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1.
Rev. bras. anestesiol ; 70(4): 443-447, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137201

ABSTRACT

Abstract Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours and 3.35 from 24-48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.


Resumo Justificativa: Existem várias abordagens para a realização do Bloqueio do Quadrado Lombar (BQL) guiado por ultrassom. Diversas abordagens são descritas para a realização do BQL: paramediana lateral, posterior, anterior ou transmuscular e subcostal, todas com o objetivo de obter a máxima dispersão da solução injetada, usando-se alto volume e baixa concentração de anestésico local. Relato de caso: Nesta nova abordagem, a sonda de ultrassom curvilínea foi usada com o paciente em decúbito dorsal. A sonda foi posicionada longitudinalmente na linha axilar média para visualizar o Músculo Quadrado Lombar (MQL) no plano coronal. A agulha foi introduzida na direção cranial-caudal, e foram inseridos cateteres na Fáscia Toracolombar Anterior (FTLA) até uma distância de 4-5 cm, em 24 pacientes a serem submetidos à correção de fratura do acetábulo pela via anterior. O bisel da agulha e a dispersão do Anestésico Local (AL) eram visíveis em todos os pacientes. Os 24 pacientes, com exceção de quatro, apresentaram excelente analgesia perioperatória, baseando-se na estabilidade hemodinâmica e nos escores EVA de 2-3/10 nas primeiras 48 horas. Todos os pacientes receberam 1 g de paracetamol intravenoso a cada 8 horas. O escore EVA no período pós-operatório foi de 2-3/10, em 20 dos 24 pacientes. No período pós-operatório, quatro pacientes apresentaram queixa de dor persistente, necessitando de bolus de fentanil por via intravenosa e analgesia multimodal. O escore médio da EVA no pós-operatório foi 2,87 entre 0-12 horas; 3,14 entre 12-24 horas e 3,35 entre 24-48 horas pós-operatórias. Não houve complicações relacionadas ao bloqueio em nenhum paciente. Conclusão: A abordagem supina axilar média coronal para BQL anterior é eficaz e viável para BQL, e pode ser realizada com os pacientes em decúbito dorsal.


Subject(s)
Humans , Male , Female , Pain, Postoperative/prevention & control , Anesthetics, Local/administration & dosage , Nerve Block/methods , Time Factors , Supine Position , Abdominal Muscles , Ultrasonography, Interventional , Acetabulum/surgery , Acetabulum/injuries , Acetaminophen/administration & dosage , Middle Aged , Nerve Block/adverse effects
3.
Rev. bras. anestesiol ; 69(6): 529-536, nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1057480

ABSTRACT

Abstract Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.


Resumo Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Self Medication/statistics & numerical data , Chronic Pain/drug therapy , Urban Population/statistics & numerical data , Brazil , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Dipyrone/administration & dosage , Cross-Sectional Studies , Analgesics/administration & dosage , Acetaminophen/administration & dosage , Middle Aged
4.
Rev. bras. anestesiol ; 69(4): 417-419, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1042012

ABSTRACT

Abstract Erector spinae plane block is gaining popularity both for its ease of application and as its comparable effect on postoperative analgesia with central regional techniques like paravertebral block or epidural anesthesia. Its use for many indications has been reported in the literature for pediatric patients. We would like to share our experiences in a 2.5-month infant scheduled for thoracotomy for a giant congenital cyst. Single shot erector spinae plane block was done at T4 level before the start of the surgery for both surgical and postoperative analgesia. No complication was seen during both surgery and follow up period. Erector spinae plane block with the combination of paracetamol was adequate for pain relief.


Resumo O bloqueio do plano do músculo eretor da espinha tem ganhado popularidade, tanto pela facilidade de aplicação quanto pelo efeito comparável em analgesia pós-operatória com técnicas regionais centrais, como o bloqueio paravertebral ou a anestesia peridural. Seu uso tem sido relatado na literatura para muitas indicações em pacientes pediátricos. Gostaríamos de compartilhar nossas experiências no caso de um bebê de 2,5 meses de idade programado para toracotomia para excisão de um cisto congênito gigante. O bloqueio do plano do eretor da espinha dorsal com injeção única foi realizado no nível de T4 antes do início da cirurgia para analgesia cirúrgica e pós-operatória. Nenhuma complicação foi observada durante a cirurgia e o período de acompanhamento. O bloqueio do plano do eretor da espinha com a combinação de paracetamol foi adequado para o alívio da dor.


Subject(s)
Humans , Infant, Newborn , Pain, Postoperative/prevention & control , Thoracotomy/methods , Nerve Block/methods , Follow-Up Studies , Analgesics, Non-Narcotic/administration & dosage , Cysts/surgery , Cysts/congenital , Acetaminophen/administration & dosage
5.
Rev. bras. anestesiol ; 69(4): 350-357, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041999

