Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 241
Filter
1.
Prensa méd. argent ; 108(3): 120-125, 20220000. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1373050

ABSTRACT

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


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


Subject(s)
Humans , Adult , Middle Aged , Aged , Pain, Postoperative/therapy , Pain Measurement , Analgesia, Epidural/methods , Double-Blind Method , Prospective Studies , Longitudinal Studies , Clonidine/administration & dosage , Aftercare , Non-Randomized Controlled Trials as Topic , Lumbosacral Region/surgery , Morphine/administration & dosage
2.
Rev. bras. anestesiol ; 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
3.
Rev. bras. anestesiol ; 70(5): 457-463, Sept.-Oct. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1143967

ABSTRACT

Abstract Background: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. Methods: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. Results: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49−5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0−0.97]), history of motion sickness (2.5 [1.27−5.25]), significant nausea during the first trimester (0.3 [0.16−0.64]), intraoperative nausea and vomiting (8.2 [3.67−20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01−4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. Conclusions: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.


Resumo Introdução: Os fatores de risco para náusea e vômitos pós-operatórios (NVPO) ainda não foram definidos para pacientes de obstetrícia. Neste estudo, nosso objetivo foi identificar potenciais fatores de risco para NVPO após parto cesariano realizado sob raquianestesia. Método: Uma coorte de pacientes submetidas a cesariana sob raquianestesia foi usada para investigar potenciais fatores de risco para NVPO. Os melhores fatores de risco numéricos foram dicotomizados por meio do método qui-quadrado. Uma rede casual de independência condicional (método de associação adicional) foi usada para selecionar os melhores preditores de NVPO. Resultados: Das 260 pacientes iniciais, 250 completaram o estudo. A razão de chances para NVPO foi estatisticamente significante para menor idade materna (< 25 anos: 2,9 [1,49−5,96]), dose mais baixa de bupivacaina raquidiana (< 13 mg, inf [2,4-inf]), dose mais baixa de morfina raquidiana (< 80 mg, 0,03 [0−0,97]), histórico de enjoo de movimento (2,5 [1,27−5,25]), náuseas importantes durante o primeiro trimestre (0,3 [0,16−0,64]), náusea e vômitos intraoperatórios (8,2 [3,67−20,47]) e menor idade gestacional (< 38 semanas, 2,0 [1,01−4,08]). A rede causal selecionou ausência de náuseas significativas durante o primeiro trimestre gestacional, náusea intraoperatória e idade gestacional < 38 semanas como os principais fatores de risco diretos para NVPO. Conclusões: Náusea intraoperatória e idade materna < 25 anos foram os principais fatores de risco para NVPO após cesariana sob raquianestesia. A ausência de náusea autorreferida durante o primeiro trimestre foi um fator protetor para náusea e vômitos após cesariana.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Cesarean Section/methods , Postoperative Nausea and Vomiting/epidemiology , Anesthesia, Spinal/methods , Prognosis , Bupivacaine/administration & dosage , Cesarean Section/adverse effects , Prospective Studies , Risk Factors , Cohort Studies , Maternal Age , Postoperative Nausea and Vomiting/etiology , Anesthesia, Spinal/adverse effects , Anesthetics, Local/administration & dosage , Morphine/administration & dosage
4.
Arq. bras. med. vet. zootec. (Online) ; 72(1): 161-168, Jan.-Feb. 2020. tab, graf
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1088917

ABSTRACT

O objetivo deste estudo foi avaliar os efeitos analgésicos transoperatórios da infusão contínua de morfina e cetamina, associada ou não à lidocaína, em gatas submetidas à OSH eletiva. Foram utilizadas 16 fêmeas adultas, hígidas, pré-medicadas com acepromazina (0,1mg/kg) e morfina (0,5mg/kg), ambas pela via intramuscular, induzidas com cetamina (1mg/kg) e propofol (4mg/kg), pela via intravenosa, e mantidas sob anestesia geral inalatória com isoflurano a 1,4 V%. Os animais foram alocados aleatoriamente em dois grupos: grupo morfina, lidocaína e cetamina (MLK, n=8), que recebeu bolus de lidocaína (1mg/kg), pela via IV, seguido de infusão de morfina, lidocaína e cetamina (0,26mg/kg/h, 3mg/kg/h e 0,6mg/kg/h, respectivamente); e grupo morfina e cetamina (MK, n=8), que recebeu bolus de solução salina, seguido de infusão de morfina e cetamina, nas mesmas doses do MLK. Os momentos avaliados foram: M0, basal, cinco minutos após a indução; M1, imediatamente após a aplicação do bolus de lidocaína ou solução salina; M2, M3, M4 e M5, a cada cinco minutos, até completar 20 minutos do início da infusão; M6, após a incisão da musculatura; M7, após pinçamento do primeiro pedículo ovariano; M8, após pinçamento do segundo pedículo ovariano; M9, após pinçamento da cérvix; M10, após sutura da musculatura; M11, ao final da cirurgia; e M12, M13 e M14, intervalos de cinco minutos, até completar uma hora de infusão. A FP no M0 foi maior no MLK quando comparado ao MK. Em ambos os grupos, a PAS foi maior no M7 e no M8 em relação ao M0, porém no MK, além da PAS, a FP foi maior do M7 ao M13, assim como a f. Os animais do MK necessitaram de um número maior de resgates transoperatorios, total de 23, do que o MLK, total de sete. Conclui-se que a adição de lidocaína incrementou a analgesia oferecida, reduzindo o número de resgates analgésicos transoperatórios, a dose total de fentanil, bem como a probabilidade de os animais necessitarem dese tipo de resgate.(AU)


The aim of this study was to evaluate the trans-operative analgesics, continuous infusion of morphine and ketamine, with or without lidocaine in cats undergoing elective OSH. Sixteen adult cats were used, otherwise healthy, pre-medicated with acepromazine (0.1mg/kg) and morphine (0.5mg/kg), both intramuscularly, induced with ketamine (1mg/kg) and propofol (4mg/kg), intravenous, maintained under general inhalation anesthesia with isoflurane 1.4 V%. The animals were randomly allocated into two groups: morphine, lidocaine and ketamine (MLK, n= 8), which received intravenous bolus of lidocaine (1mg/kg) followed by infusion of morphine, lidocaine and ketamine (0.26mg / kg/h, 3mg / kg/h and 0.6mg / kg/h, respectively); Morphine and ketamine (MK, n= 8), who received bolus of saline followed by infusion of morphine and ketamine at the same doses of MLK. The evaluated moments were: M0, basal, 5 minutes after induction; M1 immediately after the application of lidocaine bolus injection or saline; M2, M3, M4 and M5, every 5 minutes to complete 20 minutes after the start of infusion; M6, after the incision of the musculature; M7, after clamping of the first ovarian pedicle; M8, after clamping of the second ovarian pedicle; M9, after clamping of the cervix; M10, after suturing of the musculature; M11, at the end of surgery; And M12, M13 and M14, 5 minute intervals until completing one hour of infusion. The time to extubating and full recovery of animals, and the need for rescue analgesic fentanyl intraoperatively were also evaluated. HR in M0 was higher in MLK when compared to MK. In both groups the SBP was higher in M7 and M8 compared to M0, but the MK, addition of SAP, HR was greater M7 to M13, as well as f. MK animals required a greater number of trans-operative rescues than the MLK. It was concluded that the addition of lidocaine to the protocol using morphine and ketamine increased its analgesia.(AU)


