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1.
Zhongguo zhenjiu ; (12): 422-426, 2023.
Article in Chinese | WPRIM | ID: wpr-980739

ABSTRACT

OBJECTIVE@#To observe the effect of preoperative, intraoperative and postoperative electroacupuncture (EA) intervention on postoperative urination function in patients with mixed hemorrhoid surgery.@*METHODS@#A total of 240 patients with mixed hemorrhoid surgery under lumbar anesthesia were randomly divided into an EA preconditioning group (group A, 60 cases, 9 cases dropped off), an intraoperative EA group (group B, 60 cases, 4 cases dropped off), a postoperative EA group (group C, 60 cases, 6 cases dropped off), and a non-acupuncture group (group D, 60 cases, 3 cases dropped off). In the groups A, B and C, EA was exerted at Zhongliao (BL 33) and Huiyang (BL 35) , with disperse-dense wave, 4 Hz/20 Hz in frequency, and lasting 30 min, at 30 min before lumbar anesthesia, immediately after lumbar anesthesia and 6 h after surgery, respectively. No EA intervention was performed in the group D. The postoperative urination smoothness score in each group was observed 24 h after surgery. The first urination time, first urination volume, urine residual volume after first urination were recorded, and incidence of indwelling catheterization, postoperative visual analogue scale (VAS) score, number of remedial analgesia, and the incidence of postoperative nausea and vomiting were observed in each group.@*RESULTS@#In the groups A, B and C, the postoperative urination smoothness scores were superior to the group D (P<0.05), and the time of first urination was earlier than the group D (P<0.05). In the group C, the time of first urination was earlier than the group A and the group B (P<0.05), the first urination volume was higher than the group D (P<0.05), and the urine residual volume after first urination was lower than the group D (P<0.05). There was no significant difference in the incidence of indwelling catheterization and postoperative nausea and vomiting among the 4 groups (P>0.05). The VAS scores of the group A, B and C were lower than that in the group D (P<0.05), and the number of remedial analgesia cases was lower than that in the group D (P<0.05).@*CONCLUSION@#EA intervention could promote the recovery of urination function and relieve postoperative pain in patients with mixed hemorrhoids surgery. Early postoperative EA intervention is more conducive to the recovery of urination function.


Subject(s)
Humans , Electroacupuncture , Hemorrhoids/surgery , Urination , Postoperative Nausea and Vomiting , Acupuncture Points
2.
Journal of Integrative Medicine ; (12): 168-175, 2023.
Article in English | WPRIM | ID: wpr-971657

ABSTRACT

BACKGROUND@#Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief.@*OBJECTIVE@#This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room.@*OUTCOMES AND MEASURES@#Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy.@*RESULTS@#The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.@*CONCLUSION@#Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.


Subject(s)
Male , Humans , Ankle , Wrist , Duration of Therapy , Thyroidectomy , Postoperative Nausea and Vomiting/drug therapy , Acupuncture Therapy , Analgesics/therapeutic use , Pain/drug therapy
3.
Zhonghua Wai Ke Za Zhi ; (12): 700-706, 2023.
Article in Chinese | WPRIM | ID: wpr-985801

ABSTRACT

Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),>0.5-2.0 hours(T2),>2.0-6.0 hours (T3),>6.0-12.0 hours (T4) and >12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). The results regarding the occurrence of complications in patients with different levels of PONV at different time intervals after surgery in the two groups were as follows: in the T3 time period of group N, a significant difference was observed only in the occurrence of postoperative complications among patients with different levels of PONV (χ2=24.786, P<0.01). However, in the T4 time period, significant differences were found in the occurrence of postoperative complications among both the same level and different level PONV patients (χ2=15.435, 15.435, both P<0.01). Significant differences were also observed in the occurrence of postoperative complications among the same level and different level PONV patients in both the T3 and T4 time periods of group S (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.


Subject(s)
Male , Humans , Female , Sugammadex , Postoperative Nausea and Vomiting/chemically induced , Neostigmine/adverse effects , Intracranial Aneurysm/surgery , gamma-Cyclodextrins/adverse effects , Atropine
4.
Braz. J. Anesth. (Impr.) ; 73(5): 635-640, 2023. tab, graf
Article in English | LILACS | ID: biblio-1520345

ABSTRACT

Abstract Background: Postoperative nausea and vomiting (PONV) are major complications after general anesthesia. Although various pathways are involved in triggering PONV, hypotension plays an important role. We hypothesized that intraoperative hypotension during general anesthesia might be responsible for the incidence of PONV. Methods: We retrospectively investigated patients who underwent thyroidectomy. The initial blood pressure measured before induction of anesthesia was used as the baseline value. The systolic blood pressure measured during the operation from the start to the end of anesthesia was extracted from anesthetic records. The time integral value when the measured systolic blood pressure fell below the baseline value was calculated as area under the curve (AUC) of s100%. Results: There were 247 eligible cases. Eighty-eight patients (35.6%) had PONV. There was no difference in patient background between the patients with or without PONV. Univariate analysis showed that the total intravenous anesthesia (TIVA) (p = 0.02), smoking history (p = 0.02), and AUC-s100% (p = 0.006) were significantly associated with PONV. Multiple logistic regression analysis revealed that TIVA (OR: 0.54, 95% CI: 0.29-0.99), smoking history (OR: 0.60, 95% CI: 0.37-0.96), and AUC-s100% (OR: 1.006, 95% CI: 1.0-1.01) were significantly associated with PONV. Conclusion: Intraoperative hypotension evaluated by AUC-s100% was related to PONV in thyroidectomy.


Subject(s)
Thyroidectomy , Postoperative Nausea and Vomiting , Hypotension
5.
Rev. Anesth.-Réanim. Med. Urg. Toxicol. ; 15(1): 14-18, 2023. tables
Article in French | AIM | ID: biblio-1437319

ABSTRACT

La rachianesthésie ambulatoire est une des méthodes d'anesthésies loco- régionales de plus en plus utilisées car permet une réhabilitation précoce. L'objectif de l'étude est d'évaluer la tolérance et l'efficacité de la rachianesthésie réalisée en ambulatoire. Méthodes : Il s'agit d'une étude rétrospective, analytique réalisée au Centre Hospitalier Universitaire Andrainjato Fianarantsoa pendant cinq ans (du mois de janvier 2016 au mois de décembre 2020). La tolérance de la rachianesthésie était évaluée par la fréquence et la gravité des incidents peropératoires et complications postopératoires. Son efficacité était estimée par le taux de sortie le jour de l'intervention et la ré-hospitalisation. Résultats : Soixante-quatre patients âgés de 44 [14-85] ans ont bénéficié d'une chirurgie viscérale, gynécologique, traumatologique ou vasculaire sous rachianesthésie. L'hypotension artérielle (n=04) et les nausées et vomissements peropératoires (n = 01) étaient les incidents retrouvés. Les complications postopératoires étaient la céphalée (n = 13), la douleur postopératoire d'intensité modérée à intense (n = 05) et les nausées et vomissements (n = 02). L'âge supérieur à 50 ans (p = 0,012) et une dose supérieure à 12 mg de bupivacaïne (p = 0,011) étaient corrélés à l'hypotension artérielle peropératoire. Le genre féminin (p = 0,004) et l'utilisation de la bupivacaïne hyperbare (p = 0,027) étaient associés aux complications postopératoires. Tous ces patients étaient sortis le jour même de l'intervention sans ré-hospitalisation. Conclusion : La rachianesthésie ambulatoire connaît actuellement un grand essor dans la pratique anesthésique. La prévention de certaines complications devrait être systématique afin d'optimiser sa tolérance et son efficacité


Subject(s)
Humans , Postoperative Nausea and Vomiting , Ambulatory Surgical Procedures , Anesthesia, Spinal , Post-Dural Puncture Headache
6.
Rev. anesth.-réanim. med. urgence ; 15(2): 111-114, 2023. figures, tables
Article in French | AIM | ID: biblio-1511740

ABSTRACT

Le chélonitoxisme est une intoxication collective par consommation de la chair, de la peau et des viscères de la tortue marine. Elle est peu fréquente. Notre objectif était de décrire l'aspect épidémio-clinique et thérapeutique de l'intoxication par tortue de mer. Méthodes : Il s'agit d'un rapport de cas effectué au Centre Hospitalier Universitaire (CHU) Antanambao Toliara, Madagascar après une intoxication collective dans la commune rurale de Soalara Sud, Toliara. Résultats : Nous avons colligé 70 patients qui ont ingéré une tortue adulte du genre Eretmochelys imbricata. Les signes cliniques étaient du type chélonitoxisme. Parmi les 70 cas, 8 patients ont été hospitalisés. L'âge des patients intoxiqués variait de 2 ans à 65 ans avec un âge moyen de 20 ± 14 ans. La tranche d'âge entre 10-20 ans était la plus touchée (44%). Les hommes représentaient 54% des patients avec un sex ratio de 1,18. Cinquante-huit pourcent ont eu leurs premiers signes 24 heures après l'intoxication et 81% des patients ont été vus au CHU entre 24 et 48 heures. Les signes cliniques du chélonitoxisme sont polymorphes : 86% ont présenté une asthénie, 91% des nausées, 25% des vomissements, 71% des céphalées et 21% des stomatites. A l'issue de l'hospitalisation, 99% des malades ont été guéris et un patient est décédé. Les traitements étaient symptomatiques. Conclusion : L'intoxication par tortue de mer est généralement bénigne. La prise en charge est symptomatique.


