Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 56
Filter
1.
Prensa méd. argent ; 108(3): 120-125, 20220000. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1373050

ABSTRACT

Introducción: El manejo inmediato del dolor postoperatorio es esencial para una comodidad y rehabilitación temprana del paciente Este estudio busca evaluar el efecto analgésico postoperatorio inmediato en cirugías de columna lumbosacra por vía posterior, como los efectos adversos con la administración de analgesia intratecal, usando Clonidina contra Morfina. Material y métodos: Es un estudio analítico de intervención, cuasi experimental, prospectivo, longitudinal, comparativo, doble ciego. Para comparar la eficacia de la analgesia intratecal post operatoria inmediata en cirugías de columna lumbosacra primarias por vía posterior y los efectos adversos. Los pacientes se distribuyeron en dos grupos previamente designados, a un grupo se le administro Clonidina 0.5 microgramos/kg/peso y a otro grupo Morfina 5 microgramos/Kg/Peso. intratecal, intraoperatorio. Resultados: Existió diferencia estadísticamente significativa con mejor manejo del dolor postoperatorio en las primeras horas y menor presencia de vómitos en el grupo de pacientes que se utilizó Clonidina intratecal. No existió diferencia estadísticamente significativa de ambas medicaciones intratecales en la valoración de otros efectos adversos. Discusión: El uso de la analgesia intratecal ha ido ganando relevancia en el tiempo y se fueron sumando estudios para ver la eficacia de diferentes medicamentos, diferentes dosis, menor presencia de efectos adversos. El estudio analiza estas variables buscando una mejor opción terapéutica. Tenemos a favor una muestra representativa a pesar de no ser aleatoria, estricto seguimiento, y análisis estadístico adecuado. Conclusión: La Clonidina intratecal es más efectiva para manejo del dolor post operatorio inmediato de cirugías de columna lumbosacra por vía posterior y con menor presencia de efectos adversos


Introduction: Immediate postoperative pain management is essential for the patient's greater comfort and early rehabilitation. Te goal of this study is to evaluate the immediate analgesic postoperative effect in posterior lumbosacral spine surgery, as well as the adverse effects of the administration of intrathecal analgesia, using Clonidine versus Morphine. Material and methods: An analytical, quasi-experimental, prospective, longitudinal, comparative, double-blinded intervention study was conducted to compare the efficacy of immediate postoperative intrathecal analgesia in primary posterior lumbosacral spine surgery, and the adverse effects. Te patients were divided into two previously designated groups. One group received Clonidine 0.5 microgramos/kg and the other group received Morphine 5 microgramos/kg. Intrathecal, intraoperative. Results: Tere was a statistically significant difference with better postoperative pain management in the first hours and less vomiting in the group of patients who received intrathecal Clonidine. Tere was no statistically significant difference between both intrathecal medications in the evaluation of other adverse effects. Discussion: Te use of intrathecal analgesia, has been on the rise over time and more studies have been conducted to see the efficacy of different drugs, different doses, with fewer adverse effects. Tis study to analyze these variables with a view to finding a better therapeutic option. Te advantage is having a representative if not random sample, strict follow-up, and appropriate statistical analysis Conclusion: Intrathecal Clonidine proved to be more effective in immediate postoperative pain management after posterior lumbosacral spine surgery and with fewer adverse effects


Subject(s)
Humans , Adult , Middle Aged , Aged , Pain, Postoperative/therapy , Pain Measurement , Analgesia, Epidural/methods , Double-Blind Method , Prospective Studies , Longitudinal Studies , Clonidine/administration & dosage , Aftercare , Non-Randomized Controlled Trials as Topic , Lumbosacral Region/surgery , Morphine/administration & dosage
2.
Rev. bras. anestesiol ; 69(3): 291-298, May-June 2019.
Article in English | LILACS | ID: biblio-1013420

ABSTRACT

Abstract The use of analgesia techniques for labor has become increasingly frequent, with neuraxial techniques being the most commonly used and most effective. Labor pain entails a number of physiological consequences that may be negative for the mother and fetus, and therefore must be treated. This literature review was performed through a search in the PubMed database, from July to November 2016, and included articles in English or Portuguese, published between 2011 and 2016 or anteriorly, if relevant to the topic. The techniques were divided into the following topics: induction (epidural, combined epidural-spinal, continuous spinal, and epidural with dural puncture) and maintenance of analgesia (continuous epidural infusion, patient-controlled epidural analgesia, and intermittent epidural bolus). Epidural analgesia does not alter the incidence of cesarean sections or fetal prognosis, and maternal request is a sufficient indication for its initiation. The combined technique has the advantage of a faster onset of analgesia; however, patients are subject to a higher incidence of pruritus resulting from the intrathecal administration of opioids. Patient-controlled analgesia seems to be an excellent technique, reducing the consumption of local anesthetics, the number of anesthesiologist interventions, and increasing maternal satisfaction.