Subject(s)
Animals , Female , Cats , Ketamine/administration & dosage , Lidocaine/administration & dosage , Morphine/administration & dosage , Ovariectomy/veterinary , Anesthetics, Combined , Salpingectomy/veterinary , Hysterectomy/veterinary
5.
Rev. bras. anestesiol ; 69(6): 580-586, nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057470

ABSTRACT

Abstract Background and objectives: The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block. Methods: Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the "corner pocket". Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed. Results: Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale numerical rating scale (NRS) at 24 hours did not differ between groups. Conclusions: Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function.


Resumo Justificativa e objetivos: O aparecimento frequente de paralisia hemidiafragmática durante o bloqueio interescalênico restringe seu uso em pacientes com insuficiência respiratória. O bloqueio supraclavicular pode ser uma opção segura e eficaz. Nosso objetivo primário foi avaliar a incidência de paralisia hemidiafragmática após bloqueio supraclavicular guiado por ultrassom e compará-lo com o bloqueio interescalênico. Métodos: Os adultos agendados para cirurgia eletiva do ombro sob anestesia regional (Hospital Universitário de Toulouse) foram prospectivamente incluídos neste estudo observacional, de maio de 2016 a maio de 2017. Vinte mililitros de ropivacaína a 0,375% foram injetados, preferencialmente objetivando a interseção da primeira costela e da artéria subclávia. A excursão diafragmática foi medida por ultrassonografia antes e 30 minutos após a anestesia regional. Uma redução ≥ 25% na excursão diafragmática durante um sniff test definiu a paralisia hemidiafragmática. Dispneia e hipoxemia foram registradas na sala de recuperação. Fatores preditivos de paralisia hemidiafragmática (sexo, idade, peso, tabagismo, capacidade funcional) foram explorados. A dor pós-operatória também foi avaliada. Resultados: Quarenta e dois e 43 pacientes dos grupos bloqueio supraclavicular e bloqueio interescalênico, respectivamente, foram avaliados. A incidência de paralisia hemidiafragmática foi de 59,5% no grupo bloqueio supraclavicular em comparação com 95,3% no grupo bloqueio interescalênico (p < 0,0001). O movimento paradoxal do diafragma foi mais comum no grupo bloqueio interescalênico (RR = 2, 95% IC 1,4-3; p = 0,0001). Uma variação semelhante na saturação de oxigênio foi registrada entre os pacientes com e sem paralisia hemidiafragmática (p = 0,08). Nenhum fator preditivo de paralisia hemidiafragmática pôde ser identificado. O consumo de morfina e o maior escore na escala numérica (NRS) em 24 horas não diferiram entre os grupos. Conclusão: Devido à frequente incidência de paralisia hemidiafragmática após bloqueio supraclavicular, essa técnica não pode ser recomendada para pacientes com função respiratória alterada.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Respiratory Paralysis/etiology , Brachial Plexus Block/methods , Ropivacaine/administration & dosage , Anesthetics, Local/administration & dosage , Pain, Postoperative/prevention & control , Pain, Postoperative/epidemiology , Respiratory Paralysis/epidemiology , Incidence , Prospective Studies , Cohort Studies , Ultrasonography, Interventional , Brachial Plexus Block/adverse effects , Analgesics, Opioid/administration & dosage , Middle Aged , Morphine/administration & dosage
6.
Rev. bras. anestesiol ; 69(4): 327-334, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042000

ABSTRACT

Abstract Background Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia. Methods Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery. Results The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48 h after surgery were -7.2 mg (95%CI: -12.5 to -2.1, p < 0.001), -3.9 mg (95%CI: -11.9 to 4.7, p = 0.26), -0.6 mg (95%CI: (-12.7 to 12.7, p = 0.80), and -1.8 mg (95%CI: (-11.6 to 15.6, p = 0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point. Conclusion Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.


Resumo Justificativa A dor pós-operatória é uma grande preocupação quando o remifentanil é usado para anestesia intravenosa total devido à sua meia-vida ultracurta. Os opioides de ação mais longa, como o sufentanil, têm sido usados durante a indução de anestesia intravenosa total à base de remifentanil como um meio de superar essa deficiência. Porém, a eficácia e segurança de tal estratégia ainda precisam de evidências advindas de ensaios clínicos randômicos. Portanto, objetivamos avaliar a eficácia analgésica e a segurança pós-operatória de uma dose única de sufentanil administrada durante a indução de anestesia intravenosa total à base de remifentanil. Métodos Quarenta pacientes eletivamente agendados para cirurgia abdominal aberta foram randomizados para receber anestesia intravenosa total à base de remifentanil, com ou sem uma dose única de sufentanil, após a indução da anestesia. Avaliamos o consumo de morfina no pós-operatório, administrado através de uma bomba de analgesia controlada pelo paciente. Os escores de dor autorrelatados e a ocorrência de náusea, vômito, prurido, agitação, sonolência e depressão respiratória também foram avaliados até dois dias após a cirurgia. Resultados A diferença média entre os grupos sufentanil e controle em relação ao consumo de morfina em sala de recuperação pós-anestesia e após 12, 24 e 48 horas da cirurgia foi de -7,2 mg (IC 95%: -12,5 a -2,1, p < 0,001), -3,9 mg (IC 95%: -11,9 a 4,7, p = 0,26), -0,6 mg (IC 95%: (-12,7 a 12,7, p = 0,80) e -1,8 mg (IC 95%: -11,6 para 15,6, p = 0,94), respectivamente. Não houve diferença significativa tanto nos escores de dor autorrelatados, quanto na incidência de eventos adversos entre os grupos. Conclusão Nossos achados sugerem que a administração de sufentanil durante a indução de anestesia intravenosa total à base de remifentanil está associada à redução do consumo de opioides no pós-operatório imediato.