Subject(s)
Humans , Poisoning , Asthenia , Therapeutics , Fabiana imbricata , Postoperative Nausea and Vomiting , Hospitals
7.
Braz. J. Anesth. (Impr.) ; 72(6): 702-710, Nov.-Dec. 2022. tab, graf
Article in English | LILACS | ID: biblio-1420625

ABSTRACT

Abstract Background and objectives The Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability. Methods This randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10 mL.kg-1 of ideal body weight was administered intravenously 30 min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid. Results The MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p= 0.001, p= 0.016, p= 0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p= 0.016, p= 0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p= 0.003, p= 0.018, p= 0.019, respectively). Conclusion Consequently, preloading can be favorable approach to preserve hemodynamic stability.


Subject(s)
Humans , Arthroscopy , Shoulder , Postoperative Nausea and Vomiting , Ephedrine , Patient Positioning , Crystalloid Solutions
8.
Braz. J. Anesth. (Impr.) ; 72(6): 762-767, Nov.-Dec. 2022. tab, graf
Article in English | LILACS | ID: biblio-1420631

ABSTRACT

Abstract Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007-2010, P1, and (2015-2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB nº 92012/33465


Subject(s)
Humans , Antiemetics/therapeutic use , Neoplasms , Dexamethasone/therapeutic use , Double-Blind Method , Retrospective Studies , Ondansetron/therapeutic use , Postoperative Nausea and Vomiting/drug therapy , Droperidol/adverse effects , Droperidol/therapeutic use
9.
J. coloproctol. (Rio J., Impr.) ; 42(3): 203-209, July-Sept. 2022. tab
Article in English | LILACS | ID: biblio-1421977

ABSTRACT

Objective: Postoperative nausea and vomiting (PONV) is a frequent complication following colorectal surgery. The present study investigated the risk factors for PONV after colorectal cancer surgery. Methods: A retrospective study of 204 patients who underwent surgery for colorectal cancer was conducted. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with PONV. Results: The overall incidence of postoperative nausea (PON) and postoperative vomit (POV) was 26.5% (54/204), and 12.3% (25/204), respectively. The univariate analysis showed that female gender (p < 0.001), no current alcohol drinking habit (p = 0.003), and no stoma creation (p = 0.023) were associated with PON. Postoperative vomit was significantly correlated with female gender (p = 0.009), high body mass index (p = 0.017), and right-sided colon cancer (p = 0.001). The multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 4.225; 95% confidence interval [CI]: 2.170-8.226; p < 0.001) was an independent risk factor for PON. A high body mass index (OR: 1.148; 95%CI: 1.018-1.295; p = 0.025), and right-sided colon cancer (OR: 3.337; 95%CI: 1.287-8.652; p = 0.013) were independent risk factors for POV. Conclusion: Our findings suggest that female gender for PON and a high body mass index and right-sided colon cancer for POV are risk factors after colorectal cancer surgery. An assessment using these factors might be helpful for predicting PONV. (AU)


Subject(s)
Humans , Male , Female , Rectum/surgery , Colon/surgery , Postoperative Nausea and Vomiting , Anesthesia/adverse effects , Medical History Taking
10.
Medisan ; 26(1)feb. 2022. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1405776

ABSTRACT

Introducción: Las náuseas y los vómitos posoperatorios muestran una alta incidencia con los procedimientos laparoscópicos y, además, se han posicionado como un marcador de calidad en anestesiología. Objetivo: Determinar la efectividad de la dexametasona en la prevención de náuseas y vómitos posoperatorios en pacientes operados de la vesícula biliar. Métodos: Se realizó una intervención terapéutica en 100 pacientes operados de la vesícula biliar mediante laparoscopia con anestesia general balanceada, en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero a diciembre de 2018. Para ello, se conformaron dos grupos: uno de estudio, tratado con dexametasona, y otro de control, que recibió un placebo; cuyos integrantes fueron seleccionados en igual número (50 para cada grupo) por el método aleatorio simple. Resultados: En ambos grupos se obtuvo una mayor frecuencia de las edades de 33 a 46 años y del sexo femenino. Las náuseas posoperatorias se identificaron en 24,0 % del grupo de estudio, mientras que, en el de control, figuraron en un porcentaje superior (52,0). También disminuyó el número de pacientes con vómitos al aplicar la dexametasona, pues 90,0 % de aquellos que la recibieron no presentaron esta reacción adversa en el período posoperatorio, en comparación con 72,0 % de controles. Conclusiones: La dexametasona redujo la aparición de náuseas y vómitos posoperatorios, de modo que puede resultar efectiva en la prevención de estos efectos secundarios en pacientes intervenidos por colecistectomía laparoscópica.


Introduction: The postoperative nausea and vomiting show a high incidence with the laparoscopic procedures and, also, they have been positioned as a marker of quality in anesthesiology. Objective: To determine the effectiveness of dexamethasone in the prevention of postoperative nausea and vomiting in patients operated on for gall bladder. Methods: A therapeutic intervention was carried out in patients operated on for gall bladder by means of laparoscopy with balanced general anesthesia, at Dr. Juan Bruno Zayas Alfonso Teachig General Hospital in Santiago de Cuba, from January to December, 2018. Two groups were conformed: a study group, treated with dexamethasone, and a control group that received a placebo; whose members were selected in same number (50 for each group) by the simple random method. Results: In both groups a higher frequency of the 33 to 46 ages and the female sex was obtained. The postoperative nausea were identified in 24.0 % of the study group, while, in the control group, it was higher percentage (52.0). Also the number of patients vomiting diminished when applying dexamethasone, because 90.0 % of those that received it didn't present this adverse reaction in the postoperative period, in comparison with 72.0 % of controls. Conclusions: Dexamethasone reduced the appearance of postoperative nausea and vomiting, so that can be effective in the prevention of these secondary effects in patients intervened by laparoscopic cholecystectomy.


Subject(s)
Dexamethasone , Cholecystectomy, Laparoscopic , Postoperative Nausea and Vomiting
12.
Braz. J. Pharm. Sci. (Online) ; 58: e191123, 2022. tab, graf
Article in English | LILACS | ID: biblio-1394050

ABSTRACT

Chemotherapy induced nausea and vomiting (CINV) and post-operative nausea and vomiting (PONV) is a problem, often occurs in patient. Inspite of high bioavailability, the demerits such as: hepatic first pass metabolism and invasive nature of oral and parenteral dosage forms can be avoided with anti-emetic therapy of transdermal device. The major objective of the present study is to modify the hydrochloride (HCl) form of Ondansetron (OND) to the base form followed by improvement of solubility and permeability of OND by employing solid dispersion (SD) loaded patches. Preformulation study, as observed, begins with an approach to enthuse solubility of OND by SD technique choosing different carriers. The choice of carriers was rationalized by phase solubility study. Several combinations of transdermal films were prepared with pure drug, carriers and SDs with plasticizer Ka values of OND-HPßCD binary system were found lower (54.43 to 187.57 M-1) than that of OND-PVP K-30 binary system (1156.77 to 12203.6 M-1). The drug content of SDs and patches were found satisfactory. Better permeation rate (236.48±3.66 µg/3.935 cm2) with promising flux enhancement (8.30 fold) was found with DBP loaded SD patch (P6*). Hence, enhancement of solubility and permeability of P6* ensures that it can successfully enhance the bioavailability


Subject(s)
Plasticizers/adverse effects , Solubility , Ondansetron/antagonists & inhibitors , Patients/classification , Vomiting , Pharmaceutical Preparations/analysis , Postoperative Nausea and Vomiting , Dosage Forms , Drug Therapy/instrumentation , Methods , Motion Pictures/classification
13.
Rev. chil. anest ; 51(2): 191-198, 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1567531

ABSTRACT

OBJECTIVE: Our goal was to evaluate acute postoperative pain in patients undergoing breast reconstructive surgery with Deep Inferior Epigastric Perforator Artery (DIEP) flap technique. MATERIAL AND METHODS: A retrospective study was carried out in patients undergoing DIEP-flap breast reconstruction between January 2014 and December 2019. The main goal was the evaluation of acute postoperative pain through visual analogic pain scale (VAS) at rest (VASr) and movement (VASm) in the immediate postoperative period in post-anesthesia care unit (0h), at 24 h and at 48 h post-intervention and intravenous (IV) morphine con- sumption, depending on whether General Anesthesia (GA group) or Combined Anesthesia (CA group) was performed. Secon- dary outcomes were chronic pain incidence, perioperative complications, postoperative nausea and vomiting (PONV), reinterven- tion and readmission rate and lenght of hospital saty. RESULTS: Sixty seven patients were included, 24 in GA group and 43 in CA group. CA group showed better VASm values at 24 h postintervention (p = 0.01). Postoperative IV morphine continuous infusion was required for acute pain management in 10.4% of patients (25% in GA vs 2.3% in the CA group; p = 0.004). Chronic pain rate was 13.4% (25% in GA vs 7% in the CA group; p = 0.038). Patients with worse initial pain control (VASr > 3 at 0 h) showed a higher incidence of chronic pain (66.6% vs 9.6%; p = 0.008). GA group presented higher rate of postoperative complications (66.6% vs 34.9%; p = 0,012), as well reintervention rate (58.3% vs 30.2%; p = 0.025). A sub-analysis showed that of the 10 patients (5 in the AC and 5 in the AG group) who reported poor initial pain control (VASr > 3 at 0 h), those belonging to the AC group, the IV morphine requirements were lower at post-anesthesia care unit (2 (0-5) mg vs 16 (9.5-23) mg; p = 0.016) and throughout the hospitalization period (4 (0-6) vs 24 (17.5-49, 2); p = 0.008). CONCLUSIONS: Locorregional techniques could offer a better control of postoperative acute pain and a lower incidence of chronic pain, without assuming implying a higher risk of complications related to them in patients undergoing breast reconstructive surgery by DIEP flap technique.


OBJETIVO: El objetivo del estudio fue evaluar el dolor agudo posoperatorio en las pacientes sometidas a cirugía de reconstrucción mamaria mediante colgajo de la arteria perforante epigástrica inferior profunda (colgajo DIEP). MATERIAL Y MÉTODOS: Se revisaron retrospectivamente las pacientes intervenidas de reconstrucción mamaria con colgajo DIEP entre enero de 2014 y diciembre de 2019. El objetivo principal fue la valoración del dolor agudo posoperatorio mediante la escala visual analógica (EVA) en reposo (EVAr) y movimiento (EVAm) en el posoperatorio inmediato en la unidad de Reanimación (0 h), a las 24 h y a las 48 h post-intervención y el consumo de morfina endovenosa (ev), según si se realizó una Anestesia General (AG) o una Anestesia Combinada (AC). Los objetivos secundarios fueron: incidencia de dolor crónico posoperatorio, complicaciones peroperatorias, náuseas y vómitos posoperatorios (NVPO), tasa de reintervención y reingreso y estancia hospitalaria. RESULTADOS: Se incluyeron 67 pacientes, 24 en el grupo AG y 43 en el grupo AC. El grupo AC mostró un mejor control del dolor en movimiento a las 24 h (p = 0,01). Un 10,4% de las pacientes precisaron infusión de morfina endovenosa (ev) para control del dolor agudo posoperatorio en reposo (25% en el grupo AG vs 2,3% en el grupo AC; p = 0,004). La incidencia de dolor crónico fue del 13,4% (25% en el grupo AG vs 7% en el grupo AC; p = 0,038). Las pacientes con mal control inicial del dolor (EVAr > 3 a las 0 h) presentaron mayor incidencia de dolor crónico (66,6% vs 9,6%; p = 0,008). El grupo AG presentó mayor tasa de complicaciones posoperatorias (66,6% vs 34,9%; p = 0,012), así como tasa de reintervención (58,3% vs 30,2%; p = 0,025). Un subanálisis mostró que de las 10 pacientes (5 en el grupo AC y 5 en el grupo AG) que refirieron un mal control inicial del dolor (EVAr > 3 a las 0 h), las pertenecientes al grupo AC requirieron menos morfina ev en unidad de reanimación postanestésica (2 (0-5) mg vs 16 (9,5-23) mg; p = 0,016) y durante toda su hospitalización (4 (0-6) vs 24 (17,5-49,2); p = 0,008). CONCLUSIONES: Las técnicas locorregionales podrían ofrecer un mejor control del manejo del dolor agudo y una menor incidencia de dolor crónico, sin suponer un mayor riesgo de complicaciones relacionadas con ellos en pacientes sometidas a cirugía reconstructiva mamaria mediante técnica de colgajo DIEP.


Subject(s)
Humans , Female , Adult , Middle Aged , Pain, Postoperative/prevention & control , Mammaplasty/adverse effects , Perforator Flap/blood supply , Anesthesia, Conduction/methods , Anesthesia, General/methods , Pain, Postoperative/epidemiology , Reoperation , Pain Measurement , Retrospective Studies , Combined Modality Therapy , Epigastric Arteries/transplantation , Postoperative Nausea and Vomiting/epidemiology , Morphine/administration & dosage
14.
Article in Spanish | LILACS | ID: biblio-1401929

ABSTRACT

El objetivo del estudio es determinar la eficacia de la Dexametasona frente a la Metoclopramida en la prevención de náuseas y vómitos posoperatorios en pacientes sometidos a procedimiento quirúrgico bajo anestesia general. Se realizó un estudio descriptivo, comparativo, observacional. Se estudiaron pacientes adultos entre 18 y 60 años de edad, los cuales se dividieron en dos grupos. Grupo A se les administro Dexametasona 8 mg IV y a otro grupo B Metoclopramida 10 mg IV, posterior a la inducción anestésica. Ambos grupos fueron comparables en cuanto a sus características según los resultados se evidencia que en el grupo A de la Dexametasona se presentó menos náuseas y vómitos postoperatorios. Después de realizar el estudio se concluye que con la dexametasona existe menos incidencia de náuseas y vómitos con la dosis administrada, por lo tanto, este medicamento es eficaz para el manejo de este tipo de pacientes a comparación de la metoclopramida.


The objective of this study is to determine the efficacy of Dexamethasone versus Metoclopramide in the prevention of postoperative nausea and vomiting in patients undergoing a surgical procedure under general anesthesia. A descriptive, comparative, observational study was carried out. Adult patients between 18 and 60 years of age were studied, who were divided into two groups. Group A received Dexamethasone 8 mg IV and another group B Metoclopramide 10 mg IV, after anesthetic induction. Both groups were comparable in terms of their characteristics. It is evidenced that in group A dexamethasone there was less postoperative nausea and vomiting. Conducting the study, it is concluded that with dexamethasone there is less incidence of nausea and vomiting with the administered dose, so it is concluded that it is effective for the management of this type of patients compared to metoclopramide.


