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2.
Rev. bras. med. esporte ; 27(spe2): 16-19, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1280086

ABSTRACT

ABSTRACT After arthroscopic ligament reconstruction, athletes still need to go through a postoperative rehabilitation training period and suffer the possible pain that can go from moderate to severe. Commonly used analgesic medications, ropivacaine and fentanyl have the effect of relieving athletes' pain. To study the analgesic effect of ropivacaine on arthroscopic reconstruction of the knee ligament, the steps of reconstruction and pharmacology of ropivacaine were first introduced. Next, the analgesic effects of ropivacaine and fentanyl in 86 athletes were compared on muscle strength recovery, patient satisfaction, and pain score. The results showed that the satisfaction of patients with ropivacaine was 95.35%, and the incidence of postoperative adverse reactions was only 9.30%. These results indicate that ropivacaine has a better analgesic effect in arthroscopic reconstruction of the knee ligament in athletes, which is suitable for postoperative rehabilitation.


RESUMO Após a reconstrução artroscópica do ligamento, os atletas ainda precisam passar por um longo período de treinamento pós-operatório de reabilitação e suportar a possível dor de moderada a severa. Os medicamentos analgésicos ropivacaina e fentanilo comumente utilizados têm o efeito de aliviar a dor dos atletas. Para estudar o efeito analgésico da ropivacaína na reconstrução artroscópica do ligamento do joelho foram introduzidos, em primeiro lugar, os passos da reconstrução artroscópica do ligamento e os da farmacologia da ropivacaína. Em seguida, os efeitos analgésicos da ropivacaína e o fentanilo em 86 atletas foram comparados com a recuperação na força muscular, na satisfação do paciente e na pontuação da dor. Os resultados mostraram que a satisfação dos doentes com a ropivacaína chegava a 95.35%, e a incidência de reações adversas pós-operatórias foi apenas de 9.30%. Estes resultados indicam que a ropivacaína tem melhor efeito analgésico na reconstrução artroscópica do ligamento do joelho, o que é adequado para a reabilitação pós-operatória.


RESUMEN Después de la reconstrucción artroscópica del ligamento, los atletas aun precisan pasar por un largo período de entrenamiento posoperatorio de rehabilitación y soportar el posible dolor que puede ir de moderado a severo. Los medicamentos analgésicos, ropivacaína y fentanilo que son comúnmente utilizados, tienen el efecto de aliviar el dolor de los atletas. Para estudiar el efecto analgésico de la ropivacaína en la reconstrucción artroscópica del ligamento de la rodilla fueron introducidos, en primer lugar, los pasos de la reconstrucción y de la farmacología de la ropivacaína. Enseguida, los efectos analgésicos de la ropivacaína y el fentanilo en 86 atletas fueron comparados en la recuperación de la fuerza muscular, en la satisfacción del paciente y en la puntuación del dolor. Los resultados mostraron que la satisfacción de los pacientes con la ropivacaína llegaba a 95.35%, y la incidencia de reacciones adversas posoperatorias fue apenas de 9.30%. Estos resultados indican que la ropivacaína tiene mejor efecto analgésico en la reconstrucción artroscópica del ligamento de la rodilla de los atletas, lo que es adecuado para la rehabilitación posoperatoria.


Subject(s)
Humans , Pain, Postoperative/prevention & control , Arthroscopy/methods , Athletic Injuries/surgery , Ropivacaine/therapeutic use , Knee Injuries/surgery , Anesthetics, Local/therapeutic use , Patient Satisfaction , Reconstructive Surgical Procedures
3.
Rev. bras. ginecol. obstet ; 43(4): 250-255, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280036

ABSTRACT

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.


Subject(s)
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
4.
Rev. chil. ortop. traumatol ; 62(1): 2-10, mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342583

ABSTRACT

INTRODUCCIÓN: La artrodesis de cuatro esquinas es una técnica de salvataje para los pacientes con artrosis avanzada del carpo. Los objetivos quirúrgicos son disminuir el dolor y mantener cierto movimiento de la muñeca. En el último tiempo, se han descrito técnicas percutáneas con asistencia artroscópica que han logrado resultados favorables, a pesar de que la técnica abierta sigue siendo el gold estándar para realizar esa técnica quirúrgica. OBJETIVO: Comparar resultados funcionales y radiológicos en pacientes con muñecas con colapso avanzado escafolunar (scapholunate advanced collapse, SLAC) o colapso avanzado en la pseudoartrosis del escafoides (scaphoid nonunion advanced collapse, SNAC) operados con técnica quirúrgica abierta versus técnica percutánea con asistencia artroscópica. MATERIALES Y MÉTODOS: Estudio retrospectivo tipo caso-control, de fichas clínicas e imagenología de pacientes con artrosis avanzada del carpo operados con técnica percutánea y asistencia artroscópica y cirugía abierta. Se estudian variables demográficas, dolor mediante la Escala Visual Analógica (EVA), función en rangos de movilidad, tiempo de consolidación, y corrección del ángulo capitolunar. Se describe la técnica quirúrgica de la cirugía abierta y la cirugía percutánea con asistencia artroscópica. RESULTADOS: Se estudiaron 22 pacientes del sexo masculino con edad promedio de 32,5 años. Había 13 pacientes en el grupo de casos (técnica percutánea con asistencia artroscópica) y 9 pacientes en el grupo de controles (técnica abierta). El dolor en la EVA al momento del egreso hospitalario fue de 3 para los casos y de 5 para los controles (p » 0,008), y a los 30 días del postoperatorio, fue de 0 y 3 respectivamente (p » 0,00). Los rangos de extensión y flexión fueron de 52,6° y 38,7° para los casos y de 35,7° y 32,4° para los controles (p » 0,1119 y 0,0016, respectivamente). El ángulo capitolunar fue de 10° para los controles y de 5° para los casos (p » 0,0008). El tiempo de consolidación fue de 8,8 semanas para los casos y de 12,5 semanas para los controles (p » 0,039). DISCUSIÓN: Tanto la técnica percutánea con asistencia artroscópica cuanto la cirugía abierta para realizar una artrodesis de cuatro esquinas son técnicas reproducibles y efectivas en lograr consolidación, disminución del dolor, y mantenimiento de rangos de movimiento en la muñeca. CONCLUSIÓN: En el presente trabajo se demuestran mejores promedios de los parámetros evaluados con la técnica percutánea que con la cirugía abierta; sin embargo, es necesario realizar estudios prospectivos para realizar una recomendación con respecto a la técnica quirúrgica de elección.


INTRODUCTION: Four-corner arthrodesis is a salvage technique for patients with advanced carpal osteoarthritis. This procedure aims to reduce pain and preserve wrist motion. Even though percutaneous techniques with arthroscopic assistance reportedly have favorable outcomes and the advantages of minimal invasiveness, open surgery remains the gold standard for four-corner arthrodesis. OBJECTIVE: The present study aims to compare the functional and radiological outcomes of patients with scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) submitted to open surgery versus percutaneous surgery with arthroscopic assistance. MATERIALS AND METHODS: Retrospective case-control study of clinical records and radiological images of patients with advanced carpal osteoarthritis submitted to percutaneous surgery with arthroscopic assistance versus open surgery. Demographic variables, pain score using the visual analog scale (VAS), function ranges of motion, time until consolidation, and correction of the capitolunate angle were analyzed. Both techniques are described. RESULTS: In total, 22 male patients with an average age of 32.5 years were studied, including 13 patients from the case group (percutaneous surgery with arthroscopic assistance) and 9 patients from the control group (open surgery). The VAS score for pain at discharge was of 3 for the cases and of 5 for the controls (p » 0.008); 30 days postoperatively, it was of 0 and 3 respectively (p » 0.00). The ranges of extension and flexion were of 52.6° and 38.7° for the case group, and of 35.7° and 32.4° for the control group (p » 0.119 and 0.0016 respectively). The capitolunate angle was of 10° for the controls and of 5° for the cases (p » 0.0008). The time until consolidation was of 8.8 weeks for the cases and of 12.5 weeks for the controls (p » 0.039). DISCUSSION: Both four-corner arthrodesis techniques are reproducible and effective in achieving consolidation, pain reduction and preservation of wrist motion. CONCLUSION: The present study demonstrates the superiority of the percutaneous technique with arthroscopic assistance over open surgery. Further prospective studies are required for an adequate recommendation.


Subject(s)
Arthrodesis/methods , Wrist Joint/surgery , Scaphoid Bone/surgery , Pain, Postoperative/prevention & control , Arthroscopy , Wrist Joint/physiopathology , Wrist Joint/diagnostic imaging , Pain Measurement , Retrospective Studies , Range of Motion, Articular , Scaphoid Bone/physiopathology , Scaphoid Bone/diagnostic imaging
5.
Arq. bras. oftalmol ; 84(1): 45-50, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1153105

ABSTRACT

ABSTRACT Purpose: To determine whether codeine plus acetaminophen after photorefractive keratectomy (PRK) have beneficial effects on sleep quality, activity levels, and food intake, beyond their effect of pain relief. Methods: We enrolled 40 patients (80 eyes) in this randomized, double-blind, paired-eye, placebo-controlled, add-on trial. Each eye was treated 2 weeks apart, and the patients were randomly allocated to receive either the placebo or the intervention (30 mg codeine and 500 mg acetaminophen) (4 times a day for 4 days). Outcomes were sleep quality, daily activity level, and food intake within 24-72 h post-photorefractive keratectomy, as measured by the McGill Pain Questionnaire. Results: Sleep quality and daily activity level were inversely associated with pain scores within the first 48 h post-photorefractive keratectomy. During the intervention, patients were significantly more likely to score their sleep quality as good at 24 h (relative risk=2.5; 95% confidence interval 1.48-4.21, p<0.001) and 48 h compared to during placebo (relative risk=1.37; 95% confidence interval: 1.03-1.84, p=0.023). The probability of reporting good daily activity level at 24 and 72 hours post-photorefractive keratectomy was three times higher when patients received the intervention compared to the placebo (relative risk=3.0; 95% confidence interval: 1.49-6.15, p=0.006 and relative risk=1.31; 95% confidence interval: 1.02-1.67, p=0.021, respectively). No difference was observed in food intake. Conclusion: The oral combination of codeine and acetaminophen significantly improves sleep quality and daily activity level within the first 24-72 h post-photorefractive keratectomy compared to a placebo.


RESUMO Objetivo: Determinar se codeína (30 mg) mais pa­racetamol (500 mg) após ceratectomia fotorrefrativa fornece efeitos benéficos sobre a qualidade do sono, níveis de atividade e ingestão de alimentos além de seu efeito analgésico. Métodos: Quarenta pacientes (80 olhos) foram incluídos neste estudo randomizado, duplo-cego, pareado, placebo-controlado, add-on. Cada olho foi tratado com 2 semanas de intervalo, sendo aleatoriamente alocado para placebo ou intervenção (4x/dia durante 4 dias). Os resultados incluíram a qualidade do sono, atividade diária e ingestão de alimentos dentro de 24-72 horas de pós-operatório, conforme medido pelo McGill Pain Questionnaire. Resultados: A qualidade do sono e os níveis de atividade foram inversamente associados aos escores de dor nas primeiras 48 horas após o ceratectomia fotorrefrativa. Durante a intervenção, os pacientes foram significativamente mais propensos a classificar seu sono como bom em 24 horas (risco relativo=2,5, intervalo de confiança de 95%: 1,48-4,21, p<0,001) e 48 horas comparado ao placebo (risco relativo=1,37, intervalo de confiança de 95%: 1,03-1,84, p=0,023). A probabilidade de relatar bons níveis de atividade em 24 e 72 horas após ceratectomia fotorrefrativa também foi significativamente maior durante a intervenção em comparação com placebo (risco relativo=3,0, intervalo de confiança de 95%: 1,49-6,15, p=0,006 e risco relativo=1,31, intervalo de confiança de 95%: 1,02 -1,67, p=0,021, respectivamente). Nenhuma diferença foi observada entre a intervenção e placebo em relação à alimentação oral. Conclusão: A combinação de codeína e paracetamol melhorou significativamente a qualidade do sono e atividades diárias nas primeiras 24-72 horas após o ceratectomia fotorrefrativa em comparação com placebo.


Subject(s)
Humans , Double-Blind Method , Codeine/therapeutic use , Photorefractive Keratectomy , Eating , Acetaminophen/therapeutic use , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Postoperative Period , Sleep
6.
ABCD arq. bras. cir. dig ; 34(1): e1530, 2021. tab, graf
Article in English | LILACS | ID: biblio-1248510

ABSTRACT

ABSTRACT Background: As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team. Aim: To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques. Methods: Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg. Results: The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups. Conclusion: Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.


RESUMO Racional: Com o aumento do número de operações bariátricas torna-se maior o interesse pelo conhecimento, experiência e habilidades no manejo operatório e anestésico de obesos. A recuperação anestésica é ponto importante na abordagem terapêutica e menos efeitos adversos que retardem a alta são necessários estar em mente da equipe cirúrgica. Objetivo: Comparar técnicas anestésico-analgésicas na era poupadora de opioides através da administração epidural de anestésico local associado à morfina em baixa dose vs. à clonidina e analisar o impacto da analgesia na efetividade da recuperação pós-operatória comparando as duas técnicas. Métodos: Ensaio clínico randomizado e duplo-cego com 66 pacientes candidatos ao bypass gastrojejunal em Y-de-Roux divididos em dois grupos: grupo morfina e grupo clonidina. A analgesia multimodal incluiu na anestesia epidural com ropivacaína 0,375% 20 ml na altura da oitava vértebra torácica a associação de morfina (grupo morfina) em dose de 15 mcg/kg ou de clonidina (grupo clonidina) na dose 1 mcg/kg. Resultados: Os grupos se mostraram homogêneos e foi encontrada significância estatística ao analisar a diferença da dor entre eles no primeiro pós operatório. A dor foi superior no grupo clonidina, como também neste período o resgate analgésico foi melhor neste grupo. Nos demais tempos não houve significância nas diferenças quanto à dor e resgate. O retorno da motilidade intestinal no grupo morfina foi mais precoce no primeiro pós-operatório. Náuseas, vômitos e a alta hospitalar não apresentaram diferenças significativas entre os grupos. Conclusão: A anestesia epidural com morfina em baixa dose permitiu menor dor durante todo internamento com impacto positivo em relação a recuperação dos pacientes.


Subject(s)
Humans , Analgesia, Epidural , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Double-Blind Method , Ropivacaine , Anesthetics, Local , Morphine
7.
Clinics ; 76: e2780, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278921

ABSTRACT

This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including "grey literature." The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The "Joanna Briggs Institute for Randomized Controlled Trials" tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure.


Subject(s)
Humans , Ibuprofen/therapeutic use , Molar, Third/surgery , Pain, Postoperative/prevention & control , Randomized Controlled Trials as Topic
8.
J. appl. oral sci ; 29: e20200502, 2021. tab
Article in English | LILACS | ID: biblio-1154619

ABSTRACT

Abstract Objective To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity. Methodology 45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS). Results The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05). Conclusion We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.


Subject(s)
Humans , Sodium Hypochlorite , Anti-Infective Agents , Pain, Postoperative/prevention & control , Temperature , Anti-Bacterial Agents
9.
J. appl. oral sci ; 29: e20200998, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286921

ABSTRACT

Abstract Objectives The aim of this study is to evaluate the effect of using gel and solution forms of NaOCI during the chemomechanical preparation of the root canals on postoperative pain at different time intervals. Methodology 114 patients with mandibular molar teeth and symptomatic irreversible pulpitis were included in the study. All patients were divided into two groups based on the irrigant used during root canal preparation (n=57): Group 1, 5.25% NaOCI, Group 2, 5.25% NaOCI gel. All groups were filled with gutta-percha and AH Plus root canal sealer using single-cone technique. VAS scale (1-10) was used for postoperative pain assessment. After endodontic treatment, all patients were asked to record their postoperative pain levels at the 6th, 24th, 48th, 72nd hours, and 1 week later. The data were analyzed using Chi-Squared, Independent Samples T, Cochran Q and Friedman tests. Results Statistically significant difference was not found between the distributions of pain levels at different times according to the groups (p>0.050). A statistically significant difference was observed between the distributions of pain levels measured at different times in the solution group (p<0.001). A statistically significant difference was found between the distributions of pain levels measured at different times in the gel group (p<0.001). In both groups, highest postoperative pain levels occurred in the first 6 hours. Pain levels of the gel group as 38,5% mild, 17.3% moderate, 5.8% severe and pain levels of the solution group were obtained as 46.2% mild, 26.9% moderate, 9.6% severe at the 6th hour. Conclusions The use of the gel form of NaOCI during the chemomechanical preparation of the root canals showed similar postoperative pain when compared to the solution form.


Subject(s)
Humans , Root Canal Filling Materials , Sodium Hypochlorite , Pain, Postoperative/prevention & control , Root Canal Obturation , Root Canal Preparation , Dental Pulp , Dental Pulp Cavity , Molar
10.
Rev. bras. anestesiol ; 70(6): 605-612, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155767

ABSTRACT

Abstract Background and objectives Preoperative use of flurbiprofen axetil (FA) is extensively adopted to modulate the effects of analgesia. However, the relationship between FA and sedation agents remains unclear. In this study, we aimed to investigate the effects of different doses of FA on the median Effective Concentration (EC50) of propofol. Methods Ninety-six patients (ASA I or II, aged 18-65 years) were randomly assigned into one of four groups in a 1:1:1:1 ratio. Group A (control group) received 10 mL of Intralipid, and groups B, C and D received 0.5 mg.kg−1, 0.75 mg.kg−1 and 1 mg.kg−1 of FA, respectively, 10 minutes before induction. The depth of anesthesia was measured by the Bispectral Index (BIS). The "up-and-down" method was used to calculate the EC50 of propofol. During the equilibration period, if BIS ≤ 50 (or BIS > 50), the next patient would receive a 0.5 µg.mL−1-lower (or -higher) propofol Target-Controlled Infusion (TCI) concentration. The hemodynamic data were recorded at baseline, 10 minutes after FA administration, after induction, after intubation and 15 minutes after intubation. Results The EC50 of propofol was lower in Group C (2.32 µg.mL−1, 95% Confidence Interval [95% CI] 1.85-2.75) and D (2.39 µg.mL−1, 95% CI 1.91-2.67) than in Group A (2.96 µg.mL−1, 95% CI 2.55-3.33) (p = 0.023, p = 0.048, respectively). There were no significant differences in the EC50 between Group B (2.53 µg.mL−1, 95% CI 2.33-2.71) and Group A (p > 0.05). There were no significant differences in Heart Rate (HR) among groups A, B and C. The HR was significantly lower in Group D than in Group A after intubation (66 ± 6 vs. 80 ± 10 bpm, p < 0.01) and 15 minutes after intubation (61 ± 4 vs. 70 ± 8 bpm, p < 0.01). There were no significant differences among the four groups in Mean Arterial Pressure (MAP) at any time point. The MAP of the four groups was significantly lower after induction, after intubation, and 15 minutes after intubation than at baseline (p < 0.05). Conclusion High-dose FA (0.75 mg.kg−1 or 1 mg.kg−1) reduces the EC50 of propofol, and 1 mg.kg−1 FA reduces the HR for adequate anesthesia in unstimulated patients. Although this result should be investigated in cases of surgical stimulation, we suggest that FA pre-administration may reduce the propofol requirement when the depth of anesthesia is measured by BIS.


Resumo Justificativa e objetivos A administração pré‐operatória de Flurbiprofeno Axetil (FA) é amplamente usada para a modulação da analgesia. No entanto, a relação entre FA e fármacos sedativos permanece obscura. Neste estudo, nosso objetivo foi investigar os efeitos de diferentes doses de FA na Concentração Efetiva mediana (CE50) do propofol. Métodos Noventa e seis pacientes (ASA I ou II, com idades de 18-65 anos) foram alocados aleatoriamente em quatro grupos na proporção de 1:1:1:1. Dez minutos antes da indução, o Grupo A (grupo controle) recebeu 10 mL de Intralipid, enquanto os grupos B, C e D receberam FA na dose de 0,5 mg.kg‐1; 0,75 mg.kg‐1 e 1 mg.kg‐1, respectivamente. A profundidade da anestesia foi medida pelo Índice Bispectral (BIS). O método up‐and‐down foi usado para calcular a CE50 do propofol. Durante o período de equilíbrio, se o valor do BIS fosse ≤ 50 ou BIS > 50, o próximo paciente tinha a infusão de propofol ajustada para uma concentração alvo‐controlada 0,5 µg.mL‐1 inferior ou superior, respectivamente. Os dados hemodinâmicos foram registrados no início do estudo, 10 minutos após a administração de FA, após a indução, após a intubação e 15 minutos após a intubação. Resultados A CE50 do propofol foi menor no Grupo C (2,32 µg.mL‐1, Intervalo de Confiança de 95% [95% IC] 1,85-2,75) e D (2,39 µg.mL‐1, 95% IC 1,91-2,67) do que no Grupo A (2,96 µg.mL‐1; 95% IC 2,55-3,33) (p = 0,023, p = 0,048, respectivamente). Não houve diferenças significantes na CE50 entre o Grupo B (2,53 µg.mL‐1, 95% IC 2,33-2,71) e o Grupo A (p > 0,05). Não houve diferenças significantes na Frequência Cardíaca (FC) entre os grupos A, B e C. A FC foi significantemente menor no grupo D do que no grupo A após a intubação (66 ± 6 vs. 80 ± 10 bpm, p < 0,01) e 15 minutos após a intubação (61 ± 4 vs. 70 ± 8 bpm, p < 0,01). Não houve diferenças significantes entre os quatro grupos na Pressão Arterial Média (PAM) em qualquer momento. A PAM dos quatro grupos foi significantemente menor após a indução, após a intubação e 15 minutos após a intubação do que na linha de base (p < 0,05). Conclusão FA em altas doses (0,75 mg.kg‐1 ou 1 mg.kg‐1) reduz a CE50 do propofol, e 1 mg.kg‐1 de FA reduz a FC durante níveis adequados de anestesia em pacientes não estimulados. Embora esse resultado deva ser investigado na presença de estimulação cirúrgica, sugerimos que a pré‐administração de FA pode reduzir a necessidade de propofol durante anestesia cuja profundidade seja monitorada pelo BIS.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Propofol/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Flurbiprofen/analogs & derivatives , Hypnotics and Sedatives/administration & dosage , Anesthesia , Pain, Postoperative/prevention & control , Phospholipids/administration & dosage , Blood Pressure/drug effects , Soybean Oil/administration & dosage , Drug Administration Schedule , Confidence Intervals , Flurbiprofen/administration & dosage , Elective Surgical Procedures , Electroencephalography/drug effects , Emulsions/administration & dosage , Fat Emulsions, Intravenous/administration & dosage , Remifentanil/administration & dosage , Heart Rate/drug effects , Analgesics, Opioid , Middle Aged
11.
Dolor ; 30(72): 20-24, nov. 2020.
Article in Spanish | LILACS | ID: biblio-1362442

ABSTRACT

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.


Subject(s)
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
12.
Rev. bras. anestesiol ; 70(4): 333-342, July-Aug. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137205

ABSTRACT

Abstract Background and objectives: PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. Methods: This was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg-1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 - 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05). Results: In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 - 5.56; mean 95% CI), 3.75 (3.13 - 4.37), 3.79 (2.93 - 4.64), and 2.29 (1.56 - 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 - 5.60), 4.00 (3.50 - 4.49), 3.93 (3.12 - 4.73), and 2.29 (1.56 - 3.01), respectively. Conclusions: PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.


Resumo Justificativa e objetivos: O bloqueio PECS I foi descrito pela primeira vez para cirurgia envolvendo os músculos peitorais. Nenhum estudo clínico randomizado foi realizado em procedimentos envolvendo diretamente os músculos peitorais, como a mamoplastia de aumento submuscular. Nossa hipótese foi de que o bloqueio PECS I diminuiria a dor pós-operatória nessa população. Método: Realizamos estudo randomizado, duplo-cego, controlado por placebo em mulheres submetidas à mamoplastia de aumento submuscular. Realizamos o bloqueio PECS I com 0,4 mL.kg-1 de solução salina a 0,9% de um lado e bupivacaína (0,25%) do outro lado, sendo cada paciente seu próprio controle. Os escores da Escala de Avaliação Numérica (EAN) de dor (0 - 10) foram obtidos em repouso e durante movimento. O desfecho primário foi o escore de dor em repouso 30 minutos após a chegada à SRPA. Para detectar uma diferença clinicamente significante de 50% na redução da dor, 14 voluntárias foram incluídas (poder de 90% e alfa < 0,05). Resultados: Na SRPA, três pacientes não apresentaram diferença na dor entre os lados, cinco relataram menos dor no lado do placebo e seis, menos dor no lado da bupivacaína. No grupo bupivacaína, os escores de dor em repouso aos 5, 30 e 60 minutos e 24 horas foram 4,89 (4,23 - 5,56; IC médio 95%), 3,75 (3,13 - 4,37), 3,79 (2,93 - 4,64) e 2,29 (1,56 - 3,01), respectivamente, enquanto no grupo placebo foram 4,96 (4,32 - 5,60), 4,00 (3,50 - 4,49), 3,93 (3,12 - 4,73) e 2,29 (1,56 - 3,01), respectivamente. Conclusões: O bloqueio PECS I em pacientes submetidas a mamoplastia de aumento não oferece melhor alívio da dor do que o placebo. Portanto, as indicações para bloqueio de PECS I na cirurgia de aumento de mama devem ser reconsideradas.


Subject(s)
Humans , Female , Adult , Pain, Postoperative/prevention & control , Bupivacaine/administration & dosage , Breast Implantation/methods , Nerve Block/methods , Pain Measurement , Double-Blind Method , Anesthetics, Local/administration & dosage
13.
Rev. bras. anestesiol ; 70(4): 443-447, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137201

ABSTRACT

Abstract Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours and 3.35 from 24-48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.


Resumo Justificativa: Existem várias abordagens para a realização do Bloqueio do Quadrado Lombar (BQL) guiado por ultrassom. Diversas abordagens são descritas para a realização do BQL: paramediana lateral, posterior, anterior ou transmuscular e subcostal, todas com o objetivo de obter a máxima dispersão da solução injetada, usando-se alto volume e baixa concentração de anestésico local. Relato de caso: Nesta nova abordagem, a sonda de ultrassom curvilínea foi usada com o paciente em decúbito dorsal. A sonda foi posicionada longitudinalmente na linha axilar média para visualizar o Músculo Quadrado Lombar (MQL) no plano coronal. A agulha foi introduzida na direção cranial-caudal, e foram inseridos cateteres na Fáscia Toracolombar Anterior (FTLA) até uma distância de 4-5 cm, em 24 pacientes a serem submetidos à correção de fratura do acetábulo pela via anterior. O bisel da agulha e a dispersão do Anestésico Local (AL) eram visíveis em todos os pacientes. Os 24 pacientes, com exceção de quatro, apresentaram excelente analgesia perioperatória, baseando-se na estabilidade hemodinâmica e nos escores EVA de 2-3/10 nas primeiras 48 horas. Todos os pacientes receberam 1 g de paracetamol intravenoso a cada 8 horas. O escore EVA no período pós-operatório foi de 2-3/10, em 20 dos 24 pacientes. No período pós-operatório, quatro pacientes apresentaram queixa de dor persistente, necessitando de bolus de fentanil por via intravenosa e analgesia multimodal. O escore médio da EVA no pós-operatório foi 2,87 entre 0-12 horas; 3,14 entre 12-24 horas e 3,35 entre 24-48 horas pós-operatórias. Não houve complicações relacionadas ao bloqueio em nenhum paciente. Conclusão: A abordagem supina axilar média coronal para BQL anterior é eficaz e viável para BQL, e pode ser realizada com os pacientes em decúbito dorsal.


Subject(s)
Humans , Male , Female , Pain, Postoperative/prevention & control , Anesthetics, Local/administration & dosage , Nerve Block/methods , Time Factors , Supine Position , Abdominal Muscles , Ultrasonography, Interventional , Acetabulum/surgery , Acetabulum/injuries , Acetaminophen/administration & dosage , Middle Aged , Nerve Block/adverse effects
14.
Rev. bras. anestesiol ; 70(4): 440-442, July-Aug. 2020.
Article in English, Portuguese | LILACS | ID: biblio-1137191

ABSTRACT

Abstract The erector spinae plane block is a safe and effective regional anesthesia technique, which has earned new indications perioperatively since its description. We introduce two pediatric anesthesia cases in which we performed the erector spinae plane block during intermediate/major orthopedic surgeries. The first patient is a 2 year-old girl submitted to surgical treatment of developmental dysplasia of the hip. The second patient is a 14 year-old boy submitted to surgical treatment of bilateral clubfoot. This last patient is potentially the first published case in which the erector spinae plane block was performed for ankle and foot surgery. Both cases experienced excellent analgesia, avoiding opiate requirement completely.


Resumo O bloqueio do plano eretor da espinha guiado por ultrassonografia é uma técnica segura e eficaz de anestesia regional, que apresenta novas indicações no perioperatório. Apresentamos dois casos de bloqueio do plano eretor da espinha realizados para analgesia de cirurgia ortopédica pediátrica de médio/grande porte. O primeiro: menina de 2 anos submetida a tratamento cirúrgico de displasia do desenvolvimento do quadril. O segundo: menino de 14 anos submetido a correção de pé valgo bilateral. Este último, no melhor do nosso conhecimento, é o primeiro caso de bloqueio do plano eretor da espinha em cirurgia de tornozelo/pé descrito na literatura. Os casos tiveram analgesia pós-operatória adequada, sem necessidade de opioides.


Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Clubfoot/surgery , Orthopedic Procedures/methods , Developmental Dysplasia of the Hip/surgery , Nerve Block/methods , Pain, Postoperative/prevention & control , Paraspinal Muscles
15.
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 376-382, May-June 2020. graf
Article in English | LILACS | ID: biblio-1132586

ABSTRACT

Abstract Introduction: Packing of the nasal cavity has traditionally been used for postoperative bleeding control and decreasing synechia formation in patients undergoing nasal surgeries. Although absorbable nasal packing has been gaining popularity in the recent years, nonabsorbable nasal packing is still often used in nasal surgeries in various parts of the world. It is known to be associated with pain and discomfort especially upon and during removal, and previous reviews have only evaluated the effects of local anesthetic infiltration of nasal packing in septal surgeries. Objective: To evaluate the effect of infiltrating nasal packing with local anesthetics in postoperative pain and anxiety following sinonasal surgeries Materials and methods: We searched the PubMed and Embase databases from their earliest record to April 27, 2019, randomized controlled trials and prospective controlled trials for review, and included only randomized controlled trials for data analysis. We included studies using topical anesthetics-infiltrated nasal packing following sinonasal surgeries and evaluated the effectiveness compared to placebo packing in pain reduction during postoperative follow up, as well as the effectiveness in anxiety reduction. Results: Among 15 studies included for review, 9 studies involving 765 participants contributed to the meta-analysis. In terms of pain reduction, our analysis showed significant standard mean differences regarding effectiveness at postoperative 1, 12, 24 h interval for all surgical groups combined, in the sinus surgery group, as well as during nasal packing removal. There was no consistent evidence to support the effectiveness in anxiety reduction. Conclusions: Our study supports anesthetics infiltration of nasal packing as an effective method in managing pain in patients with nasal packing after sinonasal surgeries. However, the level of evidence is low. More high-quality randomized controlled trials are needed to establish its effectiveness in reducing anxiety. We believe this review is of great clinical significance due to the vast patient population undergoing sinonasal surgeries. Postoperative local hemorrhage remains the greatest concern for ear nose and throat surgeons due to the rich vasculature of the nose and sinuses. Sinonasal packing provides structural support and serves as an important measure for hemostasis and synechia formation. Although absorbable packing has been gaining popularity in the recent years, nonabsorable packing materials are still used in many countries due to lower cost. Infiltration of nasal packing with local anesthetic provides a solution to the discomfort, nasal pressure and nasal pain experienced commonly by the patients as evidenced by our analysis.


Resumo Introdução: O tamponamento da cavidade nasal tem sido usado tradicionalmente para controle do sangramento pós-operatório e diminuição da formação de sinéquia em pacientes submetidos a cirurgias nasais. Embora o tamponamento nasal absorvível tenha ganhado popularidade nos últimos anos, o tampão nasal não absorvível ainda é frequentemente usado em várias partes do mundo. Sabe-se que o tamponamento está associado a dor e desconforto, especialmente na sua remoção, e revisões anteriores avaliaram apenas os efeitos do tampão com anestésico local em cirurgias do septo nasal. Objetivo: Avaliar o efeito do tamponamento nasal infiltrado com anestésicos locais na dor e ansiedade pós-operatórias após cirurgias nasosinusais. Material e métodos: Para a revisão, pesquisamos nos bancos de dados PubMed e Embase desde o registro mais antigo até 27 de abril de 2019, incluímos ensaios clínicos controlados e randomizados, a ensaios clínicos prospectivos controlados e apenas ensaios clínicos controlados e randomizados para análise de dados. Incluímos estudos que usaram tamponamento nasal infiltrado com anestésicos tópicos após cirurgias nasosinusais e avaliamos a eficácia em comparação com o tamponamento com placebo na redução da dor durante o acompanhamento pós-operatório, bem como os efeitos na redução da ansiedade. Resultados: Entre os 15 estudos incluídos, 9, que envolveram 765 participantes, contribuíram para a metanálise. Em termos de redução da dor, nossa análise mostrou diferenças médias padrão significantes em relação à eficácia no pós-operatório nos intervalos de 1, 12, 24 horas para todos os grupos cirúrgicos combinados, no grupo da cirurgia sinusal e durante a remoção do tamponamento nasal. Não houve evidências consistentes para apoiar a eficácia na redução da ansiedade. Conclusões: Nosso estudo apoia o uso de tamponamentos nasais infiltrados com anestésicos locais como um método eficaz no tratamento da dor em pacientes após cirurgias nasosinusais. No entanto, o nível de evidência é baixo. São necessários mais ensaios clínicos randomizados de alta qualidade para estabelecer sua eficácia na redução da ansiedade. Acreditamos que esta revisão seja de grande significado clínico devido à vasta população submetida a cirurgias nasosinusais. A hemorragia local pós-operatória continua a ser a maior preocupação para os cirurgiões otorrinolaringológicos devido à rica vasculatura do nariz e seios nasais. O tamponamento nasosinusal fornece suporte estrutural e serve como uma medida importante para a hemostasia e formação de sinéquias. Embora o tamponamento absorvível tenha ganhado popularidade nos últimos anos, os materiais de tamponamento não absorvíveis ainda são usados em muitos países devido ao menor custo. A infiltração do tamponamento nasal com anestésicos locais fornece uma solução para desconforto, pressão e dor nasal comumente referida pelos pacientes, como evidenciado por nossa análise.


Subject(s)
Humans , Anxiety/psychology , Pain, Postoperative/prevention & control , Paranasal Sinuses/surgery , Postoperative Hemorrhage/prevention & control , Nasal Surgical Procedures/methods , Anesthetics, Local/administration & dosage , Pain, Postoperative/psychology , Bandages , Clinical Trials as Topic , Postoperative Hemorrhage/psychology
16.
Rev. bras. anestesiol ; 70(2): 178-183, Mar.-Apr. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137152

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Aged , Pain, Postoperative/prevention & control , Arthroplasty, Replacement, Hip , Analgesia/methods , Nerve Block/methods , Prospective Studies , Back Muscles , Middle Aged
17.
Rev. bras. anestesiol ; 70(2): 97-103, Mar.-Apr. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137158

ABSTRACT

Abstract Background: Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. Objectives: The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. Methods: This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. Results: Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 h (p = 0.002) and 6 h (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. Conclusions: The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.


Resumo Justificativa: O estresse cirúrgico causa resposta neuroendócrina, resultando em instabilidade hemodinâmica indesejável, modificações na resposta metabólica e disfunção no sistema imune. Objetivos: O objetivo deste estudo foi avaliar, em pacientes pediátricos, a eficácia do bloqueio peridural caudal no controle da dor intra e pós-operatória e na redução da resposta ao estresse nesses períodos. Métodos: Estudo clínico prospectivo randomizado que incluiu 60 pacientes submetidos à herniorrafia eletiva. Um grupo (n = 30) recebeu anestesia geral e o outro (n = 30), anestesia geral combinada a bloqueio caudal. Foram medidos os parâmetros hemodinâmicos, o consumo de medicamentos e a intensidade da dor. Amostras de sangue para medir glicemia e cortisol plasmático foram obtidas antes da indução e após o despertar dos pacientes. Resultados: As crianças que receberam bloqueio peridural caudal apresentaram valores significantemente mais baixos para glicemia (p < 0,01), concentração de cortisol (p < 0,01) e escores de dor de 3 horas (p = 0,002) e 6 horas (p = 0,003) após a cirurgia, maior estabilidade hemodinâmica e menor consumo de medicamentos. Além disso, não foram observados efeitos colaterais ou complicações nesse grupo. Conclusões: O bloqueio peridural caudal combinado à anestesia geral é uma técnica segura e que se associa a menor estresse, maior estabilidade hemodinâmica, redução nos escores de dor e baixo consumo de medicamentos.


Subject(s)
Humans , Male , Child, Preschool , Pain, Postoperative/prevention & control , Stress, Physiological , Surgical Procedures, Operative , Herniorrhaphy , Hemodynamics , Nerve Block/methods , Sacrum , Prospective Studies , Epidural Space , Anesthesia, General
18.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 62-67, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090549

ABSTRACT

Abstract Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo (p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.


Subject(s)
Humans , Male , Female , Child , Adolescent , Pain, Postoperative/drug therapy , Tonsillectomy , Analgesia , Analgesics/administration & dosage , Analgesics/therapeutic use , Intraoperative Care , Pain, Postoperative/diagnosis , Pain, Postoperative/prevention & control , Pakistan , Placebos/administration & dosage , Postoperative Complications , Pain Measurement/methods , Bupivacaine/administration & dosage , Bupivacaine/therapeutic use , Double-Blind Method , Prospective Studies , Injections, Intravenous , Lidocaine/administration & dosage , Lidocaine/therapeutic use
19.
Clinics ; 75: e2026, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133409

ABSTRACT

OBJECTIVES: We compared the analgesic efficacy of a continuous suprascapular nerve block (C-SSNB) and a single-shot interscalene brachial plexus block (S-ISNB) for postoperative pain management in patients undergoing arthroscopic rotator cuff repair. METHODS: A total of 118 patients undergoing arthroscopic rotator cuff repair were randomly allocated to the S-ISNB or C-SSNB groups. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 6, 12, and 24 h postoperatively. Supplemental analgesic use was recorded as total equianalgesic fentanyl consumption. RESULTS: The C-SSNB group showed significantly higher VAS scores at 0−1 h and 1−2 h after the surgery than the S-ISNB group (4.9±2.2 versus 2.3±2.2; p<0.0001 and 4.8±2.1 versus 2.4±2.3; p<0.0001, respectively). The C-SSNB group showed significantly lower VAS scores at 6−12 h after the surgery than the S-ISNB group (4.1±1.8 versus. 5.0±2.5; p=0.031). The C-SSNB group required significantly higher doses of total equianalgesic fentanyl in the post-anesthesia care unit than the S-ISNB group (53.66±44.95 versus 5.93±18.25; p<0.0001). Total equianalgesic fentanyl in the ward and total equianalgesic fentanyl throughout the hospital period were similar between the groups (145.99±152.60 versus 206.13±178.79; p=0.052 and 199.72±165.50 versus 212.15±180.09; p=0.697, respectively) CONCLUSION: C-SSNB was more effective than S-ISNB at 6−12 h after the surgery for postoperative analgesia after arthroscopic rotator cuff repair.


Subject(s)
Humans , Brachial Plexus Block , Rotator Cuff Injuries/surgery , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Arthroscopy , Rotator Cuff/surgery , Anesthetics, Local
20.
Rev. bras. anestesiol ; 69(6): 561-568, nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057475

ABSTRACT

Abstract Background and objectives: The primary aim of this study is to assess the effect of ultrasoung-guided erector spinae block on postoperative opioid consumption after laparoscopic cholecystectomy. The secondary aims are to assess the effects of erector spinae plane block on intraoperative fentanyl need and postoperative pain scores. Methods: Patients between 18-70 years old, ASA I-II were included in the study and randomly allocated into two groups. In Group ESP, patients received bilateral US-ESP with 40 ml of 0.25% bupivacaine at the level of T7, while in Group Control, they received bilateral US-ESP with 40 ml of saline before the induction of anesthesia. Then a standard general anesthesia procedure was conducted in both groups. NRS scores at the postoperative 15th, 30th, 60th minutes, 12th and 24th hours, intraoperative fentanyl need and total postoperative tramadol consumption were recorded. Results: There were 21 patients in Group ESP and 20 patients in Group Control. Mean postoperative tramadol consumption was 100 ± 19.2 mg in Group ESP, while it was 143 ± 18.6 mg in Group Control (p < 0.001). The mean intraoperative fentanyl need was significantly lower in Group ESP (p = 0.022). NRS scores at the postoperative 15th, 30th min, 12th hour and 24th hour were significantly lower in ESP group (p < 0.05). According to repeated measures analysis, NRS score variation over time was significantly varied between two groups (F[1, 39] = 24.061, p < 0.0005). Conclusions: Bilateral US-ESP block provided significant reduction in postoperative opioid consumption, intraoperative fentanyl need and postoperative pain scores of patients undergoing laparoscopic cholecystectomy.


Resumo Justificativa e objetivos: O objetivo primário deste estudo foi avaliar o efeito do bloqueio do plano do músculo eretor da espinha guiado por ultrassom (US-ESP) sobre o consumo de opioides no pós-operatório após colecistectomia laparoscópica. Os objetivos secundários foram avaliar os efeitos do bloqueio do plano eretor da espinha sobre a necessidade de fentanil no intraoperatório e nos escores de dor pós-operatória. Métodos: Pacientes entre 18 e 70 anos, ASA I-II, foram incluídos no estudo e alocados randomicamente em dois grupos. No Grupo ESP, os pacientes receberam o bloqueio bilateral US-ESP com 40 mL de bupivacaína a 0,25% no nível de T7, enquanto no Grupo Controle os pacientes receberam o bloqueio bilateral US-ESP com 40 mL de solução salina antes da indução da anestesia. Em seguida, um procedimento-padrão de anestesia geral foi feito em ambos os grupos. Os escores da NRS aos 15, 30 e 60 minutos e em 12 e 24 horas de pós-operatório, a necessidade de fentanil no intraoperatório e o consumo total de tramadol no pós-operatório foram registrados. Resultados: O grupo ESP foi constituído por 21 pacientes e o Grupo Controle por 20. O consumo médio de tramadol no pós-operatório foi de 100 ± 19,2 mg no Grupo ESP e de 143 ± 18,6 mg no grupo controle (p < 0,001). A necessidade média de fentanil no intraoperatório foi significativamente menor no grupo ESP (p = 0,022). Os escores da NRS aos 15, 30 e 60 minutos e em 12 e 24 horas de pós-operatório foram significativamente menores no grupo ESP (p < 0,05). De acordo com a análise de medidas repetidas, a variação do escore NRS ao longo do tempo foi estatisticamente significativa entre dois grupos (F [1,39] = 24,061, p < 0,0005). Conclusões: O bloqueio bilateral US-ESP reduziu de forma significativa o consumo de opioides no pós-operatório, a necessidade de fentanil no intraoperatório e os escores de dor no pós-operatório dos pacientes submetidos à colecistectomia laparoscópica.


Subject(s)
Humans , Male , Female , Adult , Pain, Postoperative/prevention & control , Cholecystectomy, Laparoscopic/methods , Anesthetics, Local/administration & dosage , Nerve Block/methods , Time Factors , Tramadol/administration & dosage , Bupivacaine/administration & dosage , Fentanyl/administration & dosage , Double-Blind Method , Ultrasonography, Interventional , Analgesics, Opioid/administration & dosage , Middle Aged
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