Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 74
Rev. bras. ginecol. obstet ; 43(4): 250-255, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280036


Abstract Objective To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. Methods The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and duringmobilization), analgesia requirement, and return of bowel motility. Results The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times. Conclusion In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominismuscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Humans , Female , Young Adult , Pain, Postoperative/etiology , Cesarean Section/methods , Abdominal Wall/surgery , Wound Closure Techniques , Pain, Postoperative/prevention & control , Cesarean Section/adverse effects , Cross-Sectional Studies , Prospective Studies , Pain Management , Gastrointestinal Motility , Analgesics/therapeutic use
Rev. bras. oftalmol ; 80(4): e0027, 2021.
Article in English | LILACS | ID: biblio-1341149


ABSTRACT Description of a patient with Fuchs endothelial dystrophy submitted to a corneal transplant, performed by Descemet membrane endothelial keratoplasty, which evolved with sudden, paroxysmal pain in the frontotemporal region, postoperatively. Due to the ophthalmologic picture of the patient, the attending physician believed in possible rejection of the graft, neglecting the complaint of pain. Even after a successful second transplant, performed due to primary failure, disabling pain persisted and the physician did not manage it. After years of investigation, consulting with several specialists, it was concluded the patient presented trigeminal neuralgia that had not been treated since the surgical procedure. In addition, it led to several psychosocial consequences. Therefore, it is essential to be aware trigeminal neuralgia is a possible outcome of corneal transplantation, and its symptoms should not be neglected by the attending physician, thus contributing to better management for transplanted patients.

RESUMO Descrição do relato de caso de uma paciente com distrofia endotelial de Fuchs submetida a transplante de córnea, realizado pela técnica DMEK, que evoluiu com quadro de dor súbita, paroxística, em região frontotemporal, no pós-operatório. Devido ao quadro oftalmológico da paciente, o médico assistente acreditava em possível rejeição do enxerto, negligenciando a dor. Mesmo após sucesso do segundo transplante, realizado devido à falência primária, as dores incapacitantes persistiam, e nenhuma conduta, por parte do médico, foi realizada. Após anos de investigação, mediante consultas com diversos especialistas, concluiu-se que a paciente apresentava um quadro de neuralgia do nervo trigêmeo que não tinha sido tratada desde a realização do procedimento cirúrgico. Além disso, apresentava uma série de consequências psicossociais. Portanto, torna-se imprescindível entender que a neuralgia do nervo trigêmeo é um possível desfecho do transplante de córnea, e seus sintomas não devem ser negligenciados por parte do médico assistente, contribuindo para melhores condutas para os pacientes transplantados.

Humans , Female , Middle Aged , Corneal Transplantation/adverse effects , Pain, Postoperative/etiology , Trigeminal Neuralgia/etiology , Trigeminal Neuralgia/drug therapy , Fuchs' Endothelial Dystrophy/surgery , Corneal Transplantation/methods , Descemet Membrane/surgery , Descemet Stripping Endothelial Keratoplasty/adverse effects , Descemet Stripping Endothelial Keratoplasty/methods , Eye Pain/etiology , Pain Management , Malpractice
J. appl. oral sci ; 29: e20200932, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250188


Abstract Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane's Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient's perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon's experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.

Humans , Tooth, Impacted/surgery , Trismus/etiology , Pain, Postoperative/etiology , Postoperative Complications , Tooth Extraction/adverse effects , Prospective Studies , Retrospective Studies , Edema , Mandible , Molar , Molar, Third/surgery
Dolor ; 30(72): 20-24, nov. 2020.
Article in Spanish | LILACS | ID: biblio-1362442