Subject(s)
Humans , Postoperative Nausea and Vomiting
15.
ARS med. (Santiago, En línea) ; 46(1): 38-43, mar. 2021.
Article in Spanish | LILACS | ID: biblio-1293297

ABSTRACT

Introducción: las náuseas y vómitos postoperatorios (PONV) son una complicación postoperatoria común de la anestesia, por lo que la búsqueda de nuevas profilaxis efectivas ha aumentado durante los últimos años, en este contexto se perfila como una opción efectiva el amisulprida, antipsicótico que actúa bloqueando los receptores dopaminérgicos D2 y D3, en dosis bajas. Métodos: se realizó una búsqueda en bases de datos establecidas como: Pubmed, Embase, Google Scholar, Medline y la Cochrane central registed of controlled trials. Con las siguientes definiciones clave: "NV" or "postoperative nausea and vomiting" or "postoperative nausea" or "postoperative vomiting" and "Amisulpride" or "APD421", con el fin de cumplir el objetivo general de verificar la efectividad de amisulprida como medicamento profiláctico en manejo de PONV. Resultados: se evaluaron 3 estudios multicéntricos randomizados controlados, con alto grado de confiabilidad y buena calidad metodológica. Se evidencia que el amisulprida es un medicamento profiláctico efectivo contra PONV y con buen perfil de seguridad. Discusión/Conclusión: el amisulprida es un medicamento profiláctico eficaz para prevención de PONV, en dosis óptima de 5 mg, administrado durante el intraoperatorio de cirugías electivas en que se utilice anestesia general en pacientes de moderado a alto riesgo de PONV según escala de Apfel.


Introduction: postoperative nausea and vomiting (PONV) are common postoperative complications of anaesthesia, that is why the search for new effective prophylaxis has increased in recent years. Between the drugs that have been tested for this purpose, Amisulpride, an antipsychotic that blocks D2 and D3 dopaminergic receptors, seems to be an effective option when used in low doses. Methods: This search was done by using databases such as Pubmed, Embase, Google Scholar, Medline and the Cochrane central register of controlled. With the following keywords: "NV" or "postoperative nausea and vomiting" or "postoperative nausea" or "postoperative vomiting" and"Amisulpride" or "APD421", with the purpose of verifying the effectiveness of Amisulpride as prophylactic medication in PONV man-agement, which is our main objective. Results: 3 randomised, controlled, multicenter, with high reliability and good methodological quality studies were evaluated. Evidence suggests that Amisulpride is effective as a prophylactic medication against PONV, and it also has a good safety profile. Discussion/Conclusion: Amisulpride administered in an optimal dose of 5 mg during intraoperative elective surgeries that required general anaesthesia, showed to be effective in preventing PONV as a prophylactic drug in patients with moderate to high risk of PONV according to the Apfel scale.


Subject(s)
Antibiotic Prophylaxis , Postoperative Nausea and Vomiting , Amisulpride , Databases, Bibliographic , Literature
16.
Article in Chinese | WPRIM | ID: wpr-921897

ABSTRACT

OBJECTIVE@#To explore clinical effect of acupoint application of Chinese herbal medicine in preventing postoperative nausea and vomiting after orthopaedic surgery under general anesthesia.@*METHODS@#From January 2018 to December 2019, 168 patients who met inclusion criteria and were underwent selective spine surgery, were double-blind divided into two groups according to central random system, 84 patients in each group. In control group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (53.83±9.17) years old, 37 patients were classified to typeⅠand 47 patients were typeⅡ according to American Society of Anesthesiologists (ASA) grading. In experiment group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (54.08±9.00) years old; 32 patients were classified to typeⅠand 52 patients were typeⅡ according to ASA grading. Both of two groups were obtained acupoint application before anesthesia induction, and acupoint application were put on @*RESULTS@#There were no statistical differences in incidence of nausea vomiting, VAS of narusea degree at 24 h after operation (@*CONCLUSION@#The curative effect of acupoint application of traditional Chinese medicine on the prevention and treatment of postoperative nausea and vomiting is not obvious.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acupuncture Points , Anesthesia, General , Drugs, Chinese Herbal/therapeutic use , Orthopedic Procedures , Postoperative Nausea and Vomiting/prevention & control , Quality of Life
17.
Rev Chil Anest ; 50(4): 576-581, 2021.
Article in Spanish | LILACS | ID: biblio-1526286

ABSTRACT

Total intravenous anesthesia (TIVA) with propofol/remifentanil appears in the literatura as a good option for neurosurgical patients who have increased intracranial pressure (ICP),risk of postoperative nausea and vomiting (PONV), need for neuromonitoring, and in those with impaired brain self-regulation. On the other hand, in patients with normal neurological status, normal ICP, a technique with volatile (halogenated) agents plus an opiiid can be used. This review describes two anesthetic techniques available for use in neurosurgery, highlighting the neurophysiological changes, advantages and disadvantages of each technique. MATERIAL AND METHOD: PubMed search engine was used for bibliographic search. DISCUSSION: The search for an ideal anesthetic in neurosurgery is still a matter of debate. There are numerous investigations aimed at finding an optimal agent that ensure the coupling between cerebral flow (CBF) and metabolism, keeping self-regulation intact without increasing the CBF and intracerebral pressure (ICP). CONCLUSIONS: Both anesthetic techniques, TIVA and volatile agents (halogenated), can be used in neurosurgical procedures and should provide neuroprotection, brain relaxation and a rapid awakening.


La anestesia total endovenosa (TIVA) con propofol/remifentanilo aparece en la literatura como una buena opción para pacientes neuroquirúrgicos que tienen aumento de la presión intracraneana (PIC), riesgo de náuseas y vómitos posoperatorios (NVPO), necesidad de neuromonitoreo, y en aquellos con alteración de la autorregulación cerebral. Por otra parte, en pacientes con estado neurológico normal, PIC normal puede usarse una técnica con agentes volátiles (halogenados) más un opioide. Esta revisión describe dos técnicas anestésicas disponibles para su uso en neurocirugía, destaca los cambios neurofisiológicos, ventajas y desventajas de cada técnica. MATERIAL Y MÉTODO: Para búsqueda bibliográfica se usó buscador PubMed. DISCUSIÓN: La búsqueda de un anestésico ideal en neurocirugía sigue siendo tema de debate. Existen numerosas investigaciones destinadas a buscar un agente óptimo que asegure el acoplamiento entre flujo sanguíneo cerebral (FSC) y metabolismo, manteniendo la autorregulación intacta sin aumentar el FSC y presión intracerebral (PIC). CONCLUSIONES: Ambas técnicas anestésicas, TIVA y agentes volátiles (halogenados), pueden ser usadas en procedimientos neuroquirúrgicos y deben brindar neuroprotección, relajación cerebral y un despertar rápido.


Subject(s)
Humans , Neurosurgical Procedures/methods , Anesthesia, Inhalation/methods , Anesthesia, Intravenous/methods , Anesthetics, Intravenous/adverse effects , Anesthetics, Intravenous/pharmacology , Anesthetics, Inhalation/adverse effects , Anesthetics, Inhalation/pharmacology , Postoperative Nausea and Vomiting/chemically induced , Neuroprotection , Nervous System/drug effects
18.
Rev. chil. anest ; 50(3): 489-497, 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1525595

ABSTRACT

Elective caesarean section is one of the surgeries with the highest intraoperative incidence of nausea, retching and vomiting (IONV), due, among other causes, to the use of anesthetics during the procedure. Some clinical trials have associated the use of low-dose intrathecal (IT) fentanyl with a lower incidence of nausea, retching and vomiting compared to other anesthetics used during caesarean sections. In this context, the objective of this meta-analysis was to evaluate the decrease in the appearance of nausea and vomiting during elective caesarean section with the application of IT fentanyl when compared with the use of intravenous ondansetron (EV). A systematic search was conducted in the main databases (PubMed, EMBASE, ClinicalTrials.gov, Cochrane Library and Google Scholar) for Randomized Clinical Trials (RCTs) that evaluated the use of IT fentanyl compared to ondansetron EV to decrease the occurrence and incidence of IONV during elective caesarean section. The meta-analysis showed a reduction in the incidence of nausea (RR 0.52, 95% CI 0.29-0.93, P = 0.03), gagging (RR 0.39, 95% CI 0, 18-0.88, P = 0.02) and vomiting (RR 0.26, 95% CI 0.11-0.64, P = 0.003) in the group of patients treated with IT fentanyl compared to the group treated with EV ondansetron. From the results, it is suggested that the administration of 12.5 to 20 µg of IT fentanyl may decrease the incidence of IONV in patients undergoing elective caesarean section, although the importance of more high-quality RCTs is highlighted.


La cesárea electiva es una de las cirugías con mayor incidencia intraoperatoria de náuseas, arcadas y vómito (NAV), debido entre otras causas, al uso de anestésicos durante el procedimiento. Algunos ensayos clínicos han asociado el uso de fentanilo intratecal (IT) a dosis bajas con una menor incidencia de náuseas, arcadas y vómito en comparación con otros anestésicos usados durante las cesáreas. En este contexto el objetivo de este metaanálisis fue evaluar la disminución en la aparición de náuseas y vómito durante cesárea electiva con la aplicación de fentanilo IT al compararlo con el uso de ondansetrón intravenoso (EV). Se realizó una búsqueda sistemática en las principales bases de datos (PubMed, EMBASE, ClinicalTrials.gov, Cochrane Library y Google Scholar) para ensayos clínicos aleatorizados (ECA) que evaluaron el uso del fentanilo IT en comparación con ondansetrón EV para disminuir la aparición e incidencia de IONV durante cesárea electiva. En el metaanálisis se evidenció una reducción en la incidencia de náusea (RR 0,52, 95% IC 0,29-0,93, P = 0,03), arcada (RR 0,39, 95% IC 0,18-0,88, P = 0,02) y vómito (RR 0,26, 95% IC 0,11-0,64, P = 0,003) en el grupo de pacientes tratados con fentanilo IT comparado con el grupo tratado con ondansetrón EV. A partir de los resultados, se sugiere que la administración de 12,5 a 20 µg de fentanilo IT puede disminuir la incidencia de NAV intraoperatorias en pacientes sometidas a cesárea electiva, aunque se resalta la importancia de más ECA de alta calidad.


Subject(s)
Humans , Female , Pregnancy , Vomiting/prevention & control , Cesarean Section , Fentanyl/administration & dosage , Nausea/prevention & control , Ondansetron/administration & dosage , Elective Surgical Procedures , Postoperative Nausea and Vomiting/prevention & control , Anesthesia, Intravenous , Anesthesia, Obstetrical , Anesthesia, Spinal
19.
Rev. colomb. anestesiol ; 48(4): e203, Oct.-Dec. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1144314

ABSTRACT

Abstract Introduction: Postoperative nausea and vomiting are frequent adverse effects of anesthesia and surgery. Impact is greater in pediatric populations compared to adults and the reported incidences are heterogeneous. Objective: To describe the incidence of postoperative vomiting in a pediatric population and to identify associated risk factors. Materials and methods: This prospective cohort study included 190 children aged 3 to 12 years undergoing surgery and anesthesia in a maternal and child health clinic in Bucaramanga (Colombia). The main outcome variable was postoperative vomiting. Data were analyzed using bivariate, multivariate analysis and logistic regression to assess the associated risk factors. Results: The overall incidence of postoperative vomiting was 18.95% (95% CI: 13.32 - 24.57), with a higher incidence at home vs. hospital (12.63% vs. 9.47%). After adjustment, associated risk factors were anesthesia time longer than 45 minutes (OR: 2.33; 95% CI: 1.10-4.90) and postoperative use of opioids (OR: 4.17; 95% IC: 1.6510.5). The incidence of postoperative vomiting was higher in patients who underwent emergency surgery. Conclusion: This is the first study in Colombia that evaluates the incidence of postoperative vomiting in children. The incidence in our pediatric population is within the ranges reported worldwide. Associated risk factors were anesthesia time longer than 45 minutes and postoperative use of opioids. Further research is required in order to study emergency surgery as a potential risk factor.


Resumen Introducción: Las náuseas y el vómito postoperatorios son un resultado adverso frecuente derivado del acto anestésico y/o quirúrgico. La magnitud de este problema es mayor en la población pediátrica en comparación con la población adulta, con una considerable heterogeneidad de datos respecto a la incidencia. Objetivo: Describir la incidencia de vómito postoperatorio en población pediátrica y sus factores de riesgo asociados. Materiales y métodos: Estudio de cohorte prospectivo realizado en Clínica Materno Infantil de III-IV nivel de Bucaramanga (Colombia), en 190 pacientes pediátricos con edades entre 3 y 12 años, sometidos a cirugía sin discriminar técnica anestésica. Se realizó análisis bivariado, multivariado y regresión logística. Resultados: La incidencia de vómito postoperatorio en el estudio fue de 18,95 % (IC-95 % [13,32-24,57]), y es mayor en la casa que en la institución hospitalaria (12,63 % vs. 9,47 %). Tras el ajuste, los factores de riesgo establecidos fueron el tiempo anestésico mayor de 45 minutos (OR 2,33; IC-95 % [1,10-4,90]) y uso de opioide postoperatorio (OR 4,17; IC-95 % [1,65-10,5]). Hubo una incidencia importante de vómito postoperatorio en pacientes sometidos a cirugía de urgencias. Conclusiones: Este es el primer estudio en Colombia que evalúa la incidencia de vómito postoperatorio en población pediátrica. La incidencia se encuentra dentro del rango reportado en la literatura mundial y se establecieron como factores asociados el tiempo anestésico mayor a 45 minutos y uso de opioides en el postoperatorio. Consideramos que debe estudiarse la cirugía de urgencias como posible factor de riesgo en estudios posteriores.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Pediatrics , Postoperative Nausea and Vomiting , Postoperative Complications , Analgesics, Opioid , Anesthesia
20.
Rev. bras. anestesiol ; Rev. bras. anestesiol;70(6): 588-594, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155777

ABSTRACT

Abstract Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. Conclusion: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.


Resumo Justificativa e objetivos: Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial. Métodos: Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA). Resultados: Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p< 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72vs. 0,02 ± 0,17; p< 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4%vs.0%; p< 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante. Conclusão: A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.


Subject(s)
Humans , Male , Female , Arthroscopy/methods , Shoulder Joint/surgery , Dexamethasone/administration & dosage , Ultrasonography, Interventional/methods , Brachial Plexus Block/methods , Anti-Inflammatory Agents/administration & dosage , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Arthroscopy/adverse effects , Time Factors , Vasoconstrictor Agents/administration & dosage , Pain Measurement , Double-Blind Method , Prospective Studies , Analysis of Variance , Postoperative Nausea and Vomiting/epidemiology , Saline Solution/administration & dosage , Levobupivacaine , Analgesia , Anesthetics, Local , Middle Aged
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