-infusion phlebitis in hospitalised adults

RESUMO Objetivo Avaliar a incidência de flebite durante o uso de cateter intravenoso periférico (CIP) e pós-infusional e analisar a associação com fatores de risco em pacientes hospitalizados. Método Estudo de coorte com 165 pacientes adultos internados em hospital universitário de Porto Alegre que totalizaram 447 acessos no período de dezembro 2014 a fevereiro 2015. A coleta dos dados foi diária, e a análise dos dados ocorreu pela estatística descritiva e analítica. Resultados A incidência de flebite durante o uso do CIP foi de 7,15% e de flebite pós-infusional, 22,9%. A flebite durante o uso do cateter associou-se com a Amoxicilina + Ácido Clavulânico. A flebite pós-infusional apresentou associação do grau de gravidade com a idade e com o uso de Amoxacilina + Ácido Clavulânico, Cloridrato de Tramadol e Anfotericina. Conclusão A incidência de flebite pós-infusional mostrou-se um indicador importante para a análise do cenário da qualidade da assistência em saúde.

RESUMEN Objetivo Evaluar la incidencia de flebitis en el uso de catéter periférico intravenoso (CIP) y posinfusional y analizar la asociación con los factores de riesgo en pacientes hospitalizados. Método Estudio de cohorte con 165 pacientes adultos ingresados en un hospital universitario de Porto Alegre, que ascendió a 447 accesos de diciembre 2014 a febrero de 2015. La recolección de datos fue diaria y el análisis de datos fue mediante estadística descriptiva y analítica. Resultados La incidencia de flebitis durante el uso de catéter periférico intravenoso fue del 7,15% y de la flebitis posinfusional fue del 22,9%. La flebitis durante el uso del catéter se asoció con el uso de Amoxicilina + Ácido clavulánico. La flebitis posinfusional presentó una asociación del grado de gravedad con la edad, y con el uso de Amoxicilina + Ácido clavulánico, Clorhidrato de tramadol y Anfotericina. Conclusión La incidencia de flebitis posinfuncional mostró ser un indicador importante para el análisis del escenario de la calidad de atención en salud.

ABSTRACT Objective to determine the incidence of phlebitis during and after the use of peripheral intravenous catheter (PIC), and analyse the association of this complication with risk factors. Methods cohort study with 165 adult patients admitted to a university hospital in Porto Alegre, totalling 447 accesses, from December 2014 to February 2015. Data were collected on a daily basis and analysed by means of descriptive and analytical statistics. Results The incidence of phlebitis during PIC was 7.15% and the incidence of post-infusion phlebitis was 22.9%. Phlebitis during catheter use was associated with the use of Amoxicillin + Clavulanic Acid. The grade of post-infusion phlebitis was associated with age and use of Amoxicillin + Clavulanic Acid, Tramadol Hydrochloride, and Amphotericin. Conclusion The incidence of post-infusion phlebitis proved to be an important indicator to analyse the quality of the healthcare setting.

Measurement of serum lactate values in domestic cats (Felis catus) submitted to physical and chemical restraint / Mensuração dos valores de lactato sérico em felinos domésticos (Felis catus) submetidos a contenção física e química

The use of serum lactate has become increasingly common in Veterinary Medicine, since it is an excellent marker of tissue oxygenation, elevated in situations of tissue hypoxia, where anaerobic glycolysis is used as an energy source. Studies point out its use in dogs as a prognostic factor in several affections; however it is not commonly used in domestic felines due to the high stress threshold of the species, which may interfere with their values. The aim of the present study was to evaluate serum lactate values in domestic cats during physical restraint and after chemical restraint using the combination of 8mg/kg ketamine-S, 0.4 mg/kg midazolam, and 2 mg/kg Tramadol. To this end, 20 clinically healthy female cats without defined race, from six months to five years of age, were divided into two groups, GPR (n = 10) represented by felines that had only physical restraint and the GCR (n = 10) by felines that underwent physical restraint (TPR) and after 30 hours by chemical restraint (TCR). It was observed that in both groups (GPR and CPR) during physical restraint presented hyperlactatemia (GPR = 6.23 ± 0.9 mmol/L ­ GCR ­ Tpr = 6.66 ± 1.59 mmol/L) and mean values of 4.42 ± 1.28 mmol/L during chemical restraint (GCR ­ Tcr). It was concluded that physical restraint interferes with serum lactate values, with the reduction of such values with the use of chemical restraint in the feline species.(AU)

