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Braz. J. Pharm. Sci. (Online) ; 58: e18681, 2022. graf
Article in English | LILACS | ID: biblio-1360162


Abstract Vascular ulcers (VU) constitute a major cause of pain and disability, and significantly compromise quality of life. VU have a natural tendency to become chronic and in many cases exhibit anunsatisfactoryresponse to many of the standard therapeutic options.The case of a 73 year-old Caucasian female with severe pain and poorly-controlled pain (Visual Analogic Scale-VAS- of 8-9) due to three lower leg long-standing VUs is reported and discussed herein. The patient was treated with topical instillations of undiluted sevoflurane as per institutional off-label protocol (starting doses of 1mL/cm2 twice a day, and up-titrated according to response to a maximum of 7 mL twice daily). The VAS score dropped to 0-1 shortly after initiation of therapy and remained stable throughout treatment up until the closure of the observations. Subsequently, opioid therapy was gradually tapered down and ultimately abandoned.Sevoflurane application resulted on adequate and sustained pain management of refractory VU, with no significant side effects. On account of its beneficial effectivity and safety profiles, topical sevoflurane emerges as an add-on alternative for the long-term management of VU, and potentially other painful conditions.

Humans , Female , Aged , Pain/drug therapy , Varicose Ulcer , Research Report , Sevoflurane/analysis , Drug Tapering/methods , Analgesics, Opioid/agonists , Patients/classification , Pain Management/classification
Rev. cuba. cir ; 60(3): e1196, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347391


Introducción: La cirugía torácica figura entre los procedimientos quirúrgicos más dolorosos. Objetivo: Describir los resultados de la alcoholización de nervios intercostales para analgesia postoperatoria. Métodos: Se realizó un estudio prospectivo, observacional y descriptivo de pacientes tratados quirúrgicamente por afecciones torácicas durante 2018-2019. La muestra incluyó 50 pacientes que cumplieron los criterios de inclusión: operados por el autor principal, mayores de 18 años, acceso intercostal y firmaron el consentimiento informado. Se excluyeron los operados por otros cirujanos o presentaron afectación de la pared torácica. La intensidad del dolor se categorizó en cuatro grupos: leve, moderado, intenso e insoportable, según escala análogo visual. Resultados: Durante la primera noche, predominaron el dolor leve (25/50 por ciento) y moderado (9/18 por ciento). El dolor intenso se presentó en dos (4 por ciento) pacientes y 14(28 por ciento) no necesitaron medicación adicional. Al día siguiente no hubo casos con dolor intenso y solo 9 acusaron dolor moderado. La analgesia peridural solo se utilizó la primera noche y al siguiente día. La tendencia a disminuir el dolor se mantuvo al segundo y tercer día. No hubo casos con dolor insoportable. A largo plazo solo un paciente presentó dolor intenso que necesitó tratamiento con bloqueos. Conclusiones: La alcoholización disminuyó el uso adicional de analgésicos. No hubo complicaciones ni dolor insoportable, por lo que consideramos que este método podría ser una alternativa segura, sobre todo cuando no se dispone de fármacos costosos o personal entrenado en las técnicas modernas de analgesia postoperatoria(AU)

Introduction: Thoracic surgery is among the most painful surgical procedures. Objective: To describe the outcomes of the alcoholization of the intercostal nerves for postoperative analgesia. Methods: A prospective, observational and descriptive study was carried out, with patients treated surgically for thoracic conditions during 2018-2019. The sample included fifty patients who met the inclusion criteria: operated by the corresponding author, older than eighteen years, intercostal access and patients who signed the informed consent. Those operated on by other surgeons or who had chest wall involvement were excluded. Pain intensity was categorized into four groups: mild, moderate, intense and unbearable, according to the analog-visual scale. Results: During the first night, mild (25: 50 percent) and moderate (9: 18 percent) pain predominated. Severe pain occurred in two (4 percent) patients, while 14 (28 percent) did not require any additional medication. The next day, there were no cases of severe pain and only nine reported moderate pain. Epidural analgesia was only used the first night and the next day. The tendency to decrease in pain was maintained on the second and third days. There were no cases with unbearable pain. In the long term, only one patient had severe pain and required, therefore, treatment with blocks. Conclusions: Alcoholization decreased the additional use of analgesics. There were no complications or unbearable pain, a reason why we consider that this method could be a safe alternative, especially when expensive drugs or personnel trained in modern postoperative analgesia techniques are not available(AU)

Humans , Pain/drug therapy , Surgical Procedures, Operative/methods , Thoracic Surgery/methods , Analgesia, Epidural/adverse effects , Intercostal Nerves/pathology , Pharmaceutical Preparations/administration & dosage , Epidemiology, Descriptive , Prospective Studies , Observational Studies as Topic , Informed Consent
J. coloproctol. (Rio J., Impr.) ; 41(2): 206-209, June 2021. tab
Article in English | LILACS | ID: biblio-1286985