Resumo O uso de técnicas de analgesia para o trabalho de parto tem se tornado cada vez mais frequente. As técnicas neuroaxiais são as mais comumente usadas e de maior eficácia. A dor do trabalho de parto traz uma série de consequências fisiológicas que podem ser negativas para a mãe e para o feto, e por isso deve ser tratada. Esta revisão de literatura foi feita na base de dados PubMed, de julho a novembro de 2016, e foram incluídos artigos em inglês ou portuguê publicados entre 2011 e 2016, ou mais antigos que fossem relevantes ao tema. As técnicas foram divididas nos tópicos: indução (peridural, raquiperidural combinada, raquianestesia contínua e peridural com punção dural) e manutenção da analgesia (infusão peridural contínua, analgesia peridural controlada pela paciente e bolus peridural intermitente). A analgesia peridural não altera a incidência de cesarianas nem o prognóstico fetal, e o desejo materno é indicação suficiente para seu início. A técnica combinada apresenta como vantagem um início mais rápido da analgesia, entretanto as pacientes estão sujeitas a maior incidência de prurido decorrente da administração intratecal de opioides. A analgesia controlada pela paciente parece ser uma excelente técnica, diminui o consumo de anestésicos locais e o número de intervenções do anestesiologista e aumenta a satisfação materna.


Subject(s)
Humans , Female , Pregnancy , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Labor Pain/drug therapy , Labor, Obstetric , Analgesia, Patient-Controlled/methods , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage
3.
Rev. cuba. anestesiol. reanim ; 17(2): 1-10, mayo.-ago. 2018. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-991023

ABSTRACT

Introducción: El dolor posoperatorio es un fenómeno observado con elevada frecuencia y constituye uno de los retos más importantes en el ámbito quirúrgico. Objetivo: Describir los resultados clínicos y hemodinámicos obtenidos con la utilización de anestesia peridural torácica alta como técnica analgésica durante el período posoperatorio en los pacientes intervenidos de tórax. Método: Se realizó un estudio descriptivo, longitudinal, prospectivo en el Hospital Abel Santamaría Cuadrado, entre enero de 2014 y enero de 2017. La muestra estuvo conformada por 37 pacientes que cumplieron con los criterios de inclusión y exclusión. Resultados: Predominaron los valores normales en los que no presentaron dolor posoperatorio, con 33 ± 5,23 y 33 ± 7,86 respectivamente. Se calculó una media de saturación de oxígeno de 99,48 por ciento y frecuencia respiratoria de 16 res/min. Se evidenció que 31 pacientes (83,78 por ciento) no presentaron complicaciones posoperatorias secundarias a la técnica analgésica. En la mayoría no fue necesaria la analgesia de rescate, elemento que representó el 89,19 por ciento. Resultó significativo que 32 pacientes (86,49 por ciento), manifestaron encontrarse satisfechos con el proceder y los resultados alcanzados. Conclusiones: La aplicación de la peridural con morfina para cirugía de tórax arrojó resultados muy efectivos como método analgésico con adecuada estabilidad, mínimas complicaciones requerimientos de rescate analgésico, lo que propició satisfacción por los pacientes(AU)


Introduction: Postoperative pain is a phenomenon that appears frequently and constitutes one of the most important challenges in the surgical field. Objective: To describe the clinical and hemodynamic results obtained with the use of high thoracic epidural as analgesic technique during the postoperative period in patients undergoing thoracic surgery. Method: A descriptive, longitudinal, prospective study was carried out in Abel Santamaría Cuadrado Hospital, during the period between January 2014 and January 2017. The sample consisted of 37 patients who met the inclusion and exclusion criteria. Results: In blood pressure and heart rate according to analgesic response, normal values prevailed in those without postoperative pain, with 33 ± 5.23 and 33 ± 7.86 respectively. A mean of oxygen saturation of 99.48 percent and respiratory rate of 16 res/min were calculated. It was evidenced that 31 patients (83.78 percent) did not present postoperative complications after the analgesic technique. In the majority, rescue analgesia was not necessary, an element that represented 89.19 percent. It was significant that 32 patients (86.49 percent) said they were satisfied with the procedure and the results achieved. Conclusions: The application of peridural with morphine for thoracic surgery yielded very effective results as an analgesic method with adequate stability, minimal complications and analgesic rescue requirements, which led to patient satisfaction(AU)