A utilização do lactato sérico é cada vez mais comum na Medicina Veterinária, por ser um excelente marcador de oxigenação tecidual, elevando-se em situações de hipóxia tecidual e realizando a glicólise anaeróbica como fonte de energia. Pesquisas científicas em cães o apontam como fator prognóstico em diversas afecções, sendo pouco utilizado em felinos domésticos devido ao elevado limiar de estresse da espécie, podendo interferir em seus valores. Assim, este trabalho avaliou os valores de lactato sérico em felinos domésticos durante contenção física e após contenção química, utilizando a associação de 8 mg/kg de cetamina-S, 0,4 mg/kg de midazolam e 2 mg/kg de cloridrato de tramadol. Foram estudados 20 felinos, fêmeas, sem raça definida, de seis meses a cinco anos de idade, clinicamente saudáveis, divididos em dois grupos, com GPR (n = 10) representado por felinos que passaram apenas por contenção física e com GCR por felinos que passaram por contenção física (TPR) e após 30 horas por contenção química (TCR). Foi observado em ambos os grupos (GPR e GCR) e durante a contenção física a hiperlactatemia sérica (GPR = 6.23 ± 0.9 mmol / L ­ GCR ­ TPR = 6.66 ± 1.59 mmol / L) com valores médios de 4,42 ± 1,28 mmol/L durante a contenção química (GCR ­ TCR). Conclui-se que a contenção física interfere nos valores do lactato sérico, com redução dos valores na utilização da contenção química na espécie felina.(AU)

Evaluación de dolor en niños hospitalizados en servicios de salud públicos y privados de Uruguay / Pain assessment in children hospitalized in public and private health institutions in Uruguay

El dolor es un problema de salud frecuentemente no reconocido e ignorado en pediatría.. Objetivo::reportar la prevalencia de dolor en niños hospitalizados: las 24 horas previas y en el momento de la entrevista. De los pacientes con dolor actual describir: intensidad y tratamiento indicado.. Metodología::estudio transversal, el 6/12/13 en el Centro Hospitalario Pereira Rossell (CHPR) y el 20/1/14 en otras instituciones del país. Se incluyeron los menores de 15 años hospitalizados. Se consideró paciente con dolor cuando el niño o su cuidador referían haberlo experimentado en las 24 horas previas y/o en el momento de la entrevista. Variables: edad, sexo, motivo de ingreso, trastorno cognitivo, tratamiento analgésico indicado, vía e intervalo de administración, tratamiento adyuvante y medidas no farmacológicas. La intensidad se evaluó mediante escalas.. Resultados::se encontraron: 168 niños hospitalizados, 109 en el CHPR; prevalencia de: dolor en las 24 horas previas: 35% (59/168) y en el momento de la encuesta: 15,5% (26/168). De los niños con dolor actual la intensidad era: leve 8/26, moderado 14/26 y severo 4/26. No tenían indicación de fármacos analgésicos: 9/26. El analgésico más indicado fue dipirona (11/17) y la asociación más prescripta: dipirona-ketoprofeno (5/17). Se constató: indicación de intervalo no adecuado: 7/17; vía intravenosa: 12/17; tratamiento adyuvante y medidas no farmacológicas: 1 cada uno.. Conclusiones::se constataron niños hospitalizados con dolor y déficits diversos en los tratamientos indicados. Es necesario que las instituciones sanitarias aborden este problema como parte de su política institucional.