Subject(s)
Humans , Male , Female , Adult , Aged , Pain, Postoperative/prevention & control , Sufentanil/administration & dosage , Remifentanil/administration & dosage , Analgesics, Opioid/administration & dosage , Anesthesia, Intravenous/methods , Time Factors , Double-Blind Method , Analgesia, Patient-Controlled/statistics & numerical data , Sufentanil/adverse effects , Remifentanil/adverse effects , Middle Aged , Morphine/administration & dosage
7.
Rev. bras. anestesiol ; 69(3): 259-265, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013414

ABSTRACT

Abstract Background: Pain management committee established a pain performance improvement plan in 2012. Objectives: The aim of the study was to assess the trends in analgesic consumption in a tertiary teaching hospital and the associated economic impact. Methods: A descriptive, retrospective study was conducted between 2011 and 2015. The analysis included: anti-inflammatory and antirheumatic products non-steroids, opioid analgesics and other analgesics and antipyretics. Data are converted into DDD/100 bed-days to analyze consumption trends. Main outcome measure: assessment of the analgesic consumption after the implementation of a pain performance improvement plan. Results: Overall, non-steroidal anti-inflammatory and antirheumatic products consumption decreased in 24.8 DDD/100 bed-days (-28.3%), accounting for most of the total analgesic consumption decrease (-13%) and total cost (-44.3%). Opioid consumption increased markedly from 22.3 DDD/100 bed-days in 2011 to 26.5 DDD/100 bed-days in 2015 (+18.9%). In 2011, the most consumed opioid was morphine (8.6 DDD/100 bed-days). However, there was an increasing trend in fentanyl consumption (from 8.1 to 12.1 DDD/100 bed-days in 2015), which resulted in fentanyl replacing morphine from the most consumed opioid in 2015 (12.1 DDD/100 bed-days). In 2015, the group of other analgesics and antipyretics represented 46.2% of the total analgesic consumption. Acetaminophen was the most commonly consumed analgesic drug (53.2 DDD/100 bed-days in 2015) and had the highest total cost, it represented 55.4% of the overall cost in 2015. Conclusion: Opioid consumption showed an increasing trend during the 5 year period, with fentanyl replacing morphine as the most used opioid. In general, analgesics diminished use was due to the decreasing trend of consumption of non-steroidal anti-inflammatory and antirheumatic products.


Resumo Justificativa: A Comissão para o Manejo da Dor estabeleceu um plano de melhoria no controle da dor em 2012. Objetivo: Avaliar as tendências do consumo de analgésicos em um hospital de ensino terciário e o impacto econômico associado. Métodos: Estudo descritivo, retrospectivo, feito entre 2011 e 2015. A análise incluiu: produtos anti-inflamatórios e antirreumáticos não esteroides, analgésicos opioides e outros analgésicos e antipiréticos. Os dados foram convertidos em DDD/100 leitos-dia para analisar as tendências de consumo. Principal medida do desfecho: avaliação do consumo de analgésicos após o estabelecimento de um plano de melhoria no controle da dor. Resultados: O consumo total de produtos anti-inflamatórios e antirreumáticos não esteroides diminuiu em 24,8 DDD/100 leitos-dia (-28,3%), representando a maior parte da redução total do consumo de analgésicos (-13%) e o custo total (-44,3%). O consumo global de opioides aumentou acentuadamente de 22,3 DDD/100 leitos-dia em 2011 para 26,5 DDD/100 leitos-dia em 2015 (+18,9%). Em 2011, o opioide mais consumido foi a morfina (8,6 DDD/100 leitos-dia). No entanto, houve uma tendência crescente no consumo de fentanil (de 8,1 para 12,1 DDD/100 leitos-dia em 2015), o que resultou na substituição de morfina por fentanil como o opioide mais consumido em 2015 (12,1 DDD/100 leitos-dia). Em 2015, o grupo dos outros analgésicos e antipiréticos representou 46,2% do consumo total de analgésicos. Acetaminofeno foi o analgésico mais consumido (53,2 DDD/100 leitos-dia em 2015) e teve o maior custo total, representou 55,4% do custo total em 2015. Conclusão: O consumo de opioides mostrou uma tendência crescente durante o período de cinco anos, fentanil substituiu morfina como o opioide mais usado. Em geral, o uso diminuído de analgésicos foi devido à tendência decrescente do consumo de produtos anti-inflamatórios e antirreumáticos não esteroides.


Subject(s)
Humans , Pain/drug therapy , Analgesics/administration & dosage , Analgesics, Opioid/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Fentanyl/administration & dosage , Retrospective Studies , Antirheumatic Agents/administration & dosage , Dose-Response Relationship, Drug , Drug Utilization/trends , Hospitals, Teaching , Morphine/administration & dosage
8.
Rev. bras. anestesiol ; 69(2): 144-151, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003406

ABSTRACT

Abstract Background and objective: Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method: 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results: No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion: The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.


Resumo Justificativa e objetivo: O bloqueio paravertebral torácico é uma técnica regional opcional para o alívio da dor pós-toracotomia, deste modo diminui o consumo de opioides, náuseas e vômitos no pós-operatório, tontura, depressão respiratória e custos com saúde. O objetivo deste estudo foi investigar os efeitos de bupivacaína isolada e bupivacaína + dexmedetomidina no escore de dor pós-operatória e no consumo de analgésicos em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom. Material e método: Noventa e três pacientes, ASA I-II, com idades entre 18 e 65 anos, foram incluídos no estudo e programados para cirurgia torácica. Antes da indução anestésica, o procedimento de bloqueio paravertebral foi realizado por um anestesista com o uso de ultrassom. Os casos foram estratificados aleatoriamente em três grupos. O procedimento de bloqueio paravertebral foi realizado com injeção de 20 mL de bupivacaína a 0,5% no Grupo B (n = 31) e de 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 µg) no Grupo BD. O Grupo C recebeu morfina intravenosa via analgesia controlada pelo paciente sem bloqueio paravertebral. Os escores de dor pós-operatória foram registrados na sala de recuperação e no pós-operatório usando a escala VAS. Parâmetros hemodinâmicos, efeitos adversos e consumo de morfina também foram registrados. Resultados: Não houve diferença significativa entre os grupos B e C em relação a efeitos adversos intraoperatórios, como bradicardia e hipotensão, enquanto esses efeitos adversos foram significativamente maiores no Grupo BD (p = 0,04). Os escores VAS em repouso e movimento foram significativamente menores no Grupo BD em relação ao Grupo C (p < 0,001). O consumo total de morfina foi significativamente menor nos grupos B e BD em comparação com o Grupo C (p < 0,001). No Grupo BD, a frequência cardíaca e a pressão arterial média foram menores, mas esse resultado não foi clinicamente significativo (p < 0,05). Conclusão: A adição de dexmedetomidina à bupivacaína reduz os escores de dor pós-operatória e o consumo de morfina em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/prevention & control , Bupivacaine/administration & dosage , Dexmedetomidine/administration & dosage , Nerve Block/methods , Thoracotomy/methods , Double-Blind Method , Prospective Studies , Analgesia, Patient-Controlled/methods , Ultrasonography, Interventional/methods , Analgesics, Non-Narcotic/administration & dosage , Drug Synergism , Drug Therapy, Combination , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Middle Aged , Morphine/administration & dosage
9.
Rev. Assoc. Med. Bras. (1992) ; 65(2): 262-269, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-990342