Subject(s)
Humans , Pain, Postoperative/diagnosis , Thoracic Surgery/methods , Analgesia, Epidural/methods , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
4.
Rev. cuba. anestesiol. reanim ; 16(3): 1-15, set.-dic. 2017. tab
Article in Spanish | LILACS, CUMED | ID: biblio-960315

ABSTRACT

Introducción: la implementación de un protocolo de recuperación posoperatoria precoz, garantiza menor morbilidad, estancia posoperatoria corta y satisfacción de los pacientes. Objetivos: evaluar la utilidad de la analgesia epidural dentro de un protocolo de recuperación precoz en cirugía colorrectal laparoscópica. Método: se realizó un estudio observacional descriptivo prospectivo y longitudinal con el objetivo de evaluar la utilidad de la analgesia epidural dentro de un protocolo de recuperación precoz en cirugía colorrectal laparoscópica en pacientes intervenidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en el período de mayo 2014-diciembre 2016. La muestra quedó conformada por 97 pacientes intervenidos de cirugía colorrectal laparoscópica con estado físico II-III según la ASA, de cualquier género, programados para cirugía electiva colorrectal laparoscópica incluidos en el protocolo. Resultados: La media de la edad fue de 70 años y predominó el sexo masculino. La analgesia obtenida fue eficaz, se logró ausencia de dolor tanto en reposo como en movimiento en todos los momentos de medición en más del 50 por ciento de los pacientes y cuando apareció el dolor este fue considerado leve. Los requerimientos de analgesia de rescate fueron de 24,7 por ciento. Las complicaciones fueron escasas. Los temblores y la hipotensión aparecieron en 11,3 y 9,3 por ciento, respectivamente. La estadía fue menor de tres días en más de la mitad de los pacientes. Conclusiones: la implementación de un protocolo de recuperación posoperatoria precoz incrementa la eficacia y la eficiencia en la atención perioperatoria(AU)


Introduction: The implementation of an early postoperative recovery protocol guarantees lower morbidity, short postoperative stay, and patient satisfaction. Objectives: To evaluate the usefulness of epidural analgesia within an early recovery protocol in laparoscopic colorectal surgery. Method: A prospective and longitudinal descriptive and observational study was carried out with the objective of evaluating the usefulness of epidural analgesia within an early recovery protocol in laparoscopic colorectal surgery in patients operated at Hermanos Ameijeiras Surgical-Clinical Hospital in the period from May 2014 to December 2016. The sample consisted of 97 patients who underwent laparoscopic colorectal surgery with physical status II-III according to the ASA, of any gender, scheduled for elective laparoscopic colorectal surgery included in the protocol. Results: The average age was 70 years and the male sex predominated. The analgesia obtained was effective, absence of pain was achieved both at rest and in movement at all measurement times in more than 50 percent of patients and, when pain appeared, it was considered mild. The requirements for rescue analgesia were 24.7 percent. The complications were minimal. Tremors and hypotension appeared in 11.3 percent and 9.3 percent of cases, respectively. Hospital stay was less than three days in more than half of the patients. Conclusions: The implementation of an early postoperative recovery protocol increases the effectiveness and efficiency in perioperative care(AU)


Subject(s)
Humans , Pain, Postoperative/prevention & control , Analgesia, Epidural/methods , Colorectal Surgery/methods , Colorectal Surgery/rehabilitation , Postoperative Care/methods , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies , Observational Study , Anesthetics, Local/therapeutic use
5.
Rev. bras. anestesiol ; 67(1): 85-88, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-843359

ABSTRACT

Abstract Background and objectives: Congenital unilateral absence of a pulmonary artery (UAPA) is a rare anomaly. Although there are several reports regarding pregnancy in patients with unilateral absence of a pulmonary artery, there are no case reports describing anesthesia for Cesarean section in a patient with unilateral absence of a pulmonary artery. Case report: We present a patient with unilateral absence of a pulmonary artery who underwent Cesarean sections twice at the ages of 24 and 26 years under spinal anesthesia for surgery and epidural analgesia for postoperative pain relief. Both times, spinal anesthesia and epidural analgesia enabled successful anesthesia management without the development of either pulmonary hypertension or right heart failure. Conclusion: Spinal anesthesia combined with epidural analgesia is a useful anesthetic method for a Cesarean section in patients with unilateral absence of a pulmonary artery.


