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1.
Dolor ; 31(73): 26-31, ene. 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1362747

ABSTRACT

Objetivo: El presente trabajo de investigación tuvo como objetivo explorar la eficacia analgésica mediante la comparación de la respuesta analgésica de los parches transdérmicos (PTD) de buprenorfina y fentanilo en dolor oncológico y patrón de uso. Material y Método: Se obtuvieron los datos y variables desde los registros clínicos de pacientes ingresados a la Unidad de Cuidados Paliativos (UCP) del Instituto Nacional del Cáncer (INC) que estaban bajo tratamiento en mayo del 2017. Se incluyó en este estudio a 78 pacientes con PTD, que representan el 13% de los pacientes en control mensual. De estos, 66 estaban bajo tratamiento con buprenorfina y 8 bajo tratamiento con fentanilo. Resultados: Los resultados mostraron que el PTD de buprenorfina se utiliza más frecuentemente que el de fentanilo. El principal motivo de rotación fue dolor no controlado, seguido por imposibilidad de contar con la administración por vía oral. En pacientes con mayores intensidades de dolor somático o visceral se indicó fentanilo y en aquellos con componente neuropático se prefirió el uso de buprenorfina. PTD de fentanilo fue indicado en dosis mayores que buprenorfina, incluso al comparar sus dosis equianalgésicas, siendo la variación de dosis alta para ambos parches: aumentó en promedio 257%. Se logró una mejor respuesta analgésica con buprenorfina, con una variación de intensidad de escala numérica verbal (ENV) de 2,94 y 1,88 puntos de promedio para buprenorfina y fentanilo, respectivamente. Adicionalmente, se presentó mayor reacción local dérmica con fentanilo. Conclusiones: Se evidenció diferencias en patrón de uso y, a diferencia de lo esperado, se obtuvo una mejor eficacia analgésica con buprenorfina. Datos que deben ser corroborados en estudios con mayor número de pacientes bajo tratamiento con fentanilo.


Objective: This study aims to explore analgesic efficacy comparisons of buprenorphine and fentanyl transdermal patches (TDP) in cancer pain and it's usage pattern. Material and Method: Data and variables were collected from patient's clinical reports who were admitted in the National Cancer Institute's (NCI) Palliative Care Unit (PCU) and were under treatment with TDP in May 2017. 78 TDP patients were studied and represented 13% of the monthly control patients in the PCU. Of these, 66 were under buprenorphine treatment and 8 under fentanyl treatment. Results: The results showed that buprenorphine TDP is more frequently used than fentanyl TDP, and the main reason for exchange between them was uncontrolled pain, followed by oral administration impossibility. Fentanyl TDP was indicated in patients with higher somatic or visceral pain intensities and Buprenorphine TDP was preferred in patients with neuropathic pain. Fentanyl TDP was indicated in higher doses than buprenorphine, even when comparing its equianalgesic doses, the dose variation was high for both patches throughout the treatment: it increased on average by 257%. A better analgesic response was achieved with buprenorphine, with a variation of intensity of the Verbal Numerical Scale (VNS) of 2.94 and 1.88 average points, for buprenorphine and fentanyl respectively. Additionally, there was a higher local dermal reaction with fentanyl TDP. Conclusions: Differences in usage patterns were evidenced and, unlike what was expected, better analgesic efficacy was obtained with buprenorphine TDP. This data should be corroborated in receiving fentanyl treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Buprenorphine/administration & dosage , Fentanyl/administration & dosage , Transdermal Patch , Cancer Pain/drug therapy , Analgesics, Opioid/administration & dosage , Palliative Care/methods , Buprenorphine/therapeutic use , Fentanyl/therapeutic use , Treatment Outcome , Dose-Response Relationship, Drug , Analgesics, Opioid/therapeutic use
2.
Rev. méd. Urug ; 36(4): 37-51, dic. 2020. tab
Article in Spanish | LILACS, BNUY | ID: biblio-1144751

ABSTRACT

Resumen: Introducción: la realización de procedimientos dolorosos es cada vez más frecuente en el área de urgencias pediátricas. El control del dolor, mitigar el temor y la ansiedad es una pieza clave en la atención del paciente pediátrico y una de las prioridades del médico emergencista. Objetivo: describir la experiencia en sedoanalgesia con ketamina y fentanilo como único fármaco o asociados a otros para procedimientos dolorosos en el Departamento de Emergencia Pediátrica (DEP) del Centro Hospitalario Pereira Rossell (CHPR). Material y método: estudio descriptivo, retrospectivo. Período: enero de 2011 a julio de 2016. Población: todos los pacientes que recibieron sedoanalgesia con ketamina o fentanilo (solos o asociado a otros fármacos) para realización de procedimientos dolorosos en el DEP-CHPR. Base de datos: historias clínicas. Se midió la eficacia mediante el éxito del procedimiento y la seguridad por la presencia de efectos adversos vinculados a la misma. Resultados: n=352, menores de 15 años; 96 recibieron ketamina y 256 recibieron fentanilo. Media de edad: 7 años, sexo masculino: 245. Dosis media de ketamina 1 mg/kg. Dosis media de fentanilo 1 ɤ/kg. Principales indicaciones de sedoanalgesia: procedimientos ortopédicos (264), toracocentesis (62). Procedimiento con éxito: 352 pacientes. Monitorización cardiovascular y saturometría durante el procedimiento: 100%. Efectos adversos: seis (no requiriendo maniobras de soporte vital avanzado). Ningún paciente cambió su destino final. Conclusiones: la utilización de sedoanalgesia resultó eficaz y segura realizada por el pediatra emergencista capacitado en el manejo farmacológico y de soporte vital avanzado. La monitorización del procedimiento durante y luego de éste es necesaria para pesquisar y resolver precozmente las complicaciones.


Summary: Introduction: painful procedures are gradually increasing frequency in pediatrics emergency units. Controlling pain and mitigating fear and anxiety are of the essence when assisting pediatric patients and one of the priorities of emergency doctors. Objective: to describe using sedoanalgesia with ketamine and fentanyl as the only drug or associated with other drugs during painful procedures, at the Pediatrics Emergency Unit, of the Pereira Rossell Hospital Center. Method: descriptive, retrospective study from January 2011 to July 2016. Population: all patients who received sedoanalgesia with ketamine and fentanyl (as the only drug or associated with other drugs) during painful procedures at the Pediatrics Emergency Unit, of the Pereira Rossell Hospital Center. Database: medical records. Effectiveness was measured by success of the procedure and safety in terms of adverse effects in connection with it. Results: N=352 children younger than 15 years old. 96 received ketamine and 256 received fentanyl. Average age was 7 years old and 245 of them were boys. Average dose of ketamine was 1 mg/kg, average dose of fentanyl was 1 ɤ/kg. Main indications for sedoanalgesia included: orthopaedic procedures (264), thoracentesis (62). Procedures were successful in 352 patients. 100% of cases involved cardiovascular monitoring and blood oxygen saturation meter. Adverse effects: 6 (no advanced life support manoeuvres required). No patient changed final destination. Conclusions: the use of sedoanalgesia was effective and safe, when applied by emergengy pediatricians qualified in the handling of drugs and advanced life support. Monitoring during and after procedure is required to determine and solve complications at an early stage.