ABSTRACT

SUMMARY INTRODUCTION: Opioids interact with both innate and adaptive immune systems and have direct effects on opioid receptors located on immune cells. Research on this topic has provided evidence of the opioid influence on the immune response associated with surgical stress. The immunological effects of opioids are currently being investigated, particularly whether they influence the outcome of surgery or the underlying disease regarding important aspects like infection or cancer progression. This review addresses background research related to the influence of the opioid receptor on the immune system, the immunosuppressive effect associated with major opioids during the perioperative period, and their clinical relevance. The objective of the study was to review the effects of opioids on the immune system. Methods: A search strategy was conducted in PubMed, Embase, and the Cochrane databases using the terms "immunosuppression," "immune system," "surgical procedures," "analgesics," "opioids" and "perioperative care." Results: The immunosuppressive effect of opioids was identified over 30 years ago. They include signaling and acting directly through immune cells, including B and T lymphocytes, NK cells, monocytes, and macrophages, as well as activating the downstream pathways of the hypothalamic-pituitary-adrenal (HPA) axis leading to the production of immunosuppressive glucocorticoids in the peripheral and sympathetic nervous system.


RESUMO INTRODUÇÃO: Os opioides interagem com ambos os sistemas imunes, inato e adaptativo, através de efeitos diretos sobre os receptores dos opioides localizados nas células imunes. As pesquisas neste assunto têm fornecido evidência da influência dos opioides sobre a resposta imune associada ao estresse cirúrgico. Os efeitos imunológicos dos opioides estão sendo pesquisados na atualidade, principalmente se eles determinam o resultado da cirurgia ou doença consequente devido a fatos importantes como infecção ou progressão do câncer. Essa revisão tem como alvo ver antecedentes em pesquisa relativa à influência dos receptores dos opioides no sistema imunológico, o efeito imunossupressor associado com opioides maiores durante o período peri-operatório e sua importância clínica. O objectivo da pesquisa foi revisar os efeitos dos opioides no sistema imunológico. MÉTODOS: Uma estrategia de procura foi dirigida na mídia PubMed, e no cadastro de Embase e The Cochrane, usando os termos "imunosuppressão", "sistema imunológico", "procedimentos cirúrgicos", "analgésicos", "opioides" e "cuidado peri-operatório". RESULTADOS: O efeito imunosuppressor dos opioides foi identificado há mais de 30 anos. Os efeitos imunosupressores incluem sinalização e ação diretamente através das células imunes, mesmo com os linfócitos B e T, células NK, monócitos e macrófagos, também como ativando as vias de corrente do eixo hipotálamo- hipófise- adrenal (HPA) levando à produção de glucocorticoides imunossupresores no sistema nervoso periférico e simpático.


Subject(s)
Humans , Analgesics, Opioid/pharmacology , Immune System/drug effects , Tramadol/administration & dosage , Tramadol/pharmacology , Fentanyl/administration & dosage , Fentanyl/pharmacology , Adaptive Immunity/drug effects , Perioperative Period , Remifentanil/administration & dosage , Remifentanil/pharmacology , Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Morphine/pharmacology
10.
Clinics ; 72(12): 729-736, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-890699

ABSTRACT

OBJECTIVES: This study examined periarticular multimodal drug injection and the use of nonsteroidal anti-inflammatory drugs for an early analgesic effect after total knee arthroplasty and total hip arthroplasty. Patient satisfaction and benefits from the treatment were also assessed. METHODS: A total of 110 patients who were scheduled to undergo total knee arthroplasty and 86 patients who were scheduled to undergo total hip arthroplasty were divided into two groups, the study group and the control group. The study group received a periarticular multimodal drug injection during surgery. The control group received an equal volume of normal saline. All patients received an analgesia pump and a moderate dose of nonsteroidal anti-inflammatory drugs. Resting and motion Numeric Rating Scale scores, the Western Ontario and McMaster Universities Arthritis Index, knee or hip joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti-inflammatory drug consumption and side effects were recorded. RESULTS: Both study groups exhibited significant improvement in pain Numeric Rating Scale scores during rest and exercise several days after the surgery. The range of joint motion was greater in the study group, and the length of postoperative hospital stay was shorter than that in the control group. Patients in the study group consumed fewer nonsteroidal anti-inflammatory drugs and reported greater satisfaction with surgery. CONCLUSION: Intraoperative periarticular multimodal drug injection significantly relieved pain after surgery and reduced nonsteroidal anti-inflammatory drug consumption. These patient had a better postoperative experience, including satisfaction and rehabilitation.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Pain, Postoperative/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/etiology , Case-Control Studies , Pain Management , Analgesia , Injections, Intra-Articular
11.
Dolor ; 25(65): 12-15, jul. 2016. graf, tab
Article in Spanish | LILACS | ID: biblio-907614

ABSTRACT

Objetivos: determinar cuáles fueron los opioides usados al momento de morir, tiempo de uso e incremento de dosis. Materiales y Métodos: Pacientes paliativos ingresados el año 2008 al Instituto Nacional del Cáncer. Los datos fueron obtenidos del libro de ingresos y registro informático de recetas. Resultados: Ingresaron 456 pacientes, de éstos fallecieron 170 (37 por ciento), con mediana de edad de 66 años (16-97) y 53 por ciento mujeres. Al momento del fallecimiento, un 14 por ciento no estaba recibiendo opioides. Los opioides utilizados fueron codeína, 11,7 por ciento; tramadol, 32,4 por ciento; oxicodona, 0,7 por ciento; morfina, 37,2 por ciento; metadona, 4,8 por ciento; buprenorfina TTS, 10,3 por ciento; y fentanilo TTS, 2,8 por ciento. En todos, las dosis promedio fueron bajas (morfina, 26,9 mg/día; metadona, 17,9 mg/ día; tramadol, 142,8 mg/día; buprenorfina, 19 ug/h; y fentanilo, 19,5 ug/h). No se evidenció un incrementosignificativo en las dosis. El tiempo promedio de uso desde el último cambio de opioide fue 41,3 DE+63,5 días con una mediana de 26 días (1 a 366). No se encontró diferencia entre los opioides. Discusión: La mitad de los pacientes fallecidos estaban en OMSIII. De los usuarios de opioides potentes, solo un 37 por ciento estaba con morfina. Las dosis promedio de todosfueron bajas. El tiempo transcurrido entre el inicio del opioide y la muerte no difirió entre opioides. En suma, no todos los pacientes paliativos en nuestra población falleció recibiendo morfina, no se evidenciaron diferencias en el tiempo de uso del opioide ni un aumento de la dosis, lo cual desmitifica dos creencias: “si uso morfina me voy a morir antes” y “si uso morfina deberé aumentar las dosis y me haré dependiente”.