Resumo Justificativa e objetivos: A ausência congênita unilateral de uma artéria pulmonar (ACAP) é uma anomalia rara. Embora existam vários relatos sobre pacientes grávidas com ACAP, não há relatos de casos que descrevam anestesia para cesariana em pacientes com ACAP. Relato de caso: Apresentamos uma paciente com ACAP que foi submetida a duas cesarianas, aos 24 e 26 anos, sob raquianestesia para a cirurgia e analgesia epidural para a dor no pós-operatório. Nas duas cesarianas, a raquianestesia e a analgesia epidural possibilitaram o manejo bem-sucedido da anestesia, sem a ocorrência de qualquer hipertensão pulmonar ou insuficiência cardíaca direita. Conclusão: Raquianestesia combinada com analgesia epidural é um método anestésico útil para cesarianas em pacientes com ACAP.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pulmonary Artery/abnormalities , Cesarean Section/methods , Pain, Postoperative/prevention & control , Pregnancy Complications, Cardiovascular , Infusions, Intravenous , Midazolam/administration & dosage , Bupivacaine/administration & dosage , Analgesia, Epidural/methods , Cesarean Section, Repeat/methods , Ropivacaine , Amides , Hypnotics and Sedatives , Anesthesia, Epidural , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods , Anesthetics, Local/administration & dosage
6.
Rev. bras. anestesiol ; 66(5): 439-444, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-794803

ABSTRACT

Abstract Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 µg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2 µg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2 µg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83). We found a higher caesarean delivery rate in group A (56.7%; p = 0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes.


Resumo Justificativa: Há evidências de que a administração de um bolus epidural intermitente programado (BEIP) comparada com a infusão epidural contínua (IEC) resulta em maior eficácia da analgesia e da satisfação materna, com redução das intervenções anestésicas. Métodos: Neste estudo, 166 mulheres com gravidezes viáveis foram incluídas. Após uma dose epidural de 10 mL de ropivacaína a 0,16% e adição de 10 µg de sufentanil, as parturientes foram aleatoriamente designadas para um dos três regimes: A - ropivacaína a 0,15% mais solução de sufentanil (0,2 µg/mL) como infusão peridural contínua (5 mL/h, imediatamente após o bolus inicial); B - ropivacaína a 0,1% mais sufentanil (0,2 µg/mL) como bolus epidural intermitente programado; C - solução idêntica à do Grupo A com bolus epidural intermitente programado. Os regimes BEIP foram programados como 10 mL por hora, começaram 60 minutos após o bolus inicial. Bolus de resgate de 5 mL da mesma solução foi administrado com bomba de infusão. A satisfação materna foi avaliada com uma escala numérica verbal de 0 a 10. Também avaliamos os resultados adversos maternais e neonatais. Resultados: Foram avaliadas 130 gestantes (A = 60, B = 33; C = 37). A mediana na escala numérica verbal para a satisfação materna foi de 8,8 no grupo A; 8,6 no grupo B e 8,6 no grupo C (p = 0,83). Encontramos uma taxa mais elevada para parto cesário no grupo A (56,7%; p = 0,02). Não observamos diferenças no bloqueio motor, taxa de parto instrumental e resultados neonatais. Conclusões: A manutenção da analgesia peridural com bolus epidural intermitente programado está associada a uma redução da incidência de parto cesariano com satisfação materna igualmente elevada e sem resultados adversos.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Infusion Pumps , Cesarean Section/statistics & numerical data , Double-Blind Method , Prospective Studies , Analgesia, Patient-Controlled , Patient Satisfaction , Endpoint Determination , Anesthetics, Local/administration & dosage
7.
Säo Paulo med. j ; 134(4): 280-284, July-Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-792824

ABSTRACT

ABSTRACT CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. CONCLUSION: Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.


RESUMO CONTEXTO E OBJETIVO: Dor pós-toracotomia é severa e intensa, causada por trauma de nervos periféricos, músculos e costelas. O objetivo foi comparar analgesia subpleural (SPA) com analgesia epidural torácica (TEA) em pacientes submetidos à toracotomia. TIPO DE ESTUDO E LOCAL: Estudo randomizado no Hospital Educação e Pesquisa de Numune, em Ancara, Turquia. MÉTODOS: Trinta pacientes com o estado físico I-III da Sociedade Americana de Anestesiologistas foram agendados para toracotomia diagnóstica eletiva e escolhidos aleatoriamente para receber, num período de 24 horas, SPA ou TEA, ambas controladas pelo próprio paciente, para controle da dor pós-toracotomia. Os dois grupos receberam mistura de 3 ug/ml de fentanil com solução de 0,05% de bupivacaína por meio de bomba de analgesia controlada pelo paciente. Foi administrada analgesia de resgate por via intravenosa, com 100 mg de tramadol, nos dois grupos. No pós-operatório, a escala visual analógica foi utilizada para medir presença de dor durante a tosse ou em repouso, ao longo de 24 horas. RESULTADOS: No grupo SPA, todos os pacientes necessitaram de analgesia de resgate. Cinco pacientes (33%) necessitaram de analgesia de resgate no grupo TEA (P < 0,05). Os pacientes com SPA exibiram pontuações superiores na escala visual analógica, em repouso e ao tossir, em comparação aos que receberam TEA. Nenhum dos pacientes teve quaisquer efeitos secundários no pós-operatório, como hipotensão ou depressão respiratória. CONCLUSÃO: A analgesia peridural torácica é superior à analgesia subpleural no alívio da dor pós-toracotomia. Consideramos que estudos sobre a dosagem de drogas eficazes para proporcionar analgesia subpleural são necessários.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Pain, Postoperative/drug therapy , Thoracotomy/adverse effects , Analgesia, Epidural/methods , Analgesia, Patient-Controlled/methods , Interpleural Analgesia/methods , Time Factors , Pain Measurement , Bupivacaine/administration & dosage , Fentanyl/administration & dosage , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Cough/complications , Drug Combinations , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage
8.
Rev. bras. anestesiol ; 66(4): 395-401,
Article in English | LILACS | ID: lil-787630