Resumo Introdução: a realização de procedimentos dolorosos é cada vez mais frequente na área de emergência pediátrica. Controlar a dor, mitigar o medo e a ansiedade é um elemento-chave no atendimento ao paciente pediátrico e uma das prioridades do médico de emergência. Objetivo: descrever a experiência em sedação e analgesia com ketamina e fentanil como fármaco único ou associado a outros para procedimentos dolorosos, no Serviço de Emergência Pediátrica (DEP) do Centro Hospitalar Pereira Rossell (CHPR) Material e métodos: estudo descritivo retrospectivo. Período: janeiro de 2011 a julho de 2016. População: todos os pacientes que receberam sedação e analgesia com ketamina ou fentanil (isoladamente ou em combinação com outras drogas) para realização de procedimentos dolorosos no DEP-CHPR. Banco de dados: prontuários médicos. A eficácia foi medida pelo sucesso do procedimento e a segurança pela presença de efeitos adversos associados. Resultados: n = 352 crianças menores de 15 anos. 96 receberam ketamina e 256 receberam fentanil. Idade média: 7 anos, sexo masculino: 245. Dose média de ketamina 1 mg / kg. Dose média de fentanil 1 ɤ/kg. Principais indicações para sedação e analgesia: procedimentos ortopédicos (264), toracocentese (62). Procedimento com sucesso: 352 pacientes. Monitorização cardiovascular e oximetria durante o procedimento: 100%. Efeitos adversos: 6 (não requer manobras de suporte avançado de vida). Nenhum paciente mudou seu destino final. Conclusões: o uso da sedação e analgesia foi eficaz e seguro realizado por pediatra de emergência capacitado em manejo farmacológico e suporte avançado de vida. O monitoramento do procedimento durante e após é necessário para investigar e resolver precocemente as complicações.


Subject(s)
Child, Preschool , Child , Fentanyl/therapeutic use , Pain Management , Analgesia , Ketamine/therapeutic use , Emergency Service, Hospital
3.
Rev. cuba. anestesiol. reanim ; 19(2): e561, mayo.-ago. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126352

ABSTRACT

Introducción: Mantener una oxigenación adecuada durante la ventilación a un solo pulmón es el problema fundamental al que se enfrenta el anestesiólogo durante la cirugía torácica, es por ello que se mantiene una constante búsqueda del método anestésico ideal que ayude a lograr dicho objetivo. Objetivos: Evaluar los resultados de dos técnicas de anestesia total intravenosa con remifentanilo y fentanilo como base analgésica e identificar la aparición de complicaciones durante la intervención quirúrgica. Métodos: Se realizó un estudio causiexperimental prospectivo, en el Hospital Docente Clínico Quirúrgico Dr. Salvador Allende, entre enero 2013 a diciembre 2015 en 40 pacientes ASA II o III que requirieron procedimientos intratorácicos. Estos se dividieron en dos grupos. A (remifentanilo-propofol) y B (fentanilo-propofol). Se estudiaron variables hemodinámicas, de oxigenación durante la ventilación unipulmonar, el tiempo de recuperación anestésica (ventilación espontánea, apertura ocular, extubación) y la analgesia posoperatoria. Resultados: No existieron variaciones significativas en la hemodinamia, ni en la oxigenación de los enfermos con el empleo de ambas técnicas anestésicas; sin embargo, el despertar y recuperación posoperatoria a corto plazo fue mejor en el grupo A. La intensidad del dolor posoperatorio según la escala visual análoga fue menor en el grupo B. Conclusiones: Ambas técnicas son efectivas para procedimientos quirúrgicos torácicos. Con mínima interferencia en la hemodinámia y parámetros de oxigenación(AU)


Introduction: Maintaining adequate oxygenation during single-lung ventilation is a fundamental concern faced by the anesthesiologist during thoracic surgery; therefore, a constant search is maintained for the ideal anesthetic method that helps achieve this goal is maintained. Objectives: To evaluate the outcomes of two total intravenous anesthesia techniques with remifentanil and fentanyl as analgesic base and to identify the onset of complications during surgery. Methods: A prospective and quasi-experimental study was carried out at Dr. Salvador Allende Clinical-Surgical Hospital, between January 2013 and December, with 40 ASA II or III patients who required intrathoracic procedures. These were divided into two groups: A (remifentanil-propofol) and B (fentanyl-propofol). Hemodynamic variables and others of oxygenation during one-lung ventilation were studied, together with anesthetic recovery time (spontaneous ventilation, ocular opening, extubation) and postoperative analgesia. Results: There were no significant variations in the hemodynamics or oxygenation of patients with the use of both anesthetic techniques; however, awakening and short-term postoperative recovery was better in group A. Postoperative pain intensity, based on the analogue-visual scale, was lower in group B. Conclusion: Both techniques are effective for thoracic surgical procedures, with minimal effect in hemodynamics and oxygenation parameters(AU)


Subject(s)
Humans , Fentanyl/therapeutic use , Thoracic Surgical Procedures , One-Lung Ventilation , Anesthesia, Intravenous/methods , Prospective Studies , Remifentanil/therapeutic use , Analgesia
4.
Brasília; s.n; 29 jul. 2020.
Non-conventional in Portuguese | PIE, LILACS, BRISA, PIE | ID: biblio-1117728

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 3 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Technology Assessment, Biomedical , Midazolam/therapeutic use , Immunoglobulins/therapeutic use , Methylprednisolone/therapeutic use , Influenza Vaccines/therapeutic use , Propofol/therapeutic use , Chloroquine/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Fentanyl/therapeutic use , Cross-Sectional Studies , Cohort Studies , Enoxaparin/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Copper/therapeutic use , Lopinavir/therapeutic use , Resveratrol/therapeutic use , Interferon alpha-2/therapeutic use , Hydroxychloroquine/therapeutic use , Ketamine/therapeutic use
5.
Rev. cuba. anestesiol. reanim ; 18(3): e441, sept.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093118

ABSTRACT

Introducción: La analgesia subaracnoidea es una alternativa para el trabajo de parto por su seguridad y adecuada relación riesgo/beneficio. Objetivo: Evaluar la efectividad de la analgesia durante el trabajo de parto con la comparación de dos métodos analgésicos. Método: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en 92 gestantes que se atendieron en el Hospital General Docente Abel Santamaría Cuadrado durante el período entre enero de 2014 y enero de 2017. Las pacientes se dividieron en dos grupos de 46 cada uno, al azar, por orden de llegada a la unidad quirúrgica. El grupo A, bupivacaína al 0,5 por ciento, en dosis de 2 mg y fentanilo en dosis de 25 mcg; y grupo B en el que se utilizó petidina en dosis de 25 mg, en todos los casos por vía intratecal. Las variables analizadas fueron: tensión arterial media, frecuencia cardíaca media, saturación parcial de oxígeno, tiempo de inicio de la analgesia, calidad analgésica, efectos adversos y nivel de satisfacción de las pacientes. Se empleó el análisis descriptivo y la diferencia de proporciones. Resultados: El grupo A mantuvo una TAM entre 84 y 88 mmHg, (Z= 6,0 significativa); FC media entre 80 y 88 lat/min, (Z= 1,94 no significativa); SpO2 con una media de 99,2 por ciento. En 46,74 por ciento (43 casos) el tiempo de inicio de la analgesia fue corto (Z= 8,47), siendo Buena en 100 por ciento de los casos (Z= 6,89 significativa), con recién nacido vigoroso en 100 por ciento (Z= 10,25 significativa). La evolución fue satisfactoria en 48,19 por ciento de las pacientes. Presentaron prurito 8,69 por ciento. En el grupo B hubo hipertensión arterial en 2,17 por ciento de los casos, con menos estabilidad de la FC, tiempos mayores de inicio de trabajo de parto en 12,96 por ciento y fue Buena en 40,22 por ciento. Estas pacientes mostraron menos satisfacción (41,30 por ciento). Conclusiones: La administración subaracnoidea de fentanilo/bupivacaína fue más efectiva que la petidina para la analgesia durante el trabajo de parto(AU)


Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 percent, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z=6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z=1.94 not significant); partial oxygen saturation with an average of 99.2 percent. In 46.74 percent (43 cases) the time of onset of analgesia was short (Z=8.47), being good in 100 percent of the cases (Z=6.89 significant), with vigorous newborn in 100 percent (Z=10.25 significant). The evolution was satisfactory in 48.19 percent of the patients. They presented pruritus 8.69 percent. In group B, there was arterial hypertension in 2.17 percent of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 percent and it was good in 40.22 percent. These patients showed less satisfaction (41.30 percent). Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor(AU)


Subject(s)
Humans , Female , Pregnancy , Bupivacaine/therapeutic use , Fentanyl/therapeutic use , Labor Pain/drug therapy , Analgesia , Anesthesia/methods , Meperidine/therapeutic use , Prospective Studies , Longitudinal Studies , Non-Randomized Controlled Trials as Topic
6.
Rev. cuba. anestesiol. reanim ; 18(3): e500, sept.-dic. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093117

ABSTRACT

Introducción: La cirugía video laparoscópica posee beneficios para los pacientes. Las intervenciones con tiempos reducidos implican técnicas anestésicas ajustadas a ellos, lo que determina no pocas dificultades cuando el dolor aparece en la práctica asistencial. El hallazgo de pacientes con dolor posoperatorio inmediato motivó la realización del estudio. Objetivo: Evaluar la efectividad de un opioide de acción rápida como analgésico posoperatorio inmediato administrado vía intranasal. Método: Se desarrolló un estudio causiexpereimental, con dos grupos de enfermos (100 cada uno) a los que se les realizó colecistectomía por vía laparoscópica en el Hospital Militar Central Dr. Luis Díaz Soto, a los 100 pacientes en estudio se les administró FENTANYL 50 mcg intranasal en gotas al llegar a la sala de cuidados posoperatorios. Las variables de estudio incluyeron el dolor según la Escala Visual Análoga (EVA), el tiempo de inicio de acción del opioide y la analgesia lograda, así como los efectos derivados de su empleo. Resultados: la edad promedio fue 51 ± 2, predominó el sexo masculino con 55 por ciento de los casos, se evidenció una EVA promedio de todos los casos iniciales en 3. Al alta, 100 por ciento de los pacientes del grupo estudio poseían analgesia excelente (EVA 2), mientras que los controles poseían una EVA promedio en 5. El prurito fue el evento adverso más frecuente tras la administración de FENTANYL intranasal. Conclusiones: El empleo de un opioide de acción rápida (FENTANYL) es una medida de control del dolor posoperatorio excelente y segura(AU)


Introduction: Videolaparoscopic surgery has benefits for patients. Interventions with reduced times involve anesthetic techniques adjusted to them, which determines many difficulties when pain manifests in the care practice. The finding of patients with immediate postoperative pain motivated the study. Objective: To evaluate the effectiveness of a fast-acting opioid as an immediate postoperative analgesic administered by intranasal way. Method: A quasiexperimental study was developed, with two groups of patients (100 each) who underwent laparoscopic cholecystectomy at Dr. Luis Díaz Soto Central Military Hospital. The hundred patients under study were administered fentanyl 50 mcg as intranasal drops upon arriving at the postoperative care room. The study variables included pain according to the Visual Analogue Scale (VAS), the onset time of opioid action, and the analgesia achieved, as well as the effects derived from its use. Results: The average age was 51 ± 2, the male sex predominated with 55 percent of the cases, an average VAS of all the initial cases was evidenced in three. At discharge, 100 percent of the patients in the study group had excellent analgesia (VAS 2), whereas the controls had an average VAS in 5. Pruritus was the most frequent adverse event after the administration of intranasal fentanyl. Conclusions: The use of a fast-acting opioid (fentanyl) is an excellent and safe postoperative pain control measure(AU)


Subject(s)
Humans , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Cholecystectomy, Laparoscopic/methods , Analgesics/therapeutic use , Fentanyl/therapeutic use , Non-Randomized Controlled Trials as Topic
7.
Rev. méd. panacea ; 8(3): 116-120, sept.-dic. 2019.
Article in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-1127870