Painful anal fissures could be distressing conditions that severely impair the patients' quality of life. The analgesic effectiveness of topical drugs, such as calcium-antagonists and nitrates is quite variable. The inhalational anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds.We report a pioneer experience treating a painful chronic anal fissure with topical sevoflurane. A young adult male was suffering from an extremely painful chronic anal fissure, which severely affected his quality of life. The topical treatment with nitroglycerine and diltiazem gels failed. The patient agreed to the treatement with topical sevoflurane as an off-label medication, and it produced an immediate, intense, and long-lasting analgesic effect. An intense but rapidly transient burning sensation, as well as persistent but well-tolerated flatulence were the only adverse effects. The quality of life was greatly improved, and the cost of the treatment was affordable. Therefore, the off-label use of topical sevoflurane appears to be an effective alternative for the symptomatic treatment of painful anal fissures (AU)

As fissuras anais dolorosas podem ser condições angustiantes que prejudicam gravemente a qualidade de vida dos pacientes. A eficácia analgésica de medicamentos tópicos, como antagonistas de cálcio e nitratos, é bastante variável. O anestésico inalatório sevoflurano está sendo reaproveitado como analgésico tópico para feridas crônicas dolorosas. Relatamos uma experiência pioneira de tratamento com sevoflurano tópico em fissura anal crônica dolorosa. Umjovemadulto do sexomasculino sofria de uma fissura anal crônica extremamente dolorosa, que afetava gravemente sua qualidade de vida. O tratamento tópico com nitroglicerina e géis de diltiazem foi ineficaz. O paciente concordou com o tratamento com sevoflurano tópico como medicamento off-label, ou seja, com uso diferente do aprovado embula. O sevoflurano tópico produziu um efeito analgésico imediato, intenso e duradouro. Uma sensação de ardência intensa, mas transitória, e flatulência persistente, embora bem tolerada, foram os únicos efeitos adversos. A qualidade de vidamelhorou significativamente, e o custo do tratamento revelou-se acessível. Portanto, o uso off-label de sevoflurano tópico pode ser uma alternativa analgésica eficaz em casos de fissuras anais dolorosas. (AU)

Humans , Male , Adult , Quality of Life , Fissure in Ano/drug therapy , Sevoflurane/therapeutic use , Analgesia , Pain/drug therapy , Treatment Outcome
Rev. Assoc. Med. Bras. (1992) ; 67(1): 125-130, Jan. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287781


SUMMARY OBJECTIVES: To assess the effect of withdrawal of the antiparkinsonian drug regimen administration on patients with PD and its relation to pain. METHODS: The sample included 22 men and 12 women who were candidates for neurosurgery to control motor signs and symptoms treated with L-dopa as a drug, alone or in combination with others (Cholinergic Antagonists; Dopamine Agents). All of them were examined at two different moments, with and without medication, and analyzed for painful symptoms. The Hoehn and Yahr scale was used for functional staging of the disease. Pain intensity was assessed by using the numerical verbal scale. RESULTS: The mean pain intensity among those on medication {2.17±0.39 (SE)} was significantly lower than in the abstinence group {4.2±0.59 (SE), p=0.006, Wilcoxon}, which corresponded to the increase in the total functional staging score from 93 to 111, respectively. CONCLUSION: The interruption of the administration of specific medications in patients with Parkinson's disease caused, or increased the intensity of, painful discomfort correlated with the intensity of functional impairment. This effect was also observed in women, but it was statistically relevant only for men. The results suggest that pain may be a "red flag" that points to the need for a therapeutic drug review when its presence or worsening is detected.

Humans , Male , Female , Parkinson Disease/drug therapy , Pain/etiology , Pain/drug therapy , Levodopa/adverse effects , Antiparkinson Agents/adverse effects
Article in English | WPRIM | ID: wpr-922421


OBJECTIVES@#To investigate the current status of the cognition of neonatal pain assessment and analgesia management among medical staff in the neonatal intensive care unit (NICU).@*METHODS@#A self-made scale was developed according to "Expert consensus on neonatal pain assessment and analgesia management (2020 edition)" and was used to distribute questionnaires to the medical staff in the NICU from the member units of Jiangsu Province Medical Quality Control Centre of Neonatal Department to evaluate their levels of understanding the basic knowledge, assessment, and management of neonatal pain.@*RESULTS@#A total of 957 questionnaires (from 383 doctors and 574 nurses) were collected. Doctors and nurses had mean correct rates of 38% and 39% respectively in answering the questions on the basic knowledge of neonatal pain. They had median correct rates of 0% and 50% respectively in answering the questions on neonatal pain assessment, and mean correct rates of 73% and 68% respectively in answering on analgesia management. Compared with those who did not receive the training on neonatal pain, the medical staff who received such training had significantly higher correct rates in answering the questions on the basic knowledge of neonatal pain and neonatal pain assessment (@*CONCLUSIONS@#The medical staff in the NICU have insufficient cognition of neonatal pain, and thus it is necessary to carry out the special training on neonatal pain, focusing on the promotion and practical application of "Expert consensus on neonatal pain assessment and analgesia management (2020 edition)", in order to improve the level of neonatal pain assessment and analgesia management among medical staff in the NICU.

Analgesia , Cognition , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Medical Staff , Pain/drug therapy , Pain Measurement , Surveys and Questionnaires
Article in Chinese | WPRIM | ID: wpr-921709


The present study optimized the extraction of flavonoids from Lonicera rupicola Hook. f. et Thoms(LRH) and explored its pharmacological effects, such as resisting inflammation, relieving pain, enhancing immunity, and inhibiting pyroptosis, aiming to provide data support and scientific basis for the development and utilization of LRH. Response surface methodology(RSM) was applied to optimize the extraction of flavonoids from LRH based on the results of single-factor experiments. Anti-inflammatory and analgesic effects of LRH flavonoids were evaluated via inflammation and pain models in mice, such as xylene-induced ear swelling, carrageenan-induced footpad swelling, writhing caused by acetic acid, and paw licking. The effect of LRH flavonoids on the carbon clearance index of monocytes and serum immunoglobulin A(IgA) and IgM levels was analyzed on the immunosuppression model induced by cyclophosphamide in mice. The anti-oxidative effect in vivo of LRH flavonoids on liver superoxide dismutase(SOD), catalase(CAT), and malondialdehyde(MDA) levels was determined based on the chronic/subacute aging model in mice induced by D-galactose. The levels of cysteinyl aspartate specific proteinase-1(caspase-1), interleukin-1β(IL-1β), and IL-18 in the supernatant of J774 A.1 mononuclear phagocytes were detected to evaluate the effect of LRH flavonoids on the pyroptosis of mononuclear phagocytes in mice induced by the combination of lipopolysaccharide(LPS) and adenosine triphosphate(ATP). Meanwhile, the effect of LRH flavonoids on the cAMP-PKA signaling pathway was also explored. The optimum conditions for the extraction of LRH flavonoids are listed below: extraction temperature of 65 ℃, the ethanol concentration of 50%, extraction time of 60 min, a material-liquid ratio at 1∶25, and the yield of LRH flavonoids of 0.553%. RSM determined the multiple quadratic regression equation model of response value and variables as follows: the yield of LRH flavonoids=0.61-0.48A+0.1B+0.029C-0.014D+0.32AB+0.04AC-0.012AD-0.02BC+0.037BD-0.031CD-0.058A~2-0.068B~2-0.069C~2-0.057D~2. LRH flavonoids could effectively inhibit ear swelling and footpad swelling, reduced acetic acid-induced writhing, and delayed the paw licking response time in mice. Additionally, LRH flavonoids could improve the carbon clearance index in immunosuppressed mice, potentiate the activities of SOD and CAT and reduce MDA levels in the liver of aging mice induced by D-galactose, and effectively inhibit macrophage pyroptosis by decreasing the levels of caspase-1, IL-1β, and IL-18. The results reveal that LRH flavonoids possess excellent pharmacological activities such as resisting inflammation and oxidation, relieving pain, and enhancing immunity. They can inhibit pyroptosis by enhancing the cAMP-PKA signaling pathway. The results of this study can underpin the pharmacological research, development, and utilization of LRH.

Analgesics/therapeutic use , Animals , Edema/drug therapy , Flavonoids/therapeutic use , Inflammation/drug therapy , Lonicera , Mice , Mice, Inbred ICR , Pain/drug therapy , Plant Extracts/therapeutic use , Pyroptosis
Journal of Integrative Medicine ; (12): 333-339, 2021.
Article in English | WPRIM | ID: wpr-888755


BACKGROUND@#Conscious patients admitted to intensive care units (ICUs) suffer from pain for various reasons, which can affect their recovery process.@*OBJECTIVE@#The present study compared the effects of aromatherapy with Citrus aurantium and lavender essential oils against placebo for reducing pain in conscious intensive care patients.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#This study was a parallel randomized placebo-controlled trial. The ICUs of two educational hospitals in Kerman in Southeastern Iran were the study setting. One hundred and fifty conscious intensive care patients were randomly divided into three groups using a stratified block randomization method. Two groups received aromatherapy with essential oils: one with lavender and the other with C. aurantium; these patients received a 30-minute therapy session using their assigned essential oil on the second day of their intensive care stay. The placebo group used 5 drops of normal saline instead of essential oil during their session.@*MAIN OUTCOME MEASURES@#Patient's pain was assessed using a visual analog scale before the aromatherapy intervention, as well as immediately after and one and three hours after intervention.@*RESULTS@#The mean pain score of the lavender group was 40.01 before the aromatherapy intervention and fell to 39.40, 30.60 and 23.68 immediately after the intervention, and at hour one and three post-intervention, respectively. The mean pain score of the C. aurantium group was 45.48 before the intervention and was reduced to 32.34 at three hours after the intervention. The mean pain of the placebo group decreased from 42.80 before the intervention to 35.20 at three hours after the intervention. Pain scores of all groups decreased during the study (P < 0.001). The mean pain of the lavender group was significantly lower than that of the placebo group at three hours after the intervention.@*CONCLUSION@#The results of this study showed that aromatherapy with lavender essential oil reduced pain in conscious ICU patients. Our data could not justify the use of C. aurantium for reducing pain in this population.@*TRIAL REGISTRATION@#No. IRCT20170116031972N9 (

Citrus , Critical Care , Humans , Intensive Care Units , Lavandula , Oils, Volatile , Pain/drug therapy , Plant Oils
Esc. Anna Nery Rev. Enferm ; 25(1): e20190337, 2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1124790


RESUMO Objetivo analisar a internalização do cuidado com o corpo pelo escolar com a doença falciforme com base na teoria do desenvolvimento de Vigotski e no conceito de cuidado de Collière. Método Estudo qualitativo com 15 escolares que convivem com a doença falciforme, acompanhados em ambulatório na cidade de Vitoria - ES. A técnica utilizada foi a entrevista individual e a análise temática. A hidratação corporal, o brincar, a prevenção e manejo da crise falcêmica, a alimentação e as roupas foram as unidades temáticas que emergiram. Resultados Os participantes referiram ingerir variados tipos de líquidos. As brincadeiras foram predominantemente ativas. Os medicamentos foram de reparação e manutenção da saúde. Não se evidenciou consumo de alimentos saudáveis. Observou-se a utilização de roupas adequadas ao frio. A dor foi um signo da internalização do cuidado e do conhecimento para brincadeiras. A diminuição de líquidos e roupas inadequadas desencadearam a crise falcêmica. Considerações Finais Evidenciaram-se a internalização do conhecimento e dos cuidados mediados pela dor e o despreparo dos professores pela falta de conhecimento. Implicações para a prática este estudo poderá subsidiar a melhor articulação entre profissional de saúde, criança e escola.

RESUMEN Objetivo analizar la internalización de la atención por parte del escolar con la enfermedad de células falciformes basado en la teoría del desarrollo de Vigotski y el concepto de atención de Collière. Método Estudio cualitativo con 15 escolares que viven con la enfermedad de células falciformes, monitoreados en una clínica ambulatoria en la ciudad de Vitoria - ES. La técnica fue la entrevista individual y el análisis temático. La hidratación corporal, el juego, la prevención y el manejo de la crisis falcémica, la alimentación y la ropa fueron las unidades temáticas que emergieron. Resultados Los participantes informaron de la ingestión de varios tipos de líquidos. Los juegos fueron predominantemente activos. Los medicamentos fueron de reparación y mantenimiento de la salud. No se ha demostrado el consumo de alimentos saludables. Se observó el uso de ropa adecuada para el frío. El dolor fue un signo de la internalización de la atención y el conocimiento para los juegos. La disminución de líquidos y la ropa inadecuada desencadenaron la crisis falcémica. Consideraciones finales Se señalaron la internalización del conocimiento y la atención mediados por el dolor y la falta de preparación de los maestros debido a la falta de conocimiento. Implicaciones para la práctica este estudio podrá subsidiar la mejor articulación entre los profesionales de la salud, los niños y la escuela.

ABSTRACT Objective to analyze the internalization of body care by the schoolchildren with sickle cell disease based on Vigotski's development theory and Collière's concept of care. Method Qualitative study with 15 schoolchildren living with sickle cell disease, followed in an outpatient clinic in the city of Vitoria - ES. The technique was the individual interview and thematic analysis. Body hydration, playing, prevention and management of the sickle cell crisis, food and clothing were the thematic units that emerged. Results Participants reported ingesting various types of liquids. The games were predominantly active. The medications were repair and maintenance of health. It was observed no consumption of healthy foods. The use of clothes suitable for the cold was evidenced. Pain was a sign of the internalization of care and knowledge for games. The decrease in liquids and inadequate clothing triggered the sickle cell crisis. Final Considerations The internalization of knowledge and care mediated by pain and the unpreparedness of teachers due to lack of knowledge were highlighted. Implications for practice this study can support the best articulation between health professionals, children and school.

Humans , Male , Female , Child , Self Care , Anemia, Sickle Cell/prevention & control , Pain/drug therapy , Play and Playthings , Dehydration , Qualitative Research , Drinking , Eating , Folic Acid/therapeutic use , Hydroxyurea/therapeutic use , Analgesics/therapeutic use
Rev. bras. oftalmol ; 79(1): 59-62, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092665


Abstract Tolosa-Hunt syndrome is a painful ophthalmoplegia caused by non-specific granulomatous inflammation, corticoid-sensitive, of the cavernous sinus. The etiology is unknown. Recurrences are common. The diagnosis is made by exclusion, and a variety of other diseases involving the orbital apex, superior orbital fissure and cavernous sinus should be ruled out. This study reports a case of a 29-year-old woman, diagnosed with Tolosa-Hunt Syndrome, who presented ophthalmoparesis and orbital pain. She had poor response to corticotherapy and developed colateral effects, so she was treated with single infliximab dose immunosuppression, evolving total remission of the disease.

Resumo A Síndrome de Tolosa-Hunt é uma oftalmoplegia dolorosa causada por uma inflamação granulomatosa não específica, sensível a corticoides, do seio cavernoso. A etiologia é desconhecida. Recorrências são comuns. O diagnóstico é feito por exclusão, devendo ser descartada uma variedade de outras doenças que envolvem o ápice orbitário, fissura orbitária superior e seio cavernoso. O presente estudo trata-se de um relato de caso de uma paciente de 29 anos, diagnosticada com Síndrome de Tolosa-Hunt, que apresentou paresia e dor em região orbital. Obteve resposta pouco efetiva a corticoterapia e desenvolveu efeitos colaterais, por isso foi tratada com dose única de infliximabe, evoluindo com remissão total da doença.

Humans , Female , Adult , Tolosa-Hunt Syndrome/drug therapy , Infliximab/administration & dosage , Infliximab/therapeutic use , Pain/drug therapy , Remission Induction , Prednisolone/adverse effects , Prednisone/adverse effects , Single Dose , Ophthalmoplegia/drug therapy , Tolosa-Hunt Syndrome/diagnosis
Rev. Salusvita (Online) ; 39(1): 103-110, 2020.
Article in Portuguese | LILACS | ID: biblio-1119728


A patela é o maior osso sesamoide do corpo humano, posicionado longitudinalmente na fáscia do músculo quadríceps, entre os tendões quadríceps e patelar. A patela bipartida dolorosa, também conhecida como "sincrondose dolorosa", é uma causa conhecida de dor no joelho anterior, é um diagnóstico de exclusão. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital Luxemburgo, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 45 anos com dor no joelho direito há 01 ano, principalmente na região anterior, que piora ao agachar. Ao exame físico apresenta edema com dor a palpação da patela. A radiografia demonstra patela bipartida. A ressonância magnética (RM) do joelho direito demonstra patela bipartida com união fibrosa entre o fragmento bipartido superolateral e a patela, associada a lesões condrais e edema subcondrais, compatível com "sincondrose dolorosa" da patela. Conclusão: Este relato demonstra a dificuldade de diagnosticar está lesão, pois seu o exame físico é inespecífico e a radiografia demonstra apenas a variação da normalidade ­ patela bipartida, sem evidenciar as alterações próprias da doença, caracterizada apenas pela RM.

The patella is the largest sesamoid bone in thehuman body, positioned longitudinally in the quadriceps muscle fascia, between the quadriceps and patellar tendons. The painful bipartite patella, also known as "painful synchondrosis", is a known cause of anterior knee pain, is a diagnosis of exclusion.Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital Luxemburgo, a photographic record of diagnostic methods, and a review from the literature. Results: 45-year-old man with right knee pain for 1 year, mainly in the anterior region, which worsens when crouching. Physical examination shows edema with pain on palpation of the patella. Right knee radiography demonstrates a bipartite patella. Magnetic resonance imaging (MRI) of the right knee demonstrates a bipartite patella with a fibrous union between the superolateral bipartite fragment and the patella, associated with chondral lesions and subchondral edema, compatible with patella "painful synchondrosis". Conclusion: This report demonstrates the difficulty of diagnosing this lesion, since its physical examination is nonspecific and the radiography shows only the normal variation ­ bipartite patella, without evidencing the disease alterations, characterized only by MRI.

Humans , Male , Adult , Patella/abnormalities , Patella/diagnostic imaging , Bone Diseases/diagnostic imaging , Pain/drug therapy , Pain/diagnostic imaging , Magnetic Resonance Imaging , Pregabalin/therapeutic use , Analgesics/therapeutic use
Article in Chinese | WPRIM | ID: wpr-878847


Pain is a complex, unpleasant feeling and emotional experience associated with actual or potential tissue damage, and manifests itself in certain autonomous psychological and behavioral responses. The commonly used opioid and non-steroidal anti-inflammatory analgesics(NSAIDs) may cause adverse reactions to the kidney, liver, cardiovascular or gastrointestinal system and cause problems of drug abuse. Therefore, it is necessary to study new analgesic drugs with less side effects and significant analgesic effects. A variety of natural products derived from terrestrial plants, microorganisms, marine organisms and fungi have been an important source of clinical medicines and provide an inexhaustible resource for the development and innovation of modern medicines. Therefore, this paper mainly reviews the natural non-alkaloids with analgesic activity in order to provide reference for the research and development of analgesic drugs derived from natural products.

Analgesics/therapeutic use , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Biological Products/therapeutic use , Humans , Pain/drug therapy
Article in English | LILACS | ID: biblio-1283629


The essential oil of Laurus nobilis L. was used to test their antinociceptive efficacy. It was applied intraperitoneally (i.p.) to rats subjected to a nociception test (C reflex and spinal wind-up). The results showed that the essential oil applied at higher doses (0.06 mg/Kg) causes a complete abolition of the spinal wind-up, while the C reflex was unchanged, indicating a clear antinociceptive effect. At lower concentrations (0.012 mg/Kg), there was a lowering in the wind-up by 85% within ten minutes of the essential i.p. oil application. Interestingly, there was an effect of naloxone (0.08 mg/Kg i.p.) When applied, a change occurs that almost entirely reversed the antinociception caused by the essential oil from Laurus nobilis. We conclude that there is a significant antinociceptive effect of the essential oil of Laurus nobilis subjected to electric nociception. In addition, it was observed that naloxone reversed the antinociceptive effect (wind-up) produced by Laurus nobilis.

El aceite esencial de Laurus nobilis L. se usó para probar su eficacia antinociceptiva. Se aplicó por vía intraperitoneal (i.p.) a ratas sometidas a una prueba de nocicepción (reflejo-C y wind-up espinal). Los resultados mostraron que el aceite esencial aplicado a dosis más altas (0.06 mg/Kg) abolió completamente el wind-up espinal, mientras que el reflejo-C no cambió, lo que indica un claro efecto antinociceptivo. A concentraciones más bajas (0.012 mg/Kg), hubo una disminución en el wind-up en un 85% dentro de los diez minutos del i.p. la aplicación del aceite esencial. Curiosamente, hubo un efecto de la naloxona (0.08 mg/Kg i.p.) la cual revierte casi por completo la antinocicepción causada por el aceite esencial de Laurus nobilis. Concluimos que existe un efecto antinociceptivo significativo del aceite esencial de Laurus nobilis sometido a nocicepción eléctrica. Además, se observó que la naloxona revirtió el efecto antinociceptivo (wind-up) producido por Laurus nobilis.

Animals , Rats , Pain/drug therapy , Oils, Volatile/administration & dosage , Laurus/chemistry , Analgesics/administration & dosage , Reflex/drug effects , Spinal Cord/drug effects , Rats, Sprague-Dawley , Naloxone/administration & dosage
Cienc. tecnol. salud ; 7(1): 39-46, 2020. ^c27 cmilus
Article in Spanish | LILACS | ID: biblio-1120258


La flexibilidad laboral es característica de la producción estacional agroindustrial, cuyo principal problema es aprovechar con intensidad los períodos en los que se incrementa la producción. Pero, ¿cómo la demandante competitividad laboral influye en las estrategias de los trabajadores para incrementar su productividad? A partir de esta pregunta, se identificaron los aspectos económicos, sociales y laborales que inciden en la salud, así como las respuestas para disminuir el dolor físico y aumentar las exigencias de competitividad, flexibilización y desregularización del mercado de trabajo. La exposición ambiental y ocupacional en las condiciones de trabajo, el estrés térmico asociado a la deshidratación en la actividad física intensa, el limitado acceso a los servicios de salud, la mala alimentación y la pobre calidad de vida, también pueden producir otras enfermedades como diabetes e hipertensión, así como infecciones y lesiones renales. En ese contexto, en los últimos 20 años, se empezaron a reportar casos de enfermedad renal. La metodología cualitativa aplicada a este estudio, permitió llevar a cabo un proceso investigativo descriptivo e interpretativo sobre la forma en que los sujetos interactúan. Para ello se utilizaron las trayectorias laborales como técnicas en la recolección de datos. Los resultados arrojaron información relevante sobre las estrategias que los trabajadores utilizan para incrementar su rendimiento laboral, entre ellas la automedicación de vitaminas y analgésicos para tratar los espasmos musculares, que estimulan el sistema nervioso central, así como de bebidas saborizadas y energizantes con posibles repercusiones en la excreción renal.

Labor flexibility is characteristic of seasonal agroindustrial production whose main problem is to take advantage of the periods in which production increases. But, how does this demanding labor competitiveness influence workers' strategies to increase their productivity? From this question, the economic, social and labor aspects that affect health were identified, as well as the answers to reduce physical pain and increase the demands for competitiveness, flexibility and deregulation of the labor market. Environmental and occupational exposure in working conditions, thermal stress associated with dehydration in intense physical activity, limited access to health services, poor diet and quality of life, can also cause other diseases such as diabetes and hypertension, as well as infections and kidney lesions. In that context, in the last 20 years, cases of kidney disease began to be reported. The qualitative methodology applied to this study, allowed to carry out a descriptive and interpretive investigation process on the way in which the subjects interact, for this, the work trajectories were used as techniques in data collection. The results yielded relevant information on the strategies that workers use to increase their work performance, including self-medication of "vitamins" and analgesics to treat muscle spasms, drugs that stimulate the central nervous system, as well as flavored and energizing drinks with possible repercussions on renal excretion.

Humans , Male , Adolescent , Adult , Middle Aged , Rural Workers , Working Conditions , Renal Insufficiency, Chronic/economics , Pain/drug therapy , Self Medication , Vitamins/administration & dosage , Coasts , Dehydration/complications , Job Market , Energy Drinks/adverse effects , Renal Elimination , Work Performance , Guatemala , Analgesics/adverse effects
Rev. bras. ter. intensiva ; 31(4): 447-455, out.-dez. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1058046


RESUMO Objetivo: Avaliar o impacto de um protocolo de manejo da dor e redução do consumo de opioides no consumo geral de opioides e nos desfechos clínicos. Métodos: Estudo em centro único, quasi-experimental, retrospectivo, de coortes antes e depois. Utilizamos uma série temporal interrompida para analisar as alterações no nível e na tendência de utilização de diferentes analgésicos. Foram usadas comparações bivariadas nas coortes antes e depois, regressão logística e regressão quantílica para estimativas ajustadas. Resultados: Incluímos 988 pacientes no período pré-intervenção e 1.838 no período pós-intervenção. O consumo de fentanil teve ligeiro aumento gradual antes da intervenção (β = 16; IC95% 7 - 25; p = 0,002), porém diminuiu substancialmente em nível com a intervenção (β = - 128; IC95% -195 - -62; p = 0,001) e, a partir de então, caiu progressivamente (β = - 24; IC95% -35 - -13; p < 0,001). Houve tendência crescente de utilização de dipirona. A duração da ventilação mecânica foi significantemente menor (diferença mediana: - 1 dia; IC95% -1 - 0; p < 0,001), especialmente para pacientes mecanicamente ventilados por períodos mais longos (diferença no 50º percentil: -0,78; IC95% -1,51 - -0,05; p = 0,036; diferença no 75º percentil: -2,23; IC95% -3,47 - -0,98; p < 0,001). Conclusão: Um protocolo de manejo da dor conseguiu reduzir o consumo de fentanil na unidade de terapia intensiva. Esta estratégia se associou com menor duração da ventilação mecânica.

ABSTRACT Objective: To evaluate the impact of an opioid-sparing pain management protocol on overall opioid consumption and clinical outcomes. Methods: This was a single-center, quasi-experimental, retrospective, before and after cohort study. We used an interrupted time series to analyze changes in the levels and trends of the utilization of different analgesics. We used bivariate comparisons in the before and after cohorts as well as logistic regression and quantile regression for adjusted estimates. Results: We included 988 patients in the preintervention period and 1,838 in the postintervention period. Fentanyl consumption was slightly increasing before the intervention (β = 16; 95%CI 7 - 25; p = 0.002) but substantially decreased in level with the intervention (β = - 128; 95%CI -195 - -62; p = 0.001) and then progressively decreased (β = - 24; 95%CI -35 - -13; p < 0.001). There was an increasing trend in the utilization of dipyrone. The mechanical ventilation duration was significantly lower (median difference: - 1 day; 95%CI -1 - 0; p < 0.001), especially for patients who were mechanically ventilated for a longer time (50th percentile difference: -0.78; 95%CI -1.51 - -0.05; p = 0.036; 75th percentile difference: -2.23; 95%CI -3.47 - -0.98; p < 0.001). Conclusion: A pain management protocol could reduce the intensive care unit consumption of fentanyl. This strategy was associated with a shorter mechanical ventilation duration.

Humans , Male , Female , Adult , Aged , Pain/drug therapy , Critical Care/methods , Analgesics, Opioid/administration & dosage , Intensive Care Units , Respiration, Artificial/statistics & numerical data , Time Factors , Dipyrone/administration & dosage , Fentanyl/administration & dosage , Retrospective Studies , Cohort Studies , Interrupted Time Series Analysis , Analgesics/administration & dosage , Middle Aged
Rev. bras. anestesiol ; 69(3): 259-265, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013414


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

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

Humans , Pain/drug therapy , Analgesics/administration & dosage , Analgesics, Opioid/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Fentanyl/administration & dosage , Retrospective Studies , Antirheumatic Agents/administration & dosage , Dose-Response Relationship, Drug , Drug Utilization/trends , Hospitals, Teaching , Morphine/administration & dosage
Rev. bras. ter. intensiva ; 31(1): 21-26, jan.-mar. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1003624


RESUMO Objetivo: Descrever e quantificar as estratégias farmacológicas e não farmacológicas utilizadas para alívio da dor/estresse de recém-nascidos durante a hospitalização em unidades neonatais. Métodos: Estudo quantitativo, descritivo longitudinal desenvolvido com 50 recém-nascidos admitidos e acompanhados até a alta da unidade neonatal. Resultados: Foram registrados 9.948 procedimentos dolorosos/estressantes, média de 11,25 (± 6,3) por dia por neonato. Foram registradas 11.722 intervenções para controle e alívio da dor, sendo 11.495 (98,1%) estratégias não farmacológicas e 227 (1,9%) farmacológicas. Cada neonato recebeu, em média, 235 intervenções de controle e tratamento da dor em sua hospitalização, sendo 13 intervenções não farmacológicas por dia e uma intervenção farmacológica a cada 2 dias. Conclusão: Os neonatos receberam poucas medidas específicas para o alívio da dor, considerando o elevado número de procedimentos dolorosos e estressantes ao longo da internação. Nesse sentido, considera-se essencial a implementação de protocolos efetivos que visam ao alívio da dor.

ABSTRACT Objective: This study sought to describe and quantify the pharmacological and nonpharmacological strategies used to relieve the pain/stress of neonates during hospitalization in neonatal intensive care units. Methods: This quantitative, longitudinal, and descriptive study examined 50 neonates from neonatal intensive care unit admission to discharge. Results: A total of 9,948 painful/stressful procedures were recorded (mean = 11.25 ± 6.3) per day per neonate. A total of 11,722 pain-management and relief interventions were performed, of which 11,495 (98.1%) were nonpharmacological strategies, and 227 (1.9%) were pharmacological interventions. On average, each neonate received 235 pain-management and treatment interventions during hospitalization, 13 nonpharmacological interventions per day, and one pharmacological intervention every 2 days. Conclusion: Neonates receive few specific measures for pain relief given the high number of painful and stressful procedures performed during hospitalization. Thus, it is essential to implement effective pain-relief protocols.

Humans , Male , Female , Infant, Newborn , Pain/drug therapy , Stress, Physiological , Critical Care/methods , Pain Management/methods , Intensive Care Units, Neonatal , Longitudinal Studies , Hospitalization
Acta cir. bras ; 34(4): e201900405, 2019. graf
Article in English | LILACS | ID: biblio-1001089


Abstract Purpose: To evaluate the effects of the nutraceuticals omega-6/3 and omega-9/6 on endometriosis-associated infertility and pain. Methods: Controlled experimental study, with each group composed of eight female rats. Fertility groups: sham-operated control (0.9% saline solution); control with endometriosis (0.9% saline); omega-6/3 (1.2 g/kg/day); omega-9/6 (1.2 g/kg/day); and meloxicam (0.8 mg/kg/day). Pain groups: sham-operated control (0.9% saline); control with endometriosis (0.9% saline); omega-6/3 (1.2 g/kg/day); omega-9/6 (1.2 g/kg/day); medroxyprogesterone acetate (5 mg/kg/every 3 days); and meloxicam (0.8 mg/kg/day). Peritoneal endometriosis was surgically induced. Pain was evaluated with the writhing test. Fertility was evaluated by counting the number of embryos in the left hemi-uterus. Results: The mean number of writhings was as follows: sham-operated, 11.1 ± 2.9; control with endometriosis, 49.3 ± 4.4; omega-6/3, 31.5 ± 2.7; omega-9/6, 34.1 ± 4.5; medroxyprogesterone acetate, 2.1 ± 0.8; meloxicam, 1 ± 0.3. There was a significant difference between both controls and all drugs used for treatment. Regarding fertility, the mean values were as follows: sham-operated, 6.8 ± 0.6; control with endometriosis, 4.2 ± 0.7; omega-6/3, 4.7 ± 1; omega-9/6, 3.8 ± 0.9; and meloxicam, 1.8 ± 0.9. Conclusions: The omega-6/3 and omega-9/6 nutraceuticals decreased pain compared to the controls. There was no improvement in fertility in any of the tested groups.

Animals , Female , Rats , Pain/drug therapy , Fatty Acids, Omega-3/administration & dosage , Medroxyprogesterone Acetate/administration & dosage , Endometriosis/drug therapy , Fertility/drug effects , Meloxicam/administration & dosage , Peritoneum/pathology , Disease Models, Animal , Endometriosis/pathology