ABSTRACT

Abstract Background and objective: Adequate analgesia after sternotomy reduces postoperative adverse events. There are various methods of treating pain after heart surgery, such as infiltration with a local anesthetic, nerve block, opioids, non-steroidal anti-inflammatory drugs, alpha-adrenergic agents, intrathecal and epidural techniques, and multimodal analgesia. Content: A review of the epidemiology, pathophysiology, prevention and treatment of pain after sternotomy. We also discuss the various analgesic therapeutic modalities, emphasizing advantages and disadvantages of each technique. Conclusions: Heart surgery is performed mainly via medium sternotomy, which results in significant postoperative pain and a non-negligible incidence of chronic pain. Effective pain control improves patient satisfaction and clinical outcomes. There is no clearly superior technique. It is believed that a combined multimodal analgesic regimen (using different techniques) is the best approach for treating postoperative pain, maximizing analgesia and reducing side effects.


Resumo Justificativa e objetivo: Analgesia adequada após esternotomia reduz eventos adversos no pós-operatório. Várias modalidades estão disponíveis para tratamento da dor após cirurgia cardíaca: infiltração com anestésico local, bloqueio de nervos, opioides, anti-inflamatórios não esteroidais, agentes alfa-adrenérgicos, técnicas intratecais e epidurais e analgesia multimodal. Conteúdo: Foi feita uma revisão sobre epidemiologia, fisiopatologia, prevenção e tratamento da dor após esternotomia. Também fora discutidas as diversas modalidades terapêuticas analgésicas, com ênfase em vantagens e desvantagens de cada técnica. Conclusões: A cirurgia cardíaca é feita principalmente por esternotomia média, que resulta em dor significativa no pós-operatório e uma incidência não insignificante de dor crônica. O controle efetivo da dor melhora a satisfação dos pacientes e os desfechos clínicos. Nenhuma técnica é claramente superior. Acredita-se que um regime analgésico combinado multimodal (com várias técnicas) seja a melhor abordagem para tratar a dor pós-operatória, o que maximiza a analgesia e reduz os efeitos colaterais.


Subject(s)
Humans , Pain, Postoperative/therapy , Sternotomy/adverse effects , Cardiac Surgical Procedures , Analgesia/methods , Pain, Postoperative/etiology , Analgesia, Epidural/methods , Anti-Inflammatory Agents, Non-Steroidal , Combined Modality Therapy , Analgesics, Opioid , Anesthetics, Local , Nerve Block/methods
9.
Rev. bras. anestesiol ; 66(3): 259-264, May.-June 2016. tab
Article in English | LILACS | ID: lil-782892

ABSTRACT

ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55) or Non-CSE (n = 55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.


RESUMO JUSTIFICATIVA E OBJETIVOS: A analgesia combinada raquiperidural (RP) tornou-se uma opção cada vez mais popular para o trabalho de parto tradicional devido ao seu rápido início de ação e ao resultado confiável. Este foi um estudo prospectivo de amostragem conveniente para determinar os efeitos da RP sobre o desfecho do parto. MÉTODOS: Foram incluídas 110 parturientes primigestas saudáveis, com gestação única de ≥ 37 semanas e na fase ativa do trabalho de parto. As pacientes foram designadas para os grupos RP (n = 55) ou não RP (n = 55) com base em seus consentimentos para a analgesia combinada RP. As parturientes do grupo não RP receberam outros métodos de analgesia para o parto. As durações do primeiro e segundo estágio do trabalho de parto, as taxas de parto vaginal instrumental e cesariana de emergência e os escores de Apgar foram comparados. RESULTADOS: A média de duração do primeiro e segundo estágio do trabalho de parto não foi significativamente diferente entre os dois grupos. As taxas de parto instrumental não foram significativamente diferentes entre os grupos, RP (11%) versus não RP (16%). A incidência ligeiramente maior de cesariana no grupo RP (16% versus 15% no não RP) não foi estatisticamente significativa. O desfecho neonatal em termos de índice de Apgar foi inferior a 7. CONCLUSÃO: Não houve diferenças significativas em relação à duração do trabalho, às taxas de parto vaginal instrumental e cesariana de emergência e ao desfecho neonatal em parturientes que receberam RP para analgesia de parto em comparação com aquelas que não receberam.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Labor, Obstetric , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Delivery, Obstetric/statistics & numerical data , Anesthesia, Spinal/methods , Time Factors , Prospective Studies , Treatment Outcome , Drug Therapy, Combination
10.
Rev. bras. anestesiol ; 65(4): 306-309, July-Aug. 2015. ilus
Article in English | LILACS | ID: lil-755139