Objectives: to determine which were the opioids used at the time of death, time usage and increasing doses. Materials and Methods: Palliative patients admitted to the National Cancer Institute in 2008. Data were obtained from the book income and prescription computer records. Results: 456 patients were treated, 170 died (37 percent), with median age of 66 (16-97) and 53 percent women. At death time, 14 percent was not receiving opioids. Used opioids were 11.7 percent codeine; 32.4 percent tramadol; 0.7 percent oxycodone; 37.2 percent morphine; 4.8 percent methadone; 10.3 percent TTS buprenorphine and 2.8 percent TTS fentanyl. All average doses were low (morphine 26,9 mg/day, methadone 17,9 mg/ day, tramadol, 142,8 mg/ day, buprenorphina 19 ug/h and fentanyl 19,5 ug/h). A significant increase in dose was not observed. Average time since the last change of opiode was 41.3 DE+63.5 days with a median of 26 days (1-366), no difference was found between different opioids. Discussion: Half of the patients who died were in OMSIII. Only 37 percent of strong opioids users was using morphine. The average doses of all were low. Time between start opioid use and death was no different for different opioids. So not all palliative patients died using morphine, and no differences were observed in opioids time of use, or increasing doses which demystifies two beliefs: “If I use morphine I will die prematurely” and “If I use morphine, I will increase dose and I will be dependent ”.


Subject(s)
Male , Female , Humans , Adolescent , Adult , Young Adult , Middle Aged , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Cancer Pain/drug therapy , Morphine/administration & dosage , Palliative Care , Neoplasms/drug therapy , Terminally Ill , Time Factors
12.
Rev. bras. anestesiol ; 66(2): 140-144, Mar.-Apr. 2016. tab
Article in English | LILACS | ID: lil-777405

ABSTRACT

ABSTRACT BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. METHODS: After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1 mg (Group I, n = 22) or 0.4 mg (Group II, n = 26) ITM in addition to 7.5 mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p < 0.05 was considered as statistically significant. The numeric data were analyzed by thet-test and presented as mean ± SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. RESULTS: Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n = 6) of the patients had vomiting during the first postoperative 24 h compared to 0% in Group I (p = 0.025). CONCLUSION: For inguinal hernia repairs, the dose of 0.1 mg of ITM provides comparable postoperative analgesia with a dose of 0.4 mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.


RESUMO JUSTIFICATIVA E OBJETIVOS: Comparar os efeitos de duas doses diferentes de morfina intratecal (MIT) sobre a analgesia no pós-operatório, os tempos até a primeira mobilização e micção no pós-operatório e a gravidade dos efeitos colaterais. MÉTODOS: Após a aprovação do Comitê de Ética Institucional, 48 pacientes com estado físico ASA I-II foram incluídos neste estudo randômico e duplo-cego. A raquianestesia foi feita com 0,1 mg (Grupo I, n = 22) ou 0,4 mg (Grupo II, n = 26) de MIT adicionados a 7,5 mg de bupivacaína hiperbárica. Os tempos até a primeira necessidade de analgésico, mobilização e micção e os efeitos colaterais no pós-operatório foram registrados. As análises estatísticas foram feitas com o programa SPSS 15.0 e p < 0,05 foi considerado estatisticamente significativo. Os dados numéricos foram analisados com o teste t e expressos como média ± DP. Os dados categóricos foram analisados com o teste do qui-quadrado e expressos como número de pacientes e porcentagem. RESULTADOS: Os dados demográficos foram semelhantes entre os grupos. Não houve diferenças em relação à dor, aos tempos até a primeira necessidade de analgésicos, à primeira mobilização e primeira micção. A única diferença entre os dois grupos foi a incidência vômito. No Grupo II, 23% (n = 6) das pacientes apresentaram vômito durante as primeiras 24 horas de pós-operatório, em comparação com 0% no Grupo I (p = 0,025). CONCLUSÃO: Para herniorrafia inguinal, a dose de 0,1 mg de MIT fornece analgesia comparável à dose de 0,4 mg, com uma incidência de vômito significativamente menor quando combinada com uma dose baixa de bupivacaína hiperbárica.


Subject(s)
Humans , Male , Female , Adult , Aged , Bupivacaine/administration & dosage , Hernia, Inguinal/surgery , Anesthesia, Spinal/methods , Morphine/administration & dosage , Pain, Postoperative/prevention & control , Pain, Postoperative/epidemiology , Vomiting/epidemiology , Double-Blind Method , Follow-Up Studies , Dose-Response Relationship, Drug , Herniorrhaphy/methods , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Anesthetics, Local/administration & dosage , Middle Aged , Morphine/adverse effects
13.
Int. j. morphol ; 34(1): 252-261, Mar. 2016. ilus
Article in English | LILACS | ID: lil-780502

ABSTRACT

Based on previous studies, a variety of bioenvironmental elements including inappropriate nutrition, diseases, infections, stressors, and medications are involved in epigenetic changes. Drug abuse is one of the most important causes of epigenetic changes and a concern in today's world. Studies have shown that morphine use by pregnant mothers causes several disorders in mothers in addition to transferring abnormalities to the next generation (placenta and embryo). Epigenetic factors such as morphine cause changes in gene expression in placenta as the first embryonic defense barrier. Because placenta does all the nutritional exchanges between mother's and embryo's blood, placental health guarantees normal embryonic development. Many studies have been conducted on defects caused by epigenetic factors including medication use. Opioid abuse including morphine abuse has endangered health of many people. Morphine changes gene expression by binding to opioid receptors on placental villi. Based on the studies, major epigenetic changes due to drug use are mediated by DNA methylation and histone changes. Recognizing different epigenetic factors and their effect on placental and embryonic development is among modern studies. The importance of recognizing epigenetic changes caused by drug abuse by pregnant mothers can be the most important way to prevent adulthood diseases in the embryo and in some cases miscarriage. Changes induced by epigenetic factors can be moderated or reversed by controlling the epigenetic factors. This study is a review of changes caused by morphine use by pregnant rats on development of placenta.


Basado en estudios anteriores, una variedad de elementos bioambientales incluyendo la nutrición inadecuada, enfermedades, infecciones, factores de estrés, y los medicamentos están involucrados en los cambios epigenéticos. El abuso de drogas es una de las causas más importantes de los cambios epigenéticos y una preocupación en el mundo actual. Los estudios han demostrado que el uso de la morfina por parte de las madres embarazadas es la causa de varios trastornos en las madres, además de la transferencia de anormalidades a la siguiente generación (la placenta y el embrión). Factores epigenéticos como la morfina causan cambios en la expresión génica en la placenta como la primera barrera de defensa embrionaria. Debido a que la placenta es el medio de todos los intercambios nutricionales entre la madre y la sangre del embrión, la salud de la placenta garantiza el desarrollo embrionario normal. Muchos estudios se han realizado sobre los defectos causados por factores epigenéticos que incluyen el uso de medicamentos. El abuso de opioides, incluyendo la morfina ha puesto en peligro la salud de muchas personas. La morfina produce cambios de expresión génica mediante la unión a los receptores opioides en vellosidades placentarias. Basado en los estudios, los principales cambios epigenéticos debido al consumo de drogas están mediadas por metilación del ADN y los cambios en las histonas. En la actualidad se han publicado estudios referente al conocimiento de diferentes factores epigenéticos y su efecto sobre la placenta y el desarrollo embrionario. La importancia de reconocer los cambios epigenéticos causados por el abuso de drogas por mujeres embarazadas puede ser la forma más importante para prevenir las enfermedades de la edad adulta en el embrión y en algunos casos del aborto espontáneo. Los cambios inducidos por factores epigenéticos pueden ser moderados o revertidos mediante el control de los factores epigenéticos. Este estudio es una revisión de los cambios en el desarrollo de la placenta causados por el uso de morfina en ratas preñadas.


Subject(s)
Humans , Female , Pregnancy , Epigenesis, Genetic , Morphine/adverse effects , Placenta/drug effects , Maternal Exposure/adverse effects , Morphine/administration & dosage
14.
Acta cir. bras ; 31(1): 67-73, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-771846

ABSTRACT

PURPOSE: To compare the effects of magnesium sulfate and ketamine on postoperative pain and total morphine consumption in a placebo-controlled design. METHODS: One hundred and twenty women scheduled for total abdominal hysterectomy were included in this prospective, randomized, double-blind study. Postoperatively, when the Numeric Pain Rating Scale (NPRS) was four or more, IV-PCA morphine was applied to all patients. The patients were randomized into three groups: Group K ketamine, Group M magnesium, and Group C saline received as infusion. Total morphine consumption for 48h, pain scores, adverse effects, and patients' satisfaction were evaluated. RESULTS: Total morphine consumption was significantly lower in Group K (32.6±9.2 mg) than in Group M (58.9±6.5 mg) and in Group C (65.7±8.2 mg). The satisfaction level of patients in Group K was higher than the other two groups (p<0.05). Pruritus and nausea were observed more frequently in Group C. CONCLUSİON: The addition of ketamine to IV-PCA morphine reduces the total consumption of morphine without psychotic effects; however, magnesium did not influence morphine consumption.


Subject(s)
Aged , Female , Humans , Middle Aged , Analgesics, Opioid/administration & dosage , Analgesics/therapeutic use , Ketamine/therapeutic use , Magnesium Sulfate/therapeutic use , Morphine/administration & dosage , Pain Management/methods , Pain, Postoperative/drug therapy , Chemotherapy, Adjuvant/methods , Double-Blind Method , Hysterectomy/rehabilitation , Ketamine/adverse effects , Magnesium Sulfate/adverse effects , Prospective Studies , Pain Measurement/methods , Patient Satisfaction/statistics & numerical data
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(1): 39-45, jan.-mar.2016.
Article in Portuguese | LILACS | ID: lil-789775

ABSTRACT

A congestão pulmonar aguda no paciente com doença cardíaca é uma manifestação clínica de extrema gravidade, ocorrendo em aproximadamente 25% dos casosde insuficiência cardíaca aguda. O diagnóstico é essencialmente clínico, baseado na anamnese e exame físico. Os exames complementares não devem retardar o início do tratamento na sala de emergência. Descontrole pressórico, progressão da doença valvar, infarto do miocárdio e arritmias são fatores desencadeantes frequentes paraedema agudo de pulmão. O tratamento inicial fundamenta-se na suplementação de oxigênio e suporte ventilatório, administração de opioides, diuréticos e vasodilatadores endovenosos. Inotrópicos estão indicados na presença de instabilidade hemodinâmicacom disfunção orgânica...


Acute pulmonary congestion in patients with cardiac disease is a clinical manifestation of extreme severity, occurring in approximately 25% of cases of acute heart failure. Diagnosis is essentially clinical, based on history and physical examination. Complementarytests should not delay the start of treatment in the emergency room. Uncontrolled blood pressure, progression of valvular disease, myocardial infarction, and arrhythmias are common triggers for acute pulmonary edema. Initial treatment is based on supplemental oxygen and ventilatory support, administration of opioids, intravenous diuretics, andvasodilators. Inotropic agents are indicated in the presence of hemodynamic instability with organ dysfunction...


Subject(s)
Humans , Pulmonary Edema/complications , Pulmonary Edema/therapy , Heart Failure/diagnosis , Heart Failure/therapy , Heart Atria , Cardiotonic Agents , Dyspnea/complications , Diuretics/administration & dosage , Echocardiography, Doppler/methods , Electrocardiography/methods , Risk Factors , Morphine/administration & dosage , Ultrafiltration/methods , Vasodilator Agents/administration & dosage
16.
Yonsei Medical Journal ; : 475-481, 2016.
Article in English | WPRIM | ID: wpr-21006

ABSTRACT

PURPOSE: Intrathecal morphine pump (ITMP) infusion therapy is efficient in managing malignant and nonmalignant chronic pain refractory to standard treatment. However, the high cost of an ITMP is the greatest barrier for starting a patient on ITMP infusion therapy. Using the revised Korean reimbursement guidelines, we investigated the cost effectiveness of ITMP infusion therapy and conducted a patient survey. MATERIALS AND METHODS: A retrospective chart review of 12 patients who underwent ITMP implantation was performed. Morphine dose escalation rates were calculated, and numeric rating scale (NRS) scores were compared before and after ITMP implantation. We surveyed patients who were already using an ITMP as well as those who were candidates for an ITMP. All survey data were collected through in-person interviews over 3 months. Data on the cost of medical treatment were collected and projected over time. RESULTS: The NRS score decreased during the follow-up period. The median morphine dose increased by 36.9% over the first year, and the median time required to reach a financial break-even point was 24.2 months. Patients were more satisfied with the efficacy of ITMP infusion therapy than with conventional therapy. The expected cost of ITMP implantation was KRW 4000000-5000000 in more than half of ITMP candidates scheduled to undergo implantation. CONCLUSION: The high cost of initiating ITMP infusion therapy is challenging; however, the present results may encourage more patients to consider ITMP therapy.


Subject(s)
Adult , Aged , Analgesics, Opioid/administration & dosage , Chronic Pain/drug therapy , Cost-Benefit Analysis , Female , Humans , Infusion Pumps, Implantable/economics , Injections, Spinal , Male , Middle Aged , Morphine/administration & dosage , Pain Management/methods , Patient Satisfaction , Republic of Korea , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome
17.
Arq. bras. med. vet. zootec ; 67(6): 1554-1562, nov.-dez. 2015. graf
Article in Portuguese | LILACS | ID: lil-768152

ABSTRACT

Objetivou-se com este estudo avaliar o efeito analgésico trans e pós-operatório da eletroacupuntura em onda denso-dispersa e frequências 3 e 200Hz, nos pontos E44, R3 e BP4, compará-lo com a analgesia promovida pelos pontos BP6, E36 e VB 34, e pela morfina, em cadelas submetidas à ovariosalpingohisterectomia (OSH). Teve-se como hipótese que a eletroacupuntura nos pontos E44, R3 e BP4 resultaria em controle da dor trans e pós-operatória melhor ou igual àquele promovido pela eletroacupuntura nos pontos BP6, E36 e VB34 e pela morfina. Trinta e seis cadelas submetidas à cirurgia eletiva de OSH foram distribuídas em blocos ao acaso em três grupos com 12 animais. Em dois grupos foi realizada eletroacupuntura denso-dispersa, com frequência de 3 e 200Hz, sendo que, no primeiro grupo (GEA), foram estimulados os pontos BP4, E44, R3 e, no segundo grupo (GEB), os pontos BP6, E36, VB34...


Thirty-six dogs undergoing elective ovariohysterectomy surgery were randomly distributed into 3 groups of 12 animals each. In the first group, dense-dispersed electroacupuncture was performed with a frequency of 3-200 Hz in SP4, ST44, KID3 points and 1.5mL of saline was given intramuscularly (GEA group). For the second group, dense-dispersed electroacupuncture was performed with a frequency of 3-200 Hz in SP6, ST36, GB34 points and 1.5mL of saline given intramuscularly (GEB group)...


Subject(s)
Animals , Female , Dogs , Acupuncture Analgesia/veterinary , Electroacupuncture , Electroacupuncture/veterinary , Hysterectomy/veterinary , Ovariectomy/veterinary , Transcutaneous Electric Nerve Stimulation/veterinary , Morphine/administration & dosage , Postoperative Period
18.
Rev. bras. anestesiol ; 65(4): 244-248, July-Aug. 2015. tab, ilus
Article in English | LILACS | ID: lil-755133

ABSTRACT

BACKGROUND AND OBJECTIVES:

The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus.

METHODS:

180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2 mg were randomized to receive, after the child's birth, metoclopramide 10 mg (Group I - control), droperidol 2.5 mg (Group II) or ondansetron 8 mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined.

RESULTS:

Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively.

CONCLUSIONS:

Ondansetron does not inhibit subarachnoid morphine-induced pruritus.

.

JUSTIFICATIVA E OBJETIVOS:

O efeito profilático do ondansetron sobre prurido provocado pela morfina subaracnoidea é controverso, enquanto evidências sugerem que o droperidol previne o prurido. O objetivo do presente trabalho é comparar o efeito do droperidol com o do ondansetron sobre o prurido provocado pela morfina subaracnoidea.

MÉTODOS:

180 pacientes ASA I ou II programadas para serem submetidas a cesarianas sob anestesia subaracnoidea à qual foram acrescentados 0,2 mg de morfina foram divididas aleatoriamente para receber, logo após o nascimento da criança, 10 mg de metoclopramida (grupo I - controle), 2,5 mg de droperidol (grupo II),ou 8 mg de ondansetron (grupo III). No período pós-operatório as pacientes foram avaliadas quanto ao prurido (ausente, leve, moderado ou intenso) ou outros efeitos colaterais por observadores que não sabiam a alocação das pacientes. As pacientes também não sabiam da sua alocação. Os grupos foram comparados pela sua tendência a apresentar formas mais severas de prurido. Também determinamos o NNT.

RESULTADOS:

As pacientes alocadas para receber droperidol [Odds RatioProporcional: 0,45 (Intervalo de Confiança de 95% 0,23 - 0,88)] relataram menos prurido do que as que receberam metoclopramida. O efeito do ondansetron foi semelhante ao da metoclopramida [Odds Ratio Proporcional: 0,95 (Intervalo de Confiança de 95% 0,49 - 1,83)]. O NNT do droperidol foi 4,0 e o do ondansetron foi 14,7.

CONCLUSÕES:

O ondansetron não inibiu o prurido provocado pela morfina subaracnoidea.

.

JUSTIFICACIÓN Y OBJETIVOS:

El efecto profiláctico del ondansetrón sobre el prurito provocado por la morfina subaracnoidea es controvertido, mientras las evidencias nos muestran que el droperidol previene el prurito. El objetivo del presente trabajo es comparar el efecto del droperidol con el del ondansetrón sobre el prurito provocado por la morfina subaracnoidea.

MÉTODOS:

Ciento ochenta pacientes ASA I o II programadas para someterse a cesáreas bajo anestesia subaracnoidea a la cual se le añadió 0,2 mg de morfina fueron divididas aleatoriamente para recibir, inmediatamente después del nacimiento del niño, 10 mg de metoclopramida (grupo I-control), 2,5 mg de droperidol (grupo II) u 8 mg de ondansetrón (grupo III). En el período postoperatorio las pacientes fueron evaluadas en cuanto al prurito (ausente, leve, moderado o intenso) u otros efectos colaterales por observadores que no sabían nada respecto de la ubicación de las pacientes. Las pacientes tampoco conocían su propia ubicación. Los grupos fueron comparados por su tendencia a presentar formas más severas de prurito. También se determinó el NNT.

RESULTADOS:

Las pacientes aleatorizadas para recibir droperidol (odds ratioproporcional: 0,45 [intervalo de confianza del 95%: 0,23-0,88]) relataron menos prurito que las que recibieron metoclopramida. El efecto del ondansetrón fue similar al de la metoclopramida (odds ratio proporcional: 0,95 [intervalo de confianza del 95%: 0,49-1,83-+). El NNT del droperidol fue 4 y el del ondansetrón 14,7.

CONCLUSIONES:

El ondansetrón no inhibió el prurito provocado por la morfina subaracnoidea.

.


