RESUMO
Abstract Objectives: To capture evidence of the efficacy and safety of pharmacological analgesia for uncomplicated acute sickle-cell pain in pediatric patients compared to placebo. Sources of data: Searches for key evidence were performed from March 1 to 31, 2018, for randomized controlled trials of pharmacological analgesia compared to placebo for uncomplicated acute sickle-cell pain in a pediatric sample. The authors searched ten scientific databases including, among others, PubMed, MEDLINE, Embase, and Clinicaltrials.gov for this systematic review and meta-analysis. Summary of the findings: Four trials (n = 227) were selected by the inclusion criteria (intranasal fentanyl, intravenous magnesium, arginine, and inhaled nitric oxide). The quality of evidence ranged from low to moderate for each outcome. Meta-analysis of changes in the ladder of pain score (p = 0.72), length-of-stay in hospital (p = 0.65), and amount of narcotics used during the study (p = 0.10) showed non-statistically significant differences and a lack of amelioration provided by pharmaceutical analgesics in treatment group. The adverse events reported that more participants in the intervention arm underwent pain, with statistically significant differences at the drug delivery site in studies using intranasal fentanyl and intravenous magnesium (p = 0.03). Conclusions: Pharmacological analgesia appears to be uncertain in improving the intensity and providing relief of acute pain crisis in pediatric patients with sickle-cell anemia. With respect to clinical advantage, no decisive deduction about the clinical efficacy may be made regarding these medications in acute sickle-cell pain management in the pediatric age group.
Resumo Objetivos Obter evidências da eficácia e segurança da analgesia farmacológica para dor falciforme aguda não complicada em pacientes pediátricos em comparação com placebo. Fontes de dados Uma busca de evidências-chave foi feita de 1° a 31 de março de 2018 por ensaios clínicos randomizados controlados de analgesia farmacológica em comparação com placebo para dor aguda falciforme não complicada em uma amostra de pacientes pediátricos. Os autores pesquisaram dez bases de dados científicos que envolveram, entre outras, PubMed, Medline, Embase e Clinicaltrials.gov para esta revisão sistemática e metanálise. Resumo dos dados Quatro ensaios (n = 227) foram considerados para critérios de inclusão (fentanil intranasal, magnésio intravenoso, arginina e óxido nítrico inalado). As evidências de qualidade variaram de baixas a moderadas para cada desfecho. A metanálise de alterações na escala de dor (p = 0,72), o tempo de internação hospitalar (p = 0,65) e a quantidade de analgésicos usados durante o estudo (p = 0,10) mostraram diferença não estatisticamente significativa e a ausência de melhoria resultante do uso do fármaco analgésico no grupo de tratamento. Os eventos adversos relatados mostraram que no braço de intervenção mais participantes sofreram dor com diferença estatisticamente significativa no local de aplicação do fármaco com o uso de fentanil intranasal e magnésio intravenoso (p = 0,03). Conclusões A analgesia farmacológica parece ter um efeito incerto na melhoria da intensidade e alívio da crise de dor aguda em pacientes pediátricos com doença falciforme. Em relação à vantagem clínica, ainda é incerta a eficácia clínica desses medicamentos no tratamento da dor aguda falciforme no grupo etário pediátrico.
Assuntos
Humanos , Criança , Dor , Manejo da Dor , Analgésicos , Anemia FalciformeRESUMO
Introduction: Analgesics are substances which work in various ways to relieve different types of pain experienced in the body. Non-prescription over-the-counter (OTC) drugs are widely used by patients to control pain and fever. Study Objective: To evaluate of knowledge, attitudes and practices about analgesic and their side effects.Methods: A cross-sectional study conducted during a period of three months from September to December 2017 in Rafhaand Riyadh -Saudi Arabia on a random sample of 237 Saudi people, the data was collected by using a self-administered questionnaire in the Arabic language. Statistical analysis was done by using MS EXCEL using descriptive statistics and chi-square test. Results: A total of 237 participants out of 260 consented to be interviewed and completed the questionnaire with a response rate (91%). Their ages ranged between 18 years and 54 years with a mean (28) and standard deviation (7.9). Majority of participants were females (92%) and about two thirds (66%) were highly educated. A quarter of study participants (25%) do not read leaflet of analgesic before use. About one-fifth of respondents (20%) reported that they cannot stop taking analgesic even if the pain is mild. 12% and 36% of respondents always and sometimes, respectively, use more than one type of analgesic for pain relief. 10% of respondents reported the occurrence of side effects from analgesic. The respondents use analgesic mainly for headache (43%) andtoothache (25%). The chronic disease for which participants take analgesic were mainly arthritis (39%) and migraine (30%).About three-quarters of respondents (74%) were aware that the use of analgesic is accompanied by side effects. The respondents believed that the reasons for analgesic misuse are that analgesic easily obtained without a medical prescription (40%) and there is no educational or awareness program regarding analgesic use (33%). Majority of participants believed that there is no sufficient awareness about analgesic. The source of information about analgesic for participants is physician (24%). Panadol analgesic is the most commonly used analgesic (48%) reported by participants.Results showed that there is a significant statistical difference between male and female regard analgesic use (P=0.048) and between different level of educations and analgesic use (P=0.334). Also, there is a highly significant statistical difference between male and female regard reading the leaflet before taking analgesic (P=0.0001) and between the educational level of participants regarding reading the leaflet before analgesic use (P=0.0008).Conclusion: The over-the-counter (OTC) analgesic drugs are commonly used and many patients are unaware of their side effects.The findings of this study showed that people's knowledge, attitudes and practices regarding analgesic use is poor. Also, it is important to improve people's knowledge, attitudes and practices regarding analgesic use to reduce the misconceptions and misguided expectations contributing to inappropriate analgesic use. Therefore, health professional practice should play a major role in people's awareness of the appropriate use of OTC analgesic drugs
RESUMO
Analgesic treatment is an important part of perioperative management. There is no standard analgesic regimen after neurosurgery. Strong opioid receptor agonists are limited in neurosurgical patients due to miosis, respiratory depression and increased intracranial pressure. Codeine,a weak opioid receptor agonist, is the preferred regimen; however, some patients have inadequate analgesia due to metabolic differences. Tramadol,dezocine,acetaminophen,non-steroidal anti-inflammatory drugs and the other adjuvant analgesics have their own advantages and disadvantages. The clinical studies on postoperative analgesic treatment of neurosurgery were collected,analyzed and summarized in the paper. The characteristics of general and local analgesic drugs in neurosurgery were described,which could promote the rational use of analgesics.
RESUMO
OBJECTIVE:To investigate the utilization of opioid analgesic drugs in a hospital,so as to provide reference for ra-tional drug use in clinic. METHODS:The utilization of opioid analgesic drugs in the hospital during 2014-2016 was analyzed and compared retrospectively in terms of consumption sum,DDDs,DDC,B/A,etc. RESULTS:Annual consumption sum of opioid an-algesic drugs in the hospital increased slightly in 2015,but decreased significantly in 2016. Fentany transdermal patches(8.4 mg), Oxycodone and acetaminophen tablets and Remifentanil hydrochloride for injection always took up the first 3 places in the list of DDDs. DDDs of Fentanyl citrate injection(0.1 mg)and Morphine sulfate sustained-release tablets increased year by year;while DDDs of Fentany transdermal patches(4.2 mg)and Fentany transdermal patches(8.4 mg)decreased year by year. DDC of all opi-oid analgesic drugs decreased in 2016,with the cancel of drug price addition at the end of 2016. B/A values of most drugs were close to 1.0;while B/A value of Oxycodone hydrochloride sustained-release tablets(40 mg)was much less than 1.0,and that of Fentany transdermal patches(8.4 mg)and Oxycodone and acetaminophen tablets were significantly more than 1.0 for consecutive 3 years. CONCLUSIONS: The variety and specifications of opioid analgesic drugs in the hospital is comprehensive during 2014-2016. The clinical utilization of opioid analgesic drugs is generally rational,but still needs to be supervised effectively and par-ticularly,so as to improve standard use of opioid andalgesic drugs.
RESUMO
The majority of patients have experienced pain or discomfort associated with surgery or mechanical ventilation in intensive care unit (ICU), and the use of analgesic drugs can relieve patients' anxiety, improve sleep, promote the disease recovery, reduce the use of sedative drug dosage and the occurrence of delirium. Because of less adverse reactions of the non opioid analgesic drugs, in recent years gradually the doctors in ICU have paid attention to them. In this study, the related literatures have been reviewed to realize the present situation of applying non opioid analgesic drugs in ICU. It was found that nowadays the application of commonly used non opioid drugs in ICU (including ketamine, non-steroidal anti-inflammatory drugs, tramadol, lidocaine, tramadol and gabapentin) can all decrease the use of sedative drugs and opioids, reduce the incidence of adverse reactions, and gradually they will obtain more and more attention.
RESUMO
Adjuvant analgesics refer to a group of drugs that are used not only to treat certain diseases but also to induce analge-sia. Such drugs demonstrate different mechanisms based on the complexity of cancer pain. Thus, opioids, nonsteroidal drugs, and adju-vant analgesics are often combined to control cancer pain. According to the WHO three-step analgesic ladder, adjuvant analgesics can be used at any cancer stage, and the usage of these drugs combined with opioids can reduce the required dosages of these pain relievers, thereby alleviating the adverse reactions associated with opioid use. Moreover, these drugs are particularly suitable for neuropathic pain patients who are not fully sensitive to opioids. The commonly used adjuvant analgesics include antidepressants, anticonvulsants, local administration drugs, corticosteroids, and N-methyl-D-aspartate (NMDA) receptor antagonists. Various adjuvant analgesics also differ in usage and dosage based on primary disease treatment. Therefore, clinical doctors should determine the adverse reactions, proper dos-age, and subsequent amount of dosage to be added in a few days or weeks to achieve balance between the desired effect and adverse re-actions.
RESUMO
Objective:To investigate the therapeutic medication for inpatients with cancer pain, and compare with the latest cancer treatment guidelines to improve the rational drug use. Methods:By a retrospective study, the medical record analysis for the inpatients with cancer from October to December in 2014 was performed, and the incidence of pain and the therapeutic medication were investiga-ted and the rationality of drug use was evaluated based on the latest cancer pain treatment guidelines. Results:The incidence of cancer pain was 25. 46% of 774 cases with new cancer, and 76. 58% of the patients with cancer pain were treated with analgesic drugs. In ac-cordance with the guidelines for the treatment scheme, there was no significant difference between the Opioid-Naive group ( guide group 1) and the Opioids-Tolerant group (guide group 2) in the combination therapy, while there was significant difference in the drug selec-tion and the time of administration. In the guide group 1 the proportion of oxywdone controlled-release tablets was signiticantly higher than that in the guide group 2, the ratio of taking the medicine on time in the guide group 1 was also higher than that in the guide group 2. Both groups showed difference from the guidelines in the pain assessment and titration and specific analgesic drug use. Conclusion:The findings indicate the difference between the pain treatment and the guidelines in therapeutic medication of cancer pain, and the propaganda and education of relevant knowledge should be strengthened to promote the treatment standard.
RESUMO
Objective:To evaluate the single dose and dosage frequency of analgesic drugs in 9 Chinese cancer hospitals in 2012. Methods:Using a retrospective method, the utilization of analgesic drugs in 9 cancer hospitals in the year of 2012 was analyzed statis-tically. Results:Most of single dosage of 15 analgesic drugs was consistent with the package inserts except for flunarizine and pethidine oral preparations with single overdose up to 50%. Most of dosage frequency of 21 analgesic drugs was consistent with the package in-serts except for oxycodone/acetaminophen, dihydrocodeine/paracetamol and dezocine with inconsistent dosage frequency ratio up to 30%. Conclusion:Most of single dose and dosage frequency of analgesic drugs is consistent with the package inserts. There is some unreasonable usage that should be paid attention to. Clinicians should be more cautious in analgesic drug use to make correct and ra-tional decision on dose and frequency, meanwhile, drug use in patients should be monitored to ensure the medication safety.
RESUMO
BACKGROUND:Pain after arthroscopic treatment can not only affect the patient’s life quality, and is not conducive to the early reasonable exercise and functional recovery of the patients after treatment. Up to 2012, there are 18 randomized placebo-control ed trials on intra-articular injection of bupivacaine for analgesia after arthroscopic surgery, but the results are different. OBJECTIVE:To examine the efficacy and safety of intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery through randomized placebo-control ed trials. METHODS:The MEDLINE database, Cochrane Central Register and Google Scholar database were retrieved for the randomized control ed trials on intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery up to April 2012. The key words were“bupivacaine, intra-articular, arthroscopic, postoperative pain, placebo”. RESULTS AND CONCLUSION:Eighteen studies (n=934) were included (461 cases in bupivacaine group and 473 cases in the placebo control group). The Meta-analysis results showed the visual analog scale score of the bupivacaine group was lower than that of the placebo control group (weighted mean difference:-1.39, 95%confidence interval:-2.17 to-0.61, Pmean difference:157.72, 95%confidence interval:16.43 to 299.01, P<0.000 01). There was no significant difference in the incidence of side effect between two groups (relative risk:0.64, 95%confidence interval:0.29 to 1.44, P=0.48). On the basis of the currently available literature, the intra-articular of bupivacaine after arthroscopic surgery can significantly relieve pain without increasing the adverse reactions when compared with the placebo control group.
RESUMO
Se realizó un estudio descriptivo y transversal en el Consultorio Médico de la Familia No 28 perteneciente al Policlínico Universitario y Docente Dr Mario Muñoz Monroy desde el 1ro. de junio al 31 de diciembre de 2008, con el objetivo de detectar las reacciones adversas más frecuentes provocadas por el consumo de antiinflamatorios no esteroideos. El universo estuvo constituido por 105 pacientes que asistieron a consulta en el tiempo de estudio y de estos se seleccionó una muestra de 60 pacientes, a quienes se les aplicó un cuestionario de preguntas donde se recogieron las variables de análisis. .Las mujeres resultaron las que más antiinflamatorios consumieron y en el rango de edades de 31-59 años. Las reacciones adversas que más se reportaron fueron la epigastralgia y la hipertensión arterial, así mismo se comprobó la automedicación en algunos pacientes
A descriptive cross-sectional study was conducted in the family physicianïs office No 28 attached to Dr Mario Muñoz Monroy university teaching polyclinics from June 1st to December 31st 2008. The objective was to detect the most common adverse reactions caused by non-steroidal anti-inflammatory drugs. The universe of study was made up of 105 patients who attended the physicianïs office during the study and from this number, a sample of 60 patients was selected. They were administered a questionnaire including analysis variables. The females aged 31-59 years consumed more antinflammatory drugs. The most reported adverse reactions were epigastralgia and blood hypertension; besides, self-medication was confirmed
Assuntos
Anti-Inflamatórios não Esteroides , Analgésicos não Narcóticos/efeitos adversosRESUMO
<b>Purpose</b>: In Japan, only a few studies reported self-management systems of narcotic drugs among hospitalized patients. Our purpose was to develop a self-management system for patients and assess its effectiveness. <b>Methods</b>: Based on the results of a questionnaire administered to our hospital medical staff, methods of selecting eligible patients and methods of self-management of narcotic drugs were determined by a multi-professional team. Selection criteria for eligible patients were: 1) satisfactory results on assessment of the patient's ability to self-manage orally-administered drugs; 2) satisfactory results on assessment of the patient's ability to self-manage narcotic drugs; 3) physician's consent was obtained; and 4) the patient wanted to participate in this program. After the period of self-management of drug administration, questionnaires were distributed to the patients and medical staff in the general ward. <b>Results</b>: One hundred hospitalized patients used narcotic drugs between April 2008 and March 2009. Among them, 26 patients met the criteria for self-management of narcotic drugs, and 20 voluntarily participated in the program. There were no reports of missing or stolen drugs. There were no reports of administration of incorrect dose of the drug during the self-management period (average 15.0 days). Ninety-four percent of the self-managing patients provided positive feedback about self-management of narcotic drugs, such as mental stability by having drugs on hand and no problems in self-management. Seventy-five percent of staff members answered that the self-management system of narcotic drugs should be continued. <b>Conclusion</b>: Our results suggest that this system of narcotic drug self-management is safe and appropriate. Palliat Care Res 2010; 5(1): 114-126
RESUMO
La Organización Mundial de la Salud define el cuidado paliativo como el cuidado total y activo en aquellos pacientes que no responden a un tratamiento curativo. El control del dolor, otros síntomas y los problemas psicológicos, sociales y espirituales son de fundamental importancia. La meta del cuidado paliativo es brindar la mejor calidad de vida a los pacientes y a sus familias. En el cuidado paliativo es necesario el manejo multidisciplinario. Nuevas estrategias como rotación de opioides y sus diferentes vías de administración pueden ofrecer analgesia con pocos efectos adversos.
The World Health Organisation defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Palliative care is necessarily multidisciplinary. New strategies such as the switching opioids and/or their route of administration may offer improved analgesia with fewer adverse effects, thus providing therapeutic alternatives for the clinical community.