ABSTRACT

Objetivo: El dolor agudo postoperatorio es un conjunto de percepciones sensoriales, emocionales y mentales desagradables, asociadas a respuestas autonómicas, psicológicas y conductuales, precipitadas por el acto quirúrgico. Objetivo: Generar conocimiento sobre la eficacia del fentanilo en anestesia raquídea para el dolor agudo postoperatorio. Material y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: La asociación de fentanilo a los anestésicos locales para la anestesia subaracnoidea, reduciendo la dosificación de anestésico local y manteniendo el tiempo de su recuperación y así de esta manera mejorar la calidad, la tasa de éxito de pequeñas dosis de los mismos, con ello, la incidencia de complicaciones hemodinámicas. La administración subaracnoidea de anestésicos locales y opioides, provocan eventos adversos, prurito (30 %), náuseas y vómito (25 %), retención urinaria (10-53 %), depresión respiratoria (3 %). Las diferentes dosis de fentanilo asociado a bupivacaína 0.5%, en la raquianestesia disminuyen la intensidad de dolor según EVA, en el trans-operatorio y el manejo del dolor agudo post-operatorio en los diferentes actos quirúrgicos. Conclusión: Se concluye que la asociación de bupivacaína 0,5% más fentanilo, mediante la técnica raquídea, en pacientes intervenidos quirúrgicamente, resulta eficaz, debido a que permite obtener un menor tiempo de latencia para el bloqueo con una duración prolongada, manteniendo una adecuada hemodinamia y estabilidad respiratoria, y también reduciendo el dolor postoperatorio y sus posibles reacciones adversas. (AU)


Introduction: Acute postoperative pain is a set of unpleasant sensory, emotional and mental perceptions associated with autonomic, psychological and behavioral responses precipitated by the surgical act. Objective: Generate knowledge about the efficacy of fentanyl in spinal anesthesia for acute postoperative pain. Material and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: The association of fentanyl with local anesthetics for subarachnoid anesthesia, reduces the dose of local anesthetic, without prolonging the recovery time, improving the quality, the success rate of small doses of them, with this, the incidence of hemodynamic complications. The subarachnoid administration of local anesthetics and opioids, cause adverse events, itching (30%), nausea and vomiting (25%), urinary retention (10-53%), respiratory depression (3%), all this as a result of interactions with opioid receptors at the brain level. The different doses of fentanyl associated with 0.5% bupivacaine, in spinal anesthesia reduce the intensity of pain according to EVA, in the trans-operative period and the management of acute post-operative pain in the different surgical acts. Conclusion: It is concluded that the association of 0.5% bupivacaine plus fentanyl, through the spinal technique, in surgically treated patients, is effective, since it allows to reach a shorter time of onset of the blockade and longer duration of the block, maintaining adequate hemodynamic and respiratory stability, the time it reduces acute post-operative pain and adverse reactions. (AU)


Subject(s)
Humans , Bupivacaine/therapeutic use , Fentanyl/therapeutic use , Acute Pain , Anesthesia, Spinal , Epidemiology, Descriptive , Prospective Studies
8.
Esc. Anna Nery Rev. Enferm ; 23(3): e20180326, 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1001974

ABSTRACT

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


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


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


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Drug Prescriptions/statistics & numerical data , Drug Interactions , Pharmacovigilance , Tramadol/therapeutic use , Health Profile , Midazolam/therapeutic use , Omeprazole/therapeutic use , Hydrocortisone/therapeutic use , Norepinephrine/therapeutic use , Fentanyl/therapeutic use , Medical Records , Cross-Sectional Studies , Retrospective Studies , Ondansetron/therapeutic use , Polypharmacy , Insulin, Regular, Human/therapeutic use , Patient Safety , Amiodarone/therapeutic use , Inpatients , Intensive Care Units , Length of Stay/statistics & numerical data
9.
Rev. guatemalteca cir ; 23(1): [36-40], ene-dic,2017.
Article in Spanish | LILACS | ID: biblio-884884

ABSTRACT

Introducción: La traqueostomía percutánea es un procedimiento frecuente en la Unidad de Terapia Intensiva indicado en el manejo del paciente críticamente enfermo que requiere ventilación mecánica prolongada. El objetivo del estudio es describir la experiencia de traqueostomía percutánea sin broncoscopía, utilizando la técnica Ciaglia Blue Rhino en la unidad de terapia intensiva del IGSS. Métodos: Estudio descriptvo, observacional, longitudinal y analítco, incluyendo a 42 pacientes críticos ingresados a UTIA del Instituto Guatemalteco de Seguridad Social, a los que se realizó traqueostomía percutánea durante un periodo de 12 meses (Febrero 2016 a Febrero 2017). Se registraron variables demográficas, de severidad, días de ventilación mecánica antes del procedimiento y las complicaciones. Resultados: Se reclutaron 42 pacientes con una edad media de 68 años, con predominio del sexo masculino (28 pacientes). La media de puntuación del Sofa Score fue de 9.3 puntos. Los pacientes requirieron en promedio 13.4 días de ventilación mecánica antes del procedimiento. El 9.53% de pacientes presentaron complicaciones transoperatorias siendo estas: punción inadvertida del tubo orotraqueal (2 casos) y sangrado autolimitado del sito de la traqueostomía (2 casos). Mientras que el 4.76% presentaron complicaciones post-operatorias. Conclusiones: La traqueostomía percutánea por dilatación sin broncoscopía mediante la técnica Ciaglia Blue Rhino es un procedimiento seguro, que se puede realizar al pie de la cama del paciente, con un bajo índice de complicaciones.


Background: Percutaneos dilatatonal tracheostomy techniques have facilitated the procedure in the Intensive Care Unit. The purpose of the study is to describe our experience using this technique, in the ICU. Methods: We collected data from forty two patents during a year. The demographic variables were recorded, also we reviewed the severity of illness, number of days of mechanical ventlaton prior to the procedure, intraoperatve and postoperatve complicatons as well. Results: Forty two patents were included, mean age was 68 years old, most of them were men (28 patents). The mean Sofa Score was 9.3 points. In average, the patents requiered 13.4 days of mechanical ventlaton prior to the perutaneos dilatatonal tracheostomy. In two patents the endotracheal tube was accidentally punctured and two patents had self-limited bleeding at the surgical site. None of the complications were life-threatng to the patents. Conclusions: Percutaneos dilatatonal tracheostomy techniques using the Ciaglia Blue Rhino technique without fber optc bronchoscope is an easy procedure with a low incidence of complications.