ABSTRACT

We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.

.

Apresentamos o caso clínico de uma paciente de 25 anos na qual uma técnica peridural foi aplicada durante o trabalho de parto e posteriormente apresentou cefaleia com características de cefaleia pós-punção dural. Foi iniciado tratamento conservador e tampão de sangue peridural. Devido à ausência de melhoria clínica e à mudança do componente postural da cefaleia, decidiu-se fazer um exame de imagem cerebral que demonstrou a presença de hematoma subdural bilateral. A cefaleia pós-punção dural é relativamente frequente, mas a falta de resposta ao tratamento médico instaurado, assim como a mudança em suas características e a presença de foco neurológico, deve levantar a suspeita de presença de um hematoma subdural que, embora infrequente, pode chegar a ser devastador se não for diagnosticado e tratado oportunamente.

.

Presentamos el caso clínico de una paciente de 25 años de edad, a quien se le realizó una técnica epidural durante el trabajo de parto y posteriormente presentó cefalea con características de cefalea pospunción dural. Se inició tratamiento conservador y se realizó parche hemático epidural. Ante la falta de mejoría clínica y debido al cambio en el componente postural de la cefalea, se decidió realizar una prueba de imagen cerebral que demostró la presencia de hematoma subdural bilateral. La cefalea pospunción dural es relativamente frecuente, pero la falta de respuesta al tratamiento médico instaurado, así como el cambio en sus características y la presencia de focalidad neurológica, deben hacer sospechar la presencia de un hematoma subdural que, aunque infrecuente, puede llegar a ser devastador si no se diagnostica y trata oportunamente.

.


Subject(s)
Humans , Female , Pregnancy , Adult , Analgesia, Epidural/adverse effects , Analgesia, Obstetrical/adverse effects , Hematoma, Subdural/etiology , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Blood Patch, Epidural/methods , Labor Pain/drug therapy , Post-Dural Puncture Headache/etiology , Post-Dural Puncture Headache/therapy , Neuroimaging/methods , Hematoma, Subdural/diagnosis
11.
Rev. bras. anestesiol ; 65(3): 200-206, May-Jun/2015. tab
Article in English | LILACS | ID: lil-748911

ABSTRACT

BACKGROUND AND OBJECTIVE: The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. METHODS: From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. RESULTS: Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (p = 0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. CONCLUSION: Postoperative epidural catheter analgesia, under these study conditions, was found to be low risk for bacterial colonization in patients at surgical wards. .


OBJETIVOS: O aumento do uso de analgesia pela via peridural com uso de cateteres leva à necessidade de se demonstrar a segurança do método. O presente estudo teve como objetivo conhecer a incidência de colonização de cateteres inseridos para analgesia peridural no pós-operatório e as bactérias responsáveis por estas colonizações. MÉTODOS: No período de novembro de 2011 a abril de 2012 foram avaliados pacientes operados eletivamente mantidos sob analgesia por cateter peridural no pós-operatório. A ponta do cateter foi coletada para análise microbiológica semi-quantitativa e qualitativa. RESULTADOS: Seis (8,8%) pontas dos 68 cateteres cultivados apresentaram culturas positivas. Nenhum paciente apresentou infecção superficial ou profunda. O tempo médio de permanência do cateter foi de 43,45 horas (18-118 horas) (p = 0,0894). O tipo de cirurgia (contaminada ou não contaminada), estado físico dos pacientes e tempo cirúrgico não mostraram relação com a colonização dos cateteres. Os micro-organismos isolados da ponta de cateter foram Staphylococcus aureus, Pseudomonas aeruginosa e Sphingomonas paucimobilis. CONCLUSÃO: Conclui-se que, a analgesia por cateter peridural no pós-operatório, nas condições do presente estudo, revelou-se procedimento com baixo risco de colonização bacteriana em pacientes de enfermarias cirúrgicas. .


OBJETIVOS: El aumento del uso de analgesia por vía epidural con el uso de catéteres nos lleva a la necesidad de demostrar la seguridad del método. El presente estudio tuvo como objetivo conocer la incidencia de la colonización de catéteres insertados para la analgesia epidural en el postoperatorio y las bacterias responsables de estas colonizaciones. MÉTODOS: En el período de noviembre de 2011 a abril de 2012, se evaluaron pacientes operados electivamente que fueron mantenidos bajo analgesia por catéter epidural en el postoperatorio. La punta del catéter fue recolectada para análisis microbiológico semicuantitativo y cualitativo. RESULTADOS: Seis (8,8%) puntas de los 68 catéteres cultivados presentaron cultivos positivos. Ningún paciente presentó infección superficial o profunda. El tiempo medio de permanencia del catéter fue de 43,45 h (18-118 h) (p = 0,0894). El tipo de cirugía (contaminada o no contaminada), estado físico de los pacientes y tiempo quirúrgico no mostraron relación con la colonización de los catéteres. Los microorganismos aislados de la punta del catéter fueron Staphylococcus aureus, Pseudomonas aeruginosa y Sphingomonas paucimobilis. CONCLUSIÓN: Concluimos que la analgesia por catéter epidural en el postoperatorio, en las condiciones del presente estudio, mostró ser un procedimiento con bajo riesgo de colonización bacteriana en pacientes quirúrgicos. .


Subject(s)
Humans , Male , Female , Adult , Aged , Bacteria/isolation & purification , Analgesia, Epidural/methods , Catheters, Indwelling/microbiology , Pain, Postoperative/drug therapy , Time Factors , Prospective Studies , Middle Aged
12.
Ann Card Anaesth ; 2015 Apr; 18(2): 153-160
Article in English | IMSEAR | ID: sea-158151

ABSTRACT

Background: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%. Aim: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses. Materials and Methods: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly. Results: 19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice. Conclusion: Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality.


Subject(s)
Adult , Analgesia, Epidural/methods , Anesthesia, Epidural/methods , Female , Humans , Maternal Mortality/etiology , Middle Aged , Morbidity , Pregnancy , Tertiary Care Centers
13.
Article in English | WPRIM | ID: wpr-69225

ABSTRACT

BACKGROUND: Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty. METHODS: We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score. RESULTS: Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score. CONCLUSIONS: Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.


Subject(s)
Adult , Aged , Aged, 80 and over , Analgesia, Epidural/methods , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Arthroplasty, Replacement, Hip , Female , Femoral Nerve , Fibrin Fibrinogen Degradation Products/analysis , Humans , Length of Stay , Male , Middle Aged , Morphine/administration & dosage , Nerve Block/methods , Pain, Postoperative/prevention & control , Retrospective Studies , Treatment Outcome
14.
Yonsei Medical Journal ; : 1106-1114, 2014.
Article in English | WPRIM | ID: wpr-207151

ABSTRACT

PURPOSE: Epidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy. MATERIALS AND METHODS: Sixty-four patients undergoing conventional open gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine combined with intravenous patient-controlled analgesia (IT) group or patient-controlled thoracic epidural analgesia (EP) group. The IT group received preoperative 0.3 mg of ITM, followed by postoperative IVPCA. The EP group preoperatively underwent epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores were assessed until 48 hrs after surgery. Adverse effects related to analgesia, profiles associated with recovery from surgery, and postoperative complications within 30 days after surgery were also evaluated. RESULTS: This study failed to demonstrate the non-inferiority of ITM-IVPCA (n=29) to PCTEA (n=30) with respect to VAS 24 hrs after surgery. Furthermore, the IT group consumed more fentanyl than the EP group did (1247.2+/-263.7 microg vs. 1048.9+/-71.7 microg, p<0.001). The IT group took a longer time to ambulate than the EP group (p=0.021) and had higher incidences of postoperative ileus (p=0.012) and pulmonary complications (p=0.05) compared with the EP group. CONCLUSION: ITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.


