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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.830-834, tab.
Monography in Portuguese | LILACS | ID: biblio-1353529
2.
Rev. cuba. anestesiol. reanim ; 20(2): e698, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289350

ABSTRACT

Introducción: La videolaparascopía es un procedimiento frecuente en los servicios de urgencias de cirugía general. El dolor agudo después de estas intervenciones es de naturaleza compleja y requiere un tratamiento analgésico efectivo. Objetivo: Determinar la utilidad del empleo de bupivacaína intraperitoneal en el alivio del dolor posoperatorio en la videolaparascopía de urgencia. Métodos: Se realizó un estudio longitudinal prospectivo y analítico en 80 pacientes mayores de 18 años, anunciados para videolaparoscopía bajo anestesia general orotraqueal en el servicio de urgencias del HMC: Dr. Luis Díaz Soto, desde septiembre de 2016 hasta septiembre de 2018. Los pacientes fueron divididos aleatoriamente en dos grupos de 40 cada uno. Al grupo 1 se aplicó lidocaína transdérmica preincisional en las incisiones de piel y, al término de la cirugía, se irrigaron ambos hemidiafragmas con bupivacaína al 0,25 por ciento. Al grupo 2 se le administró dosis preincisional de analgésicos endovenosos solamente. Resultados: Predominó significativamente el sexo femenino sin diferencia entre grupos. La analgesia posoperatoria fue mejor en el grupo 1 estadísticamente significativa a las 4, 8 y 12 horas. Los requerimientos de analgesia de rescate fueron menores en el grupo 1 (p=0,0024). No se reportaron efectos adversos. Conclusiones: La administración de lidocaína transdérmica preincisional y la instilación de bupivacaína intraperitoneal al final de la videolaparoscopía de urgencia, reduce significativamente el dolor en las primeras horas de posoperatorio. Su aplicación es sencilla, fácil y segura sin evidencias de efectos adversos(AU)


Introduction: Videolaparoscopy is a frequent general surgery procedure in emergency services. Acute pain after these interventions is complex in nature and requires effective analgesic treatment. Objective: To determine the usefulness of intraperitoneal bupivacaine in the relief of postoperative pain in emergency videolaparoscopy. Methods: A prospective, analytical and longitudinal study was carried out in eighty patients older than eighteen years old, announced for videolaparoscopy under orotracheal general anesthesia in the emergency department of Hospital Militar Central Dr. Luis Díaz Soto, from September 2016 to September 2018. The patients were randomly divided into two groups of forty individuals each. Group 1 was applied pre-incisional transdermal lidocaine on skin incisions and, at the end of surgery, both hemidiaphragms were irrigated with bupivacaine 0.25 percent. Group 2 received pre-incisional doses of intravenous analgesics only. Results: The female sex predominated significantly, without difference between the two groups. Postoperative analgesia was better in group 1, insofar it was statistically significant at four, eight and twelve hours. Rescue analgesia requirements were lower in group 1 (p=0.0024). No adverse effects were reported. Conclusions: The administration of pre-incisional transdermal lidocaine and the instillation of intraperitoneal bupivacaine at the end of emergency videolaparoscopy significantly reduces pain during the first hours after surgery. Its application is simple, easy and safe, without evidence of adverse effects(AU)


Subject(s)
Humans , Pain, Postoperative/drug therapy , General Surgery , Bupivacaine/therapeutic use , Longitudinal Studies , Emergency Service, Hospital , Analgesia/methods
3.
Rev. bras. ter. intensiva ; 33(1): 48-67, jan.-mar. 2021. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1289052

ABSTRACT

RESUMEN Objetivo: Proponer estrategias agile para este abordaje integral de la analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente con síndrome de dificultad respiratoria aguda por COVID-19, considerando el alto riesgo de infección que existe entre los trabajadores de salud, el tratamiento humanitario que debemos brindar al paciente y su familia, en un contexto de falta estrategias terapéuticas específicas contra el virus globalmente disponibles a la fecha y una potencial falta de recursos sanitarios. Metodos: Se llevó a cabo una revision no sistemática de la evidencia científica en las principales bases de datos bibliográficos, sumada a la experiencia y juicio clínico nacional e internacional. Finalmente, se realizó un consenso de recomendaciones entre los integrantes del Comité de Analgesia, Sedación y Delirium de la Sociedad Argentina de Terapia Intensiva. Resultados: Se acordaron recomendaciones y se desarrollaron herramientas para asegurar un abordaje integral de analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente adulto con síndrome de dificultad respiratoria aguda por COVID-19. Discusión: Ante el nuevo orden generado en las terapias intensivas por la progresión de la pandemia de COVID-19, proponemos no dejar atrás las buenas prácticas habituales, sino adaptarlas al contexto particular generado. Nuestro consenso está respaldado en la evidencia científica, la experiencia nacional e internacional, y será una herramienta de consulta atractiva en las terapias intensivas.