Subject(s)
Humans , Female , Pregnancy , Adult , Pruritus/prevention & control , Ondansetron/therapeutic use , Droperidol/therapeutic use , Morphine/adverse effects , Pruritus/chemically induced , Cesarean Section/methods , Double-Blind Method , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Anesthesia, Obstetrical/adverse effects , Anesthesia, Obstetrical/methods , Metoclopramide/therapeutic use , Morphine/administration & dosage
19.
Rev. bras. ortop ; 50(3): 300-304, May-Jun/2015. tab
Article in English | LILACS | ID: lil-753142

ABSTRACT

OBJETIVO: Comparar o efeito analgésico da administração intra-articular de morfina e levobupivacaína (isoladas ou associadas) com a administração intratecal de morfina em pacientes submetidos à reconstrução do LCA com enxerto autólogo de tendão patelar. MÉTODOS: Análise retrospectiva dos dados coletados nos prontuários de 60 pacientes entre 20 e 50 anos, submetidos à vídeoartroscopia de joelho para reconstrução do LCA. Os pacientes encontravam-se separados em quatro grupos de 15 pessoas (A, B, C e D) de acordo com a administração intra-articular e peri-incisional de 20 mL de solução salina com 5 mg de morfina em A, 20 mL de solução a 0,5% levobupivacaína em B, 10m L de solução com 2,5 mg de morfina e 10 mL de solução a 0,5% de levobupivacaína em C e morfina intratecalmente em D. RESULTADOS: Todos os grupos apresentaram baixos escores de dor nas primeiras 12 horas após a cirurgia. Os grupos B e C apresentaram escores de dor significativamente maiores do que o grupo D (controle) 24 horas após a cirurgia. Não houve diferença estatística entre os escores de dor do grupo A e do grupo D. CONCLUSÃO: Nos pacientes do grupo A houve analgesia comparável à dos pacientes do D, ao passo que o procedimento em C não foi capaz de reproduzir o efeito analgésico observado em D quando os indivíduos foram estudados após 24 horas da cirurgia. Novos estudos são necessários para evidenciar o exato mecanismo de ação, bem como a dose e concentração ideais para aplicação articular de opioides.


OBJECTIVE: To compare the analgesic effect of intra-articular administration of morphine and levobupivacaine (separately or in combination) with intrathecal administration of morphine in patients undergoing anterior cruciate ligament (ACL) reconstruction using autologous grafts from the patellar tendon. METHODS: This was a retrospective analysis on data gathered from the medical files of 60 patients aged 20 to 50 years who underwent knee video arthroscopy for ACL reconstruction. The patients were divided into four groups of 15 individuals (A, B, C and D) according to the agent administered into the joint and around the incision: 20 mL of saline solution with 5 mg of morphine in A; 20 mL of 0.5% levobupivacaine solution in B; 10 mL of solution with 2.5 mg of morphine plus 10 mL of 0.5% levobupivacaine solution in C; and morphine administered intrathecally in D. RESULTS: All the groups presented low pain scores during the first 12 h after the surgery. Groups B and C presented significantly greater pain scores than shown by group D (control), 24 h after the surgery. There was no statistical difference in pain scores between group A and group D. CONCLUSION: The patients in group A presented analgesia comparable to that of the patients in group D, whereas the procedure of group C was no capable of reproducing the analgesic effect observed in group D, as observed 24 h after the surgery. Further studies are needed in order to show the exact mechanism of action, along with the ideal dose and concentration for applying opioids to joints.


Subject(s)
Humans , Male , Female , Young Adult , Middle Aged , Anesthesia , Arthroscopy , Anterior Cruciate Ligament/surgery , Morphine/administration & dosage
20.
Acta ortop. mex ; 29(1): 34-39, ene.-feb. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-755662

ABSTRACT

Antecedentes: El manejo adecuado del dolor postoperatorio en pacientes intervenidos de artrodesis vertebral instrumentada es esencial para disminuir la morbimortalidad postoperatoria. El uso de morfina por vía intratecal podría proporcionar una analgesia efectiva minimizando la dosis necesaria y los efectos adversos secundarios. El objetivo del estudio es valorar la eficacia de la morfina intratecal en el control del dolor postoperatorio en pacientes intervenidos de artrodesis vertebral instrumentada. Material y métodos: Se realizó un estudio prospectivo aleatorizado incluyendo a 46 pacientes intervenidos de fusión vertebral instrumentada. Los pacientes fueron divididos mediante randomización al azar en dos grupos, uno de los cuales recibió una dosis de morfina intratecal de 0.003 mg/kg antes del cierre de la herida quirúrgica. Durante el postoperatorio se registró frecuencia respiratoria, PCO2, PO2, necesidad de analgesia coadyuvante y valoración subjetiva del dolor mediante la escala visual analógica (EVA) a las 6, 24 y 48 horas tras la intervención. Los resultados fueron analizados mediante pruebas no paramétricas. Resultados: Los pacientes que recibieron morfina intratecal presentaron una disminución estadísticamente significativa del dolor postoperatorio durante las primeras 48 h con una puntuación EVA promedio cercana a 3. En 24.1% de los pacientes presentaron complicaciones asociadas al uso de cloruro mórfico, tales como náuseas o vómitos, sin diferencias significativas respecto al grupo control. Conclusiones: El uso de morfina intratecal es una opción terapéutica segura y efectiva en el control del dolor postquirúrgico precoz en pacientes intervenidos de fusión vertebral instrumentada, permitiendo una recuperación más cómoda y rápida.


Background: Proper postoperative pain management in patients undergoing vertebral arthrodesis with instrumentation is essential to reduce postoperative morbidity and mortality. Intrathecal morphine may provide effective analgesia minimizing the dose required and adverse side effects. The objective of this study is to assess the efficacy of intrathecal morphine to control postoperative pain in patients undergoing vertebral arthrodesis with instrumentation. Material and methods: A prospective randomized trial was conducted; it included 46 patients who underwent vertebral fusion with instrumentation. Patients were randomly divided into two groups: one of them received a 0.003 mg/kg dose of intrathecal morphine before closing the surgical wound. The following parameters were recorded during the postoperative period: respiratory rate, PCO2, PO2, need for adjuvant anesthesia and subjective pain assessment with the visual analog scale (VAS), at 6, 24 and 48 hours after the surgery. The results were analyzed with non-parametric tests. Results: Patients who received intrathecal morphine had a statistically significant decrease in postoperative pain within 48 hours after the surgery, with a mean VAS score close to 3. In 24.1 percent of patients had complications associated with the use of morphine chloride, such as nausea and vomiting, without any statistically significant differences compared with the control group. Conclusions: Intrathecal morphine is a safe and effective treatment option to control early postoperative pain in patients undergoing vertebral fusion with instrumentation. This leads to a more convenient and quick recovery.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/prevention & control , Spinal Fusion/methods , Analgesics, Opioid/adverse effects , Injections, Spinal , Morphine/adverse effects , Pain Measurement , Prospective Studies , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL