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ABSTRACT BACKGROUND AND OBJECTIVES: According to the redefinition, acute pain is a somatic experience, with individual perception of physical or existential threat, comprising affective, cognitive and behavioral components. In critically ill patients, pain is a frequent and poorly controlled symptom, causing worse outcomes. The objective of this study was to explore the topic of acute pain in critically ill adult patients, focusing on some aspects of pathophysiology, in addition to updates regarding diagnosis, multimodal therapy and discussion of its control as a marker of good care practice. CONTENTS: A search strategy was performed with the descriptors previously defined in the Pubmed and Cochrane portals, in the period from 2011 to 2021, without a language restriction filter. Acute pain represents a physiological response to a nociceptive stimulus, with high relevance due to its ability to activate complex pathways (inflammatory, hormonal and immune), with systemic repercussions. Pain assessment is often performed using recognized scales, but with limited validation in patients with traumatic brain injury, burns and patients with severe delirium and/or dementia. Studies considering these patients point to the use of new technologies in an attempt to target this diagnosis, such as bedside pupillometry and the use of platforms capable of integrating multiparametric measurements. Regarding therapy, the concept of analgosedation, aiming at prioritizing analgesia in critically ill patients, presents an approach capable of improving clinical outcomes. In addition, there is a preference for multimodal therapy as a good medical practice through the association of different drugs with different mechanisms of no-ciceptive blockade as a strategy to achieve pain control and facilitate the reduction of opioid consumption. CONCLUSION: Due to its systemic effects and prevalence, acute pain is still a relevant problem in intensive care units. New diagnostic methods are being marketed with the aim of targeting this evaluation in complex patients. The approach to acute pain should prioritize the use of multimodal techniques, which present more consistent clinical responses, in addition to reducing the consumption of opioids. The existence of multidisciplinary teams specialized in pain control in the hospital environment is able to assist in difficult cases and help in quality audits.
RESUMO JUSTIFICATIVA E OBJETIVOS: Conforme redefinição, a dor aguda é uma experiência somática, com percepção individual de ameaça física ou existencial, compreendendo componentes afetivos, cognitivos e comportamentais. Em pacientes críticos, a dor representa um sintoma frequente e mal controlado, ocasionando piores desfechos. O objetivo deste estudo foi explorar a temática da dor aguda nos pacientes críticos adultos, com enfoque em alguns aspectos de fisiopatologia, além de atualizações em relação a diagnóstico, terapêutica multimodal e discussão de seu controle como um marcador de boa prática assistencial. CONTEÚDO: Foi realizada estratégia de busca com os descritores previamente definidos nos portais Pubmed e Cochrane, no período de 2011 a 2021, sem filtro de restrição para idioma. A dor aguda representa uma resposta fisiológica a um estímulo nociceptivo, tendo alta relevância por sua capacidade de ativar vias complexas (inflamatórias, hormonais e imunes), com repercussões sistêmicas. A avaliação da dor é frequentemente realizada através de escalas reconhecidas, porém com validação limitada em pacientes com trauma cranioencefálico, queimados e portadores de delirium e/ou demência acentuados. Os estudos considerando esses pacientes apontam para o uso de novas tecnologias na tentativa de objetivar esse diagnóstico, como a pupilometria à beira leito e o uso de plataformas capazes de integrar medidas multiparamétricas. Em relação à terapêutica, o conceito de analgosedação, objetivando priorização de analgesia nos pacientes críticos, apresenta abordagem capaz de melhorar desfechos clínicos. Além disso, há preferência da terapêutica multimodal como boa prática médica através da associação de diferentes fármacos com diversos mecanismos de bloqueio nociceptivo como estratégia para alcançar controle álgico e facilitar a redução do consumo de opioides. CONCLUSÃO: Por seus efeitos sistêmicos e sua prevalência, a dor aguda ainda é problemática relevante nas unidades de terapia intensiva. Novos métodos diagnósticos estão sendo comercializados com a proposta de objetivar essa avaliação em pacientes complexos. A abordagem da dor aguda deve priorizar o emprego de técnicas multimodais, que apresentam respostas clínicas mais consistentes, além de redução no consumo de opioides. A existência de equipes multidisciplinares especializadas no controle da dor no ambiente hospitalar é capaz de auxiliar em casos difíceis e ajudar nas auditorias de qualidade.
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Objective: To retrospectively analyze the efficacy and safety of three high-dose opioids in the treatment of cancer pain in our hospital.Methods: The medical records of 73 patients with severe cancer pain were collected, and according to the taken drugs, they were divided into group A (sustained-release morphine tablets, 25 ones), group B (sustained-release oxycodone tablets, 36 ones) and group C (transdermal fentanyl, 12 ones).Evaluation of patients with average of pain NRS,breakthough pain NRS,dosage of opioids,quality of life on admission and in 24h after the 4 weeks treatment;In addition,the other analgesic medications,auxiliary medicines,and adverse drug reations were recorded at the same time.Results: The NRS was significantly lowed in the three groups after the 4-week treatment (P＜0.01), and that in group B was lowest with notable difference when compared with that in group A (P＜0.05).The number of breakthrough pain also significantly decreased in the three groups after the treatment (P＜0.01), and there was no significant difference among them (P＞0.05).The doses of opioids analgesics after the 4-week treatment were significantly higher than those on admission (P＜0.01), and the doses in group B were slightly lower than those in the other two groups, while there was no significant difference among them (P＞0.05).The quality of life in the three groups was improved significantly after the treatment (P＜0.01), and no significant difference was shown among them (P＞0.05).The other pain medications and auxiliary medicines used in the three groups were similar (P＞0.05).The incidence of adverse reactions in the three groups had no significant difference (P＞0.05).Conclusion: The standardization of the three high-dose opioids analgesics can control pain effectively and improve the quality of life, which is worthy of clinical promotion.In addition, oxycodone shows the best analgesic effect, whiel fentanyl transdermal patches have the lowest incidence of adverse reactions.
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Objetivo: Describir un diagnóstico situacional de las condiciones de trabajo y perfil sanitario de los profesionales de salud y técnicos del Hospital Nacional Almanzor Aguinaga Asenjo (HNAAA). Materiales y métodos: Estudio descriptivo, transversal, en la cual participaron todos los trabajadores de salud (73 médicos (as), 91 enfermeras y 73 técnicos (as) de enfermería) del Hospital Nacional Almanzor Aguinaga Asenjo. La recolección de datos se realizó aplicando una encuesta individual a cada sujeto del estudio durante 4 semanas en el mes de septiembre y octubre del año 2009. Resultados: Se aplicaron 237 cuestionarios, el 47.3% en su mayoría corresponden al femeninos, con edades comprendidas entre los 40 - 59 años, por otro lado un 38.4% del sexo femenino tienen como grupo ocupacional Enfermera, un 25.3% son técnicas y un 3% son médicos, así mismo tenemos que en un 27.8% del sexo masculino tienen como grupo ocupacional medico, un 5.5% técnicos y finalmente con un 0% del sexo masculino son enfermeros. Conclusiones: Según el tipo de enfermedades o problemas de salud existentes en los profesionales de salud y técnicos del HNAAA, resultó que el 19% de los encuestados tiene problemas músculo esqueléticas. Y respecto a las condiciones de trabajo, los factores que más resaltaron fueron los riesgos biológicos y ergonómicos.(AU)
Objetive: To describe a situational analysis of working conditions and health profile of the health professionals and technicians of the National Hospital Almanzor Aguinaga Asenjo (HNAAA). Materials and Methods: A descriptive, crosssectional, with the participation of all health workers (73 doctors (as), 91 nurses and 73 technicians (as) nursing) National Hospital Almanzor Aguinaga Asenjo. Data collection was performed by applying an individual survey each study subject during four weeks in September and October of 2009. Results: 237 questionnaires were applied, 47.3% correspond mainly to female, aged between 40-59 years old, on the other hand 38.4% of females have as Nurse occupational group, 25.3% are technical and 3 % are doctors, also we have a 27.8% male as an occupational group have medical, technical 5.5% and finally to 0% are male nurses. Conclusions: Depending on the type of disease or existing health problems health professionals and technicians HNAAA, was that 19% of respondents have musculoskeletal problems. And with regard to working conditions, the factors that were highlighted biological and ergonomic hazards.(AU)
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Embora existam muitos estudos clínicos avaliando analgésicos e o controle da dor em cães, poucos são realizados em animais com dor do câncer e submetidos a procedimento cirúrgico para ressecção da neoplasia como a maxilectomia e mandibulectomia. Este estudo clínico foi realizado de forma prospectiva, comparativa, aleatória e de maneira simples cego com o propósito de avaliar a eficácia analgésica de diferentes tratamentos no período pós-operatório em cães submetidos à maxilectomia ou mandibulectomia. Foram utilizados no estudo 42 cães com neoplasia oral. Todos os animais foram prémedicados com acepromazina (0,05mg/kg) associado à meperidina (2mg/kg) por via intramuscular e a anestesia foi induzida com propofol por via iv na dose suficiente realizar a intubação (2.3-6.5mg/kg). O isoflurano foi utilizado para a manutenção da anestesia. Trinta minutos antes do fim do procedimento cirúrgico, os cães foram distribuídos aleatoriamente em um dos 5 diferentes grupos para analgesia pósoperatória: tramadol 2mg/kg (Tra), codeína 2mg/kg (Co), cetoprofeno 2mg/kg (Ce), tramadol 2mg/kg associado ao cetoprofeno 2mg/kg (TraCe) ou codeína 2mg/kg associado ao cetoprofeno 2mg/kg (CoCe), por via subcutânea. A freqüência cardíaca (FC) e respiratória (FR), pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão arterial média (PAM), glicose sanguínea, cortisol e interleucina-6 (IL- 6) e grau de sedação foram verificados até 24 horas, e grau de analgesia foi verificado por até 120 horas do início da administração do analgésico, ou seja, os respectivos tratamentos foram mantidos por 5 dias da seguinte forma: tramadol ou codeína a cada 8 horas e cetoprofeno a cada 24 horas por via oral (MBL, M1, M2, M3, M4, M5, M24, M48, M72, M96 e M120). O resgate analgésico foi realizado nos animais que apresentaram escore de dor 4 em qualquer momento do estudo (dipirona 25mg/kg e morfina 0,1mg/kg). A análise estatística foi realizada por meio do Kruskal-Wallis...
Although there are many clinical studies evaluating analgesics and pain control in dogs, very few were carried out in animals with cancer pain, and submitted to oncologic surgery with tumor resections such as maxillectomy and mandibulectomy. This clinical, prospective, randomized, simple blinded study was performed with the purpose of evaluating analgesic efficacy of different treatments in the postoperative period in dogs submitted to maxillectomy or mandibulectomy. Forty-two client-owned dogs with oral tumor were used in the study. Dogs were premedicated with acepromazine (0.05mg kg-1) and meperidine (2mg kg-1) by the intramuscular route and anesthesia was induced with intravenous propofol in a dose sufficient to allow intubation (2.3-6.5mg-1). Isoflurane was used for maintenance of anesthesia. Thirty minutes prior to the end of surgery, dogs were randomly allocated in one of 5 different groups for postoperative analgesia: tramadol 2mg kg-1 (Tra), codeine 2mg kg-1 (Co), ketoprofen 2mg kg-1 (Ke), tramadol 2mg kg-1 + ketoprofen 2mg kg-1 (TraKe) or codeine 2mg kg-1 + ketoprofen 2mg kg-1 (CoKe), subcutaneously. Heart (HR) and respiratory (RR) rates, systolic (SBP), median (MBP) and diastolic (DBP) blood pressures, blood glucose, serum cortisol and interleukin-6 (IL-6) and degree of sedation were recorded for 24 hours, and degree of analgesia were evaluated until 120 hours of the start of analgesic administration (MBL, M1, M2, M3, M4, M5, M24, M48, M72, M96 and M120), being that treatments were maintained for 5 days as follows: codeine or tramadol every 8 hours and the ketoprofen every 24 hours orally. Analgesic rescue was delivered to animals with pain scores equal or superior to 4 at any time of the study (dypirone 25mg -1 and morphine 0,1mg-1). Statistical analyses were performed by means of the Kruskal-Wallis, Friedmann for repeated measures, ANOVA and 2 tests. Graphics boxplot or box diagrams represents dates of distribution. Values of p<0.05 were...