ABSTRACT

Abstract Objectives The administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2 mg.kg-1) administered 30 min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5 mg.kg-1) and saline placebo. Methods One hundred children aged (7-12) years were randomly allocated in four groups (n = 25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5 mg.kg-1 (Group K-IV), Nebulized Ketamine 1 mg.kg-1 (Group K-N1) or 2 mg.kg-1 (Group K-N2). The primary endpoint was the total consumption of rescue analgesics in the first 24 h postoperative. Results The mean time to first request for rescue analgesics was prolonged in K-N1 (400.9 ± 60.5 min, 95% CI 375.9-425.87) and K-N2 (455.5 ± 44.6 min, 95% CI 437.1-473.9) groups compared with Group K-IV (318.5 ± 86.1 min, 95% CI 282.9-354.1) and Group C (68.3 ± 21.9 min, 95% CI 59.5-77.1; p < 0.001), with a significant difference between K-N1 and K-N2 Groups (p < 0.001). The total consumption of IV paracetamol in the first 24 h postoperative was reduced in Group K-IV (672.6 ± 272.8 mg, 95% CI 559.9-785.2), Group K-N1 (715.6 ± 103.2 mg, 95% CI 590.4-840.8) and Group K-N2 (696.6 ± 133.3 mg, 95% CI 558.8-834.4) compared with Control Group (1153.8 ± 312.4 mg, 95% CI 1024.8-1282.8; p < 0.001). With no difference between intravenous and Nebulized Ketamine Groups (p = 0.312). Patients in intravenous and Nebulized Ketamine Groups showed lower postoperative VRS scores compared with Group C (p < 0.001), no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects. Conclusion Preemptive nebulized ketamine was effective for post-tonsillectomy pain relief. It can be considered as an effective alternative route to IV ketamine.


Resumo Objetivos A administração de cetamina por via inalatória através de nebulizador é relativamente nova e os estudos sobre este assunto são escassos. Nosso objetivo foi investigar a eficácia analgésica da cetamina nebulizada (1 e 2 mg.kg-1) administrada 30 minutos antes da anestesia geral em crianças submetidas à amigdalectomia eletiva, em comparação com cetamina intravenosa (0,5 mg.kg-1) e placebo (soro fisiológico). Métodos Cem crianças entre 7-12 anos foram randomicamente alocadas em quatro grupos (n = 25) e receberam: soro fisiológico para controle (Grupo C); 0,5 mg.kg-1 de cetamina intravenosa (Grupo C-IV); 1 mg.kg-1 de cetamina nebulizada (Grupo C-N1); 2 mg.kg-1 de cetamina nebulizada (Grupo C-N2). O desfecho primário foi o consumo total de analgésicos de resgate nas primeiras 24 horas de pós-operatório. Resultados O tempo médio para a primeira solicitação de analgésicos de resgate foi prolongado nos grupos C-N1 (400,9 ± 60,5 min, IC 95% 375,9-425,87) e C-N2 (455,5 ± 44,6 min, IC 95% 437,1-473,9) em comparação com o Grupo C-IV (318,5 ± 86,1 min, IC 95% 282,9-354,1) e o Grupo C (68,3 ± 21,9 min, IC 95% 59,5-77,1; p < 0,001), com uma diferença significativa entre os grupos C-N1 e C-N2 (p < 0,001). O consumo total de paracetamol IV nas primeiras 24 horas de pós-operatório foi reduzido no Grupo C-IV (672,6 ± 272,8 mg, IC 95% 559,9-785,2), Grupo C-N1 (715,6 ± 103,2 mg, IC 95% 590,4-840,8) e Grupo C-N2 (696,6 ± 133,3 mg, IC 95% 558,8-834,4) em comparação com o Grupo C (1153,8 ± 312,4 mg, IC 95% 1024,8-1282,8; p < 0,001). Não houve diferença entre os grupos de cetamina intravenosa e nebulizada (p = 0,312). Os pacientes dos grupos de cetamina intravenosa e nebulizada apresentaram escores VRS pós-operatórios menores, em comparação com o Grupo C (p < 0,001), sem diferenças entre os grupos C-IV, C-N1 ou C-N2 e sem efeitos adversos significativos. Conclusão A administração preventiva de cetamina nebulizada foi eficaz no alívio da dor pós-amigdalectomia. Cetamina nebulizada pode ser considerada como uma via alternativa eficaz à cetamina IV.


Subject(s)
Humans , Male , Female , Child , Pain, Postoperative/prevention & control , Tonsillectomy/methods , Analgesics/administration & dosage , Ketamine/administration & dosage , Administration, Inhalation , Nebulizers and Vaporizers , Double-Blind Method , Administration, Intravenous , Anesthesia, General/methods , Acetaminophen/administration & dosage
6.
Int. j. odontostomatol. (Print) ; 13(2): 184-188, jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1002303

ABSTRACT

RESUMEN: El objetivo de este trabajo fue determinar la efectividad analgésica de paracetamol post-cirugía mucogingival. El estudio, prospectivo, longitudinal, comparativo y experimental, se desarrolló en la Clínica Odontológica de la Universidad Privada Antenor Orrego (Trujillo, Perú) con los pacientes de la asignatura Periodoncia II. Se incluyeron 39 pacientes, quienes fueron distribuidos de manera aleatoria en 2 grupos de 19 y 20 cada uno, según los criterios establecidos. La medicación se inició 20 minutos después de concluida la cirugía, y se mantuvo por 24 horas. Para determinar la efectividad analgésica se usó la escala visual analógica (0-100 mm) y se recogió la información que fue procesada, utilizando la prueba de U Mann-Whitney con un nivel de significancia del 5 %. No existe diferencia en cuanto a la efectividad analgésica post-cirugías mucogingivales entre paracetamol y el control a las 2 horas (p=0.415), 8 horas (p=0.279) y 24 horas (p=0.736). Paracetamol es efectivo como analgésico post-cirugía mucogingival.


ABSTRACT: The objective of this study was to determine the analgesic effectiveness of paracetamol after mucogingival surgery. This prospective, longitudinal, comparative and experimental study was developed in the Stomatology Clinic of the Universidad Privada Antenor Orrego (Trujillo, Perú) with the patients of the Periodontics II subject. We included 39 patients, who were randomly distributed into 2 groups of 19 and 20 each, according to the established criteria. The medication was started 20 minutes after the surgery was completed, and was maintained for 24 hours. To determine the analgesic effectiveness, the analogue visual scale (0-100 mm) was used and the information that was processed was collected, using the U Mann-Whitney test with a level of significance of 5 %. There is no difference in terms of analgesic effectiveness post-mucogingival surgery between paracetamol and control at 2 hours (p = 0.415), 8 hours (p = 0.279) and 24 hours (p = 0.736). Paracetamol is effective as a mucogingival post-surgery analgesic.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Analgesics, Non-Narcotic/administration & dosage , Gingival Recession/surgery , Acetaminophen/administration & dosage , Peru , Effectiveness , Gingiva
7.
Rev. bras. anestesiol ; 69(2): 131-136, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003408

ABSTRACT

Abstract Background: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. Methods: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000 mg acetaminophen (propacetamol) or 2 mcg.kg-1 fentanyl intravenously, 15 min before the end of surgery. The postoperative pain was evaluated every 6 h for 24 h using the Visual Analog Scale. Total morphine dose taken in 24 h and hemodynamic status were evaluated. Results: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24 h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18 h after surgery (p < 0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. Conclusions: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).


Resumo Justificativa: A dor pós-operatória é a complicação mais comum no período pós-operatório. Este estudo foi realizado para avaliar o efeito de acetaminofeno versus fentanil no alívio da dor pós-operatória em pacientes submetidos a cirurgias urológicas. Métodos: Este ensaio clínico foi realizado com pacientes cujas idades variou entre 18 e 65 anos. Os pacientes foram randomicamente designados para receber 2.000 mg de acetaminofeno (propacetamol) ou 2 mcg.kg-1 de fentanil por via intravenosa 15 min antes do final da cirurgia. A dor pós-operatória foi avaliada a cada 6 horas por 24 horas, utilizando a escala visual analógica. A dose total de morfina administrada em 24 horas e o estado hemodinâmico foram avaliados. Resultados: Oitenta pacientes foram incluídos no estudo. O escore médio de dor em 6, 12, 18 e 24 horas após a cirurgia foi menor no grupo acetaminofeno que no grupo fentanil, mas a diferença não foi estatisticamente significativa, exceto em 12 e 18 horas após a cirurgia (p < 0,05). A quantidade de morfina administrada foi maior no grupo fentanil que no grupo acetaminofeno, mas a diferença não foi estatisticamente significativa. O estado hemodinâmico, incluindo pressão arterial sistólica e diastólica e frequência cardíaca, foi quase o mesmo nos dois grupos, mas a média de SpO2 foi significativamente maior no grupo acetaminofeno que no grupo fentanil. Conclusões: Este estudo indicou que acetaminofeno intravenoso é tão eficaz quanto fentanil intravenoso no alívio da dor após cirurgias urológicas (litotripsia transuretral).


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/drug therapy , Lithotripsy/methods , Fentanyl/administration & dosage , Analgesics, Opioid/administration & dosage , Acetaminophen/administration & dosage , Time Factors , Pain Measurement , Single-Blind Method , Analgesics, Non-Narcotic/administration & dosage , Administration, Intravenous , Middle Aged
8.
Mem. Inst. Oswaldo Cruz ; 111(12): 757-764, Dec. 2016. graf
Article in English | LILACS | ID: biblio-829258

ABSTRACT

We evaluated the effects of a non-hepatotropic parasite infection (Taenia crassiceps) on the outcome of acetaminophen-induced acute liver failure in mice. Uninfected and T. crassiceps infected mice orally received either 300 mg/kg acetaminophen or water as vehicle (n = 5 per group). Survival analysis, hepatocyte necrosis, alanine aminotransferase (ALT) levels, CYP2E1 protein, interleukin (IL-) 5, and IL-6 were assessed for all groups. All infected mice died within 16 h after exposure to acetaminophen (Tc+APAP group), whereas only one-third of uninfected animals exposed to acetaminophen (APAP group) died. Uninfected (Control group) and infected (Tc group) mice that received the vehicle showed no liver damage. Tc+APAP mice exhibited massive liver necrosis characterised by marked balloning degeneration of hepatocytes and higher serum ALT compared to Control, Tc, and APAP animals. Liver tissue from Tc+APAP mice also displayed increased expression of CYP2E1 protein and higher mRNA and protein levels of IL-5 and IL-6 compared to the other groups. These findings suggest that non-hepatotropic parasite infections may increase mortality following acute liver failure by promoting hepatocyte necrosis via IL-5 and IL-6-dependent CYP2E1 overproduction. This study identifies new potential risk factors associated with severe acute liver failure in patients.


Subject(s)
Animals , Female , Acetaminophen , Analgesics, Non-Narcotic , Liver Failure, Acute , Taeniasis/parasitology , Acetaminophen/administration & dosage , Alanine Transaminase/blood , Analgesics, Non-Narcotic/administration & dosage , Biomarkers/blood , Cytochrome P-450 CYP2E1/biosynthesis , Cytochrome P-450 CYP2E1/blood , Disease Models, Animal , Hepatocytes/parasitology , Hepatocytes/pathology , Interleukin-5/blood , Interleukin-6/blood , Liver Failure, Acute/chemically induced , Liver Failure, Acute/mortality , Liver Failure, Acute/parasitology , Liver Failure, Acute/pathology , Mice , Mice, Inbred BALB C , Mice, Inbred C57BL , Taeniasis/pathology
9.
Bogotá; IETS; mayo 2016. tab, ilus, graf.
Monography in Spanish | LILACS, BRISA | ID: biblio-846626