El síndrome de dolor crónico postmastectomía es frecuente en pacientes sometidas a cirugía por cáncer de mamas, llegando a ser invalidante en casos severos. Existen distintos factores de riesgo para que éste se presente, siendo el dolor agudo postoperatorio el único en el cual podemos intervenir. La importancia de implementar estrategias de prevención en el periodo perioperatorio es fundamental. En la mantención de la anestesia general, la utilización de propofol se asocia con menor incidencia de dolor agudo postoperatorio. El uso de anestésicos locales, ya sea por vía tópica, subcutánea y sistémica, ha demostrado su beneficio para disminuir el dolor agudo. No obstante, solo el uso tópico y endovenoso ha sido útil para reducir el dolor hasta 3 meses postcirugía. Técnicas de analgesia regional, como el bloqueo PEC I y II, bloqueo paravertebral y bloqueo del erector de la espina han demostrado ser útiles para reducir el dolor agudo; pero solo el bloqueo paravertebral ha demostrado su utilidad en reducir el dolor hasta 1 año postcirugía. El uso de gabapentina, pregabalina y ketamina desde el periodo preoperatorio disminuyen la incidencia de dolor agudo postoperatorio. En tanto, la venlafaxina y dexmedetomidina demostraron su utilidad para reducir el dolor crónico.

Postmastectomy chronic pain syndrome is common in patients undergoing surgery for breast cancer, becoming invalidating in severe cases. There are different risk factors for this to occur, with acute post-operative pain being the only one in which we can intervene. The importance of implementing prevention strategies in the perioperative period is essential. In the maintenance of general anesthesia, the use of propofol is associated with a lower incidence of acute post-operative pain. The use of local anesthetics, whether topically, subcutaneously and systemically, has shown its benefit in reducing acute pain. However, only topical and endovenous use has been useful to reduce pain up to 3 months after surgery. Regional analgesia techniques, such as PEC I and II block, paravertebral block, and spinal erector block have been shown to reduce acute pain; but only the paravertebral block has shown its usefulness in reducing pain up to 1 year after surgery. The use of gabapentin, pregabalin and ketamine from the preoperative period reduce the incidence of acute postoperative pain. Meanwhile, venlafaxine and dexmedetomidine proved useful in reducing chronic pain.

Humans , Female , Pain, Postoperative/prevention & control , Chronic Pain/prevention & control , Analgesics/therapeutic use , Mastectomy/adverse effects , Pain, Postoperative/etiology , Breast Neoplasms/surgery , Propofol/therapeutic use , Dexmedetomidine/therapeutic use , Chronic Pain/etiology , Pregabalin/therapeutic use , Gabapentin/therapeutic use , Ketamine/therapeutic use , Anesthetics, Local
Rev. bras. anestesiol ; 70(3): 271-277, May-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137178


Abstract Background and objectives: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. Methods: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. Results: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p < 0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24 hours (p < 0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction. Conclusion: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.

Resumo Justificativa e objetivos: Estima-se que 38-45% dos pacientes apresentem ansiedade pré-operatória. Observamos que doadores vivos submetidos à nefrectomia para doação apresentam ansiedade. A ansiedade pré-operatória pode complicar a recuperação anestésica e controle pós-operatório de dor do paciente. O presente estudo mediu as taxas de ansiedade no pré-operatório e seus efeitos na recuperação anestésica e dor pós-operatória em pacientes doadores submetidos a nefrectomia. Método: Quarenta e oito doadores vivos submetidos a nefrectomia para doação de rim foram incluídos neste estudo de coorte prospectivo observacional. A ansiedade pré-operatória foi medida usando os inventários IDATE-I e IDATE-II. As relações entre os escores de ansiedade e dados relacionados a demografia, recuperação da anestesia e escores de dor no pós-operatório foram estudadas. Resultados: Os achados foram notáveis porque os escores de ansiedade de doadores renais vivos se correlacionaram de maneira significante com as variáveis de recuperação, a saber, tempo para respiração espontânea, tempo para respiração adequada, tempo para extubação e tempo para alta da RPA (p < 0,01). Os escores de ansiedade apresentaram correlação significantemente positiva com os escores de dor do 30o minuto e horas 1, 2, 4, 8, 12 e 24, e a quantidade total de analgésicos administrada nas 24 horas (p < 0,05). Foi observada também correlação significantemente negativa entre os escores de ansiedade e satisfação dos pacientes. Conclusão: Nosso estudo mostrou que doadores vivos submetidos a nefrectomia para doação com altos níveis de ansiedade apresentaram tempos de recuperação tardios e altos escores de dor no pós-operatório. Assim, a identificação dos pacientes com alto nível de ansiedade no pré-operatório é crucial para propiciar recuperação da anestesia e controle da dor no pós-operatório satisfatórios durante a nefrectomia para doação de órgão.

Humans , Male , Female , Adolescent , Adult , Young Adult , Anxiety/complications , Pain, Postoperative/etiology , Pain, Postoperative/epidemiology , Anesthesia Recovery Period , Living Donors/psychology , Nephrectomy , Prospective Studies , Preoperative Period , Middle Aged
Rev. Col. Bras. Cir ; 47: e20202607, 2020. graf
Article in English | LILACS | ID: biblio-1155352


ABSTRACT Herniorrhaphy is one of the most common surgical procedures, with an estimated 20 million operations performed annually worldwide. One of the common complications associated with this procedure is inguinodynia, defined as pain beyond three months after inguinal hernia surgery. In this review, we have addressed the main aspects of this complication with current articles, published in the last five years. Inguinodynia has a multifactorial nature and studies have shown that its development is related to the surgical technique and intrinsic factors of the patient that imply greater predisposition to this phenomenon. In this regard, it has been discussed which surgical techniques imply a lower incidence of this complication. Many studies have focused on understanding intrinsic features of each patient, both in physical and cognitive aspects, and how the approach of these factors can favor a better post-surgical recovery. The treatment of this condition is still challenging, and there are no established universal guidelines. We believe that due to its multifactorial nature, the treatment is hampered due to the individuality inguinodynia presentations.

RESUMO A herniorrafia é um dos procedimentos cirúrgicos mais realizados, com estimativa de 20 milhões de operações feitas anualmente em todo o mundo. Uma das complicações comuns associadas a esse procedimento é a inguinodinia, definida como dor inguinal crônica, com duração superior a três meses após herniorrafia inguinal. Nesta revisão, abordamos os principais aspectos dessa complicação com base em artigos sobre o tema, publicados nos últimos cinco anos. A inguinodinia tem natureza multifatorial e estudos mostram que está relacionada à técnica cirúrgica e aos fatores intrínsecos do paciente, que implicam maior predisposição a esse fenômeno. Nesse sentido, têm sido discutidas quais técnicas cirúrgicas implicam menor incidência dessa complicação. Muitos estudos têm se concentrado em compreender características inerentes a cada paciente, tanto no aspecto físico, quanto cognitivo, e como a abordagem desses fatores pode favorecer a melhor recuperação pós-cirúrgica. O tratamento dessa condição ainda é desafiador e não há diretrizes universais estabelecidas. Acreditamos que, devido à natureza multifatorial, o tratamento é dificultado em razão da individualidade das apresentações da inguinodinia.

Humans , Pain, Postoperative/etiology , Surgical Mesh , Herniorrhaphy/adverse effects , Hernia, Inguinal/surgery , Pain, Postoperative/diagnosis , Postoperative Complications , Causality , Treatment Outcome , Chronic Pain , Groin
Rev. Assoc. Med. Bras. (1992) ; 65(9): 1174-1180, Sept. 2019. graf
Article in English | LILACS | ID: biblio-1041070


SUMMARY OBJECTIVE The study aims to explore the relationship between preoperative anxiety and chronic postoperative pain. METHODS A total of forty rats were divided into four groups, control, single-prolonged stress alone, Hysterectomy alone, and SPS+ Hysterectomy. The paw withdrawal mechanical thresholds (PWMT) were examined. qRT-PCR and western blotting assay were performed to detect the GFAP expression in astrocytes isolated from the anterior cingulate cortex (ACC) region. In addition, the long-term potentiation (LTP) in ACC was examined. RESULTS Rats in the SPS group or the Hysterectomy alone group had no significant effect on chronic pain formation, but SPS can significantly induce chronic pain after surgery. Astrocytes were still active, and the LTP was significantly increased three days after modeling in the SPS+Hysterectomy group. CONCLUSIONS anxiety can induce chronic pain by activating astrocytes in the ACC region.

RESUMO OBJETIVO O objetivo deste estudo é explorar a relação entre a ansiedade no pré-operatório e a dor crônica no pós-operatório. MÉTODOS Um total de 40 ratos foram divididos em quatro grupos: controle, estresse prolongado (SPS), histerectomia e SPS + histerectomia. Os limiares de retirada da pata em resposta a estímulo mecânico (PWMT) foram examinados. Ensaios qRT-PCR e imunoenzimáticos (western blotting) foram realizados para detectar a expressão de GFAP em astrócitos isolados da região do córtex cingulado anterior (CCA). Além disso, a potenciação de longa duração (LTP) no CCA também foi examinada. RESULTADOS Os ratos no grupo de estresse prolongado e no grupo de histerectomia não apresentaram nenhum efeito significativo na formação de dor crônica. Porém, o estresse prolongado foi capaz de induzir dor crônica significativamente após a cirurgia. Três dias após o modelo, o grupo de SPS + histerectomia ainda apresentava astrócitos ativos e LTP significativamente maior. CONCLUSÃO A ansiedade pode provocar dor crônica através da ativação de astrócitos na região do CCA.

Animals , Female , Anxiety/complications , Pain, Postoperative/etiology , Astrocytes/metabolism , Chronic Pain/etiology , Pain, Postoperative/psychology , Stress, Psychological/etiology , Time Factors , Random Allocation , Rats, Sprague-Dawley , Pain Threshold/physiology , Long-Term Potentiation/physiology , Disease Models, Animal , Preoperative Period , Chronic Pain/psychology , Glial Fibrillary Acidic Protein/metabolism , Gyrus Cinguli/metabolism , Hindlimb , Hysterectomy
Rev. Assoc. Med. Bras. (1992) ; 65(9): 1201-1207, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041066


SUMMARY OBJECTIVES Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.

RESUMO OBJETIVOS As técnicas de hernioplastia inguinal foram melhoradas desde a primeira hernioplastia. Técnicas livres de tensão que aplicam materiais de malha sintética, como na abordagem de Lichtenstein, são o padrão ouro. A hernioplastia laparoscópica é a alternativa mais forte ao Lichtenstein. A superioridade da hernioplastia laparoscópica sobre o Lichtenstein é um dos principais temas debatidos. Neste estudo, procuramos encontrar uma conclusão para esse debate comparando nossas experiências totalmente extraperitoneais (TEP) com as experiências de Lichtenstein. MÉTODOS Pacientes submetidos à hernioplastia inguinal no Gulhane Training and Research Hospital de 2013 a 2018 foram incluídos neste estudo de coorte retrospectivo. A amostra incluiu 96 pacientes TEP e 90 pacientes Lichtenstein para um total de 186 pacientes. As variáveis avaliadas foram tempo de internação, escore da escala analógica visual precoce no pós-operatório, dor crônica, parestesia, recidiva e complicações pós-operatórias precoces. Os dados foram coletados dos prontuários e do questionário por telefone, se necessário. A análise dos dados foi realizada pelo SPSS v20, utilizando os testes qui-quadrado, exato de Fisher e U de Mann-Whitney. RESULTADOS As razões homem/mulher foram semelhantes entre os grupos TEP e Lichtenstein. Não houve diferença na média de idade entre os grupos (p=0,1). A permanência hospitalar foi menor (p=0,1) e a escala visual analógica precoce foi menor no grupo TEP (p=0,003). Dor crônica, parestesia, recorrência e complicações pós-operatórias imediatas (hematoma, seroma, infecção da ferida) foram semelhantes. CONCLUSÕES O TEP é superior ao Lichtenstein, com menor tempo de internação e menores taxas de dor pós-operatória precoce. Nenhuma diferença entre as duas técnicas foi encontrada para dor crônica. Acreditamos que a abordagem de hernioplastia laparoscópica pode ser a melhor técnica alternativa para correção de hérnia inguinal.

Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Laparoscopy/methods , Herniorrhaphy/methods , Hernia, Inguinal/surgery , Pain, Postoperative/etiology , Paresthesia/etiology , Recurrence , Retrospective Studies , Follow-Up Studies , Laparoscopy/adverse effects , Chronic Pain/etiology , Herniorrhaphy/adverse effects , Length of Stay , Middle Aged
Dolor ; 29(71): 36-40, jul. 2019. tab
Article in Spanish | LILACS | ID: biblio-1118184


El dolor crónico postoperatorio de cirugía de columna lumbar tiene una incidencia entre un 10-50 por ciento de los pacientes postoperados, siendo de difícil manejo. Se ha denominado síndrome de fracaso de cirugía espinal lumbar (FBSS) a aquellos pacientes que han sido beneficiarios de una cirugía del raquis lumbosacro y en quienes no se logra una mejoría de manera satisfactoria, presentando dolor crónico lumbar, siendo su incidencia de alrededor de un 20 por ciento, y debido a una mala evolución del proceso de recuperación que puede ocasionar fibrosis en el canal medular. Existen diversas alternativas terapéuticas para afrontar este problema, donde destacan el tratamiento farmacológico, medicina física y el abordaje intervencionista no quirúrgico y quirúrgico implementados últimamente, con el fin de disminuir de manera efectiva el dolor en este grupo de pacientes. Sin embargo, a pesar de las terapias combinadas, existe un grupo de pacientes que debe ser sometido a una nueva intervención quirúrgica con resultados poco promisorios.

Chronic postoperative pain of lumbar spine surgery has an incidence between 10-50 percent of postoperative patients, being difficult to manage. The Failed Back Surgery Syndrome (FBSS) has been referred to those patients who have been beneficiaries of lumbosacral spinal surgery and who do not achieve a satisfactory improvement, presenting chronic lumbar pain with an incidence around 20 percent and due to a poor evolution of the recovery process that can cause fibrosis in the medullary canal. There are several therapeutic alternatives to address this problem, which highlights the pharmacological treatment, physical medicine and the non-surgical and surgical intervention approach recently implemented, in order to effectively reduce pain in this group of patients. However, despite the combination therapies, there is a group of patients that must undergo a new surgical intervention with little promising results.

Humans , Pain, Postoperative/etiology , Pain, Postoperative/therapy , Low Back Pain/etiology , Low Back Pain/therapy , Failed Back Surgery Syndrome/complications , Failed Back Surgery Syndrome/therapy , Neurosurgical Procedures/adverse effects , Chronic Pain , Lumbar Vertebrae/surgery
Einstein (Säo Paulo) ; 17(4): eAO4905, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019804


ABSTRACT Objective To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Methods The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Results For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. Conclusion Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III

RESUMO Objetivo Comparar a analgesia e o uso de opioides em pacientes submetidos à artroplastia total do quadril primária com bloqueio pré-operatório do quadrado lombar posterior e pacientes que não receberam o bloqueio do quadrado lombar. Métodos Revisamos os prontuários de pacientes submetidos à artroplastia total do quadril unilateral entre 1º de janeiro de 2017 e 31 de março de 2018, e 238 pacientes foram incluídos no estudo. O desfecho primário foi o consumo de opioides no pós-operatório nas primeiras 24 horas. Os desfechos secundários foram consumo de opioide no intraoperatório, na sala de recuperação pós-anestésica e nas primeiras 48 horas, escores de Escala Visual Analógica de dor pós-operatória, e tempo de permanência na recuperação pós-anestésica. Os desfechos primário e secundários foram comparados entre os pacientes submetidos à artroplastia total do quadril primária com bloqueio pré-operatório do quadrado lombar posterior e aqueles que não receberam o bloqueio do quadrado lombar. Resultados Para o grupo que recebeu o bloqueio, as doses totais de morfina por via oral em 24 horas foram menores (53,82mg±37,41) em comparação ao grupo sem bloqueio (77,59mg±58,42), com p=0,0011. A utilização de opioides foi consistentemente menor para o grupo que recebeu o bloqueio em cada tempo adicional de avaliação até 48 horas. Os escores da Escala Visual Analógica até 12 horas após a cirurgia para os pacientes que receberam o bloqueio do quadrado lombar posterior e o tempo de permanência na sala de recuperação pós-anestésica foram menores para o grupo que recebeu o bloqueio. Conclusão O bloqueio anestésico do quadrado lombar posterior para artroplastia total do quadril primária está associado à diminuição do uso de opioides nas primeiras 48 horas, diminuição do escore de dor da Escala Visual Analógica em até 12 horas, e menor tempo de permanência na sala de recuperação pós-anestésica. Nível de evidência: III

Pain, Postoperative/drug therapy , Arthroplasty, Replacement, Hip/adverse effects , Analgesics/therapeutic use , Anesthetics, Local/therapeutic use , Pain, Postoperative/etiology , Time Factors , Anesthesia Recovery Period , Retrospective Studies , Abdominal Muscles/innervation , Dose-Response Relationship, Drug , Perioperative Period/methods , Pain Management , Analgesics/administration & dosage , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Anesthesia, General , Anesthesia, Spinal , Anesthetics, Local/administration & dosage , Nerve Block/methods
Clinics ; 74: e605, 2019. tab
Article in English | LILACS | ID: biblio-1039555


OJECTIVES: The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS: In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS: The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS: The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.

Humans , Male , Female , Adult , Middle Aged , Pain, Postoperative/prevention & control , Thyroidectomy/methods , Cervical Plexus Block/methods , Anesthesia, General/adverse effects , Pain, Postoperative/etiology , Preoperative Care , Prospective Studies , Treatment Outcome , Analgesics, Opioid/adverse effects
Revista Digital de Postgrado ; 8(1): 153, 2019. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1022854


La presencia de gasas intracavitarias posterior a procedimientos quirúrgicos es una situación que genera importantes complicaciones, con graves repercusiones médico-legales. El objetivo de este estudio es describir la presencia de un cuerpo extraño vesical como complicación iatrogénica. Se presentan dos casos, el primero es de un hombre de 63 años de edad, con antecedente de prostatectomía simple por hiperplasia prostática benigna, quien acude por episodio de retención aguda de orina (RAO); y el segundo es de una mujer de 65 años, con antecedente de histerectomía abdominal por leiomiomatosis uterina, quien presenta dolor pélvico crónico e infecciones urinarias a repetición. A los pacientes se les realizó un ecosonograma pélvico que reportó lesión ocupante de espacio en vejiga, la urotomografia (urotac) evidencia un cuerpo extraño intravesical de apariencia radiopaca, y en la uretrocistoscopia se visualiza material sintético intravesical flotando. Al primer paciente se le realiza una cistotomía con extracción de material compatible con gasa y a la segunda paciente se le realiza extracción endoscópica de la misma, ambos presentando evolución satisfactoria. La revisión del sitio quirúrgico y el contaje transoperatorio de gasas antes de la síntesis final de los tejidos es un paso fundamental para el éxito de una cirugía pélvica(AU)

The presence of intracavitary gauzes after the surgical procedures is a situation that generates important complications, with serious medico-legal repercussions. The objective of this study is describe the presence of a bladder foreign body as an iatrogenic complication. Two cases are presented, the first is from a 63-year-old man with a history of simple prostatectomy for benign prostatic hyperplasia who presents with episodes of acute urinary retention; and the second is a 65-year-old woman with a history of abdominal hysterectomy due to leiomyomatosis that presents with chronic pelvic pain and recurrent urinary tract infections. A pelvic ecosonogram was performed on the patients who reported a bladder space-occupying lesion, urotac showed an intravesical foreign body with a radiopaque appearance, and intravesical synthetic flotation material was visualized in the urethrocystoscopy. The patient underwent a cystotomy with gas-compatible material extraction and the patient underwent endoscopic extraction, both showing a satisfactory evolution. Surgical site revision and transoperative gauze infection before the final synthesis of tissues is a fundamental step for the success of pelvic surgery(AU)

Humans , Male , Middle Aged , Aged , Prostatic Hyperplasia , Urinary Retention , Foreign Bodies/complications , Hysterectomy , Pain, Postoperative/etiology , Pelvic Pain
Arq. bras. oftalmol ; 81(4): 339-340, July-Aug. 2018. graf
Article in English | LILACS | ID: biblio-950464


ABSTRACT Bilateral simultaneous cataract surgery (BSCS) has gained popularity among eye surgeons in many countries. This study examines the case of a 77-year-old patient who developed bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery. Immediate bilateral vitrectomy and intravitreal antibiotics injection were performed. Ultimately, both eyes were eviscerated due to pain refractory to treatment and no light perception.