Pain is a health problem often unrecognized and ignored in pediatrics. Objective: to report the prevalence of pain in hospitalized children: 24 hours before and during the interview. To describe intensity and prescribed treatment in patients with current pain. Methods: transversal study, on 06/12/13 at Pereira Rossell Hospital Center (PRHC) and on 20/1/14 in other institutions. Hospitalized children under 15 years old were included. “Patient in pain” was considered when the child or caregiver reported pain experienced in the previous 24 hours and/or at the time of the interview. Variables: age, gender, reason for admission, cognitive disorder, analgesic treatment indicated, route of administration, dosing interval, adjuvant and non-pharmacological treatments. Validated scales were used to assess intensity. Results: 168 hospitalized children, 109 at PRHC; prevalence of pain in the previous 24 hours: 35% (59/168) and during the interview: 15.5% (26/168). Intensity of pain found in children with current pain was: 8/26 mild, 14/26 moderate and 4/26 severe; 9/26 did not have any analgesic prescription. The most prescribed analgesic was: dipirone (11/17) and most prescribed association was: dipirone-ketoprofen (5/17). Interdose interval was inappropriate in 7/17; intravenous route of administration was indicated in 12/17; adjuvant and non-pharmacological treatments were found in one patient each. Conclusions: hospitalized children in pain and several problems in analgesic treatment prescription were found. Institutional policies directed to address this problem in management are needed.

Meloxicam associado ou não ao tramadol no controle da dor após ovário-histerectomia videoassistida em cadelas / Meloxican with or without tramadol for control of pain undergoing laparoscopic-assisted ovariohysterectomy in bitches

O objetivo deste estudo foi avaliar a eficácia do meloxicam associado ou não ao tramadol, no controle da dor após ovário-histerectomia (OVH) laparoscópica com dois portais. Foram selecionadas 14 cadelas hígidas. Os animais foram separados de forma aleatória, em dois grupos. O grupo M (GM) recebeu meloxicam (0,2mg kg-1, s.i.d.), enquanto os animais do grupo MT (GMT) receberam a associação de meloxicam (0,2mg kg-1, s.i.d.) e tramadol (4mg kg-1, t.i.d.), ambos durante dois dias de pós-operatório. Para avaliação da dor pós-cirúrgica, foram utilizadas as escalas de Melbourne e escala visual analógica (EVA), além de mensurações de glicemia e cortisol sérico. Não houve diferença ao se avaliarem os grupos GM e GMT pela escala de Melbourne nem pela EVA. As mensurações de cortisol não atingiram valores superiores aos de referência para a espécie, enquanto os valores de glicemia não apresentaram variação significativa ao longo do tempo de avaliação nem entre grupos. Com os resultados deste estudo, foi possível concluir que a utilização de meloxicam associado ou não ao tramadol, nas doses e posologias propostas, é eficaz para controlar a dor pós-operatória de cadelas submetidas à OVH laparoscópica com dois portais.

The aim of this study was to evaluate the efficacy of meloxicam with or without tramadol for pain control after laparoscopic-assisted ovariohysterectomy (OVH) by two-portal access. Were selected 14 healthy dogs to perform video-assisted OVHs. The animals were divided randomly into two groups (GM and GMT). The GM group received meloxicam (0.2mg kg-1, s.i.d), whereas the GMT group received the combination of meloxicam (0.2mg kg-1, s.i.d) and tramadol (4mg kg-1, tid), both for two days after surgery. To evaluate the post-surgical pain Melbourne and EVA scales were used, and blood glucose and serum cortisol were measured. There was no statistical difference when evaluating GM and GMT groups and the Melbourne scale or the visual analogue scale VAS. Cortisol measurements did not reach values higher than the reference for the species, while blood glucose levels did not present significant statistical variation throughout the evaluation time or between groups. With these results, we concluded that the use of meloxicam with or without the tramadol at the doses and dosage schedules proposed, is effective to control postoperative pain in bitches that had undergone video-assisted OVH with two-portal access.

Avaliação hemogasométrica em cadelas com piometra / Hemogasometric evaluation in bitches with pyometra

A piometra é uma afecção comum em cadelas com uma etiologia hormonal associada à infecção bacteriana, levando ao acúmulo de exsudato uterino. Desequilíbrios ácido-base e hidroeletrolíticos são complicações que contribuem para a progressão da doença, o que piora o estado geral da paciente e pode levá-la ao óbito. O objetivo do presente trabalho foi caracterizar os distúrbios ácido-base e eletrolíticos em cadelas com piometra, além de avaliar se a terapia hídrica pré-cirúrgica (Ringer lactato) é efetiva na correção desses desequilíbrios. Vinte cadelas com piometra foram submetidas à hemogasometria em oito tempos preestabelecidos. Concluiu-se que o distúrbio ácido-base mais frequente foi a alcalose respiratória e que a terapia hídrica no pré-cirúrgico com solução Ringer lactato foi efetiva na correção da acidose metabólica e proporcionou melhora na alcalose respiratória, embora não tenha corrigido quadros de alcalose metabólica.