ABSTRACT Objective: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. Methods: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. Results: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. Discussion: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


Subject(s)
Humans , Respiratory Distress Syndrome, Newborn/therapy , Delirium/therapy , Consensus , Pain Management/standards , COVID-19/complications , Analgesia/standards , Psychomotor Agitation/therapy , Neuromuscular Blockade/methods , Delirium/diagnosis , Early Ambulation , Checklist , Pain Management/methods , COVID-19/drug therapy , Analgesia/methods , Intensive Care Units , Intubation, Intratracheal/methods
4.
Article in English | LILACS, BBO | ID: biblio-1180866

ABSTRACT

ABSTRACT Objective: To assess the attitudes, experiences, training levels, and interest in future education regarding the use of hypnosis by dentists working in Dental Clinic of Monastir, Tunisia. Material and Methods: A cross-sectional study was conducted among 330 dentists working in Dental Clinic of Monastir in November 2019. Students, internship, residents, and professors were randomly selected. This was a survey with a structured questionnaire mailed to all dentists. The questionnaire was pre-fabricated, simple, and close-ended. Data were analyzed using SPSS 24.0 statistical software. Results: A total of 202 dentists respond to this survey. 54% of the participants were interns with a female predominance (66.5%). Findings revealed that beliefs toward hypnosis in the sample were generally positive. Using a visual analogue scale, dentists reported having moderate acknowledge in hypnosis (3.4). 60% of the participants in our study consider that hypnosis is useful in dentistry and, more particularly, in pediatric dentistry. 78.2% of respondents want to follow training courses in hypnosis. Conclusion: Our survey highlights the weak knowledge of participants in hypnosis and reveals certain misconceptions about this procedure. More efforts are required to better educate dentists about hypnosis's benefits in their practice.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Health Knowledge, Attitudes, Practice , Dental Clinics , Dentists , Analgesia/methods , Hypnosis, Dental/instrumentation , Tunisia/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies/methods , Surveys and Questionnaires
5.
Rev. bras. anestesiol ; 70(6): 678-681, Nov.-Dec. 2020. tab
Article in English, Portuguese | LILACS | ID: biblio-1155781

ABSTRACT

Abstract Background: Opioid-free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid-free infusions with a nociception monitor may be the solution. Case report: We describe the feasibility and potential limitations of titrating opioid-free antinociception during major abdominal surgery using the Analgesia Nociception Index (Mdoloris, Lille, France) in an obese patient. After stabilizing the patient's nociception-antinociception balance intraoperatively we quickly reversed anesthesia and the patient did not require postoperative opioids. Conclusion: Personalizing opioid-free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort.


Resumo Introdução A anestesia sem opioides diminui a incidência de eventos adversos associados aos opioides, mas a profundidade antinociceptiva ideal dessa abordagem não está claramente definida. Personalizar a infusão intraoperatória sem opioides com o uso de monitor de nocicepção pode ser a solução. Relato de caso Descrevemos a viabilidade e as eventuais limitações da titulação da antinocicepção sem opioides por meio do uso do Índice de Analgesia/Nocicepção (Mdoloris, Lille, França) durante cirurgia abdominal de grande porte em paciente com obesidade. Depois de estabilizar o equilíbrio nocicepção-antinocicepção da paciente no intraoperatório, revertemos rapidamente a anestesia e a paciente não precisou de opioides no pós-operatório. Conclusão A personalização da antinocicepção sem opioides por meio do emprego de monitor de nocicepção é factível. A abordagem pode otimizar a antinocicepção intraoperatória e melhorar o conforto pós-operatório.


Subject(s)
Humans , Female , Urinary Incontinence/surgery , Vesicovaginal Fistula/surgery , Precision Medicine/methods , Nociception , Anesthesia, Inhalation , Anesthesia, Intravenous , Urinary Incontinence/etiology , Obesity, Morbid/complications , Vesicovaginal Fistula/complications , Electroencephalography , Analgesia/instrumentation , Analgesia/methods , Analgesics, Opioid/adverse effects , Middle Aged
6.
Rev. bras. anestesiol ; 70(6): 613-619, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155774

ABSTRACT

Abstract Background and objectives There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. Method Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░µg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. Results Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (p░<░0.05). Conclusion There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.


Resumo Justificativa e objetivos Não há consenso sobre qual é a técnica ideal para prover analgesia em reconstruções ligamentares de joelho. Objetivou‐se comparar a intensidade da dor pós‐operatória desses pacientes sob diferentes modalidades de analgesia. Método Ensaio clínico randomizado e controlado de pacientes submetidos à reconstrução do ligamento cruzado anterior com tendões flexores entre dezembro de 2013 e 2014. Todos os pacientes foram submetidos a raquianestesia e analgesia de resgate com tramadol. Compararam‐se os grupos C, M, R0,375 e R0,25; aos quais se ofertou apenas a técnica anteriormente descrita, morfina subaracnóidea (100 µg) ou bloqueio de nervo femoral com 25 mL de ropivacaína 0,375% e 0,25%, respectivamente. Avaliou‐se intensidade da dor em 6, 12 e 24 horas, idade, sexo, analgesia de resgate, reações adversas e satisfação. Resultados Entre os 83 pacientes elegíveis, observou‐se predomínio do sexo masculino (85,7%) entre 28 e 31 anos. O Grupo C solicitou mais opioide (27,3%) do que os demais grupos, sem significância quando comparados. Não houve diferenças significativas na intensidade da dor em 6, 12 e 24 horas. Houve maior incidência de retenção urinária no Grupo M (23,8%) do que no R0,375 (0%) e de bloqueio motor prolongado do quadríceps no Grupo R0,375 (30%) do que nos Grupos M e C (0%), com significância estatística (p< 0,05). Conclusão Não houve diferença na intensidade da dor pós‐operatória nos pacientes submetidos à reconstrução de ligamento cruzado anterior com tendões flexores sob as modalidades analgésicas avaliadas, apesar do predomínio de retenção urinária no Grupo M e bloqueio motor no Grupo R0,375.


Subject(s)
Humans , Male , Female , Adult , Pain, Postoperative/drug therapy , Femoral Nerve , Anterior Cruciate Ligament Reconstruction , Analgesics, Opioid/administration & dosage , Anesthesia, Spinal/methods , Morphine/administration & dosage , Nerve Block/methods , Time Factors , Tramadol/administration & dosage , Pain Measurement , Urinary Retention/chemically induced , Quadriceps Muscle/drug effects , Acute Pain/drug therapy , Ropivacaine/administration & dosage , Analgesia/methods , Anesthetics, Local/administration & dosage
8.
Rev. cuba. pediatr ; 92(2): e508, abr.-jun. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1126755

ABSTRACT

Introducción: El dolor posterior a una intervención quirúrgica, es un síntoma frecuentemente observado, no cumple una función útil y el peligro de no tratarlo aumenta la morbilidad y mortalidad posoperatoria. Objetivo: Destacar la importancia de la analgesia multimodal en el control del dolor agudo posoperatorio. Métodos: Revisión en la literatura impresa tanto nacional como internacional, sobre la analgesia y la modalidad multimodal y además, se hizo búsqueda en Internet. En los artículos revisados se obtuvieron distintos aspectos clínicos de la analgesia multimodal y de sus protocolos. Resultados: En la actualidad para mitigar el dolor y alcanzar la máxima expresión en la analgesia posoperatoria se han desarrollado diferentes modalidades analgésicas, aunque de todas ellas solo ha alcanzado mayor grado de recomendación, la analgesia multimodal porque es capaz de conseguir con su efecto sinérgico y con pequeñas dosis, una mejor potencia para producir analgesia y menos efectos adversos. Consideraciones finales: La analgesia multimodal logra un control adecuado del dolor agudo posoperatorio, disminuye las complicaciones posoperatorias y la necesidad de analgesia de rescate, pero todo esto depende del protocolo de analgesia multimodal propuesto, la vía de administración de los fármacos elegidos, sus dosis y el cumplimiento de los intervalos de aplicación(AU)


Introduction: The pain after surgery is a frequently observed symptom, it is not a useful function and the danger of not treating it increases postoperative morbidity and mortality. Objective: To highlight the importance of multimodal analgesia in the control of acute postoperative pain. Methods: It was made a review in the printed literature both national and international on the multimodal analgesia, and in addition, a search in Internet. In the reviewed articles there were obtained different clinical aspects of multimodal analgesia and its protocolization. Results: Nowadays, in order to mitigate the pain and achieve the maximum expression in the postoperative analgesia, there have been developed different analgesic modalities, although of all of them it only has achieved a greater degree of recommendation, the multimodal analgesia because it is capable of achieving with its synergetic effect and with small doses, a better power to produce analgesia and fewer adverse effects. Conclusions: The multimodal analgesia achieved adequate control of acute postoperative pain, decreasing the inherent complications of this state and the need of rescue analgesia. All of the above depends on the proposed protocol of multimodal analgesia, the route of administration of the chosen drugs, their doses and the compliance of the application intervals(AU)


Subject(s)
Humans , Male , Female , Pain, Postoperative/therapy , Combined Modality Therapy/methods , Analgesia/methods
9.
Rev. bras. anestesiol ; 70(2): 178-183, Mar.-Apr. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137152

ABSTRACT

Abstract Background: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients. Methods: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique. Results: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases. Conclusions: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.


Resumo Justificativa: O controle efetivo da dor é essencial para a reabilitação bem-sucedida e melhor recuperação após artroplastia. O bloqueio do quadrado lombar tem sido descrito principalmente para cirurgia abdominal, mas recentemente também tem sido usado para pacientes submetidos a cirurgia de quadril. Método: Na série de casos a seguir, sugerimos modificação na técnica do bloqueio transmuscular do quadrado lombar descrita como bloqueio do Quadrado Lombar Paraespinhoso Sagital (PES). Nossa hipótese é de que a técnica permitiria melhor dispersão do anestésico local para as raízes dos nervos lombares. Tal técnica envolve acesso craniocaudal para injeção do anestésico local entre os músculos quadrado lombar e psoas maior atrás da Fáscia Toracolombar Anterior (FTLA) no nível de L4. Os casos foram submetidos a anestesia geral combinada a técnica modificada PES para bloqueio do quadrado lombar via injeção única ou cateter. Resultados: Verificou-se que a distribuição sensorial do bloqueio nos quatro pacientes estudados cobriu a área entre os dermátomos T11-12 e L4-5. A dispersão do anestésico injetado foi confirmada via fluoroscopia A-P da coluna lombo-sacral após injeção, em dois casos, de solução de anestésico local e contraste no plano entre os músculos quadrado lombar e psoas maior. Conclusões: A técnica PES para bloqueio transmuscular do quadrado lombar pode ser benéfica como componente da analgesia multimodal para cirurgias de quadril. A técnica pode ser alternativa segura para bloqueio do compartimento psoas; entretanto, estudos comparativos futuros são recomendados. A técnica PES para bloqueio transmuscular do quadrado lombar pode também fornecer acesso fácil para inserção do cateter.


Subject(s)
Humans , Male , Female , Aged , Pain, Postoperative/prevention & control , Arthroplasty, Replacement, Hip , Analgesia/methods , Nerve Block/methods , Prospective Studies , Back Muscles , Middle Aged
10.
Rev. bras. anestesiol ; 70(1): 22-27, Jan.-Feb. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137130

ABSTRACT

Abstract Introduction and objectives: Blockade of the Erector Spinal Muscle (ESP Block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural Block, with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries. Methods: Controlled single-blind randomized clinical trial with 31 patients (ESP Block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine. Results: The ESP Block group presented higher mean ​​Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP Block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046). Conclusion: ESP Block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.


Resumo Justificativa e objetivo: O Bloqueio do Plano do Músculo Eretor da Espinha (ESP block) é um bloqueio relativamente novo, inicialmente descrito para analgesia de dor torácica crônica, porém já descrito para anestesia e analgesia em procedimentos cirúrgicos torácicos e, mais recentemente, para cirurgias abdominais altas. O estudo objetivou comparar as técnicas de bloqueio ESP e bloqueio Epidural com morfina e anestésico local para analgesia pós-operatória de cirurgias de colecistectomia aberta. Método: Estudo clínico randomizado controlado, unicego com 31 pacientes (ESP block, n = 15; Epidural, n = 16), de ambos os sexos, idades entre 27 e 77 anos. O ESP block foi realizado no nível de T8 com injeção de 20 mL de ropivacaína 0,5% bilateral. O bloqueio Epidural foi realizado no espaço T8-T9 com 20 mL de ropivacaína 0,5% e 1 mg de morfina. Resultados: O grupo ESP block apresentou valores médios de dor pela Escala Visual Numérica (EVN) maiores nas avaliações até 2 horas (p= 0,001) e em 24 horas (p= 0,001). O grupo ESP block apresentou um risco três vezes maior - 43,7%vs.13,3% - de uso de opioide de resgate em 24 horas pós-operatórias do que o grupo epidural (RR = 3,72; 95% IC 0,91 a 15,31; p= 0,046). Conclusão: Nas doses realizadas nesse estudo, o ESP block não se mostrou uma técnica efetiva para analgesia pós-operatória de colecistectomia aberta, com mais uso de opioide de resgate e sem diferenças na escala visual numérica de dor. Necessita-se de estudos mais abrangentes avaliando a eficácia do ESP block para o componente visceral e somático abdominal, considerando o nível do bloqueio específico.


Subject(s)
Humans , Male , Female , Adult , Aged , Pain, Postoperative/therapy , Cholecystectomy/methods , Analgesia/methods , Nerve Block/methods , Analgesia, Epidural , Single-Blind Method , Back Muscles/innervation , Middle Aged
11.
Einstein (Säo Paulo) ; 18: eAO5168, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056039

ABSTRACT

ABSTRACT Objective To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in pediatric intensive care units. Methods A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units. Results Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process. Conclusion This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.


RESUMO Objetivo Compreender o uso de ferramentas, protocolos e medidas de conforto relacionadas à sedação/analgesia, além de rastrear a presença de delirium em unidades de terapia intensiva pediátricas. Métodos Um inquérito com 14 questões foi distribuído, por meio de correio eletrônico, para médicos pediatras intensivistas brasileiros. Oito questões eram sobre os dados demográficos dos médicos e dos hospitais, e seis questões eram sobre as práticas na avaliação da sedação, analgesia e delirium em unidades de terapia intensiva pediátrica. Resultados Responderam ao inquérito 61 médicos dos 373 e-mails enviados (taxa de resposta de 16,3%). A maioria dos médicos era da Região Sudeste (57,2%) e 46,5% trabalhavam em hospitais públicos, sendo 28,6% sob administração direta do Estado. Dos respondedores, 57,1% utilizavam protocolos formais de sedação e analgesia, sendo a escala de Ramsay a mais utilizada (52,5%). Não utilizavam escores de rastreamento de delirium 48,2% dos médicos, e o Cornell Asssessment of Pediatric Delirium (23,2%) foi o mais utilizado. A maioria (85,7%) dos médicos não utilizou a prática da interrupção diária da sedação, e apenas 23,2% utilizavam medidas não farmacológicas para o conforto do paciente com frequência, com a participação heterogênea dos pais nesse processo. Conclusão Este estudo destaca a heterogeneidade nas práticas de avaliação da sedação/analgesia e insuficiência de rastreamento de delirium entre os intensivistas pediátricos brasileiros.


Subject(s)
Humans , Practice Patterns, Physicians'/statistics & numerical data , Intensive Care Units, Pediatric/statistics & numerical data , Delirium/diagnosis , Deep Sedation/methods , Pediatricians/statistics & numerical data , Analgesia/methods , Respiration, Artificial/methods , Respiration, Artificial/statistics & numerical data , Brazil , Surveys and Questionnaires , Delirium/etiology , Deep Sedation/adverse effects , Deep Sedation/statistics & numerical data , Analgesia/adverse effects , Analgesia/statistics & numerical data
12.
Rev. chil. pediatr ; 90(6): 649-656, dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058196

ABSTRACT

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.


INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.


Subject(s)
Humans , Infant , Child, Preschool , Child , Clinical Protocols , Patient Satisfaction , Pediatricians/psychology , Analgesia/methods , Anesthesia/methods , Job Satisfaction , Midazolam , Family/psychology , Prospective Studies , Analgesics, Non-Narcotic , Pain, Procedural/prevention & control , Analgesia/adverse effects , Analgesia/psychology , Hypnotics and Sedatives , Anesthesia/adverse effects , Anesthesia/psychology , Nitrous Oxide , Nursing Staff, Hospital/psychology
13.
Rev. bras. anestesiol ; 69(5): 455-460, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1057458

ABSTRACT

Abstract Introduction: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methods: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. Results: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p= 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p< 0.01), 30 (p< 0.01) minutes, and 1 (p< 0.01), 2 (p< 0.01), 6 (p< 0.01), 12 (p< 0.01) and 24 (p= 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p= 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p= 0.004). Conclusion: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.


Resumo Introdução: O bloqueio bilateral do plexo cervical superficial (BPCS) é um método comumente usado para analgesia em tireoidectomia. Avaliamos a eficácia analgésica do bloqueio bilateral do BPCS nos períodos intraoperatório e pós-operatório. Materiais e métodos: Os pacientes (n = 46) submetidos à tireoidectomia foram randomicamente separados em dois grupos para receber anestesia geral (Grupo GA; n = 23) e anestesia geral mais bloqueio bilateral do BPCS (Grupo GS; n = 23). Avaliamos a necessidade de analgésico no intraoperatório (remifentanil) e os escores VAS (Visual Analog Scale) em vários momentos no pós-operatório (após a extubação, aos 15 e 30 minutos e em 1, 2, 6, 12, 24 e 48 horas de pós-operatório). O consumo total de tramadol e paracetamol e a quantidade usada de ondansetrona foram registrados. Resultados: A necessidade de remifentanil no intraoperatório foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,009). Os escores de dor pós-operatória foram significativamente menores no Grupo GS do que no grupo GA aos 15 (p < 0,01) e 30 (p < 0,01) minutos e em 1 (p < 0,01), 2 (p < 0,01), 6 (p < 0,01), 12 (p < 0,01) e 24 (p = 0,03) horas de pós-operatório. A necessidade de tramadol no pós-operatório foi significativamente menor no Grupo GS do que no grupo GA (p = 0,01). O número de pacientes que recebeu ondansetrona foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,004). Conclusão: O bloqueio bilateral do BPCS com bupivacaína a 0,25% reduz a intensidade da dor pós-operatória e a dependência de opioides em pacientes submetidos à tireoidectomia.


Subject(s)
Humans , Male , Female , Adult , Pain, Postoperative/prevention & control , Thyroidectomy , Cervical Plexus Block/methods , Analgesia/methods , Anesthesia, General , Treatment Outcome , Middle Aged
14.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 81-85, sept. 2019.
Article in Spanish | LILACS | ID: biblio-1048229

ABSTRACT

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)


Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)


Subject(s)
Chronic Pain/therapy , Hyperbaric Oxygenation/methods , Phantom Limb/therapy , Quality of Life , Reflex Sympathetic Dystrophy/therapy , Vascular Headaches/therapy , Brain Diseases/therapy , Facial Pain/therapy , Fibromyalgia/therapy , Causalgia/therapy , Diabetic Neuropathies/therapy , Edema/therapy , Neuralgia, Postherpetic/therapy , Chronic Pain/epidemiology , Cancer Pain/therapy , Hyperbaric Oxygenation/trends , Analgesia/methods , Inflammation/therapy , Neuralgia/therapy
15.
Rev. bras. anestesiol ; 69(4): 396-402, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041998

ABSTRACT

Abstract Background and objectives Patient self-rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values. Methods A total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated-based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients' pain was rated on a 0-10 point Numerical Rating Scale. The patients' heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined. Results The study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤3, compared with Numerical Rating Scale >3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p < 0.001). A significant negative linear relationship (r 2 = -0.312, p = 0.001) was observed between analgesia nociception index and Numerical Rating Scale. Conclusion Analgesia nociception index measurements at postoperative period after volatile agent and opioid-based anesthesia correlate well with subjective Numerical Rating Scale scores.


Resumo Justificativa e objetivo As escalas baseadas na autoavaliação de pacientes, como a Escala Visual Numérica e a Escala Visual Analógica, que são usadas para avaliar a dor pós-operatória podem ser problemáticas em pacientes geriátricos ou em estado crítico com problemas de comunicação. Portanto, um método capaz de avaliar a dor de maneira objetiva vem sendo pesquisado há anos. O índice de analgesia/nocicepção, baseado em dados eletrocardiográficos que refletem a atividade parassimpática, tem sido proposto para tal avaliação. Neste estudo, objetivamos investigar a eficácia do índice de analgesia/nocicepção como uma ferramenta para a avaliação da dor pós-operatória aguda. Nossa hipótese foi que o índice de analgesia/nocicepção pode ter boa correlação com os valores da Escala de Classificação Numérica. Métodos Um total de 120 pacientes com estado físico ASA I e II, submetidos a qualquer procedimento cirúrgico com o uso de anestésicos halogenados associados a fentanil ou remifentanil, foi incluído no estudo. No 15º minuto após a chegada à sala de recuperação pós-anestesia, a dor dos pacientes foi avaliada em uma escala numérica de 0-10 pontos. Os escores de frequência cardíaca, pressão arterial e o índice de analgesia/nocicepção dos pacientes foram medidos simultaneamente naquele momento. A correlação entre o índice de analgesia/nocicepção, frequência cardíaca, pressão arterial e a Escala Visual Numérica foi avaliada. Resultados O estudo foi concluído com 107 pacientes, dos quais 46 eram do sexo masculino (43%). Os valores da média (DP) do índice de analgesia/nocicepção foram significativamente maiores nos pacientes com valor inicial na Escala Visual Numérica ≤ 3, em comparação com valor na mesma escala > 3 (69,1 [13,4] vs. 58,1 [12,9], respectivamente, p < 0,001). Uma relação linear negativa significativa (r2 = -0,312, p = 0,001) foi observada entre o índice de analgesia/nocicepção e a Escala Visual Numérica. Conclusão As mensurações do índice de analgesia/nocicepção no pós-operatório após anestesia com agentes halogenados e opioides mostraram boa correlação com os escores subjetivos da Escala Visual Numérica.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Pain Measurement/methods , Acute Pain/diagnosis , Nociception/drug effects , Analgesia/methods , Pain, Postoperative/diagnosis , Pain, Postoperative/prevention & control , Fentanyl/administration & dosage , Prospective Studies , Acute Pain/prevention & control , Remifentanil/administration & dosage , Analgesics, Opioid/administration & dosage , Middle Aged
16.
Rev. cuba. anestesiol. reanim ; 18(2): e548, mayo.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093102

ABSTRACT

Introducción: El dolor es un síntoma tan antiguo como la propia humanidad y ha formado parte inseparable de esta. Objetivo: Evaluar la efectividad de la analgesia preventiva con diclofenaco en el dolor posoperatorio en niños operados por cirugía general electiva. Método: Se realizó un estudio prospectivo, cuasiexperimental, en 230 niños operados por cirugía general electiva. La muestra se distribuyó en dos grupos; analgesia preventiva con diclofenaco (grupo estudio), versus dipirona por vía rectal (grupo control). Las variables analizadas fueron intensidad del dolor, modificaciones hemodinámicas, evolución clínica y eventos adversos. Resultados: En ambos grupos prevalecieron los pacientes entre los 6 y 10 años de edad. En el grupo estudio, el dolor apareció a partir de las 6 h después de la operación, en solo 23 pacientes. No así en el grupo control que desde las 4 h, 19 pacientes refirieron dolor. En el grupo estudio los 23 pacientes tuvieron aproximadamente 2 h de duración del dolor y de ellos, solo 4 con intensidad severa; mientras que en el control 65 refirieron 2 h de dolor y el resto lo refirieron durante 4 h a pesar del rescate analgésico. Nueve de ellos, presentaron intensidad severa. Algunos pacientes presentaron modificaciones de la tensión arterial, frecuencia cardiaca y respiratoria asociadas al dolor. Los efectos adversos frecuentes fueron náuseas y vómitos. Conclusiones: La administración preventiva de diclofenaco disminuye la intensidad del dolor posoperatorio en los procedimientos quirúrgicos de cirugía general electiva en niños(AU)


Introduction: Pain is a symptom as old as humanity itself and has been an inseparable part of it. Objective: To evaluate the effectiveness of preventive analgesia with diclofenac for postoperative pain in elective paediatric general surgery. Methods: A prospective, quasi-experimental study was carried out with 230 children who underwent elective general surgery. The sample was divided into two groups: preventive analgesia with diclofenac (study group) versus dipyrone by the rectal way (control group). The variables analyzed were pain intensity, hemodynamic modifications, clinical evolution and adverse events. Results: In both groups, patients aged 6-10 years of age prevailed. In the study group, pain onset occurred at 6 hours after surgery, in only 23 patients; not being that way in the control group, in which, at 4 hours, 19 patients reported pain. In the study group, the 23 patients had approximately 2 hours of pain duration and, among them, only 4 hours with severe intensity; while in the control group, 65 patients reported 2 hours of pain and the rest referred it for 4 hours despite the analgesic rescue. Nine of them presented severe intensity. Some patients presented changes in blood pressure, heart rate and breathing associated with pain. The frequent adverse effects include nausea and vomiting. Conclusions: The preventive administration of diclofenac decreases the intensity of posoperative pain in surgical procedures of elective paediatric general surgery(AU)


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Pain, Postoperative/prevention & control , Pain, Postoperative/epidemiology , Diclofenac/therapeutic use , Dipyrone/therapeutic use , Analgesia/methods , Prospective Studies , Non-Randomized Controlled Trials as Topic
17.
Odovtos (En línea) ; 21(1): 10-14, Jan.-Apr. 2019. graf
Article in English | LILACS, BBO | ID: biblio-1091466

ABSTRACT

Abstract Dental pain is usually managed by clinical interventions and pharmacological coadjuvants such as NSAIDs. However, its perception and modulation is mediated by different nociceptive mechanisms and these strategies can be insufficient. The multimodal analgesia refers to the use of 2 or more analgesic drugs that attenuate or blockade different mechanisms of pain, obtaining a greater clinical effect. Within this concept, pharmacological synergism plays a leading role, combining different molecules in lower doses to diminish also side effects. Since there are no standard prescriptions to be use in all the patients, multimodal approaches allow the clinician to make responsible effective combinations, individualizing analgesia as the pathway to success.


Resumen El dolor dental generalmente se trata con intervenciones clínicas y coadyuvantes farmacológicos como los AINEs. Sin embargo, su percepción y modulación está mediada por diferentes mecanismos nociceptivos y estas estrategias pueden ser insuficientes. La analgesia multimodal se refiere al uso de 2 o más fármacos analgésicos que atenúan o bloquean diferentes mecanismos de dolor, obteniendo un mayor efecto clínico. Dentro de este concepto, el sinergismo farmacológico juega un papel importante, combinando diferentes moléculas en dosis más bajas para disminuir también los efectos secundarios. Dado que no hay prescripciones estándar para ser usadas en todos los pacientes, los enfoques multimodales permiten al clínico realizar combinaciones responsables y eficaces, individualizando la analgesia como el camino hacia el éxito.


Subject(s)
Toothache/drug therapy , Combined Modality Therapy , Drug Synergism , Analgesia/methods , Anesthesia, Dental/methods
18.
Rev. bras. anestesiol ; 69(1): 87-90, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-977421

ABSTRACT

Abstract Thoracic trauma with rib fractures is a challenging condition due to the severe associated pain. Uncontrolled pain impairs breathing and an adequate pain control is necessary to provide comfort and to avoid further complications. Serratus Anterior Plane block is a procedure safe and easy to accomplish. The authors describe a case of thoracic trauma with rib fractures and respiratory compromise. Pain control was only achieved after performing a Serratus Anterior Plane block. The technique was done as described in the medical literature with placement of a catheter. Pain relief was achieved with a low concentration infusion of local anesthetic.


Resumo O trauma torácico com fraturas de costelas é uma condição desafiadora devido à dor intensa associada. O não controle da dor prejudica a respiração enquanto, o seu controle adequado é necessário para proporcionar conforto e evitar maiores complicações. O bloqueio do plano serrátil anterior é um procedimento seguro e fácil de fazer. Descrevemos um caso de trauma torácico com fraturas de costelas e comprometimento respiratório. O controle da dor só foi obtido após o bloqueio do plano serrátil anterior. A técnica foi aplicada conforme descrito na literatura médica, com a colocação de um cateter. O alívio da dor foi obtido com uma infusão de anestésico local em baixa concentração.


Subject(s)
Humans , Male , Adult , Pain/etiology , Rib Fractures/complications , Pain Management/methods , Fractures, Multiple/complications , Analgesia/methods , Nerve Block/methods , Thoracic Wall
19.
Rev. bras. anestesiol ; 69(1): 91-94, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-977420

ABSTRACT

Abstract Introduction: The erector spinae plane block is a newly described and effective interfascial plane block for thoracic and abdominal surgery. This case report describes a patient with multiple rib fractures undergoing ultrasound-guided continuous erector spinae plane block for analgesia. Case report: A 37-year-old male patient was taken for surgical fixation of multiple rib fractures. At the end of the surgery, using ultrasound-guided longitudinal parasagittal orientation 3 cm to the lateral aspect of the T5 spinous process and an in-plane technique, 20 mL 0.25% bupivacaine was administered between the erector spinae muscle and the transverse process, and a catheter was then inserted in the same plane. Before the end of surgery, 1 g paracetamol and 50 mg dexketoprofen were administered. Postoperative analgesia was applied with patient controlled analgesia method using 0.25% bupivacaine via the catheter. The patient's Visual Analogue Scale score at rest in the first 24 h was 0. The patient was monitored for 3 days with Visual Analogue Scale < 4, and the catheter was removed on postoperative day 4. No opioid requirement other than paracetamol and dexketoprofen occurred during this time. No postoperative complications were recorded. Discussion: The erector spinae plane block is an alternative to paravertebral, intercostal, epidural or other regional techniques. It may be a suitable technique in anesthesia and algology practice due to providing analgesia in the postoperative period with a catheter in the erector spinae plane.


Resumo Introdução: O bloqueio do plano do eretor da espinha é um bloqueio do plano interfacial recentemente descrito e eficaz para cirurgia torácica e abdominal. Neste relato descrevemos o caso de um paciente com fratura de múltiplas costelas, submetido ao bloqueio contínuo do plano do eretor da espinha guiado por ultrassom para analgesia. Relato de caso: Paciente do sexo masculino, 37 anos, encaminhado para fixação cirúrgica de fratura de múltiplas costelas. Ao final da cirurgia, usando a orientação parassagital longitudinal guiada por ultrassom 3 cm em relação à face lateral do processo espinhoso T5 e a técnica no plano, 20 ml de bupivacaína a 0,25% foram administrados entre o músculo eretor da espinha e o processo transverso, e um cateter foi então inserido no mesmo plano. Antes do final da cirurgia, 1 g de paracetamol e 50 mg de dexcetoprofeno foram administrados. A analgesia pós-operatória foi aplicada com o método de analgesia controlada pelo paciente, com bupivacaína a 0,25% via cateter. Na Escala Visual Analógica, o escore do paciente em repouso nas primeiras 24 h foi zero. O paciente foi monitorado por três dias com a Escala Visual Analógica < 4, e o cateter foi removido no quarto dia de pós-operatório. Exceto por paracetamol e dexcetoprofeno, não houve necessidade de outro agente opioide durante esse tempo. Não houve registro de complicação pós-operatória. Discussão: O bloqueio do plano do eretor da espinha é uma alternativa às técnicas paravertebrais, intercostais, epidurais ou outras técnicas regionais. Pode ser uma técnica adequada na prática de anestesia e algologia devido ao fornecimento de analgesia no período pós-operatório mediante um cateter no plano do eretor da espinha.


Subject(s)
Humans , Male , Adult , Pain, Postoperative/therapy , Rib Fractures/surgery , Pain Management/methods , Fractures, Multiple/surgery , Analgesia/methods , Nerve Block/methods , Paraspinal Muscles
20.
Rev. bras. anestesiol ; 69(1): 95-98, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-977415

ABSTRACT

Abstract Background and objective: Erector spinae plane block is a valid technique to provide simultaneously analgesia for combined thoracic and abdominal surgery. Case report: A patient underwent open esophagectomy followed by reconstructive esophagogastroplasty but refused thoracic epidural analgesia; a multi-modal analgesia with a multiple erector spinae plane block was then planned. Three erector spinae plane catheters (T5 and T10 on the right side and T9 on the left side) for continuous analgesia were placed before surgery. During the first 48 h pain was never reported in the thoracic area but the patient reported multiple times to feel a pain well localized in epigastrium, but never localized in any other abdominal quadrant. Discussion: Erector spinae plane block is a valid technique to provide analgesia simultaneously for combined thoracic and abdominal surgery and could be a valid alternative strategy if the use of epidural analgesia is contraindicated.


Resumo Justificativa e objetivo: O bloqueio do plano do eretor da espinha é uma técnica válida para fornecer analgesia em cirurgias combinadas, torácica e abdominal, de modo simultâneo. Relato de caso: Um paciente foi submetido à esofagectomia aberta seguida de esofagogastroplastia reconstrutiva, mas recusou analgesia peridural torácica; uma analgesia multimodal com o bloqueio dos múltiplos segmentos do eretor da espinha foi então planejada. Três cateteres foram colocados no plano do eretor da espinha (T5 e T10 no lado direito e T9 no lado esquerdo) para analgesia contínua antes da cirurgia. Durante as primeiras 48 horas, não houve queixa de dor na área torácica, mas várias vezes o paciente relatou sentir uma dor bem localizada no epigástrio, mas nunca localizada em qualquer outro quadrante abdominal. Discussão: O bloqueio do plano do eretor da espinha é uma técnica válida para fornecer analgesia de modo simultâneo em cirurgias combinadas - torácica e abdominal - e pode ser uma estratégia opcional também válida nos casos em que o uso de analgesia peridural for contraindicado.


Subject(s)
Humans , Male , Aged , Pain, Postoperative/prevention & control , Esophagectomy/methods , Analgesia/methods , Nerve Block/methods , Catheters , Paraspinal Muscles , Nerve Block/instrumentation
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