RESUMO A cirurgia bilateral simultânea de catarata ganhou popularidade entre cirurgiões oftalmológicos em muitos países. Este estudo examina o caso de um paciente de 77 anos que desenvolveu endoftalmite bilateral por Pseudomonas aeruginosa após uma cirurgia bilateral simultânea de catarata. Vitrectomia bilateral imediata e injeção de antibióticos intravítreos foram realizadas. Em última análise, ambos os olhos foram eviscerados devido à dor refratária ao tratamento e sem percepção de luz.

Humans , Male , Aged , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/etiology , Cataract Extraction/adverse effects , Endophthalmitis/etiology , Pain, Postoperative/etiology , Pseudomonas Infections/surgery , Pseudomonas Infections/diagnosis , Vitrectomy , Cataract Extraction/methods , Endophthalmitis/surgery , Endophthalmitis/diagnosis , Eye Evisceration
Braz. j. med. biol. res ; 51(2): e6825, 2018.
Article in English | LILACS | ID: biblio-1019561


This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.

Humans , Male , Female , Adult , Middle Aged , Aged , Obesity, Morbid/surgery , Laryngeal Masks/standards , Thoracic Surgical Procedures/instrumentation , One-Lung Ventilation/instrumentation , Intubation, Intratracheal/instrumentation , Pain, Postoperative/etiology , Pulmonary Atelectasis , Time Factors , Pharyngitis/etiology , Ventilators, Mechanical/standards , Double-Blind Method , Prospective Studies , Reproducibility of Results , Treatment Outcome , Thoracic Surgical Procedures/methods , Equipment Design , One-Lung Ventilation/methods , Operative Time , Intubation, Intratracheal/methods
Clinics ; 72(12): 729-736, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-890699


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.

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
Int. braz. j. urol ; 43(3): 518-524, May.-June 2017. tab
Article in English | LILACS | ID: biblio-840851


ABSTRACT Purpose To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. Materials and Methods 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. Results Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). Conclusion Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.

Humans , Male , Female , Adolescent , Pain, Postoperative/prevention & control , Pressure , Urologic Surgical Procedures/instrumentation , Insufflation/methods , Laparoscopy/instrumentation , Pain, Postoperative/etiology , Turkey , Pain Measurement , Prospective Studies , Laparoscopy/adverse effects
Int. j. odontostomatol. (Print) ; 11(1): 47-51, abr. 2017. ilus
Article in English | LILACS | ID: biblio-841015


The aim of this paper was to compare the efficacy of two different anti-inflammatory agents, Diclofenac (Deltaflogin®) and Lumiracoxib (Prexige®) in the control of postoperative pain that results from surgical removal of impacted lower third molars. Twenty adult patients from the Oral and Maxillofacial Surgery Division of the Araraquara Dentistry School, UNESP who presented bilateral impacted lower third molars were included in the study. Removal of the impacted teeth was performed in each side in different operative moments in a split mouth design for the study. The anti-inflammatory drugs evaluated were randomly administered on the first and second surgical procedures. The pain level was recorded using an analogical visual scale at 6, 24, 48 and 72 hours after surgical intervention. Both lumiracoxib 400 mg and diclofenac 100 mg are efficient for acute pain control after surgical removal of impacted lower third molars. However, lumiracoxib offered better pain control.

El objetivo de este trabajo fue comparar la eficacia de dos agentes antiinflamatorios distintos, Diclofenaco (Deltaflogin®) y Lumiracoxib (Prexige®) en el control del dolor postoperatorio resultante de la extracción quirúrgica de terceros molares inferiores impactados. Fueron incluídos, veinte pacientes adultos de la División de Cirugía Oral y Maxilofacial de la Escuela de Odontología de Araraquara, UNESP que presentaron terceros molares inferiores impactados. La extracción de los dientes impactados se realizó en distintos tiempos operatorios a cada lado en un diseño de estudio de boca dividida. Los antinflamatorios evaluados fueron administrados de forma aleatoria en el primer y segundo procedimento quirúrgico. El nivel de dolor se registró utilizando una escala visual análoga a las 6, 24, 48 y 72 horas después de la intervención. Ambos; lumiracoxib 400 mg y diclofenaco 100 mg son eficientes para el control del dolor agudo, después de la extracción quirúrgica de terceros molares inferiores impactados. Sin embargo, lumiracoxib ofreció mejor control del dolor.