ABSTRACT

Problema de investigación: Analizar los costos y la efectividad del condroitín más glucosamina, cetaminofén, celecoxib y AINEs para pacientes mayores de 50 años con osteoartrosis sintomática (primaria y secundaria) en Colombia. Tipo de evaluación económica: Análisis de costo-efectividad. Población objetivo: Personas mayores de 50 años de edad (hombres y mujeres) con osteoartrosis sintomática (primaria y secundaria) en Colombia. intervención y comparadores: I: condroitín más glucosamina, C: acetaminofén, celecoxib y AINEs. Horizonte temporal: Se empleó como horizonte temporal la expectativa de vida promedio de los pacientes con OA mayores a 50 años en Colombia. Puesto que la expectativa de vida promedio en Colombia es de 74 años para la población general (hombres y mujeres), se utilizó un horizonte de tiempo del modelo de 24 años con base en las estadísticas vitales del DANE. Perspectiva: La del Sistema General de Seguridad Social en Salud (SGSSS). Tasa de descuento: Tanto los costos como los beneficios son descontados al valor presente, utilizando una tasa de descuento del 5%. Estructura del modelo: Se estructuró un modelo Markov reflejando el curso clínico de la enfermedad con ciclos anuales. Fuentes de datos de efectividad y seguridad: Revisión de ensayos clínicos, meta-análisis y literatura clínica para la obtención de los parámetros para la modelación dinámica de la osteoartrosis sintomática en Colombia, y para la determinación de la efectividad de las alternativas de comparación. Desenlaces y valoración: Años de vida ganados. Costos incluidos: Costo de medicamentos para el tratamiento, Costo relacionados al manejo de eventos adversos, Costo de procedimientos e insumos. Fuentes de datos de costos: SISMED, Manual tarifario ISS 2001, Guía de práctica clínica para el síndrome coronario agudo. Resultados del caso base: El costo esperado por año de vida ajustado por calidad ganado de condroitín más glucosamina fue de $ 4.218.759,75 por persona, de $5.694.205,75 con AINEs, de $3.312.855,30 con celecoxib y de $2.616.444,62 con acetaminofén. El acetaminofén resultó en el mayor número de años de vida ajustados por calidad ganados (6,917). Estos resultados implican que el acetaminofén sería costo-efectivo y que es una estrategia dominante respecto a sus comparadores. Análisis de sensibilidad: Los análisis de sensibilidad llevados a cabo sobre la tasa de descuento y las variables con mayor impacto sobre la RICE evidencian que ninguno de estos parámetros \r\nmodifica los resultados encontrados. La dominancia del acetaminofén es consistente ante los escenarios \r\nplanteados. Adicionalmente, con el umbral establecido de mínimo un PIB y máximo tres PIB per cápita, se observa que el acetaminofén tiene una probabilidad de cerca de 100% de ser más costo-efectivo que los otros medicamentos incluidos en este estudio. Conclusiones: En Colombia, desde la perspectiva del sistema general de seguridad social en salud, la terapia combinada de condroitín más glucosamina para el tratamiento sintomático de pacientes mayores de 50 años de edad con osteoartrosis de rodilla o mano, es una tecnología dominada, indicando que no sería una alternativa costo-efectiva para el país. Entre las opciones evaluadas, el acetaminofén es la tecnología con mejor costo-efectividad, pues se asocia con costos más bajos y un incremento en años de vida ajustados por calidad.(AU)


Subject(s)
Humans , Adult , Arthritis, Rheumatoid/therapy , Hand , Osteoarthritis, Knee/therapy , Acetaminophen/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Biomedical Technology , Celecoxib/administration & dosage , Chondroitin/administration & dosage , Colombia , Cost-Benefit Analysis/economics , Glucosamine/administration & dosage , Health Evaluation/economics
10.
Bogotá; IETS; mayo 2016. tab.
Monography in Spanish | LILACS, BRISA | ID: biblio-846733

ABSTRACT

Tecnologías evaluadas: Nuevas: condroitín más glucosamina y AINES (celecoxib y meloxicam) Actuales: acetaminofén y AINES (ibuprofeno, naproxeno y diclofenaco). Población: Pacientes mayores de 50 años con osteoartrosis sintomática (primaria y secundaria) en Colombia. Perspectiva: La perspectiva del presente AIP corresponde al tercero pagador, que en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costos por mg de los medicamentos analizados y costos de eventos adversos relacionados al uso de los medicamentos. Fuente de costos: Los precios de cada tecnología considerada fueron calculados con la base de datos SISMED 2014 y los precios relacionados con los eventos adversos fueron extraídos de la guía de práctica clínica para el síndrome coronario agudo. Escenarios: En el escenario 1 se considera que la adopción de las nuevas tecnologías no llevaría a ningún cambio en el mercado, debido a la fuerte preferencia de los médicos para el uso de las tecnologías actuales. En el escenario 2 se asume que la adopción de las nuevas tecnologías resultará en una disminución en el costo de dichas tecnologías, implicando un pequeño aumento en su participación de mercado. Resultados: Se requeriría una inversión de $324.848.741.965,21 para el año 1, $408.850.393.031,63 para el año 2 y $516.306.727.474,66 para el año 3 para la adopción de las terapias condroitín más glucosamina, meloxicam y celecoxib en el POS para el tratamiento de pacientes con osteoartrosis sintomática (primaria y secundaria) de la rodilla en Colombia, bajo el presupuesto que la inclusión de los nuevos medicamentos no llevaría a un cambio en la participación del mercado. Asumiendo que el precio de las nuevas terapias disminuyera y por tal razón la participación del mercado de dichas terapias aumentaría,\tel impacto presupuestal aumentaría a \r\n$33.328.838.947,92 en el año 1, de $44.301.385.949,68 en el año 2 y de $59.253.690.046,56 en el año 3.(AU)


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Acetaminophen/administration & dosage , Celecoxib/administration & dosage , Chondroitin/administration & dosage , Glucosamine/administration & dosage , Osteoarthritis, Knee/therapy , Biomedical Technology , Colombia , Costs and Cost Analysis/methods , Drug Therapy, Combination , Health Evaluation/economics , Reproducibility of Results
11.
Int. braz. j. urol ; 41(4): 669-675, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-763070

ABSTRACT

ABSTRACTPurpose:We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.Materials and Methods:Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5g paracetamol was given intravenoulsy in the 24 postoperative period. In group 3, 8mg lornoxicam i.v. was given 30 minutes before extubation and 8mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated.Results:Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024).Conclusions:Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Adrenal Glands/surgery , Kidney/surgery , Laparoscopy/methods , Pain Management/methods , Pain, Postoperative/drug therapy , Administration, Intravenous , Acetaminophen/administration & dosage , Acetaminophen/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Anesthesia, Local/methods , Anesthetics, Local/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Bupivacaine/analogs & derivatives , Bupivacaine/therapeutic use , Pain Measurement/methods , Piroxicam/administration & dosage , Piroxicam/analogs & derivatives , Piroxicam/therapeutic use , Visual Analog Scale
12.
Bogotá; IETS; dic. 2014. tab, ilus.
Monography in Spanish | LILACS, BRISA | ID: biblio-847020

ABSTRACT

Introducción: la OA es la forma más común de enfermedad de las articulaciones y la principal causa de discapacidad de las personas de la tercera edad. Su alta prevalencia en una población que usualmente tiene comorbilidades asociadas que requieren otros medicamentos obliga a buscar otras alternativas terapéuticas con mínimos eventos adversos y pocas interacciones medicamentosas. Condroitín es un medicamento regenerador de cartílago que se ha usado en el manejo de estos pacientes. Esta evaluación tecnológica se desarrolló en el marco de la actualización integral del Plan Obligatorio de Salud para el año 2015. Objetivo: evaluar la efectividad y seguridad del uso de condroitín comparado con acetaminofén, antiinflamatorios no esteroideos, glucosamina, condroitín más glucosamina, diacereina, ácido hialurónico ó fitoterapéuticos, en pacientes osteoartrosis. Metodología: la evaluación fue realizada de acuerdo con un protocolo definido a priori por el grupo desarrollador. Se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects y LILACS, con restricción al idioma inglés y español y limitada a revisiones sistemáticas publicadas en los últimos cinco años y ensayos clínicos sin restricción de tiempo. Las búsquedas electrónicas fueron hechas entre octubre y diciembre de 2014 y se complementaron mediante búsqueda manual en bola de nieve y una consulta con expertos temáticos. La tamización de referencias se realizó por un revisor. La selección de estudios fue realizada mediante la revisión en texto completo de las referencias preseleccionadas, verificando los criterios de elegibilidad. La calidad de los estudios fue valorada con la herramienta de riesgo de sesgo de la Colaboración Cochrane. Las características de los estudios fueron extraídas a partir de las publicaciones originales. Se realizó una síntesis narrativa de las estimaciones del efecto para las comparaciones y desenlaces de interés a partir de los estudios de mejor calidad. Se estimaron medidas combinadas del efecto a través de un metanálisis con el método de Mantel-Haenszel y un modelo de efectos aleatorios, empleando el programa RevMan 5.2. Resultados: condroitín es semejante a los AINEs, glucosamina y glucosamina más condroitín en mejorar los desenlaces como dolor y funcionalidad a los seis meses y el desenlace radiológico proporción de pacientes con progresión de la disminución de la amplitud del espacio articular. Los AINEs, glucosamina y glucosamina más condroitín son superiores en los desenlaces rigidez a los seis meses según puntaje en la escala WOMAC (RR=5.97 IC 95% 1.45, 10.49). Condroitín sulfato es no inferior a pascledina en estos mismos desenlaces. Además en relación a seguridad no se reportó ningún evento adverso serio a ninguno de los medicamentos evaluados, incluyendo condroitín. La adherencia al tratamiento fue muy buena tanto a los seis meses como a los 24 meses y la percepción de tolerancia fue superior al 94%. Conclusiones: condroitín es semejante en efectividad y seguridad a glucosamina, glucosamina más condroitín, AINEs y pascledina en pacientes con osteoartrosis.(AU)


Subject(s)
Humans , Osteoarthritis/drug therapy , Acetaminophen/administration & dosage , Anthraquinones/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Biomedical Technology , Chondroitin/administration & dosage , Colombia , Cost-Benefit Analysis , Drug Therapy, Combination , Glucosamine/administration & dosage , Hyaluronic Acid/administration & dosage , Phytotherapeutic Drugs
13.
J. appl. oral sci ; 22(3): 204-208, May-Jun/2014. graf
Article in English | LILACS, BBO | ID: lil-711716

ABSTRACT

Objective: The main objective of this study was to evaluate changes in prescribing pattern of Dentistry students throughout academic course. Methods: A case of non-complicated dental extraction was presented to all students that had completed their pharmacology coursework (from 4th semester to the last semester). The students were grouped according to year of study and were asked to prescribe paracetamol for pain control. A maximal score of 5 points was calculated from three subscores for identification of professional and patient (1.0 point), drug concentration, dosage, and quantity (1.5 points); and drug information, instructions, and warnings (2.5 points). The data were expressed as medians [95% confidence intervals (CIs)] and were compared using the Kruskal-Wallis test followed by Dunn's post hoc test. A p<0.05 value was considered statistically significant. A total of 92 students participated the study (2nd year, N=12; 3rd year, N=32; 4th year, N=28; 5th year, N=20). Results: The quality of prescription showed improvement between 2nd-year students [2.0 (1.5-2.5)] and 4th-year students [3.2 (2.9-3.5), p<0.05]; 4th- and 5th-year students [3.6 (3.5-3.8)] performed similarly. Lack of information about pharmacological treatment, side effects, and administration route were the major deficiencies observed. Conclusion: Although Dentistry students present a general improvement in their prescribing performance, deficiencies remain even in advanced students. The data suggest that the teaching of good prescription practices should extend throughout the later phases of preprofessional dental education. .


Subject(s)
Humans , Adult , Young Adult , Drug Prescriptions/standards , Education, Dental/standards , Students, Dental , Acetaminophen/administration & dosage , Analgesics, Non-Narcotic/administration & dosage , Brazil , Clinical Competence , Quality Control , Statistics, Nonparametric , Time Factors
14.
Rev. paul. pediatr ; 32(1): 144-148, Jan-Mar/2014. tab
Article in English | LILACS | ID: lil-704747

ABSTRACT

Objective: Severe hepatotoxicity caused by paracetamol is rare in neonates. We report a case of paracetamol-induced acute liver failure in a term neonate. Case description: A 26-day-old boy was admitted with intestinal bleeding, shock signs, slight liver enlargement, coagulopathy, metabolic acidosis (pH=7.21; bicarbonate: 7.1mEq/L), hypoglycemia (18mg/dL), increased serum aminotransferase activity (AST=4,039IU/L; ALT=1,087IU/L) and hyperbilirubinemia (total: 9.57mg/dL; direct: 6.18mg/dL) after receiving oral paracetamol (10mg/kg/dose every 4 hours) for three consecutive days (total dose around 180mg/kg; serum concentration 36-48 hours after the last dose of 77µg/ mL). Apart from supportive measures, the patient was successfully treated with intravenous N-acetylcysteine infusion during 11 consecutive days, and was discharged on day 34. The follow-up revealed full recovery of clinical and of laboratory findings of hepatic function. Comments: The paracetamol pharmacokinetics and pharmacodynamics in neonates and infants differ substantially from those in older children and adults. Despite the reduced rates of metabolism by the P-450 CYP2E1 enzyme system and the increased ability to synthesize glutathione - which provides greater resistance after overdoses -, it is possible to produce hepatotoxic metabolites (N-acetyl-p-benzoquinone) that cause hepatocellular damage, if glutathione sources are depleted. Paracetamol clearance is reduced and the half-life of elimination is prolonged. Therefore, a particular dosing regimen should be followed due to the toxicity risk of cumulative doses. This report highlights the risk for severe hepatotoxicity in neonates after paracetamol multiple doses for more than two to three days. .


Objetivo: La hepatotoxicidad grave inducida por el paracetamol es muy rara en neonatos. Se relata el caso de un neonato a término que desarrolló falencia hepática aguda después del uso de paracetamol. Descripción del caso: Niño, 26 días, admitido con sangrado intestinal, señales de choque, discreta hepatomegalia, coagulopatía, acidosis metabólica (pH=7,21; bicarbonato: 7,1mEq/L), hipoglucemia (18mg/dL), aumento de las aminotransferasas séricas (AST=4.039UI/L; ALT=1.087UI/L) e hiperbilirrubinemia (total: 9,75mg/dL; directa: 6,18mg/dL), después del uso de paracetamol por vía oral (10mg/kg/dosis a cada cuatro horas) durante tres días consecutivos (dosis alrededor de 180mg/kg; nivel sérico de 36-48 horas después de la última dosis de 77µg/mL). Además de las medidas de soporte, el paciente fue tratado con N-acetilcisteína (infusión intravenosa continua por 11 días consecutivos), recibiendo alta después de 34 días de internación. El seguimiento mostró recuperación clínica y de los parámetros laboratoriales de la función hepática. Comentarios : La farmacocinética y la farmacodinámica del paracetamol en neonatos y lactantes jóvenes (menores de un año) difieren substancialmente de niños más grandes y adultos. A pesar de que las tasas de metabolismo del sistema enzimático P-450 CYP2E1 están reducidas y la capacidad de generar glutatión, aumentada - confiriendo más protección después de superdosis -, existe la posibilidad de producción de metabólitos hepatotóxicos (N-acetil-pbenzoquinoneimina) que determinan lisis celular, caso se agoten las reservas de glutatión. La depuración es reducida y la media vida de la eliminación, alargada, recomendándose posología distinta por el riesgo de toxicidad ...


Objetivo: A hepatoxicidade grave induzida pelo paracetamol é muito rara em neonatos. Relata-se o caso de um neonato de termo que desenvolveu falência hepática aguda após o uso de paracetamol. Descrição do caso: Menino, 26 dias, admitido com sangramento intestinal, sinais de choque, discreta hepatomegalia, coagulopatia, acidose metabólica (pH=7,21; bicarbonato: 7,1mEq/L), hipoglicemia (18mg/dL), aumento das aminotransferases séricas (AST=4.039UI/L; ALT=1.087UI/L) e hiperbilirrubinemia (total: 9,57mg/dL; direta: 6,18mg/dL), após uso de paracetamol via oral (10mg/kg/dose a cada quatro horas) por três dias consecutivos (dose total ao redor de 180mg/kg; nível sérico de 36-48 horas após a última dose de 77µg/mL). Além das medidas de suporte, o paciente foi tratado com N-acetilcisteína (infusão intravenosa contínua por 11 dias consecutivos), recebendo alta após 34 dias de internação. O seguimento mostrou recuperação clínica e dos parâmetros laboratoriais da função hepática. Comentários: A farmacocinética e a farmacodinâmica do paracetamol em neonatos e lactentes jovens (menores de um ano) diferem substancialmente de crianças maiores e adultos. Apesar de as taxas de metabolismo do sistema enzimático P-450 CYP2E1 estarem diminuídas e a capacidade de gerar glutationa, aumentadas - conferindo maior proteção após superdosagens -, existe a possibilidade de produção de metabólitos hepatotóxicos (N-acetil-p-benzoquinoneimina) que determinam lise celular, caso se esgotem as reservas de glutationa. A depuração é diminuída e a meia-vida de eliminação é prolongada, recomendando-se posologia distinta pelo risco de toxicidade de doses cumulativas. O presente relato destaca o risco de hepatotoxicidade grave ...


Subject(s)
Humans , Infant, Newborn , Male , Acetaminophen/adverse effects , Antipyretics/adverse effects , Liver Failure, Acute/chemically induced , Acetaminophen/administration & dosage , Antipyretics/administration & dosage
15.
SJA-Saudi Journal of Anaesthesia. 2014; 8 (1): 45-50
in English | IMEMR | ID: emr-138057

ABSTRACT

Circumcision in children is a painful procedure. We aim compare the intraoperative and postoperative efficacy of three different surgical procedures of the ring block using levobupivacaine 0.25% combined with rectal paracetamol as opposed to rectal paracetamol alone. The study included 106 boys scheduled to undergo circumcision. The patients were randomly assigned within two groups to receive either ring block with levobupivacaine 0.25% and rectal paracetamol 30 mg/kg, or rectal paracetamol 30 mg/kg alone. The following surgical procedures were performed: sutureless proctoplasty, preputial plasty, and conventional circumcision. The efficacy of intraoperative analgesia was estimated on the basis of increases in heart rate and mean arterial pressure. Postoperatively, children were assessed for pain, pain-free [PF] period, and the total doses of analgesics administered during hospitalization, on the day after discharge, and on the first and second postoperative days. All children remained stable during anesthesia. Postoperatively, the mean pain score did not show statistical differences between the groups. Children who received combined analgesia had a longer PF period [P < 0.001]. However, the total doses of paracetamol administered during the observational period showed no differences. Children undergoing sutureless prepuceplasty received lower doses of paracetamol postoperatively [P < 0.001]. Subcutaneous ring block either with levobupivacaine 0.25% plus rectal paracetamol or rectal paracetamol alone provides adequate intraoperative and postoperative analgesia in circumcised children. However, combined analgesia allows a longer PF period. The need for less analgesic administration in children undergoing sutureless prepuceplasty could mean that the circumcision techniques might be a mitigating factor in terms of pain


Subject(s)
Humans , Male , Bupivacaine , Anesthetics, Local , Child , Prospective Studies , Acetaminophen , Acetaminophen/administration & dosage , Bupivacaine/administration & dosage , Drug Therapy, Combination
17.
Int. braz. j. urol ; 39(4): 551-557, Jul-Aug/2013. tab, graf
Article in English | LILACS | ID: lil-687295

ABSTRACT

Purpose To evaluate the postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol administration following circumcision. Materials and Methods In this prospective randomized study a total of 159 patients underwent circumcision under general anesthesia at urology clinic of Ufuk University Faculty of Medicine and Sorgun State Hospital between May 2012 and September 2012. The patients were randomized to three groups to receive penile block (Group 1), caudal block (Group 2) and intravenous paracetamol administration (group 3). Pain measurement of the patients was done via CHEOPS scoring system at 30,60,120 and 180 minutes postoperatively and compared. Statistical tests were performed with a conventional statistics program and statistical significance was set at a p value of < 0.05. Results The mean age of the patients was 5.7 years. Patients in group 1 had significantly lower pain score at 30 minutes compared to other two groups. At 60 minutes groups 1 and 2 had significantly lower score compared to group 3. At 120 and 180 minutes no difference between the groups was observed. No significant major complications were observed in all 3 groups. Conclusion Penile block and caudal block provide similar pain scores and painless postoperative periods after circumcision under general anesthesia. Intravenous paracetamol is insufficient at the early postoperative period. The three procedures were shown to be safe for analgesia following circumcision. .


Subject(s)
Child, Preschool , Humans , Male , Acetaminophen/administration & dosage , Analgesics, Non-Narcotic/administration & dosage , Anesthesia, Caudal/methods , Circumcision, Male , Nerve Block/methods , Pain, Postoperative/drug therapy , Administration, Intravenous , Pain Measurement , Prospective Studies , Time Factors , Treatment Outcome
18.
J. pediatr. (Rio J.) ; 89(1): 25-32, jan.-fev. 2013. tab
Article in Portuguese | LILACS | ID: lil-668822

ABSTRACT

OBJETIVO: As evidências sobre a eficácia do uso alternado de antitérmicos no manejo da febre são escassas e apontam diferenças clinicamente desprezíveis. O objetivo do estudo foi descrever condutas terapêuticas e uso alternado de antipiréticos em crianças, e avaliar fatores associados ao uso alternado. MÉTODOS: Estudo transversal com 692 crianças de zero a seis anos, residentes no Sul do Brasil. Por meio de amostragem por conglomerados, foram realizadas entrevistas domiciliares com os cuidadores, utilizando questionário estruturado. Foi realizada análise descritiva e avaliada a associação entre o uso alternado de antipiréticos e fatores sociodemográficos. Foram analisados 630 casos (91,0%), correspondendo às crianças com histórico de febre. RESULTADOS: Cerca de 73% dos cuidadores informaram que a primeira medida adotada no último episódio de febre foi administrar medicamentos. A média de temperatura considerada febre foi de 37,4 ºC, e febre alta, 38,7 ºC. A utilização de terapia alternada com antipiréticos foi relatada por 26,7% dos entrevistados, justificada pela ausência de resposta à monoterapia e indicação médica, na maioria dos casos. Os medicamentos mais utilizados foram dipirona e paracetamol. Crianças cujo principal cuidador era um dos pais, com melhores condições socioeconômicas e maior nível educacional, receberam mais medicamentos alternados. Cerca de 70% das doses utilizadas estavam abaixo da dose mínima recomendada para tratamento de febre. CONCLUSÕES: O uso de medicamentos para controlar a febre é uma prática comum, incluindo esquemas alternados de antipiréticos. A maioria dos cuidadores considera como febre temperaturas inferiores às preconizadas, e apontou não resposta à monoterapia e indicação médica como as principais razões para o uso alternado.


OBJECTIVE: The evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors. METHODS: This was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the children's caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever. RESULTS: Approximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4 ºC, and as high fever, 38.7 ºC. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever. CONCLUSIONS: The use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication.


Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Antipyretics/administration & dosage , Fever/drug therapy , Acetaminophen/administration & dosage , Cross-Sectional Studies , Drug Administration Schedule , Dipyrone/administration & dosage , Drug Therapy, Combination/methods , Fever/diagnosis , Socioeconomic Factors , Surveys and Questionnaires , Urban Population
19.
Braz. j. otorhinolaryngol. (Impr.) ; 79(1): 89-94, jan.-fev. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-667981

ABSTRACT

O manejo da dor pós-amigdelectomia pode ser feito com uma série de medicamentos. OBJETIVO: O presente estudo duplo-cego placebo controlado pretendeu avaliar a eficácia de paracetamol e dipirona administrados por via endovenosa na analgesia de pacientes pediátricos pós-amigdelectomia. MÉTODO: Cento e vinte crianças com idades entre três e seis anos submetidas à amigdelectomia com ou sem adenoidectomia e/ou entubação foram randomizadas para receber infusões de paracetamol (15 mg/kg), dipirona (15 mg/kg) ou placebo (0,9% NaCl) durante a cirurgia. As avaliações foram executadas com 0,25, 0,50, 1, 2, 4, 6h de pós-operatório. Petidina 0,25 mg/kg foi utilizada como analgésico de resgate. Dose acumulada de petidina foi o desfecho primário. Medições de intensidade da dor, alívio da dor, nível de sedação, náusea e vômitos, hemorragia no pós-operatório e outros efeitos adversos foram anotados. RESULTADOS: Nenhuma diferença significativa foi encontrada na dose acumulada de petidina entre os grupos paracetamol e dipirona. A dose acumulada de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação ao grupo placebo. Nenhuma diferença significativa foi observada entre os escores de dor no pós-operatório dos grupos durante o estudo. CONCLUSÃO: Paracetamol endovenoso tem eficácia analgésica semelhante à da dipirona endovenosa; ambos ajudam a reduzir a necessidade de opioides na analgesia pós-operatória de pacientes pediátricos submetidos à amigdelectomia em hospital-dia.


Tonsillectomy is associated with severe postoperative pain for which, several drugs are employed for management. OBJECTIVE: In this double-blind, placebo-controlled study we aimed to evaluate the efficacy of intravenous paracetamol and dipyrone when used for post-tonsillectomy analgesia in children. METHOD: 120 children aged 3-6 yr, undergoing tonsillectomy with or without adenoidectomy and/or ventilation tube insertion were randomized to receive intraoperative infusions of paracetamol (15 mg/kg), dipyrone (15 mg/kg) or placebo (0.9% NaCl). Evaluation was carried out at 0.25, 0.50, 1, 2, 4, 6h postoperatively. Pethidine 0.25 mg/kg was utilized as rescue analgesic. Cumulative pethidine requirement was the primary outcome. Pain intensity measurement, pain relief, sedation level, nausea and vomiting, postoperative bleeding and any other adverse effects were noted. RESULTS: No significant difference was found in pethidine requirement between paracetamol and dipyrone groups. Cumulative pethidine requirement was significantly less in paracetamol and dipyrone groups vs. placebo. No significant difference was observed between groups in postoperative pain intensity scores throughout the study. CONCLUSION: Intravenous paracetamol is found to have a similar analgesic efficacy as intravenous dipyrone and they both help to reduce the opioid requirement for postoperative analgesia in pediatric day-case tonsillectomy.


Subject(s)
Child , Child, Preschool , Female , Humans , Male , Acetaminophen/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Dipyrone/administration & dosage , Pain, Postoperative/drug therapy , Tonsillectomy/methods , Analgesics, Opioid/administration & dosage , Double-Blind Method , Meperidine/administration & dosage , Pain Measurement , Prospective Studies , Treatment Outcome
20.
Acta méd. (Porto Alegre) ; 34: [6], 20130.
Article in Portuguese | LILACS | ID: biblio-880510

ABSTRACT

A intoxicação por paracetamol está entre as principais causas de falência hepática no mundo, sendo importante o diagnóstico precoce para o estabelecimento do tratamento adequado e consequente diminuição da mortalidade.


The acetaminophen poisoning is among the leading causes of liver failure in the world, early diagnosis is important for the establishment of appropriate treatment and consequent reduction in mortality.


Subject(s)
Acetaminophen/administration & dosage , Acetaminophen/toxicity
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