Pyometra is a common disease in dogs with a hormonal etiology associated with a bacterial infection and leading to accumulation of uterine exudates. Acid-base and electrolyte disturbances are complications that contribute to disease progression, worsening the condition of the patient, possibly leading death. The aim of this study was to characterize the acid-base and electrolyte disturbances in dogs with pyometra, and to evaluate whether preoperative fluid therapy (Ringer's lactate) is effective in correcting these imbalances. Twenty bitches with pyometra were subjected to blood gas analysis in eight pre-set times. It was concluded that the acid-base disorder was the most frequent respiratory alkalosis and fluid therapy in the preoperative Ringer 's lactate solution was effective in the correction of metabolic acidosis, although this has not corrected metabolic alkalosis frames and has provided improved alkalosis breathing .

Tramadol Alleviates Myocardial Injury Induced by Acute Hindlimb Ischemia Reperfusion in Rats / Tramadol Atenua Lesões Miocárdicas Induzidas pela Reperfusão Pós- Isquêmica Aguda de Membros Posteriores em Ratos

AbstractBackground:Organ injury occurs not only during periods of ischemia but also during reperfusion. It is known that ischemia reperfusion (IR) causes both remote organ and local injuries.Objective:This study evaluated the effects of tramadol on the heart as a remote organ after acute hindlimb IR.Methods:Thirty healthy mature male Wistar rats were allocated randomly into three groups: Group I (sham), Group II (IR), and Group III (IR + tramadol). Ischemia was induced in anesthetized rats by left femoral artery clamping for 3 h, followed by 3 h of reperfusion. Tramadol (20 mg/kg, intravenous) was administered immediately prior to reperfusion. At the end of the reperfusion, animals were euthanized, and hearts were harvested for histological and biochemical examination.Results:The levels of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were higher in Groups I and III than those in Group II (p < 0.05). In comparison with other groups, tissue malondialdehyde (MDA) levels in Group II were significantly increased (p < 0.05), and this increase was prevented by tramadol. Histopathological changes, including microscopic bleeding, edema, neutrophil infiltration, and necrosis, were scored. The total injuryscore in Group III was significantly decreased (p < 0.05) compared with Group II.Conclusion:From the histological and biochemical perspectives, treatment with tramadol alleviated the myocardial injuries induced by skeletal muscle IR in this experimental model.

ResumoFundamento:Lesões a órgãos ocorrem não apenas durante períodos de isquemia, mas paradoxalmente, também durante a reperfusão. Sabe-se que a reperfusão pós-isquêmica (RPI) causa lesões tanto remotas quanto locais no órgão afetado.Objetivo:Este estudo avaliou os efeitos do tramadol no coração como órgão remoto, após RPI aguda dos membros posteriores.Métodos:Trinta ratos Wistar, machos, adultos e saudáveis, foram distribuídos aleatoriamente em três grupos: Grupo I (controle), Grupo II (RPI) e Grupo III (RPI + tramadol). Isquemia foi induzida em ratos anestesiados através do pinçamento da artéria femoral esquerda por 3 horas, seguidas de 3 horas de reperfusão. Tramadol foi administrado (20 mg/kg, IV) imediatamente antes da reperfusão. Ao final da reperfusão, os animais foram sacrificados e seus corações coletados para exames histológicos e bioquímicos.Resultados:Os níveis de superóxido-dismutase (SOD), catalase (CAT) e glutationa-peroxidase (GPx) foram maiores nos grupos I e III que no grupo II (p < 0.05). Em comparação aos outros grupos, os níveis tissulares de malondialdeído (MDA) estavam significativamente mais elevados no grupo II (p < 0.05), o que foi evitado pelo uso de tramadol. Foram pontuadas as alterações histopatológicas, incluindo micro-hemorragia, edema, infiltração por neutrófilos e necrose. A pontuação total das lesões do grupo III foi significativamente menor (p < 0.05) em comparação ao grupo II.Conclusão:Do ponto de vista histológico e bioquímico, o tratamento com tramadol diminuiu as lesões miocárdicas induzidas pela RPI da musculatura esquelética neste modelo experimental.

Comparison of tapentadol with tramadol for analgesia after cardiac surgery.

Background: Tapentadol is a relatively new analgesic. We decided to compare it with tramadol for their various effects after cardiac surgery. Setting: A study in a tertiary care hospital. Materials and Methods: Sixty adults undergoing cardiac surgery were divided into 2 groups of 30 each by computerized random allotment (Group X = tapentadol 50 mg oral and Group Y = tramadol 100 mg oral). Informed Consent and Institutional Ethics Committee approval were obtained. The patients were given either drug X or drug Y after extubation in this single blinded study, wherein the data collectors and analyzers were blinded to the study. All patients received oral paracetamol qds and either drug X or drug Y tds. The pain score was noted on a Visual Analog Scale before each drug dose, 3 h later and on coughing. Heart rate, respiratory rate, and blood pressure were recorded before the drug dose and 3 h later. Postoperative nausea or vomiting (PONV), temperature, and modified Glasgow Coma Scale readings were recorded. The above readings were obtained for 6 doses (up to 48 h after extubation). Statistics: t‑test, Pearson Chi‑square test, Fisher exact test, and Mantel–Haenszel test were used for statistics. Results: Tapentadol group patients had significantly better analgesia 3 h after the drug and “on coughing” than tramadol group. The difference in their effects on blood creatinine levels, temperature, hemodynamics, oxygen saturation, and respiratory rate were not clinically significant. Tapentadol produced lesser drowsiness and lesser vomiting than tramadol. Conclusions: Tapentadol, due to its norepinephrine reuptake inhibition properties, in addition to mu agonist, is a better analgesic than tramadol and has lesser PONV.

Fibromialgia: princípios práticos que auxiliam na indicação e no ajuste do tratamento medicamentoso / Fibromyalgia: practical principles that help in the indication and adjustment of drug treatment

A fibromialgia (FM) é uma síndrome de dor difusa crônica acompanhada de sintomas somáticos, tais como fadiga, transtornos do humor, do sono e da cognição. Em uma abordagem prática do paciente com FM, além das medidas não farmacológicas, cada sintoma pode ser tratado com medicamento específico. O objetivo deste artigo é prover revisão atualizada da literatura sobre os principais medicamentos atualmente disponíveis no Brasil para o tratamento da FM em adultos. O sucesso terapêutico da FM depende, essencialmente, do uso racional de medicamentos voltados para os sintomas refratários às medidas não farmacológicas.

Fibromyalgia (FM) is the chronic widespread pain syndrome associated with fatigue, mood, sleep and cognitive disorders. Besides non-pharmacological approach, each symptom should be treated with a specific drug. The goal of this study is to provide up-to-date literature review on main aspects of adult FM drugs available for use in Brazil. Treatment success in FM depends essentially on using drugs based on symptoms that are not responsive to non-pharmacological approach.

Effect of tramadol on lung injury induced by skeletal muscle ischemia-reperfusion: an experimental study / Efeito do tramadol na lesao pulmonar induzida por isquemia-reperfusao de musculo esqueletico: um estudo experimental

OBJECTIVE: To determine whether tramadol has a protective effect against lung injury induced by skeletal muscle ischemia-reperfusion. METHODS: Twenty Wistar male rats were allocated to one of two groups: ischemia-reperfusion (IR) and ischemia-reperfusion + tramadol (IR+T). The animals were anesthetized with intramuscular injections of ketamine and xylazine (50 mg/kg and 10 mg/kg, respectively). All of the animals underwent 2-h ischemia by occlusion of the femoral artery and 24-h reperfusion. Prior to the occlusion of the femoral artery, 250 IU heparin were administered via the jugular vein in order to prevent clotting. The rats in the IR+T group were treated with tramadol (20 mg/kg i.v.) immediately before reperfusion. After the reperfusion period, the animals were euthanized with pentobarbital (300 mg/kg i.p.), the lungs were carefully removed, and specimens were properly prepared for histopathological and biochemical studies. RESULTS: Myeloperoxidase activity and nitric oxide levels were significantly higher in the IR group than in the IR+T group (p = 0.001 for both). Histological abnormalities, such as intra-alveolar edema, intra-alveolar hemorrhage, and neutrophil infiltration, were significantly more common in the IR group than in the IR+T group. CONCLUSIONS: On the basis of our histological and biochemical findings, we conclude that tramadol prevents lung tissue injury after skeletal muscle ischemia-reperfusion. .

OBJETIVO: Investigar se o tramadol tem um efeito protetor contra a lesão pulmonar induzida por isquemia-reperfusão de músculo esquelético. MÉTODOS: Vinte ratos Wistar machos foram divididos em dois grupos: grupo isquemia-reperfusão (IR) e grupo isquemia-reperfusão + tramadol (IR+T). Os animais foram anestesiados com cetamina e xilazina (i.m., 50 mg/kg e 10 mg/kg, respectivamente). Todos os animais foram submetidos a 2 h de isquemia por oclusão da artéria femoral e 24 h de reperfusão. Antes da oclusão da artéria femoral, foram administrados 250 UI de heparina pela veia jugular para impedir a coagulação. Os ratos do grupo IR+T foram tratados com tramadol (20 mg/kg i.v.) imediatamente antes da reperfusão. Após o período de reperfusão, os animais foram sacrificados com pentobarbital (300 mg/kg i.p.), os pulmões foram removidos cuidadosamente, e os espécimes foram preparados adequadamente para estudos histopatológicos e bioquímicos. RESULTADOS: A atividade de mieloperoxidase e os níveis de óxido nítrico foram significativamente maiores no grupo IR que no grupo IR+T (p = 0,001 para ambos). Anormalidades histológicas, como edema intra-alveolar, hemorragia intra-alveolar e infiltração neutrofílica, foram significativamente mais frequentes no grupo IR que no grupo IR+T. CONCLUSÕES: Com base nos resultados histológicos e bioquímicos ...

Tramadol frente a morfina en la analgesia peridural posoperatoria de pacientes con histerectomía abdominal / Tramadol versus morphine for postoperative peridural analgesia in patients with abdominal hysterectomy

Introducción: el tratamiento del dolor posoperatorio es necesario para evitar sus efectos desfavorables. Objetivo: comparar la analgesia posoperatoria con el uso de tramadol y morfina por vía peridural en pacientes con histerectomía abdominal. Métodos: se realizó un estudio observacional analítico, longitudinal prospectivo en 140 pacientes que se les efectuó histerectomía por vía abdominal en el Hospital Militar Central "Dr. Carlos J. Finlay". Se aplicó anestesia general orotraqueal y se utilizó el catéter epidural para el manejo del dolor posoperatorio. Se dividieron aleatoriamente en dos grupos, cada uno con 70 pacientes. Un grupo recibió analgesia con morfina, 4 mg, y el otro tramadol, 100 mg. Se estudiaron las variables: duración, calidad de la analgesia posoperatoria y presencia de reacciones adversas. Resultados: la duración de la analgesia posoperatoria fue mayor en el grupo en que se empleó morfina (16,7 ± 4,0 h) que en el de tramadol (13,6 ± 4,2 h). Los valores de la escala visual análoga resultaron más elevados en el grupo Tramadol y con menor cantidad de reacciones adversas (38,6 por ciento) comparado con el grupo Morfina (55,7 por ciento). Conclusiones: la duración y la calidad de la analgesia posoperatoria en las pacientes que se les efectuó histerectomía, resultó mayor con el empleo de morfina peridural, aunque la utilización del tramadol por igual vía, constituye una alternativa eficaz y con menor incidencia de efectos adversos

Introduction: the treatment of postoperative pain is necessary to prevent its unfavorable effects. Objective: compare the use of peridural tramadol versus morphine for postoperative analgesia in patients with abdominal hysterectomy. Methods: an observational analytical prospective longitudinal study was conducted with 140 patients who underwent abdominal hysterectomy at Dr. Carlos J. Finlay Central Military Hospital. General orotracheal anesthesia was administered and an epidural catheter used to manage postoperative pain. Patients were randomly distributed into two groups, each with 70 members. One group received analgesia with morphine 4 mg and the other tramadol 100 mg. The variables studied were duration, quality of postoperative analgesia and presence of adverse reactions. Results: duration of postoperative analgesia was longer in the morphine group (16.7 ± 4.0 h) versus the tramadol group (13.6 ± 4.2 h). Visual analog scale values were higher in the Tramadol group with fewer adverse reactions (38.6 percent) versus the Morphine group (55.7 percent). Conclusions: the duration and quality of postoperative analgesia in patients with hysterectomy were greater with the use of peridural morphine, though the use of peridural tramadol is an effective alternative with fewer adverse effects.

A comparison of extradural tramadol and extradural morphine for postoperative analgesia in female dogs undergoing ovariohysterectomy / Tramadol peridural comparativamente à morfina para analgesia pós-operatória em cadelas submetidas à ovariosalpingohisterectomia

PURPOSE: To compare the postoperative analgesic effects of the extradural tramadol or morphine in female dogs undergoing ovariohysterectomy. METHODS: Sixteen female dogs were randomly assigned to two groups of eight animals each and received morphine (0.1mg kg-1 M group) or tramadol (2mg kg-1 T group). The pre-anesthetic medication was intravenously (iv) acepromazine (0.05mg kg-1). Anesthesia was induced with propofol (4mg kg-1iv) and maintained with isoflurane. The degree of analgesia was evaluated using a numerical rating scale that included physiologic and behavior variables. Dogs were scored at one, three, six and 12 hours after surgery by one blinded observer. Dogs were treated with morphine (0.5mg kg-1) if their scores were >6. Serum cortisol was measured before the pre-anesthetic medication was administered (basal), at the time of the ovarian pedicle clamping (T0), and at 1 (T1), 6 (T6) and 12 (T12) hours postoperative. RESULTS: The pain score did not differ between morphine and tramadol treatments. Rescue analgesia was administered to one dog in the T treatment group. Serum cortisol did not differ between treatments. CONCLUSION: The extradural administration of morphine or tramadol is a safe and effective method of inducing analgesia in female dogs undergoing ovariohyterectomy.

OBJETIVO: Comparar o efeito analgésico pós-operatório do tramadol em relação à morfina quando utilizados por via peridural em cadelas submetidas à ovariosalpingohisterectomia (OSH). MÉTODOS: Dezesseis cadelas foram aleatoriamente distribuídas em dois tratamentos, com oito animais em cada, tratadas com morfina (0,1mg kg-1, M) e tramadol (2mg kg-1, T). A medicação pré-anestésica foi feita por via intravenosa (iv) com acepromazina (0,05mg kg-1), seguindo-se indução e manutenção anestésicas com propofol (4mg kg-1 iv) e isofluorano, respectivamente. O grau de analgesia foi avaliado uma, três, seis e 12 horas após o término da cirurgia, com escala descritiva numérica, que incluiu a observação de alterações fisiológicas e comportamentais. Animais com escore > 06 foram tratados com morfina (0,5mg kg-1). A concentração sérica de cortisol foi mensurada antes da sedação (basal), ao término da cirurgia (T0), 1 (T1), 6 (T6) e 12 (T12) horas após a cirurgia. RESULTADOS: Os escores de dor e a concentração sérica de cortisol não diferiram entre os tratamentos. Analgesia de resgate foi necessária em um cão do tratamento T. CONCLUSÃO: A administração peridural de morfina e de tramadol resulta em analgesia adequada e de longa duração em cadelas submetidas à ovariosalpingohisterectomia.

Miomectomía durante el embarazo / Myomectomy during pregnancy

Antecedentes: La miomatosis uterina es un hallazgo común en mujeres en edad reproductiva. El tratamiento con miomectomía durante el embarazo es un procedimiento no habitual, por el alto riesgo materno fetal, realizándose en casos extremos de dolor abdominal severo y después de confirmar las características del mioma mediante una resonancia magnética. Caso clínico: primigesta de 27 años con embarazo de 14 semanas de gestación e historia de dolor abdominal crónico severo y hallazgo por resonancia magnética de dos fibromiomas uno de 10x10 cm y el otro de 23.4x13.8 cm y el embarazo de 14.2 semanas gestacionales; se le realizó miomectomía a las 16 semanas de gestacion obteniendo un único mioma de 25x18 cm y peso de 3600 g. Se interrumpió el embarazo a las 39 semanas de gestación sin complicaciones. Conclusión: La miomectomía en mujeres embarazadas puede realizarse con seguridad y bajo riesgo en pacientes bien seleccionadas...