Humans , Male , Female , Adolescent , Adult , Young Adult , Anti-Inflammatory Agents/administration & dosage , Diclofenac/administration & dosage , Diclofenac/analogs & derivatives , Pain, Postoperative/prevention & control , Tooth Extraction/adverse effects , Anti-Inflammatory Agents/therapeutic use , Comparative Study , Diclofenac/therapeutic use , Molar, Third , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Time Factors
J. appl. oral sci ; 25(1): 20-26, Jan.-Feb. 2017. tab, graf
Article in English | LILACS, BBO | ID: biblio-841169


Abstract Postoperative pain is a frequent complication associated with root canal treatment, especially during apical instrumentation of tooth with preexisting periradicular inflammation Objectives The aim of this clinical study was to evaluate the influence of the instrumentation techniques on the incidence and intensity of postoperative pain in single-visit root canal treatment. Material and Methods Ninety patients with single root/canal and non-vital pulps were included. The patients were assigned into 3 groups according to root canal instrumentation technique used; modified step-back, reciprocal, and rotational techniques. Root canal treatment was carried out in a single visit and the severity of postoperative pain was assessed via 4-point pain intensity scale. All the participants were called through the phone at 12, 24 and 48 h to obtain the pain scores. Data were analyzed through the Kruskal–Wallis test. Results There was significant difference between all groups (p<0.05). The modified step-back technique produced postoperative pain significantly lower than the rotational (p=0.018) and reciprocal (p=0.020) techniques. No difference was found between the reciprocal and rotational techniques (p=0.868). Postoperative pain in the first 12 h period (p=0.763) and in the 24 h period (p=0.147) was not significantly different between the groups. However, the difference in the 48 h period was statistically different between the groups (p=0.040). Conclusion All instrumentation techniques caused postoperative pain. The modified step-back technique produced less pain compared to the rotational and reciprocal techniques.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Pain, Postoperative/etiology , Root Canal Therapy/adverse effects , Root Canal Therapy/instrumentation , Dental Instruments/adverse effects , Time Factors , Severity of Illness Index , Pain Measurement , Treatment Outcome , Statistics, Nonparametric , Equipment Design
Int. j. odontostomatol. (Print) ; 10(3): 385-391, dic. 2016. ilus
Article in English | LILACS | ID: biblio-840986


The sensation of pain at the surgical site may be increased and persist for long periods after the noxious stimulus has been removed. Post-operative pain from the extraction of impacted molar may cause serious discomfort to the patient resulting in considered moderate to severe in intensity. Analgesia for this surgical procedure is related to the use of nonsteroidal anti-inflammatory drugs, steroids, analgesics of central and peripheral actions used in combination or individually. The aim of this review is to show an update about the use and the physiological bases for indications of the analgesic therapy in third molar surgery.

La sensación de dolor en el sitio quirúrgico puede ser mayor y persistente por largos periodos de tiempo después de que el estímulo nocivo ha sido retirado. El dolor postoperatorio desde la extracción de un molar impactado puede causar molestias moderadas o severas en intensidad. La analgesia para estos procedimientos son relacionadas con el uso de fármacos antiinflamatorios no esteroidales, esteroides, analgésicos de acción central y periféricos utilizados en combinación o individualmente. El objetivo de esta revisión es mostrar una puesta al día en el uso y las bases fisiológicas para la indicación de terapia analgésica en cirugía de tercer molar.

Humans , Molar, Third/surgery , Pain, Postoperative/drug therapy , Tooth Extraction/adverse effects , Analgesics/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Pain, Postoperative/etiology , Pain, Postoperative/physiopathology
Rev. bras. anestesiol ; 66(4): 395-401,
Article in English | LILACS | ID: lil-787630


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

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

Humans , Pain, Postoperative/therapy , Sternotomy/adverse effects , Cardiac Surgical Procedures , Analgesia/methods , Pain, Postoperative/etiology , Analgesia, Epidural/methods , Anti-Inflammatory Agents, Non-Steroidal , Combined Modality Therapy , Analgesics, Opioid , Anesthetics, Local , Nerve Block/methods