Subject(s)
Humans , Male , Female , Middle Aged , Critical Care , Fentanyl/therapeutic use , Intraoperative Complications/diagnosis , Midazolam/therapeutic use , Propofol/therapeutic use , Respiration, Artificial , Respiratory Therapy , Surgical Procedures, Operative , Observational Study
10.
Rev. Assoc. Med. Bras. (1992) ; 63(11): 962-970, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-896306

ABSTRACT

Summary Objective: The authors performed an economic assessment of opioids currently being used for control of postoperative pain relating to the surgical treatment of cancer (fentanyl and sufentanil) within the Brazilian Unified Health System (SUS, in the Portuguese acronym). Method: The assessment was based on the perspective of the government, in order to collaborate with the promotion of effectiveness in public policies of health, and to optimize the allocation of public resources into health. A cost-effectiveness analysis was performed using data collected from the Brazilian Unified Health System and information from literature review, in order to build a decision tree on the alternatives for control of postoperative pain related to cancer treatment among adult patients. The outcomes considered were: effectiveness of postoperative analgesia and occurrence of nausea and vomit in the 48 hour period after surgery, and additional 24-hour cycles in patient follow-up. A univariate sensitivity analysis was conducted in order to verify robustness of the model estimated. Results: Literature review showed a limited number of studies directly comparing fentanyl and sufentanil for control of postoperative pain. The adoption of sufentanil (cost = U$ 25.72 / outcome = 1.6 VAS points) was dominant in relation to the use of fentanyl (cost = U$ 32.58 / outcome = 2.6 VAS points). The estimated model showed robustness in relation to changes in the parameters analyzed. Conclusion: Sufentanil presented higher cost-effectiveness ratio in relation to fentanyl for control of postoperative pain in surgeries related to cancer treatment among adult patients in the Brazilian Unified Health System.


Resumo Objetivo: O artigo apresenta uma avaliação econômica de opioides atualmente utilizados no controle de dor pós-operatória relacionada ao tratamento cirúrgico do câncer (fentanil e sufentanil) no contexto do Sistema Único de Saúde. Método: A avaliação baseou-se na perspectiva do governo, de forma a colaborar na promoção da efetividade das políticas públicas de saúde e melhorar a alocação de recursos públicos em saúde. Uma análise custo-efetividade foi realizada a partir de dados coletados no Sistema Único de Saúde e de informações provenientes de revisão da literatura para construção de uma árvore de decisão contendo alternativas para controle de dor pós-operatória relacionada ao tratamento cirúrgico do câncer entre pacientes adultos. Os desfechos considerados foram: efetividade da analgesia pós-operatória e ocorrência de náusea e vômito no período de 48 horas após cirurgia e em ciclos adicionais de 24 horas de seguimento do paciente. Uma análise de sensibilidade univariada foi conduzida para verificar a robustez do modelo estimado. Resultados: Na revisão de literatura, um número limitado de estudos efetuou comparação direta entre fentanil e sufentanil no controle de dor pós-operatória. A adoção de sufentanil (custo = U$ 25,72 / desfecho = 1,6 pontos VAS) foi dominante em relação ao uso do fentanil (custo = U$ 32,58 / desfecho = 2,6 pontos VAS). O modelo estimado demonstrou robustez em relação a mudanças nos parâmetros analisados. Conclusão: O sufentanil apresentou razão custo-efetividade superior em relação ao fentanil no controle de dor pós-operatória em cirurgias relacionadas ao tratamento de câncer entre pacientes adultos no Sistema Único de Saúde.


Subject(s)
Humans , Adult , Pain, Postoperative/congenital , Fentanyl/economics , Sufentanil/economics , Analgesics, Opioid/economics , Neoplasms/drug therapy , Pain Measurement , Pain Measurement/drug effects , Brazil , Fentanyl/therapeutic use , Cost-Benefit Analysis , Sufentanil/therapeutic use , Analgesics, Opioid/therapeutic use , National Health Programs
11.
Rev. medica electron ; 39(3): 495-506, may.-jun. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902189

ABSTRACT

Introducción: en la actualidad se han descrito diversos modelos de raquianestesia con bupivacaína a dosis diferentes, asociadas o no con fentanilo, que proveen de una anestesia segura y eficaz, disminuyen la intensidad de dolor posquirúrgico, preservan la función cognoscitiva, y reduce las complicaciones atribuidas a la lidocaína hiperbárica por neurotoxicidad. Objetivo: evaluar el efecto de bajas dosis de bupivacaína con fentanilo para anestesia subaracnoidea en pacientes sometidos a resección transuretral de próstata. Materiales y Métodos: se realizó un estudio descriptivo cuantitativo, longitudinal, prospectivo en 200 pacientes programados para dicha cirugía e indicación de anestesia subaracnoidea con bupivacaína, los cuales fueron distribuidos de forma aleatoria en cuatro grupo. Resultados: tanto el bloqueo sensitivo como motor fue más rápido en los pacientes de los Grupos B (3,0; 11,2) y (7,1; 8,3), Grupo C (5,0; 9,4) y (6,2; 9,4) y Grupo D (6,1; 8,3) y (4,7; 10,9); mientras que el Grupo A fue de (6,0; 8,5) y (9,9; 11,7), respectivamente. Se observó que en la totalidad de los pacientes de los Grupos C y D se obtuvo anestesia de buena calidad. Conclusiones: la administración intratecal de 7,5 mg de bupivacaina con 25 µg de fentanilo produjo anestesia satisfactoria, disminuyó el periodo de latencia, mantuvo mejor estabilidad hemodinámica, prolongó la analgesia postoperatoria y se asoció a menor incidencia de complicaciones peri operatorias (AU).


Introduction: currently, several models of spinal anesthesia with bupivacaine in different doses, associated or not to fentanyl, have been described providing a safe and efficacious anesthesia, reducing the intensity of the postsurgical pain, preserving the cognitive function, and reducing the complications attributed to hyperbaric lidocaine due to its neurotoxicity. Aim: to assess the effect of low doses of bupivacaine with fentanyl as subarachnoid anesthesia in patients undergoing a prostate trans-urethral resection. Materials and Methods: a prospective, longitudinal, quantitative, descriptive study was carried out in 200 patients programmed for that kind of surgery and with the indication of subarachnoid anesthesia through bupivacaine; they were randomly distributed in four groups. Outcomes: both, the sensory block and the motor one were faster in the patients of the Group B (3,0; 11,2) and (7,1; 8,3), Group C (5,0; 9,4) and (6,2; 9,4) and Group D (6,1; 8,3) and (4,7; 10,9); while in the patients of the Group A they were (6,0; 8,5) y (9,9; 11,7) respectively. It was observed a good quality anesthesia in all the patients of the Groups C and D. Conclusions: the intrathecal administration of 7,5 mg of bupivacaine with 25 µg of fentanyl produced a satisfactory anesthesia, reduced the latency period, kept a better hemodynamic stability up, extended the post-surgery analgesia and was associated to fewer incidences of perioperative complications (AU).


Subject(s)
Humans , Male , Female , Bupivacaine/therapeutic use , Fentanyl/therapeutic use , Anesthesia, Spinal/methods , Transurethral Resection of Prostate/methods , Observational Studies as Topic , Anesthesia, Local/methods
12.
Anaesthesia, Pain and Intensive Care. 2017; 21 (1): 59-64
in English | IMEMR | ID: emr-187464

ABSTRACT

Aims and Background: To prolong postoperative analgesia many adjuvants has been used opioids and alpha-2 agonists are very popular among them. This study was aimed at comparing the sensory, motor, hemodynamic, sedative and analgesic properties of epidural administration of fentanyl and dexmedetomidine as an adjuvant to ropivacaine


Methodology: With Institutional ethical committee clearance this study was conducted at our hospital. After obtaining informed and written consent, a total of 60 patients scheduled for elective percutaneous nephrolithotomy [PCNL] were randomly allocated into two groups of 30 each. Patients of both genders, aged 21-60 y, ASA physical status I and II were enrolled. Group RD received 28 ml of inj ropivacaine 0.5% + dexmedetomidine 1 ng/kg and Group RF received 28 ml of ropivacaine 0.5% + inj fentanyl 1 pig/kg epidurally. Hemodynamic parameters, sedation scores, and time to onset of sensory loss, complete motor blockade, two segmental dermatomal regression and time of first rescue analgesic were recorded. Data were compiled systematically and analyzed using unpaired t-test, Chi-square and Mann-Whitney U test. P < 0.05 was considered significant


Results: The demographic profile of patients was comparable in both groups. Onset of sensory analgesia up to T10 was 6.8 +/- 2.8 min vs. 8.7 +/- 2.7 min and time to reach maximum motor block was 19.8 +/- 5.8 min vs. 23.9 +/- 4.9 min in Group RD and Group RF respectively, which was significantly less in the Group RD. Postoperative analgesia was significantly prolonged in the Group RF as compared to Group RD, e.g. 394.5 +/- 36.5 vs. 268.5 +/- 28.3 min respectively. Sedation scores were better in the Group RD and highly significant on statistical comparison [P < 0.001]. Incidence of hypotension, nausea and vomiting was high in the Group RF, while incidence of dry mouth was higher in the Group RD


Conclusion: Dexmedetomidine is a better adjuvant than fentanyl when added to epidural ropivacaine in terms of early onset of sensory and motor block, prolonged postoperative analgesia and better sedation with less side effects


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Fentanyl/therapeutic use , Amides/therapeutic use , Adjuvants, Anesthesia , Anesthesia, Epidural , Nephrolithotomy, Percutaneous
13.
Anaesthesia, Pain and Intensive Care. 2017; 21 (1): 65-78
in English | IMEMR | ID: emr-187465

ABSTRACT

Background: Subarachnoid block is still the most commonly used anesthetic technique for lower abdominal surgeries, however local anesthetics alone are associated with relatively short duration of action.The intrathecal adjuvants has been reported to improve the quality of anesthesia along with prolongation of postoperative analgesia and has gained popularity nowadays. So the aim of our study was to compare the dexmedetomidine and fentanyl as intrathecal adjuvant to 0.5% hyberbaric 0.396 bupivacaine with regards respect to onset and duration of sensory and motor block, duration of analgesia, hemodynamic variations and incidence of side effects


Material and Methods: Sixty four female patients, aged 30-60 years, belonging to American Society of Anesthesiologists [ASA] physical status I or II, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomly allocated into two groups, Group BD received 2.5 ml of 0.5% hyperbaric bupivacaine and 5 microg dexmedetomidine diluted in 0.5 ml preservative free normal saline while Group BF received 2.5 ml of 0.5% hyperbaric bupivacaine and 25microg [0.5 ml] fentanyl


Results: There was no statistically significant difference between two groups with respect to onset of sensory and motor block, [p > 0.05]. The mean time for two segment sensory regression was significantly slower in Group BD as compared to Group BF, [p < 0.05]. Patients in Group BD had significantly prolonged duration of sensory and motor block as compared to Group BF [p < 0.05]. Similarly the duration of analgesia was significantly prolonged in Group BD [p < 0.05], along with reduced requirement of rescue analgesics. The patients in both groups did not show any significant difference with respect to hemodynamic changes and incidence of side effects [p > 0.05]


Conclusion: Dexmedetomidine as intrathecal adjuvant was found to have prolonged sensory and motor block, provide good quality of intraoperative analgesia, stable hemodynamics, minimal side effects and prolonged postoperative analgesia along with reduced demand for rescue analgesics as compared to fentanyl


Subject(s)
Adult , Humans , Middle Aged , Female , Subarachnoid Space , Injections, Spinal , Dexmedetomidine/therapeutic use , Fentanyl/therapeutic use , Bupivacaine/analogs & derivatives , Adjuvants, Anesthesia , Prospective Studies , Double-Blind Method
14.
Braz. j. med. biol. res ; 50(2): e5286, 2017. tab, graf
Article in English | LILACS | ID: biblio-839258

ABSTRACT

We aimed to study the effect of fentanyl (Fen) preconditioning on cardiomyocyte apoptosis induced by ischemia-reperfusion (I/R) in rats. A total of 120 Sprague Dawley male rats (age: 3 months) were randomly divided into: sham operation group (S group), I/R group, normal saline I/R group (NS group), and fentanyl low, middle, and high dose groups (Fen1: 2 μg/kg; Fen2: 4 μg/kg; Fen3: 6 μg/kg). Heart rate (HR), mean arterial pressure (MAP), left ventricular developed pressure (LVDP), ±dp/dtmax, malondialdehyde (MDA), superoxide dismutase (SOD) activity, creatine phosphokinase-MB (CK-MB), and cardiac troponin-I (cTnI) were measured. Myocardial ischemic (MI) area, total apoptotic myocardial cells, and protein and mRNA expressions of B-cell lymphoma 2 (Bcl-2) and Bax were detected. HR and MAP were higher, while LVDP and ±dp/dtmax were close to the base value in the Fen groups compared to those in the I/R group. Decreased MDA concentration and CK-MB value and increased SOD activity were found in the Fen groups compared to the I/R group, while cTnI concentration was significantly lower in the Fen1 and Fen2 groups (all P<0.05). Myocardial damage was less in the Fen groups compared to the I/R group and the MI areas and apoptotic indexes were significantly lower in the Fen1 and Fen2 groups (all P<0.05). Furthermore, significantly increased protein and mRNA expressions of Bcl-2, and decreased protein and mRNA expressions of Bax were found in the Fen groups compared to the I/R group (all P<0.05). Fentanyl preconditioning may suppress cardiomyocyte apoptosis induced by I/R in rats by regulating Bcl-2 and Bax.


Subject(s)
Animals , Male , Rats , Apoptosis/drug effects , Fentanyl/therapeutic use , Myocardial Reperfusion Injury/prevention & control , Myocytes, Cardiac/drug effects , Protective Agents/therapeutic use , Myocardial Reperfusion Injury/pathology , Myocytes, Cardiac/pathology , Rats, Sprague-Dawley
15.
Braz. j. med. biol. res ; 48(4): 370-376, 4/2015. tab
Article in English | LILACS | ID: lil-744355

ABSTRACT

Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Androstanols/administration & dosage , Anesthesia, General/methods , Coronary Vessels/surgery , Electrocardiography/drug effects , Intubation/adverse effects , Neuromuscular Nondepolarizing Agents/administration & dosage , Anesthetics, Intravenous/therapeutic use , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Arterial Pressure/drug effects , Double-Blind Method , Etomidate/therapeutic use , Fentanyl/therapeutic use , Heart Rate/drug effects , Intubation/methods , Laryngoscopy , Statistics, Nonparametric
16.
Article in English | WPRIM | ID: wpr-23618

ABSTRACT

The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14+/-12.49 vs. 27.74+/-13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74+/-4.77, P<0.001) than in group L (3.05+/-2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65+/-37.01 vs. 1,720.19+/-361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910)


Subject(s)
Adolescent , Adult , Aged , Analgesia, Patient-Controlled , Anesthetics, Local/therapeutic use , Cardiac Catheters/adverse effects , Chest Tubes/adverse effects , Coronary Artery Bypass , Drainage , Female , Fentanyl/therapeutic use , Humans , Lidocaine/therapeutic use , Male , Middle Aged , Pain Management/methods , Pain Measurement , Pain, Postoperative/drug therapy , Random Allocation , Young Adult
17.
Actas peru. anestesiol ; 21(1): 13-17, ene.-abr. 2013. graf, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-721980

ABSTRACT

Objetivo: Determinar la eficacia analgésica que brinda la administración epidural continua de bupivacaína al 0.125% y fentanilo2 μg/ml en pacientes postoracotomizados. Material y métodos : Se realizó un estudio observacional, prospectivo y descriptivo. La población estuvo conformada por todos los pacientes postoracotomizados durante los meses de marzo y abril del 2012 en elHospital IV Guillermo Almenara Irigoyen. Se evaluó el dolor con la escala visual análoga (EVA) y la escala de Andersen en la unidad de recuperación postanestésica (URPA) y durante las primeras 24 horas en su servicio. De igual manera, se hizo el registro de los eventos colaterales. Se aplicó el ANOVA de medidas repetidas, test de correlación de Pearson y t de student para las medidas dela EVA, y la prueba de chi cuadrado para las medidas de la escala de Andersen. Resultados : La muestra estuvo conformada por veinte pacientes. La edad promedio fue 38 ± 18 años y la lobectomía pulmonar el procedimiento quirúrgico más frecuente (55%). Al ingreso a la URPA la EVA fue 0, luego 1 por 12 horas, 2 a las 24 horas y finalmente 4 a las 48 horas. El dolor leve y moderado,medido por la escala de Andersen, se presentó durante las dos primeras horas. El tiempo que duró la analgesia fue 15.4 ± 7.1 horas. El número de bolos adicionales fue 3 ± 2. El 65% de los pacientes no requirieron analgesia de rescate. La eficacia analgésicamedida por EVA ≤ a 3 fue 85% y medida por Andersen ≤ a 2 fue 80%. 15% presentaron mareo y vómito y 15% sólo náusea. Conclusión:La analgesia epidural continua con bupivacaína al 0.125% y fentanilo 2 μg/ml en pacientes postoracotomizados eseficaz según la evaluación de la EVA y la escala de Andersen


Objective: To determine the analgesic efficacy that continuous epidural administration of 0.125% bupivacaine and 2 æg/ml fentanyl provides in patients after thoracic surgery. Material and Methods: An observational, prospective and descriptive study. The population included all patients who underwent thoracic surgery in March and April 2012 at the Hospital IV Guillermo Almenara Irigoyen. Pain was assessed with visual analogue scale (VAS) and the Andersen scale in the post-anesthesia care unit (PACU) and the next 24 hours. Side events were recorded too. We applied ANOVA for repeated measures, Pearson correlation test and student’s t for measures of VAS, and the chi-square test for measures of Andersen scale. Results: The sample consisted of twenty patients. The mean age was 38 ñ 18 and the most frequent surgical procedure was lung lobectomy (55%). On admission to the PACU VAS was 0, then 1 for 12 hours, 2 at 24 hours and finally 4 at 48 hours. Mild to moderate pain, as measured by the Andersen scale, was present during the first two hours. The analgesia lasted 15.4 ñ 7.1 hours. The number of additional boluses was 3 ñ 2. The 65% of patients did not require rescue analgesia. The analgesic efficacy as measured by EVA less than or equal to 3 was 85% and measured by Andersen scale less than or equal to 2 was 80%. 15% of patients had dizziness and vomiting and 15% only nausea. Conclusion: Continuous epidural analgesia with bupivacaine 0.125% and 2 ug/ml fentanyl in patients after thoracic surgery is effective as assessed by the VAS and Andersen scale.


Subject(s)
Female , Analgesia, Epidural , Bupivacaine/therapeutic use , Thoracic Surgery , Pain, Postoperative/therapy , Fentanyl/therapeutic use , Treatment Outcome , Epidemiology, Descriptive , Observational Studies as Topic , Longitudinal Studies , Prospective Studies
18.
Assiut Medical Journal. 2013; 37 (2 Supp.): 27-40
in English | IMEMR | ID: emr-187327

ABSTRACT

Background: major spinal fusion surgery causes severe postoperative pain, which persists for at least 3 days. Efficient and safe methods for postoperative analgesia after spinal fusion surgery are, therefore, mandatory. This study aimed to compare the analgesic effect of different epidural analgesia combinations and their effects on blood level of Beta-endorphin. We also studied the impact of these analgesic regimens on defined postoperative mobilization maneuvers and on patient satisfaction


Methods: This study was registered in clinical trials number NCT01838707. Sixty patients scheduled for elective posterior lumbar fusion surgery for correction of Spondylolisthesis were enrolled in this study. Patients were randomly allocated into three equal groups [20 each] according to analgesic drugs combinations administered through epidural catheter inserted intraoperatively. All patients received standard general anesthesia. Al the end of posterior instrumentation, the surgeon inserted the epidural catheter under direct vision in the midline. All patients in this study were nursed in a high dependency intensive care facility and received analgesics according to the following protocol. Continuous drug flow will be maintained with a syringe pump. The syringe pump was connected to the epidural catheter [with the reservoir contain either: 0.125% Bupivacaine HCI at flow rate of 4 5 ml/h [5-6.25mg/h bupivacaine]. 0.125% Bupivacaine HCI fentanyl 100 microg at flow rate of 3 5 ml/h [3.75-6.24 mg/h bupivacaine I 6-10 microg /h fentanyl] 0.125% Bupivacaine HCI morphine sulphate 3 mg at flow rate of 3 5 ml/h [3.75-6.24 mg/h bupivacaine 0.18-0.3 mg/h morphine]. Infusion was continued until the third postoperative day. The rate was increased if pain VAS >3 [visual analogue scale] at rest or VAS >6 with movement. The rate was decreased when patients have intolerable relevant motor block [Bromage score >0] or sensory disturbances [numbness], or hypotension [systolic blood pressure <90 mm Hg]. IV rescue analgesia will be Ketrolactromethamine 30 mg. Epidural catheters were removed on the third postoperative day. Pain was assessed using the VAS ranging from "0" [no pain] to "10" [worst imaginable pain]. Pain was evaluated at rest and during mobilization. Maneuvers of particular clinical importance for postoperative mobilization [alone and with help] were chosen: Turning in bed. Standing in front of the bed and walking, and using the toilet without help. The time needed until the patient can first successfully perform these maneuvers was documented. Three venous samples to measure serum B-endorphin level first one preoperative base line, second at first time VAS more three at rest and third sample when VAS less than three at rest. For assessment of patients satisfaction with postoperative pain management a verbal rating score was used. Motor block was quantified with the Bromage scale. Patients will be asked about sensory deficits. Verbal rating scores was used for sedation. Nausea and vomiting and the incidence of pruritus were recorded


Results: There were no significant differences observed between the studied groups regarding patient characteristics [age, sex, ASA status, anesthesia time, surgery duration and number of segments fused]. There were no significant differences in all hemodynamic variables between the three groups, the results of this study showed less pain scores as recorded by VAS all over the study time for group 3 [bupivacaine+ morphine]. Pain scores were lowest for group Ill [bupivacaine + morphine] all over the study time when testing pain during movement. The mean times to turn in bed with and without assistance were lowest in group Ill [bupivacaine morphine]. B-endorphin level, there was no significant differences between means of B-endorphin samples between the groups or within each group. Patients were more satisfied in group 3 all over the study period. The incidence of nausea, vomiting or itching within the observation period was significantly different between the three groups. It was more common in the bupivacaine morphine group


In Conclusion: Epidural analgesia after spine surgery improve pain control and enhance functional recovery, but potential cost issues related to maintenance of the epidural infusion and ICU slay versus potential cost savings in hospital stay and effect on long term outcome must be considered. Also the cost of use B-endorphin as a biomarker of pain severity needs to be revised against the subjective assessment of pain


Subject(s)
Humans , Male , Female , Analgesia, Epidural , Bupivacaine/therapeutic use , Fentanyl/therapeutic use , Drug Combinations/therapeutic use , Morphine/therapeutic use , Pain Measurement
19.
Lima; s.n; 2013. 36 p. tab, graf.
Thesis in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-1112997

ABSTRACT

OBJETIVO: Este estudio estuvo dirigido para mostrar los resultados anestésicos de dosis bajas de bupivacaína hiperbárica asociado a fentanilo intratecal en operación cesárea electiva en el Servicio de Anestesia, Analgesia y Reanimación del Hospital II Suárez Angamos-EsSalud, durante el año 2011. DISEÑO: Se realizó un estudio descriptivo y de diseño transversal en pacientes del Hospital II Suárez Angamos-EsSalud, durante el año 2011. MATERIALES y MÉTODOS: Se seleccionaron a todos los pacientes postoperadas de cesárea electiva que hayan recibido anestesia raquídea y que hayan utilizado Bupivacaina y fentanilo intratecal, durante el periodo de estudio. RESULTADOS: Se estudiaron 40 pacientes con una edad media de 26.925 años. La técnica que se realizó proporcionó unas aceptables condiciones intraoperatorias a las pacientes gestantes programados para cesárea. Las alteraciones cardiovasculares como hipotensión se presento en 30 por ciento y en 15 por ciento náuseas. Ninguna paciente necesitó etilefrina para tratar la hipotensión arterial. El bloqueo motor fue en 100 por ciento de las pacientes a los 5 minutos y el sensitivo a los 3 minutos. No se observo casos de cefalea post punción dural. CONCLUSIÓN: El resultado de este estudio confirma que la bupivacaína hiperbárica asociado a fentanilo, proporciona una rápida y efectiva anestesia para cesareadas.


OBJECTIVE: This study was directed to show the anesthesia bupivacaine hyperbaric intratecal with fentanyl results in elective Caesarean operation in the Service of Anesthesia, Analgesia and Resuscitation of the Hospital II Suarez Angamos-EsSalud, during year 2011. MATERIALS AND METHODS: It was realised a cross-sectional descriptive study in patients of the Hospital II Suarez Angamos-EsSalud, during year 2011. They were selected to all the patients had an operation of Caesarean elective who have received rachidian anesthesia and who have used intratecal bupivacaine and fentanyl, during the period of study. RESULTS: 40 patients with an average age of 26,925 years studied. The technique was performed intraoperative conditions provides some acceptable to pregnant patients scheduled for cesarean section. The cardiovascular alterations as hypotension appear in 30 per cent, and in 15 per cent nauseas. No patient needed etilefrine to treat arterial hypotension. The blockade motor was in 100 per cent of the patients to the 5 minutes and the sensitive one to the 3 minutes. I am not observed cases of migraine post dural puncture. CONCLUSION: The result of this study confirms that bupivacaine hyperbaric associate to fentanyl, provides a fast and effective anesthesia for cesareadas.


Subject(s)
Female , Humans , Pregnancy , Adult , Anesthetics, Combined , Bupivacaine/therapeutic use , Cesarean Section , Fentanyl/therapeutic use , Anesthesia, Spinal , Cross-Sectional Studies
20.
Article in English | WPRIM | ID: wpr-121609

ABSTRACT

PURPOSE: To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery. METHODS: Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 microg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed. RESULTS: The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups). CONCLUSIONS: Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Eye Enucleation , Eye Evisceration , Female , Fentanyl/therapeutic use , Humans , Ketorolac/therapeutic use , Male , Middle Aged , Pain, Postoperative/drug therapy , Retrospective Studies , Treatment Outcome , Young Adult
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