Subject(s)
Adult , Analgesia, Epidural/methods , Analgesia, Patient-Controlled/methods , Analgesics, Opioid/administration & dosage , Female , Gastrectomy/methods , Humans , Male , Middle Aged , Morphine/administration & dosage , Pain Management/methods , Pain, Postoperative/drug therapy
15.
Article in English | IMSEAR | ID: sea-157512

ABSTRACT

Spinal muscarinic M1 receptors are believed to be involved in the analgesic properties of spinal neostigmine. Aims were to determine the effect of adding neostigmine to bupivacaine on the duration of caudal analgesia as compared with caudal bupivacaine alone, to determine the need for rescue analgesics in the post-operative period. Material and Methods: 50 patients of ASA Grade I and II, aged between 2 to 8 years, of either sex underwent infraumbilical surgeries. Post-operative caudal epidural analgesia was activated after completion of the surgery and before recovery from anaesthesia Group-A (n=25) received caudal epidural injection of preservative free bupivacaine 0.125%. 2 mg/kg, Group-B (n=25) received both preservative free bupivacaine 0.125% and neostigmine 2μg/kg. Results and Analysis: After extubation children were evaluated for pain using the CHEOPS pain scale, shows no significant difference between the two study groups at 2 post-operative hours. Group B patients required less rescue analgesic than Group A patients in 24 hrs postoperative period. Conclusion: Addition of neostigmine to bupivacaine in caudal epidural bupivacaine prolonged the duration of caudal analgesia in the post-operative period compared to caudal bupivacaine alone.


Subject(s)
Analgesia, Epidural/methods , Analgesics/administration & dosage , Anesthesia, Epidural/methods , Anesthesia, Caudal/methods , Bupivacaine/administration & dosage , Child , Child, Preschool , Drug Combinations , Female , Humans , Male , Neostigmine/administration & dosage , Pain, Postoperative/drug therapy , Umbilicus/surgery
16.
Article in English | IMSEAR | ID: sea-157496

ABSTRACT

Low back pain is a problem that is common and costly to society and its effective management remains a challenge. Major cause of morbidity due to low back pain is prolapsed intervertebral disc which mostly affects young adults in their fourth decade of life. Epidural steroid injection (ESI) is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation. This follow up study was planned to know the results of epidural injections with corticosteroids in symptomatic patients of lumbar disc prolapse. Out of 159 patients who were evaluated before and after the ESI for pain relief, 78% had positive response. No major post-injection complications were reported in this study. Carefully administered epidural steroid injection is a safe and effective modality in the treatment of pain in lumbar disc herniation.


Subject(s)
Adult , Analgesia, Epidural/methods , Female , Humans , Injections, Spinal , Intervertebral Disc Degeneration/complications , Intervertebral Disc Degeneration/drug therapy , Intervertebral Disc Degeneration/epidemiology , Low Back Pain/drug therapy , Low Back Pain/etiology , Male , Middle Aged , Steroids/administration & dosage , Steroids/therapeutic use , Young Adult
18.
Rev. centroam. obstet. ginecol ; 17(2): 59-61, abr.-jun. 2012.
Article in Spanish | LILACS | ID: lil-734052

ABSTRACT

Con la utilización de la anestesia neuroaxial en casos quirúrgicos ginecológicos donde su empleo este indicado, se puede utilizar los set de catéter epidural para la aplicación de la misma y aprovechar el procedimiento invasivo para la colocación de un catéter epidural. Este último proporciona una vía de aplicación local para la infusión de protocolos analgésicos principalmente combinaciones de anestésicos locales más un opiáceo...


Subject(s)
Humans , Analgesia, Epidural/adverse effects , Analgesia, Epidural/methods , Analgesia, Epidural , Bupivacaine/administration & dosage , Bupivacaine , Morphine/administration & dosage , Morphine
19.
Acta cir. bras ; 27(2): 137-143, Feb. 2012. ilus, graf, tab
Article in English | LILACS | ID: lil-614532

ABSTRACT

PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1) ketamine (KE; 2.5 mg/kg), (2) magnesium sulphate (MG; 100 mg), and (3) KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline) and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD), that is, more than twice that obtained with KE (41 ± 7 min) or MG (29 ± 5 min) alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.


OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1) quetamina (KE; 2,5 mg/kg), (2) sulfato de magnésio (MG; 100 mg) e (3) KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente). As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal) e depois da administração dos fármacos até o fim da analgesia. RESULTADOS: A duração da analgesia com o tratamento KEMG foi 115 ± 17 min (média ± DP), duas vezes superior ao obtido com o tratamento KE (41 ± 7 min) ou tratamento MG (29 ± 5 min) isolados. Os tratamentos KE e KEMG induziram bloqueio motor severo. As pressões arteriais e freqüência cardíaca não foram estatisticamente significantes nestes animais. CONCLUSÃO: A adição de sulfato de magnésio a analgesia epidural com quetamina é viável, e pode ser usado para prolongar os efeitos analgésicos destes bloqueios em carneiros.


Subject(s)
Animals , Male , Analgesics , Anesthetics, Combined , Analgesia, Epidural/methods , Conscious Sedation/methods , Ketamine , Magnesium Sulfate , Pain Measurement , Reproducibility of Results , Sheep , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL