Eficacia de la analgesia peridural continua con bupivacaína y fentanilo en la cirugía de colon / Efficacy of continuous peridural analgesia with bupivacaine and fentanyl in colon surgery

Introducción: En la cirugía de colon se persigue lograr una recuperación acelerada y se debate el método analgésico más ventajoso. Objetivo: Comparar la eficacia analgésica de la infusión continua peridural con bupivacaína y fentanilo frente a la analgesia parenteral en este tipo de intervención. Métodos: Se realizó un estudio cuasi-experimental, prospectivo y longitudinal, en 30 pacientes operados de colon entre agosto 2018 agosto 2019 en el Hospital Militar Central Dr. Carlos J. Finlay; divididos de forma no aleatoria en grupo analgesia peridural y grupo analgesia multimodal endovenosa. Resultados: La demora en despertar y extubar en el grupo peridural fue inferior (1,6-1,8 min) a los 4,9-5,0 min en el multimodal, igual ocurrió con la estadía en Unidad Cuidados Intensivos Quirúrgicos y hospitalaria aunque con discreta diferencia. El 60 por ciento de los pacientes en el grupo peridural presentaron ruidos hidroaéreos en las primeras 24 h y el 80 por ciento expulsó gases a las 48 h o antes, con marcada diferencia del multimodal. La analgesia fue buena en ambos grupos, valores de escala visual análoga inferiores en el grupo peridural, solo el 13,3 por ciento necesitó dosis rescate frente al 26,7 por ciento en el multimodal. Las complicaciones más frecuentes fueron hipotensión (23,3 por ciento) y bradicardia (10 por ciento), sin diferencias entre grupos. La analgesia aceleró la recuperación en el 87,5 por ciento de los casos en el grupo peridural superior al 76 por ciento del grupo multimodal. Conclusiones: La analgesia peridural continua con bupivacaína y fentanilo es más eficaz que la analgesia multimodal endovenosa en la cirugía de colon y acelera la recuperación posoperatoria(AU)

Introduction: In colon surgery, accelerated recovery is pursued and the most advantageous analgesic method is still under debate. Objective: To compare the analgesic efficacy of continuous epidural infusion with bupivacaine and fentanyl versus parenteral analgesia in this type of operation. Methods: A quasiexperimental, prospective and longitudinal study was carried out with thirty patients who underwent colon surgery, between August 2018 and August 2019 at Dr. Carlos J. Finlay Central Military Hospital, nonrandomly divided into an epidural analgesia group and a multimodal intravenous analgesia group. Results: The awakening and extubation time in the epidural group was lower (1.6 -1.8 min) than the 4.9 to 5.0 min for the multimodal group. The same happened with intensive care unit and hospital stay, although with a discrete difference. 60 percent of the patients from the epidural group presented hydroaerial noise within the first 24 hours and 80 percent expelled gasses at 48 hours or earlier, with a marked difference in the multimodal group. Analgesia was good in both groups, with lower visual analog scale values in the peridural group; only 13.3 percent required rescue doses compared to 26.7 percent in the multimodal group. The most frequent complications were hypotension (23.3 percent ) and bradycardia (10 percent ), without differences between groups. Analgesia accelerated recovery for 87.5 percent of cases in the epidural group, compared to 76 percent in the multimodal group. Conclusions: Continuous epidural analgesia with bupivacaine and fentanyl is more effective than multimodal intravenous analgesia in colon surgery and accelerates postoperative recovery(AU)

Exploración de la eficacia analgésica de dos parches transdérmicos analgésicos de opioides, buprenorfina y fentanilo, según sus variaciones de dosis en el control del dolor en pacientes paliativos oncológicos / Exploration of the analgesic efficacy of two-transdermal analgesic patches of opioids, buprenorphine and fentanyl, according to their dose variations in pain control in palliative cancer patients

Objetivo: El presente trabajo de investigación tuvo como objetivo explorar la eficacia analgésica mediante la comparación de la respuesta analgésica de los parches transdérmicos (PTD) de buprenorfina y fentanilo en dolor oncológico y patrón de uso. Material y Método: Se obtuvieron los datos y variables desde los registros clínicos de pacientes ingresados a la Unidad de Cuidados Paliativos (UCP) del Instituto Nacional del Cáncer (INC) que estaban bajo tratamiento en mayo del 2017. Se incluyó en este estudio a 78 pacientes con PTD, que representan el 13% de los pacientes en control mensual. De estos, 66 estaban bajo tratamiento con buprenorfina y 8 bajo tratamiento con fentanilo. Resultados: Los resultados mostraron que el PTD de buprenorfina se utiliza más frecuentemente que el de fentanilo. El principal motivo de rotación fue dolor no controlado, seguido por imposibilidad de contar con la administración por vía oral. En pacientes con mayores intensidades de dolor somático o visceral se indicó fentanilo y en aquellos con componente neuropático se prefirió el uso de buprenorfina. PTD de fentanilo fue indicado en dosis mayores que buprenorfina, incluso al comparar sus dosis equianalgésicas, siendo la variación de dosis alta para ambos parches: aumentó en promedio 257%. Se logró una mejor respuesta analgésica con buprenorfina, con una variación de intensidad de escala numérica verbal (ENV) de 2,94 y 1,88 puntos de promedio para buprenorfina y fentanilo, respectivamente. Adicionalmente, se presentó mayor reacción local dérmica con fentanilo. Conclusiones: Se evidenció diferencias en patrón de uso y, a diferencia de lo esperado, se obtuvo una mejor eficacia analgésica con buprenorfina. Datos que deben ser corroborados en estudios con mayor número de pacientes bajo tratamiento con fentanilo.

Objective: This study aims to explore analgesic efficacy comparisons of buprenorphine and fentanyl transdermal patches (TDP) in cancer pain and it's usage pattern. Material and Method: Data and variables were collected from patient's clinical reports who were admitted in the National Cancer Institute's (NCI) Palliative Care Unit (PCU) and were under treatment with TDP in May 2017. 78 TDP patients were studied and represented 13% of the monthly control patients in the PCU. Of these, 66 were under buprenorphine treatment and 8 under fentanyl treatment. Results: The results showed that buprenorphine TDP is more frequently used than fentanyl TDP, and the main reason for exchange between them was uncontrolled pain, followed by oral administration impossibility. Fentanyl TDP was indicated in patients with higher somatic or visceral pain intensities and Buprenorphine TDP was preferred in patients with neuropathic pain. Fentanyl TDP was indicated in higher doses than buprenorphine, even when comparing its equianalgesic doses, the dose variation was high for both patches throughout the treatment: it increased on average by 257%. A better analgesic response was achieved with buprenorphine, with a variation of intensity of the Verbal Numerical Scale (VNS) of 2.94 and 1.88 average points, for buprenorphine and fentanyl respectively. Additionally, there was a higher local dermal reaction with fentanyl TDP. Conclusions: Differences in usage patterns were evidenced and, unlike what was expected, better analgesic efficacy was obtained with buprenorphine TDP. This data should be corroborated in receiving fentanyl treatment.

Experiencia en sedoanalgesia vinculada a procedimientos en un departamento de emergencia pediátrica / Experience in procedural sedation and analgesia in a pediatrics emergency unit / Experiência em sedação e analgesia ligada a procedimentos em um departamento de emergência pediátrica

Resumen: Introducción: la realización de procedimientos dolorosos es cada vez más frecuente en el área de urgencias pediátricas. El control del dolor, mitigar el temor y la ansiedad es una pieza clave en la atención del paciente pediátrico y una de las prioridades del médico emergencista. Objetivo: describir la experiencia en sedoanalgesia con ketamina y fentanilo como único fármaco o asociados a otros para procedimientos dolorosos en el Departamento de Emergencia Pediátrica (DEP) del Centro Hospitalario Pereira Rossell (CHPR). Material y método: estudio descriptivo, retrospectivo. Período: enero de 2011 a julio de 2016. Población: todos los pacientes que recibieron sedoanalgesia con ketamina o fentanilo (solos o asociado a otros fármacos) para realización de procedimientos dolorosos en el DEP-CHPR. Base de datos: historias clínicas. Se midió la eficacia mediante el éxito del procedimiento y la seguridad por la presencia de efectos adversos vinculados a la misma. Resultados: n=352, menores de 15 años; 96 recibieron ketamina y 256 recibieron fentanilo. Media de edad: 7 años, sexo masculino: 245. Dosis media de ketamina 1 mg/kg. Dosis media de fentanilo 1 ɤ/kg. Principales indicaciones de sedoanalgesia: procedimientos ortopédicos (264), toracocentesis (62). Procedimiento con éxito: 352 pacientes. Monitorización cardiovascular y saturometría durante el procedimiento: 100%. Efectos adversos: seis (no requiriendo maniobras de soporte vital avanzado). Ningún paciente cambió su destino final. Conclusiones: la utilización de sedoanalgesia resultó eficaz y segura realizada por el pediatra emergencista capacitado en el manejo farmacológico y de soporte vital avanzado. La monitorización del procedimiento durante y luego de éste es necesaria para pesquisar y resolver precozmente las complicaciones.

Summary: Introduction: painful procedures are gradually increasing frequency in pediatrics emergency units. Controlling pain and mitigating fear and anxiety are of the essence when assisting pediatric patients and one of the priorities of emergency doctors. Objective: to describe using sedoanalgesia with ketamine and fentanyl as the only drug or associated with other drugs during painful procedures, at the Pediatrics Emergency Unit, of the Pereira Rossell Hospital Center. Method: descriptive, retrospective study from January 2011 to July 2016. Population: all patients who received sedoanalgesia with ketamine and fentanyl (as the only drug or associated with other drugs) during painful procedures at the Pediatrics Emergency Unit, of the Pereira Rossell Hospital Center. Database: medical records. Effectiveness was measured by success of the procedure and safety in terms of adverse effects in connection with it. Results: N=352 children younger than 15 years old. 96 received ketamine and 256 received fentanyl. Average age was 7 years old and 245 of them were boys. Average dose of ketamine was 1 mg/kg, average dose of fentanyl was 1 ɤ/kg. Main indications for sedoanalgesia included: orthopaedic procedures (264), thoracentesis (62). Procedures were successful in 352 patients. 100% of cases involved cardiovascular monitoring and blood oxygen saturation meter. Adverse effects: 6 (no advanced life support manoeuvres required). No patient changed final destination. Conclusions: the use of sedoanalgesia was effective and safe, when applied by emergengy pediatricians qualified in the handling of drugs and advanced life support. Monitoring during and after procedure is required to determine and solve complications at an early stage.

Resumo Introdução: a realização de procedimentos dolorosos é cada vez mais frequente na área de emergência pediátrica. Controlar a dor, mitigar o medo e a ansiedade é um elemento-chave no atendimento ao paciente pediátrico e uma das prioridades do médico de emergência. Objetivo: descrever a experiência em sedação e analgesia com ketamina e fentanil como fármaco único ou associado a outros para procedimentos dolorosos, no Serviço de Emergência Pediátrica (DEP) do Centro Hospitalar Pereira Rossell (CHPR) Material e métodos: estudo descritivo retrospectivo. Período: janeiro de 2011 a julho de 2016. População: todos os pacientes que receberam sedação e analgesia com ketamina ou fentanil (isoladamente ou em combinação com outras drogas) para realização de procedimentos dolorosos no DEP-CHPR. Banco de dados: prontuários médicos. A eficácia foi medida pelo sucesso do procedimento e a segurança pela presença de efeitos adversos associados. Resultados: n = 352 crianças menores de 15 anos. 96 receberam ketamina e 256 receberam fentanil. Idade média: 7 anos, sexo masculino: 245. Dose média de ketamina 1 mg / kg. Dose média de fentanil 1 ɤ/kg. Principais indicações para sedação e analgesia: procedimentos ortopédicos (264), toracocentese (62). Procedimento com sucesso: 352 pacientes. Monitorização cardiovascular e oximetria durante o procedimento: 100%. Efeitos adversos: 6 (não requer manobras de suporte avançado de vida). Nenhum paciente mudou seu destino final. Conclusões: o uso da sedação e analgesia foi eficaz e seguro realizado por pediatra de emergência capacitado em manejo farmacológico e suporte avançado de vida. O monitoramento do procedimento durante e após é necessário para investigar e resolver precocemente as complicações.

Anestesia total intravenosa con remifentanilo vs fentanilo como base analgésica en cirugía torácica electiva / Intravenous total anesthesia with remifentanil and fentanyl as analgesic base in elective thoracic surgery

Introducción: Mantener una oxigenación adecuada durante la ventilación a un solo pulmón es el problema fundamental al que se enfrenta el anestesiólogo durante la cirugía torácica, es por ello que se mantiene una constante búsqueda del método anestésico ideal que ayude a lograr dicho objetivo. Objetivos: Evaluar los resultados de dos técnicas de anestesia total intravenosa con remifentanilo y fentanilo como base analgésica e identificar la aparición de complicaciones durante la intervención quirúrgica. Métodos: Se realizó un estudio causiexperimental prospectivo, en el Hospital Docente Clínico Quirúrgico Dr. Salvador Allende, entre enero 2013 a diciembre 2015 en 40 pacientes ASA II o III que requirieron procedimientos intratorácicos. Estos se dividieron en dos grupos. A (remifentanilo-propofol) y B (fentanilo-propofol). Se estudiaron variables hemodinámicas, de oxigenación durante la ventilación unipulmonar, el tiempo de recuperación anestésica (ventilación espontánea, apertura ocular, extubación) y la analgesia posoperatoria. Resultados: No existieron variaciones significativas en la hemodinamia, ni en la oxigenación de los enfermos con el empleo de ambas técnicas anestésicas; sin embargo, el despertar y recuperación posoperatoria a corto plazo fue mejor en el grupo A. La intensidad del dolor posoperatorio según la escala visual análoga fue menor en el grupo B. Conclusiones: Ambas técnicas son efectivas para procedimientos quirúrgicos torácicos. Con mínima interferencia en la hemodinámia y parámetros de oxigenación(AU)

Introduction: Maintaining adequate oxygenation during single-lung ventilation is a fundamental concern faced by the anesthesiologist during thoracic surgery; therefore, a constant search is maintained for the ideal anesthetic method that helps achieve this goal is maintained. Objectives: To evaluate the outcomes of two total intravenous anesthesia techniques with remifentanil and fentanyl as analgesic base and to identify the onset of complications during surgery. Methods: A prospective and quasi-experimental study was carried out at Dr. Salvador Allende Clinical-Surgical Hospital, between January 2013 and December, with 40 ASA II or III patients who required intrathoracic procedures. These were divided into two groups: A (remifentanil-propofol) and B (fentanyl-propofol). Hemodynamic variables and others of oxygenation during one-lung ventilation were studied, together with anesthetic recovery time (spontaneous ventilation, ocular opening, extubation) and postoperative analgesia. Results: There were no significant variations in the hemodynamics or oxygenation of patients with the use of both anesthetic techniques; however, awakening and short-term postoperative recovery was better in group A. Postoperative pain intensity, based on the analogue-visual scale, was lower in group B. Conclusion: Both techniques are effective for thoracic surgical procedures, with minimal effect in hemodynamics and oxygenation parameters(AU)

Informe diário de evidências COVID-19: busca realizada em 29 de julho de 2020 / COVID-19 daily evidence report: search conducted on July 29, 2020

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 3 protocolos.

Eficacia del fentanilo en anestesia raquídea para el dolor agudo postoperatorio / Efficacy of fentanil in spinal anesthesia for acute postoperative pain

Objetivo: El dolor agudo postoperatorio es un conjunto de percepciones sensoriales, emocionales y mentales desagradables, asociadas a respuestas autonómicas, psicológicas y conductuales, precipitadas por el acto quirúrgico. Objetivo: Generar conocimiento sobre la eficacia del fentanilo en anestesia raquídea para el dolor agudo postoperatorio. Material y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: La asociación de fentanilo a los anestésicos locales para la anestesia subaracnoidea, reduciendo la dosificación de anestésico local y manteniendo el tiempo de su recuperación y así de esta manera mejorar la calidad, la tasa de éxito de pequeñas dosis de los mismos, con ello, la incidencia de complicaciones hemodinámicas. La administración subaracnoidea de anestésicos locales y opioides, provocan eventos adversos, prurito (30 %), náuseas y vómito (25 %), retención urinaria (10-53 %), depresión respiratoria (3 %). Las diferentes dosis de fentanilo asociado a bupivacaína 0.5%, en la raquianestesia disminuyen la intensidad de dolor según EVA, en el trans-operatorio y el manejo del dolor agudo post-operatorio en los diferentes actos quirúrgicos. Conclusión: Se concluye que la asociación de bupivacaína 0,5% más fentanilo, mediante la técnica raquídea, en pacientes intervenidos quirúrgicamente, resulta eficaz, debido a que permite obtener un menor tiempo de latencia para el bloqueo con una duración prolongada, manteniendo una adecuada hemodinamia y estabilidad respiratoria, y también reduciendo el dolor postoperatorio y sus posibles reacciones adversas. (AU)

Introduction: Acute postoperative pain is a set of unpleasant sensory, emotional and mental perceptions associated with autonomic, psychological and behavioral responses precipitated by the surgical act. Objective: Generate knowledge about the efficacy of fentanyl in spinal anesthesia for acute postoperative pain. Material and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: The association of fentanyl with local anesthetics for subarachnoid anesthesia, reduces the dose of local anesthetic, without prolonging the recovery time, improving the quality, the success rate of small doses of them, with this, the incidence of hemodynamic complications. The subarachnoid administration of local anesthetics and opioids, cause adverse events, itching (30%), nausea and vomiting (25%), urinary retention (10-53%), respiratory depression (3%), all this as a result of interactions with opioid receptors at the brain level. The different doses of fentanyl associated with 0.5% bupivacaine, in spinal anesthesia reduce the intensity of pain according to EVA, in the trans-operative period and the management of acute post-operative pain in the different surgical acts. Conclusion: It is concluded that the association of 0.5% bupivacaine plus fentanyl, through the spinal technique, in surgically treated patients, is effective, since it allows to reach a shorter time of onset of the blockade and longer duration of the block, maintaining adequate hemodynamic and respiratory stability, the time it reduces acute post-operative pain and adverse reactions. (AU)

Analgesia subaracnoidea en el trabajo de parto: bupivacaína/fentanilo vs. petidina / Subarachnoid analgesia in labor: bupivacaine/fentanyl vs pethidine

Introducción: La analgesia subaracnoidea es una alternativa para el trabajo de parto por su seguridad y adecuada relación riesgo/beneficio. Objetivo: Evaluar la efectividad de la analgesia durante el trabajo de parto con la comparación de dos métodos analgésicos. Método: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en 92 gestantes que se atendieron en el Hospital General Docente Abel Santamaría Cuadrado durante el período entre enero de 2014 y enero de 2017. Las pacientes se dividieron en dos grupos de 46 cada uno, al azar, por orden de llegada a la unidad quirúrgica. El grupo A, bupivacaína al 0,5 por ciento, en dosis de 2 mg y fentanilo en dosis de 25 mcg; y grupo B en el que se utilizó petidina en dosis de 25 mg, en todos los casos por vía intratecal. Las variables analizadas fueron: tensión arterial media, frecuencia cardíaca media, saturación parcial de oxígeno, tiempo de inicio de la analgesia, calidad analgésica, efectos adversos y nivel de satisfacción de las pacientes. Se empleó el análisis descriptivo y la diferencia de proporciones. Resultados: El grupo A mantuvo una TAM entre 84 y 88 mmHg, (Z= 6,0 significativa); FC media entre 80 y 88 lat/min, (Z= 1,94 no significativa); SpO2 con una media de 99,2 por ciento. En 46,74 por ciento (43 casos) el tiempo de inicio de la analgesia fue corto (Z= 8,47), siendo Buena en 100 por ciento de los casos (Z= 6,89 significativa), con recién nacido vigoroso en 100 por ciento (Z= 10,25 significativa). La evolución fue satisfactoria en 48,19 por ciento de las pacientes. Presentaron prurito 8,69 por ciento. En el grupo B hubo hipertensión arterial en 2,17 por ciento de los casos, con menos estabilidad de la FC, tiempos mayores de inicio de trabajo de parto en 12,96 por ciento y fue Buena en 40,22 por ciento. Estas pacientes mostraron menos satisfacción (41,30 por ciento). Conclusiones: La administración subaracnoidea de fentanilo/bupivacaína fue más efectiva que la petidina para la analgesia durante el trabajo de parto(AU)

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 percent, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z=6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z=1.94 not significant); partial oxygen saturation with an average of 99.2 percent. In 46.74 percent (43 cases) the time of onset of analgesia was short (Z=8.47), being good in 100 percent of the cases (Z=6.89 significant), with vigorous newborn in 100 percent (Z=10.25 significant). The evolution was satisfactory in 48.19 percent of the patients. They presented pruritus 8.69 percent. In group B, there was arterial hypertension in 2.17 percent of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 percent and it was good in 40.22 percent. These patients showed less satisfaction (41.30 percent). Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor(AU)

Analgesia posoperatoria con opioide de acción rápida en la colecistectomía video laparoscópica / Postoperative analgesia with fast-acting opioid during videolaparoscopic cholecystectomy

Introducción: La cirugía video laparoscópica posee beneficios para los pacientes. Las intervenciones con tiempos reducidos implican técnicas anestésicas ajustadas a ellos, lo que determina no pocas dificultades cuando el dolor aparece en la práctica asistencial. El hallazgo de pacientes con dolor posoperatorio inmediato motivó la realización del estudio. Objetivo: Evaluar la efectividad de un opioide de acción rápida como analgésico posoperatorio inmediato administrado vía intranasal. Método: Se desarrolló un estudio causiexpereimental, con dos grupos de enfermos (100 cada uno) a los que se les realizó colecistectomía por vía laparoscópica en el Hospital Militar Central Dr. Luis Díaz Soto, a los 100 pacientes en estudio se les administró FENTANYL 50 mcg intranasal en gotas al llegar a la sala de cuidados posoperatorios. Las variables de estudio incluyeron el dolor según la Escala Visual Análoga (EVA), el tiempo de inicio de acción del opioide y la analgesia lograda, así como los efectos derivados de su empleo. Resultados: la edad promedio fue 51 ± 2, predominó el sexo masculino con 55 por ciento de los casos, se evidenció una EVA promedio de todos los casos iniciales en 3. Al alta, 100 por ciento de los pacientes del grupo estudio poseían analgesia excelente (EVA 2), mientras que los controles poseían una EVA promedio en 5. El prurito fue el evento adverso más frecuente tras la administración de FENTANYL intranasal. Conclusiones: El empleo de un opioide de acción rápida (FENTANYL) es una medida de control del dolor posoperatorio excelente y segura(AU)

Introduction: Videolaparoscopic surgery has benefits for patients. Interventions with reduced times involve anesthetic techniques adjusted to them, which determines many difficulties when pain manifests in the care practice. The finding of patients with immediate postoperative pain motivated the study. Objective: To evaluate the effectiveness of a fast-acting opioid as an immediate postoperative analgesic administered by intranasal way. Method: A quasiexperimental study was developed, with two groups of patients (100 each) who underwent laparoscopic cholecystectomy at Dr. Luis Díaz Soto Central Military Hospital. The hundred patients under study were administered fentanyl 50 mcg as intranasal drops upon arriving at the postoperative care room. The study variables included pain according to the Visual Analogue Scale (VAS), the onset time of opioid action, and the analgesia achieved, as well as the effects derived from its use. Results: The average age was 51 ± 2, the male sex predominated with 55 percent of the cases, an average VAS of all the initial cases was evidenced in three. At discharge, 100 percent of the patients in the study group had excellent analgesia (VAS 2), whereas the controls had an average VAS in 5. Pruritus was the most frequent adverse event after the administration of intranasal fentanyl. Conclusions: The use of a fast-acting opioid (fentanyl) is an excellent and safe postoperative pain control measure(AU)

Factors associated to potential drug interactions in one Intensive Care Unit: a cross-sectional study / Factores asociados a interacciones medicamentosas potenciales en un Centro de Terapia Intensiva: estudio transversal / Fatores associados a interações medicamentosas potenciais em um Centro de Terapia Intensiva: estudo transversal

ABSTRACT Objective: to identify the factors associated to Potential Drug Interactions with High Alert Medications in the Intensive Care Unit of a Sentinel Hospital. Methods: a cross-sectional, retrospective study using a quantitative approach carried out at a Sentinel Hospital in Rio de Janeiro. The research was based on the analysis of the prescriptions of patients hospitalized in the Intensive Care Unit of the Hospital, in a period of one year, in order to identify the drug interactions related to high alert medications in these prescriptions. Results: Of the 60 prescriptions analyzed, 244 were selected. In these prescriptions, 846 potential drug interactions related to high alert medications and 33 high alert medications were identified. Of the 112 types of potential drug interactions identified, some were more recurrent: tramadol e ondansetron, midazolam and omeprazole, regular insulin and hydrocortisone, fentanyl and midazolam, and regular insulin and noradrenaline. The variables polypharmacy, length of hospital stay, and some specific medications were associated with drug interactions with high alert medications. Conclusion and Implications for practice: It is important to strengthen strategies to reduce adverse drug events. Therefore, the relevance of studies that investigate the origin of these events is highlighted. Drug interactions can represent medication errors. It's indispensable to work with strategies to better manage the medication system.

RESUMEN Objetivo: identificar los puntos asociados a las Interacciones Medicamentos Potenciales con Medicamentos de alta vigilancia en un Centro de Cuidados Intensivos de un Hospital de Guardia. Métodos: estudio transversal, retrospectivo, de abordaje cuantitativo, realizado en un hospital de guardia en Rio de Janeiro. Esta investigación se basó en el análisis de las prescripciones medicamentosas de pacientes internados en un Centro de Cuidados Intensivos de un hospital, en un período de 1 año, con el objetivo de identificar las interacciones medicamentosas relacionadas con Medicamentos de alta Vigilancia recurrentes en las mismas. Resultados: de los informes analizados, se seleccionaron 244 prescripciones medicamentosas. En las 244 prescripciones de medicamentos, se pudieron identificar 846 Interacciones de Medicamentos Potenciales (IMP) relacionados a Medicamentos de Alta Vigilancia y 33 Medicamentos de Alta Vigilancia. De los 112 tipos de interacciones de medicamentos potenciales identificados, algunos han sido más recurrentes; a saber: tramadol y ondansetrón, midazolam y omeprazol, insulina regular e hidrocortisona, fentanilo y midazolam, insulina regular y noradrenalina. Las variables polifarmacia, tiempo de internación y algunos medicamentos específicos se asociaron a las interacciones medicamentosas potenciales con Medicamentos de Alta Vigilancia. Conclusión e Implicaciones para la práctica: es importante fortalecer las estrategias para reducir los eventos adversos relacionados con medicamentos. Por lo tanto, se destaca la relevancia de los estudios que plantean la naturaleza de estos eventos. Las interacciones medicamentosas pueden provocar errores de medicación. Es imprescindible trabajar con estrategias para administrar mejor el sistema de medicación.

RESUMO Objetivo: Identificar os fatores associados às Interações Medicamentosas Potenciais com Medicamentos de alta vigilância em Centro de Terapia Intensiva de um Hospital Sentinela. Métodos: Estudo transversal, retrospectivo, de abordagem quantitativa, realizado em um hospital sentinela no Rio de Janeiro. A pesquisa apoiou-se na análise das prescrições de pacientes internados no setor, com recorte temporal de 1 ano, a fim de identificar as interações medicamentosas relacionadas a medicamentos de alta vigilância recorrentes nas mesmas. Resultados: Dos 60 prontuários analisados, selecionaram-se 244 prescrições. Nelas identificaram-se 846 interações medicamentosas potenciais, relacionadas aos medicamentos de alta vigilância e 33 medicamentos de alta vigilância. Dos 112 pares de interações identificadas, foram mais recorrentes: tramadol e ondansetrona, midazolam e omeprazol, insulina regular e hidrocortisona, fentanil e midazolam, e insulina regular e noradrenalina. As variáveis polifarmácia, tempo de internação e alguns medicamentos específicos foram associadas às interações com medicamentos de alta vigilância. Conclusão e Implicações para a prática: É importante fortalecer as estratégias para reduzir os eventos adversos relacionados a medicamentos. Portanto, destaca-se a relevância de estudos que levantem a natureza desses eventos. As interações medicamentosas podem configurar erros de medicação. Portanto, é indispensável que se trabalhe com estratégias para melhor manejar o sistema de medicação.

Traqueostomía percutánea por dilatación sin broncoscopía: Experiencia en la Unidad de Terapia Intensiva del Insttuto Guatemalteco de Seguridad Social / Percutaneos dilatatonal tracheostomy without fber optc bronchoscopy. Experience at Intensive Care Unit

Introducción: La traqueostomía percutánea es un procedimiento frecuente en la Unidad de Terapia Intensiva indicado en el manejo del paciente críticamente enfermo que requiere ventilación mecánica prolongada. El objetivo del estudio es describir la experiencia de traqueostomía percutánea sin broncoscopía, utilizando la técnica Ciaglia Blue Rhino en la unidad de terapia intensiva del IGSS. Métodos: Estudio descriptvo, observacional, longitudinal y analítco, incluyendo a 42 pacientes críticos ingresados a UTIA del Instituto Guatemalteco de Seguridad Social, a los que se realizó traqueostomía percutánea durante un periodo de 12 meses (Febrero 2016 a Febrero 2017). Se registraron variables demográficas, de severidad, días de ventilación mecánica antes del procedimiento y las complicaciones. Resultados: Se reclutaron 42 pacientes con una edad media de 68 años, con predominio del sexo masculino (28 pacientes). La media de puntuación del Sofa Score fue de 9.3 puntos. Los pacientes requirieron en promedio 13.4 días de ventilación mecánica antes del procedimiento. El 9.53% de pacientes presentaron complicaciones transoperatorias siendo estas: punción inadvertida del tubo orotraqueal (2 casos) y sangrado autolimitado del sito de la traqueostomía (2 casos). Mientras que el 4.76% presentaron complicaciones post-operatorias. Conclusiones: La traqueostomía percutánea por dilatación sin broncoscopía mediante la técnica Ciaglia Blue Rhino es un procedimiento seguro, que se puede realizar al pie de la cama del paciente, con un bajo índice de complicaciones.

Background: Percutaneos dilatatonal tracheostomy techniques have facilitated the procedure in the Intensive Care Unit. The purpose of the study is to describe our experience using this technique, in the ICU. Methods: We collected data from forty two patents during a year. The demographic variables were recorded, also we reviewed the severity of illness, number of days of mechanical ventlaton prior to the procedure, intraoperatve and postoperatve complicatons as well. Results: Forty two patents were included, mean age was 68 years old, most of them were men (28 patents). The mean Sofa Score was 9.3 points. In average, the patents requiered 13.4 days of mechanical ventlaton prior to the perutaneos dilatatonal tracheostomy. In two patents the endotracheal tube was accidentally punctured and two patents had self-limited bleeding at the surgical site. None of the complications were life-threatng to the patents. Conclusions: Percutaneos dilatatonal tracheostomy techniques using the Ciaglia Blue Rhino technique without fber optc bronchoscope is an easy procedure with a low incidence of complications.

Economic assessment of postoperative pain control strategies for treatment of adult patients with cancer / Avaliação econômica de estratégias para controle da dor pós-operatória para tratamento de pacientes adultos com câncer

Summary Objective: The authors performed an economic assessment of opioids currently being used for control of postoperative pain relating to the surgical treatment of cancer (fentanyl and sufentanil) within the Brazilian Unified Health System (SUS, in the Portuguese acronym). Method: The assessment was based on the perspective of the government, in order to collaborate with the promotion of effectiveness in public policies of health, and to optimize the allocation of public resources into health. A cost-effectiveness analysis was performed using data collected from the Brazilian Unified Health System and information from literature review, in order to build a decision tree on the alternatives for control of postoperative pain related to cancer treatment among adult patients. The outcomes considered were: effectiveness of postoperative analgesia and occurrence of nausea and vomit in the 48 hour period after surgery, and additional 24-hour cycles in patient follow-up. A univariate sensitivity analysis was conducted in order to verify robustness of the model estimated. Results: Literature review showed a limited number of studies directly comparing fentanyl and sufentanil for control of postoperative pain. The adoption of sufentanil (cost = U$ 25.72 / outcome = 1.6 VAS points) was dominant in relation to the use of fentanyl (cost = U$ 32.58 / outcome = 2.6 VAS points). The estimated model showed robustness in relation to changes in the parameters analyzed. Conclusion: Sufentanil presented higher cost-effectiveness ratio in relation to fentanyl for control of postoperative pain in surgeries related to cancer treatment among adult patients in the Brazilian Unified Health System.

Resumo Objetivo: O artigo apresenta uma avaliação econômica de opioides atualmente utilizados no controle de dor pós-operatória relacionada ao tratamento cirúrgico do câncer (fentanil e sufentanil) no contexto do Sistema Único de Saúde. Método: A avaliação baseou-se na perspectiva do governo, de forma a colaborar na promoção da efetividade das políticas públicas de saúde e melhorar a alocação de recursos públicos em saúde. Uma análise custo-efetividade foi realizada a partir de dados coletados no Sistema Único de Saúde e de informações provenientes de revisão da literatura para construção de uma árvore de decisão contendo alternativas para controle de dor pós-operatória relacionada ao tratamento cirúrgico do câncer entre pacientes adultos. Os desfechos considerados foram: efetividade da analgesia pós-operatória e ocorrência de náusea e vômito no período de 48 horas após cirurgia e em ciclos adicionais de 24 horas de seguimento do paciente. Uma análise de sensibilidade univariada foi conduzida para verificar a robustez do modelo estimado. Resultados: Na revisão de literatura, um número limitado de estudos efetuou comparação direta entre fentanil e sufentanil no controle de dor pós-operatória. A adoção de sufentanil (custo = U$ 25,72 / desfecho = 1,6 pontos VAS) foi dominante em relação ao uso do fentanil (custo = U$ 32,58 / desfecho = 2,6 pontos VAS). O modelo estimado demonstrou robustez em relação a mudanças nos parâmetros analisados. Conclusão: O sufentanil apresentou razão custo-efetividade superior em relação ao fentanil no controle de dor pós-operatória em cirurgias relacionadas ao tratamento de câncer entre pacientes adultos no Sistema Único de Saúde.

Anestesia subaracnoidea con dosis variables de bupivacaina con fentanilo, en la resección transuretral de la próstata / Subarachnoid anesthesia with variable doses of bupivacaine with fentanyl in the trans-urethral resection of the prostate

Introducción: en la actualidad se han descrito diversos modelos de raquianestesia con bupivacaína a dosis diferentes, asociadas o no con fentanilo, que proveen de una anestesia segura y eficaz, disminuyen la intensidad de dolor posquirúrgico, preservan la función cognoscitiva, y reduce las complicaciones atribuidas a la lidocaína hiperbárica por neurotoxicidad. Objetivo: evaluar el efecto de bajas dosis de bupivacaína con fentanilo para anestesia subaracnoidea en pacientes sometidos a resección transuretral de próstata. Materiales y Métodos: se realizó un estudio descriptivo cuantitativo, longitudinal, prospectivo en 200 pacientes programados para dicha cirugía e indicación de anestesia subaracnoidea con bupivacaína, los cuales fueron distribuidos de forma aleatoria en cuatro grupo. Resultados: tanto el bloqueo sensitivo como motor fue más rápido en los pacientes de los Grupos B (3,0; 11,2) y (7,1; 8,3), Grupo C (5,0; 9,4) y (6,2; 9,4) y Grupo D (6,1; 8,3) y (4,7; 10,9); mientras que el Grupo A fue de (6,0; 8,5) y (9,9; 11,7), respectivamente. Se observó que en la totalidad de los pacientes de los Grupos C y D se obtuvo anestesia de buena calidad. Conclusiones: la administración intratecal de 7,5 mg de bupivacaina con 25 µg de fentanilo produjo anestesia satisfactoria, disminuyó el periodo de latencia, mantuvo mejor estabilidad hemodinámica, prolongó la analgesia postoperatoria y se asoció a menor incidencia de complicaciones peri operatorias (AU).

Introduction: currently, several models of spinal anesthesia with bupivacaine in different doses, associated or not to fentanyl, have been described providing a safe and efficacious anesthesia, reducing the intensity of the postsurgical pain, preserving the cognitive function, and reducing the complications attributed to hyperbaric lidocaine due to its neurotoxicity. Aim: to assess the effect of low doses of bupivacaine with fentanyl as subarachnoid anesthesia in patients undergoing a prostate trans-urethral resection. Materials and Methods: a prospective, longitudinal, quantitative, descriptive study was carried out in 200 patients programmed for that kind of surgery and with the indication of subarachnoid anesthesia through bupivacaine; they were randomly distributed in four groups. Outcomes: both, the sensory block and the motor one were faster in the patients of the Group B (3,0; 11,2) and (7,1; 8,3), Group C (5,0; 9,4) and (6,2; 9,4) and Group D (6,1; 8,3) and (4,7; 10,9); while in the patients of the Group A they were (6,0; 8,5) y (9,9; 11,7) respectively. It was observed a good quality anesthesia in all the patients of the Groups C and D. Conclusions: the intrathecal administration of 7,5 mg of bupivacaine with 25 µg of fentanyl produced a satisfactory anesthesia, reduced the latency period, kept a better hemodynamic stability up, extended the post-surgery analgesia and was associated to fewer incidences of perioperative complications (AU).

comparative study to assess the effect of dexmedetomidine and fentanyl as an adjuvant to ropivacaine for epidural anesthesia in percutaneous nephrolithotomy

Aims and Background: To prolong postoperative analgesia many adjuvants has been used opioids and alpha-2 agonists are very popular among them. This study was aimed at comparing the sensory, motor, hemodynamic, sedative and analgesic properties of epidural administration of fentanyl and dexmedetomidine as an adjuvant to ropivacaine

Methodology: With Institutional ethical committee clearance this study was conducted at our hospital. After obtaining informed and written consent, a total of 60 patients scheduled for elective percutaneous nephrolithotomy [PCNL] were randomly allocated into two groups of 30 each. Patients of both genders, aged 21-60 y, ASA physical status I and II were enrolled. Group RD received 28 ml of inj ropivacaine 0.5% + dexmedetomidine 1 ng/kg and Group RF received 28 ml of ropivacaine 0.5% + inj fentanyl 1 pig/kg epidurally. Hemodynamic parameters, sedation scores, and time to onset of sensory loss, complete motor blockade, two segmental dermatomal regression and time of first rescue analgesic were recorded. Data were compiled systematically and analyzed using unpaired t-test, Chi-square and Mann-Whitney U test. P < 0.05 was considered significant

Results: The demographic profile of patients was comparable in both groups. Onset of sensory analgesia up to T10 was 6.8 +/- 2.8 min vs. 8.7 +/- 2.7 min and time to reach maximum motor block was 19.8 +/- 5.8 min vs. 23.9 +/- 4.9 min in Group RD and Group RF respectively, which was significantly less in the Group RD. Postoperative analgesia was significantly prolonged in the Group RF as compared to Group RD, e.g. 394.5 +/- 36.5 vs. 268.5 +/- 28.3 min respectively. Sedation scores were better in the Group RD and highly significant on statistical comparison [P < 0.001]. Incidence of hypotension, nausea and vomiting was high in the Group RF, while incidence of dry mouth was higher in the Group RD

Conclusion: Dexmedetomidine is a better adjuvant than fentanyl when added to epidural ropivacaine in terms of early onset of sensory and motor block, prolonged postoperative analgesia and better sedation with less side effects

Comparison of dexmedetomidine and fentanyl as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for total abdominal hysterectomy under subarachnoid block: a prospective randomized double blind study

Background: Subarachnoid block is still the most commonly used anesthetic technique for lower abdominal surgeries, however local anesthetics alone are associated with relatively short duration of action.The intrathecal adjuvants has been reported to improve the quality of anesthesia along with prolongation of postoperative analgesia and has gained popularity nowadays. So the aim of our study was to compare the dexmedetomidine and fentanyl as intrathecal adjuvant to 0.5% hyberbaric 0.396 bupivacaine with regards respect to onset and duration of sensory and motor block, duration of analgesia, hemodynamic variations and incidence of side effects

Material and Methods: Sixty four female patients, aged 30-60 years, belonging to American Society of Anesthesiologists [ASA] physical status I or II, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomly allocated into two groups, Group BD received 2.5 ml of 0.5% hyperbaric bupivacaine and 5 microg dexmedetomidine diluted in 0.5 ml preservative free normal saline while Group BF received 2.5 ml of 0.5% hyperbaric bupivacaine and 25microg [0.5 ml] fentanyl

Results: There was no statistically significant difference between two groups with respect to onset of sensory and motor block, [p > 0.05]. The mean time for two segment sensory regression was significantly slower in Group BD as compared to Group BF, [p < 0.05]. Patients in Group BD had significantly prolonged duration of sensory and motor block as compared to Group BF [p < 0.05]. Similarly the duration of analgesia was significantly prolonged in Group BD [p < 0.05], along with reduced requirement of rescue analgesics. The patients in both groups did not show any significant difference with respect to hemodynamic changes and incidence of side effects [p > 0.05]

Conclusion: Dexmedetomidine as intrathecal adjuvant was found to have prolonged sensory and motor block, provide good quality of intraoperative analgesia, stable hemodynamics, minimal side effects and prolonged postoperative analgesia along with reduced demand for rescue analgesics as compared to fentanyl

Protective effects of fentanyl preconditioning on cardiomyocyte apoptosis induced by ischemia-reperfusion in rats

We aimed to study the effect of fentanyl (Fen) preconditioning on cardiomyocyte apoptosis induced by ischemia-reperfusion (I/R) in rats. A total of 120 Sprague Dawley male rats (age: 3 months) were randomly divided into: sham operation group (S group), I/R group, normal saline I/R group (NS group), and fentanyl low, middle, and high dose groups (Fen1: 2 μg/kg; Fen2: 4 μg/kg; Fen3: 6 μg/kg). Heart rate (HR), mean arterial pressure (MAP), left ventricular developed pressure (LVDP), ±dp/dtmax, malondialdehyde (MDA), superoxide dismutase (SOD) activity, creatine phosphokinase-MB (CK-MB), and cardiac troponin-I (cTnI) were measured. Myocardial ischemic (MI) area, total apoptotic myocardial cells, and protein and mRNA expressions of B-cell lymphoma 2 (Bcl-2) and Bax were detected. HR and MAP were higher, while LVDP and ±dp/dtmax were close to the base value in the Fen groups compared to those in the I/R group. Decreased MDA concentration and CK-MB value and increased SOD activity were found in the Fen groups compared to the I/R group, while cTnI concentration was significantly lower in the Fen1 and Fen2 groups (all P<0.05). Myocardial damage was less in the Fen groups compared to the I/R group and the MI areas and apoptotic indexes were significantly lower in the Fen1 and Fen2 groups (all P<0.05). Furthermore, significantly increased protein and mRNA expressions of Bcl-2, and decreased protein and mRNA expressions of Bax were found in the Fen groups compared to the I/R group (all P<0.05). Fentanyl preconditioning may suppress cardiomyocyte apoptosis induced by I/R in rats by regulating Bcl-2 and Bax.

Dor irruptiva oncológica:revisão da literatura e análise crítica do seu tratamento / Critical analysis of breakthrough cancer pain treatment

Breakthroughpain ou dor irruptiva oncológica (DIO) é uma exacerbação da dor em pacientes com dor basal oncológica estabilizada e que já recebem terapia com opioides.O objetivo do estudo foi identificar as melhores terapias farmacológicas para o correto tratamento da condição. Realizou-se pesquisa nas bases de dados MEDLINE e LILACS e foram selecionados artigos que abordavam o tratamento da dor e que comparavam os resultados de diferentes medicações. Dos 38 artigos identificados nabusca, os 22 disponíveis (pelo portal Capes ou livremente na internet) foram usados.Trabalhos e pesquisas brasileiros e escritos em português sobre a DIO são escassos, o que pode constituir um empecilho para se instituir o tratamento eficaz da condição em nosso país. O tratamento convencional com morfina, que ainda é utilizado no Brasil, mostrou-se ineficaz pelo longo tempo de início de ação. A partir de evidênciasatuais, o CF spray nasal alcançou alto nível de alívio da dor em um tempo mais curto.Esses resultados precisam ser amplamente divulgados em nosso país, uma vez que o tratamento no Brasil é geralmente realizado com morfina.

Breakthrough cancer pain (BCP) is characterized by an exacerbation of pain in patients with background cancer pain adequately controlled with opioides.The aim of the study was to identify the best drug therapies for the correct treatment of BCP. A search in MEDLINE and LILACS databases was conducted. The articles that addressed the treatment of BCP and those that compared the results of different medications were selected. Ofthe 38 papers on the subject, 22 were used (those freely available at the web or through Capes portal). There are quite a few Brazilian research or papers on BCP, which could be a major setback to establishing an effective treatment for BCP in Brazilian patients. Conventionaltreatment with morphine, widely used in Brazil, is ineffective due to its long gap for onset of action. Current evidence suggests that FC pectin nasal spray reached a higher level of pain relief in a shorter time. These results must be widely spread in our country, since the usual prescribed treatment in Brazil seems to still be morphine.

Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized, double-blind, parallel trial

Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.

Application of Lidocaine Jelly on Chest Tubes to Reduce Pain Caused by Drainage Catheter after Coronary Artery Bypass Surgery

The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14+/-12.49 vs. 27.74+/-13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74+/-4.77, P<0.001) than in group L (3.05+/-2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65+/-37.01 vs. 1,720.19+/-361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910)

Eficacia de la analgesia epidural continua con bupivacaína al 0.125 por cento y fentanilo 2 ug/ml en pacientes postoracotomizados. Hospital IV Guillermo Almenara Irigoyen, 2011 / Efficacy of continuous epidural analgesia with 0.12 por cento bupivacaine and 2 ug/ml fentanyl after thoracic surgery. Hospital IV Guillermo Almenara Irigoyen, 2011

Objetivo: Determinar la eficacia analgésica que brinda la administración epidural continua de bupivacaína al 0.125% y fentanilo2 μg/ml en pacientes postoracotomizados. Material y métodos : Se realizó un estudio observacional, prospectivo y descriptivo. La población estuvo conformada por todos los pacientes postoracotomizados durante los meses de marzo y abril del 2012 en elHospital IV Guillermo Almenara Irigoyen. Se evaluó el dolor con la escala visual análoga (EVA) y la escala de Andersen en la unidad de recuperación postanestésica (URPA) y durante las primeras 24 horas en su servicio. De igual manera, se hizo el registro de los eventos colaterales. Se aplicó el ANOVA de medidas repetidas, test de correlación de Pearson y t de student para las medidas dela EVA, y la prueba de chi cuadrado para las medidas de la escala de Andersen. Resultados : La muestra estuvo conformada por veinte pacientes. La edad promedio fue 38 ± 18 años y la lobectomía pulmonar el procedimiento quirúrgico más frecuente (55%). Al ingreso a la URPA la EVA fue 0, luego 1 por 12 horas, 2 a las 24 horas y finalmente 4 a las 48 horas. El dolor leve y moderado,medido por la escala de Andersen, se presentó durante las dos primeras horas. El tiempo que duró la analgesia fue 15.4 ± 7.1 horas. El número de bolos adicionales fue 3 ± 2. El 65% de los pacientes no requirieron analgesia de rescate. La eficacia analgésicamedida por EVA ≤ a 3 fue 85% y medida por Andersen ≤ a 2 fue 80%. 15% presentaron mareo y vómito y 15% sólo náusea. Conclusión:La analgesia epidural continua con bupivacaína al 0.125% y fentanilo 2 μg/ml en pacientes postoracotomizados eseficaz según la evaluación de la EVA y la escala de Andersen

Objective: To determine the analgesic efficacy that continuous epidural administration of 0.125% bupivacaine and 2 æg/ml fentanyl provides in patients after thoracic surgery. Material and Methods: An observational, prospective and descriptive study. The population included all patients who underwent thoracic surgery in March and April 2012 at the Hospital IV Guillermo Almenara Irigoyen. Pain was assessed with visual analogue scale (VAS) and the Andersen scale in the post-anesthesia care unit (PACU) and the next 24 hours. Side events were recorded too. We applied ANOVA for repeated measures, Pearson correlation test and student’s t for measures of VAS, and the chi-square test for measures of Andersen scale. Results: The sample consisted of twenty patients. The mean age was 38 ñ 18 and the most frequent surgical procedure was lung lobectomy (55%). On admission to the PACU VAS was 0, then 1 for 12 hours, 2 at 24 hours and finally 4 at 48 hours. Mild to moderate pain, as measured by the Andersen scale, was present during the first two hours. The analgesia lasted 15.4 ñ 7.1 hours. The number of additional boluses was 3 ñ 2. The 65% of patients did not require rescue analgesia. The analgesic efficacy as measured by EVA less than or equal to 3 was 85% and measured by Andersen scale less than or equal to 2 was 80%. 15% of patients had dizziness and vomiting and 15% only nausea. Conclusion: Continuous epidural analgesia with bupivacaine 0.125% and 2 ug/ml fentanyl in patients after thoracic surgery is effective as assessed by the VAS and Andersen scale.

Postoperative epidural analgesia: trials of bupivacaine combined with fentanyl or morphine after spinal fusion surgery

Background: major spinal fusion surgery causes severe postoperative pain, which persists for at least 3 days. Efficient and safe methods for postoperative analgesia after spinal fusion surgery are, therefore, mandatory. This study aimed to compare the analgesic effect of different epidural analgesia combinations and their effects on blood level of Beta-endorphin. We also studied the impact of these analgesic regimens on defined postoperative mobilization maneuvers and on patient satisfaction

Methods: This study was registered in clinical trials number NCT01838707. Sixty patients scheduled for elective posterior lumbar fusion surgery for correction of Spondylolisthesis were enrolled in this study. Patients were randomly allocated into three equal groups [20 each] according to analgesic drugs combinations administered through epidural catheter inserted intraoperatively. All patients received standard general anesthesia. Al the end of posterior instrumentation, the surgeon inserted the epidural catheter under direct vision in the midline. All patients in this study were nursed in a high dependency intensive care facility and received analgesics according to the following protocol. Continuous drug flow will be maintained with a syringe pump. The syringe pump was connected to the epidural catheter [with the reservoir contain either: 0.125% Bupivacaine HCI at flow rate of 4 5 ml/h [5-6.25mg/h bupivacaine]. 0.125% Bupivacaine HCI fentanyl 100 microg at flow rate of 3 5 ml/h [3.75-6.24 mg/h bupivacaine I 6-10 microg /h fentanyl] 0.125% Bupivacaine HCI morphine sulphate 3 mg at flow rate of 3 5 ml/h [3.75-6.24 mg/h bupivacaine 0.18-0.3 mg/h morphine]. Infusion was continued until the third postoperative day. The rate was increased if pain VAS >3 [visual analogue scale] at rest or VAS >6 with movement. The rate was decreased when patients have intolerable relevant motor block [Bromage score >0] or sensory disturbances [numbness], or hypotension [systolic blood pressure <90 mm Hg]. IV rescue analgesia will be Ketrolactromethamine 30 mg. Epidural catheters were removed on the third postoperative day. Pain was assessed using the VAS ranging from "0" [no pain] to "10" [worst imaginable pain]. Pain was evaluated at rest and during mobilization. Maneuvers of particular clinical importance for postoperative mobilization [alone and with help] were chosen: Turning in bed. Standing in front of the bed and walking, and using the toilet without help. The time needed until the patient can first successfully perform these maneuvers was documented. Three venous samples to measure serum B-endorphin level first one preoperative base line, second at first time VAS more three at rest and third sample when VAS less than three at rest. For assessment of patients satisfaction with postoperative pain management a verbal rating score was used. Motor block was quantified with the Bromage scale. Patients will be asked about sensory deficits. Verbal rating scores was used for sedation. Nausea and vomiting and the incidence of pruritus were recorded

Results: There were no significant differences observed between the studied groups regarding patient characteristics [age, sex, ASA status, anesthesia time, surgery duration and number of segments fused]. There were no significant differences in all hemodynamic variables between the three groups, the results of this study showed less pain scores as recorded by VAS all over the study time for group 3 [bupivacaine+ morphine]. Pain scores were lowest for group Ill [bupivacaine + morphine] all over the study time when testing pain during movement. The mean times to turn in bed with and without assistance were lowest in group Ill [bupivacaine morphine]. B-endorphin level, there was no significant differences between means of B-endorphin samples between the groups or within each group. Patients were more satisfied in group 3 all over the study period. The incidence of nausea, vomiting or itching within the observation period was significantly different between the three groups. It was more common in the bupivacaine morphine group

In Conclusion: Epidural analgesia after spine surgery improve pain control and enhance functional recovery, but potential cost issues related to maintenance of the epidural infusion and ICU slay versus potential cost savings in hospital stay and effect on long term outcome must be considered. Also the cost of use B-endorphin as a biomarker of pain severity needs to be revised against the subjective assessment of pain