Medidas para optimizar cuidados post rinoplastia. Revisión sistemática de la literatura / Measures to optimize rhinoplasty post operative care, systematic review of the literature

Introducción: El cuidado postoperatorio de la rinoplastia ha evolucionado, paralelamente, al desarrollo de la técnica quirúrgica. Existen varias recomendaciones, sin embargo, hay una gran variabilidad interprofesional de las indicaciones post quirúrgicas. Objetivo: Realizar una revisión sistemática de la literatura científica sobre los cuidados post operatorios de la rinoplastia. Material y Método: Para la realización de este estudio se llevaron a cabo búsquedas en PubMed y en Cochrane Database of Systematic Reviews con los perfiles: ([rhinoplasty] AND [post operative care]) y ([rhinoplasty] AND [post surgical care]). Se seleccionaron los artículos publicados en los últimos 10 años, desde 2013 hasta 2023, ambos inclusive. Resultados: Los documentos analizados recogen la evidencia de los diferentes métodos de cuidados post quirúrgicos en rinoplastia. Estos confirman la utilización de corticoides en el período postoperatorio, así como el reposo en 90° y exponen la variabilidad interprofesional que existe en el protocolo postquirúrgico de esta cirugía. Conclusión: El uso de corticoides y el reposo en 90° disminuyen las complicaciones postquirúrgicas de la rinoplastia. Debe existir una clara información sobre lo que el paciente debe esperar post cirugía. El uso de opioides debe ser restringido y la analgesia debe ser multimodal. Es preciso realizar estudios futuros con mayor nivel de evidencia y tener protocolos uniformes para la práctica clínica.

Introduction: The postoperative care of rhinoplasty has evolved along with the development of the surgical technique. There are several recommendations, however there is enormous interprofessional variability of post-surgical indications. Aim: To carry out a systematic review of the scientific literature on rhinoplasty postoperative care. Material and Method: To carry out this study, searches were carried out in PubMed and in the Cochrane Database of Systematic Reviews with the profiles: ([rhinoplasty] AND [post operative care]) and ([rhinoplasty] AND [post surgical care]). Articles published in the last 10 years were selected, from 2013 to 2023, both inclusive. Results: The documents analyzed collect the evidence of the different methods of post-surgical care in rhinoplasty, they confirm the use of corticosteroids in the postoperative period as well as rest at 90° and expose the interprofessional variability that exists in the post-surgical protocol of this surgery. Conclusion: The use of corticosteroids and rest at 90° reduce the post-surgical complications of rhinoplasty. There must be clear information about what the patient should expect post surgery. The use of opioids must be restricted and analgesia must be multimodal. It is necessary to carry out future studies with a higher level of evidence and have uniform protocols for clinical practice.

Precise and Sensitive Ambient Temperature Based Analytical Colorimetric Method for Pregabalin

Abstract Pregabalin, a GABA analogue is used to treat epilepsy and neuropathic pain. The drug poses problems in analytical quantification when estimated at a shorter UV wavelength. The expensive and non-repetitive reported analytical methods necessitate the utility and development of an accurate, precise, repetitive, simple and highly sensitive colorimetric method for pregabalin in solution as well as sustained release mini matrices. Pregabalin (having primary amino group) was derivatized at alkaline pH of mixture with optimized ninhydrin solution at ambient temperature (25oC). The ninhydrin-pregabalin derivatized complex (Ruhemann's Purple) was analyzed for drug concentration at absorption maximum (λmax) of 570nm. The linearity was observed in the concentration range of 5-150 µg/mL with coefficient of correlation, 0.998. The developed analytical method was validated according to ICH guidelines and proved to be highly sensitive (LOD 0.917µg/mL, LOQ 3.055µg/mL), with good inter-day as well as intra-day accuracy and precision as 4.65% and 3.75%, respectively. The proposed method was proved to be a simple, sensitive, precise and accurate for the estimation of the minute concentrations of pregabalin in pure form and the developed formulations. Results verified that the proposed method could determine pregabalin at the ambient temperature without requiring high temperatures used in the existing methods. It was concluded that developed method was easier and more suitable for analysis of pregabalin in quality control of commercial preparations

The effects of pregabalin, solifenacin and their combination therapy on ureteral double-J stent-related symptoms: A randomized controlled clinical trial

ABSTRACT Background: Many medical therapies have been tested to deal with urinary stent-related symptoms (USRS). Several preventive and pharmaceutical methods have been already used for better compatibility of stents. However, the existing evidence for pharmacological treatment is still controversial. This study aims to evaluate the effects of pregabalin, solifenacin, and combination therapy on ureteral double-J stent-related symptoms following ureteroscopy and transureteral lithotripsy (TUL). Materials and methods: In a randomized controlled clinical trial, from November 2017 to March 2019, 256 patients who underwent ureteroscopy were enrolled. Patients were randomly divided into four groups including: group A received pregabalin 75mg BID (twice daily), group B received solifenacin 5mg orally once daily, group C received combination of pregabalin and solifenacin and the group D (control) given no drugs. Results: One hundred and fifty-one (58.9%) males and 101 (41.1%) females were enrolled in this study with a mean age of 43.47±7 (p=0.32, p=0.67). USSQ domains score such as urinary symptoms, pain, general condition, work performance, sexual matters and additional problems were significantly differenced during second and fourth week of follow-up among study groups (p <0.0001). In Tukey's multiple comparison test, urinary symptoms (p=0.735), pain (p=0.954) and sexual matters (p=0.080) in second week and work performance in forth week in group B was not significantly better than group D. Only group C in all indexes of USSQ showed significantly beneficial effects over group D (p <0.0001). Conclusion: Combination therapy of pregabalin and solifenacin has a significant effect on stent-related symptoms and is preferred over monotherapy of the respected medications.

Síndrome trófico trigeminal / Trigeminal trophic syndrome

El síndrome trófico trigeminal es una enfermedad infrecuente caracterizada por úlceras faciales autoprovocadas en regiones de anestesia o hipoestesia, secundarias al daño del nervio trigémino. Presentamos tres casos de este síndrome en seguimiento en nuestro centro.

Trigeminal trophic syndrome is an uncommon disease characterized by self-inflicted facial ulcers in anesthetic or hypoesthetic areas, secondary to trigeminal nerve damage. We present three cases in follow up at our hospital.

Eficácia e segurança de Pregabalina, Gabapentina, Memantina, Amitriptilina, treinamento físico com exercícios em solo ou aquáticos para tratamento de Fibromialgia: revisão rápida de evidências / Effectiveness and safety of Pregabalin, Gabapentin, Memantine, Amitriptyline, exercises on land or aquatic exercises for Fibromyalgia treatment: rapid evidence review

Tecnologia: Pregabalina, drogas não-opioides disponíveis no SUS, treinamento físico no solo ou em meio aquático. Indicação: Tratamento da fibromialgia. Pergunta: Há diferenças de eficácia e segurança entre a Pregabalina e as outras drogas não opioides ou terapias disponíveis no SUS para tratamento da dor crônica relacionada à fibromialgia? Métodos: Levantamento bibliográfico foi realizado nas bases eletrônicas PUBMED e Cochrane Database, seguindo estratégias de buscas predefinidas, com busca adicional na página eletrônica da Comissão Nacional de Incorporação de Tecnologias em Saúde. Avaliou-se a qualidade metodológica das revisões sistemáticas com Assessing the Methodological Quality of Systematic Reviews versão 2 (AMSTAR-II). Resultados: Foram selecionadas e incluídas 6 revisões sistemáticas. Conclusão: A afirmação de eficácia da Gabapentina, Amitriptilina e Memantina para tratamento da fibromialgia é pouco confiável, pois as evidências são de nível 3, provenientes de ensaios clínicos de baixa qualidade metodológica. Pregabalina é eficaz para reduzir a dor em curto prazo (risco absoluto é 50%, nível 1 de evidência), mas não em longo prazo. O treinamento físico, relatado como única estratégia eficaz para tratamento da fibromialgia nas diretrizes do SUS, não tem efeito clinicamente importante sobre a dor

Technology: Pregabalin, non-opioid drugs available in Brazilian Public Health System, aquatic exercise or exercise on land. Indication: Treatment of fibromyalgia. Question: Are there differences in efficacy and safety between Pregabalin and other non-opioid drugs or therapies available in the SUS for the treatment of chronic pain related to fibromyalgia? Methods: A bibliographic survey was carried out in the electronic databases PUBMED and Cochrane Database, following pre-defined search strategies, with an additional search on the website of the National Commission for the Incorporation of Health Technologies. The methodological quality of systematic reviews was evaluated with Assessing the Methodological Quality of Systematic Reviews version 2 (AMSTAR-II). Results: Six systematic reviews were selected and included. Conclusion: There is not confidence about effectiveness of Gabapentin, Amitriptyline and Memantine for fibromyalgia treatment (level 3 of evidence, from clinical trials of low methodological quality). Pregabalin, in the short term, is effective for reducing pain (absolut risk is 50%, level 1 of evidence), but not in the long term. Physical training, reported as the only effective strategy for treating fibromyalgia in Brazilian Public Health System guidelines, has no clinically important effect on pain.

Meta-analysis on the role of Pregabalin in Fibromyalgia

Background@#Fibromyalgia is a difficult-to-treat chronic musculoskeletal pain and tenderness syndrome. It is considered due to augmented pain processing in central nervous system. Interest in antiepileptic drugs, included pregabalin, for treatment of fibromyalgia is currently growing. This study aimed to investigate the effectiveness of pregabalin for fibromyalgia.@*Methods@#We conducted the study according to the meta-analysis PRISMA guideline. Relevant randomized controlled trials (RCTs) were identified from a search of PubMed and Cochrane databases. Quality of selected studies was assessed using Jadad score for randomized placebo-controlled trials (RCT). Primary outcome was pain score reduction (30% and 50% reduction) and secondary outcome was patient global impression of change. Statistical analysis was performed using Review Manager 5.3.@*Results@#Six international, multicenter, high-quality RCTs with 8-15 weeks duration of treatment met inclusion criteria. Four studies used different fixed dose (300 mg/d, 450 mg/d, 600mg/d) and 2 studies used titrated dose in evaluating the efficacy of pregabalin. There was statistically significant benefit of pregabalin over placebo in mean pain score reduction [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.56-2.10 p < 0.00001 in fixed dose pregabalin 30% pain reduction; OR 2.06 95% CI 1.66-2.56 p < 0.00001 in fixed dose pregabalin 50% pain reduction; OR 1.53 95% CI 1.10-2.13 p 0.01 in titrated dose pregabalin 30% pain reduction; OR 1.80 95% CI 1.12-2.88 p 0.01 in titrated dose pregabalin 50% pain reduction]. Pregabalin also demonstrated significantly better patient global impression of change than placebo. No heterogeneity was seen in most groups. No publication bias was observed.@*Conclusion@#Our study showed pregabalin monotherapy was effective for pain treatment associated with fibromyalgia. Further studies with longer treatment duration are needed to confirm the long-term effectiveness of pregabalin for fibromyalgia treatment.

Síndrome de dolor crónico postmastectomía: ¿qué podemos hacer en el período perioperatorio para disminuir su incidencia? / Postmastectomy chronic pain syndrome: what can we do to reduce the incidence?

El síndrome de dolor crónico postmastectomía es frecuente en pacientes sometidas a cirugía por cáncer de mamas, llegando a ser invalidante en casos severos. Existen distintos factores de riesgo para que éste se presente, siendo el dolor agudo postoperatorio el único en el cual podemos intervenir. La importancia de implementar estrategias de prevención en el periodo perioperatorio es fundamental. En la mantención de la anestesia general, la utilización de propofol se asocia con menor incidencia de dolor agudo postoperatorio. El uso de anestésicos locales, ya sea por vía tópica, subcutánea y sistémica, ha demostrado su beneficio para disminuir el dolor agudo. No obstante, solo el uso tópico y endovenoso ha sido útil para reducir el dolor hasta 3 meses postcirugía. Técnicas de analgesia regional, como el bloqueo PEC I y II, bloqueo paravertebral y bloqueo del erector de la espina han demostrado ser útiles para reducir el dolor agudo; pero solo el bloqueo paravertebral ha demostrado su utilidad en reducir el dolor hasta 1 año postcirugía. El uso de gabapentina, pregabalina y ketamina desde el periodo preoperatorio disminuyen la incidencia de dolor agudo postoperatorio. En tanto, la venlafaxina y dexmedetomidina demostraron su utilidad para reducir el dolor crónico.

Postmastectomy chronic pain syndrome is common in patients undergoing surgery for breast cancer, becoming invalidating in severe cases. There are different risk factors for this to occur, with acute post-operative pain being the only one in which we can intervene. The importance of implementing prevention strategies in the perioperative period is essential. In the maintenance of general anesthesia, the use of propofol is associated with a lower incidence of acute post-operative pain. The use of local anesthetics, whether topically, subcutaneously and systemically, has shown its benefit in reducing acute pain. However, only topical and endovenous use has been useful to reduce pain up to 3 months after surgery. Regional analgesia techniques, such as PEC I and II block, paravertebral block, and spinal erector block have been shown to reduce acute pain; but only the paravertebral block has shown its usefulness in reducing pain up to 1 year after surgery. The use of gabapentin, pregabalin and ketamine from the preoperative period reduce the incidence of acute postoperative pain. Meanwhile, venlafaxine and dexmedetomidine proved useful in reducing chronic pain.

Treatment data from the Brazilian fibromyalgia registry (EpiFibro)

Abstract Background: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). Objective: To analyze the therapeutic measures prescribed by Brazilian physicians. Materials and methods: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. Results: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). Conclusion: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.(AU)

Updates on the Diagnosis and Treatment of Restless Legs Syndrome / 신경정신의학

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.

Sincondrose Dolorosa da Patela ­ uma causa incomum de dor no joelho / Patellar painful Synchondrosis ­ An uncommon cause of knee pain

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

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

Efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery: a systematic review and meta-analysis / Eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica de hombro: una revisión sistemática y metanálisis

Abstract: Objective: To assess the efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery. Material and methods: A PRISMA-compliant systematic review and meta-analysis was conducted in PubMed, Cochrane Library and ScienceDirect databases. Randomized Controlled Trials (RCTs) comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing shoulder arthroscopic surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score at 24 hours and cumulative morphine consumption at 24 hours. The secondary outcomes were complications of nausea/vomiting, sedation and dizziness. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary. Results: Five clinical studies (gabapentin group n = 4 and pregabalin group n = 1) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 24 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea/vomiting. There were no significant differences in the occurrence of sedation and dizziness. Conclusions: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following arthroscopic shoulder surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after shoulder surgery.

Resumen: Objetivo: Evaluar la eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica del hombro. Material y métodos: Se llevó a cabo una revisión sistemática y metaanálisis conforme a PRISMA en las bases de datos PubMed, Cochrane Library y ScienceDirect. Se recuperaron ensayos controlados aleatorios (RCT) que comparaban los gabapentinoides (gabapentina y pregabalina) con placebo en pacientes sometidos a cirugía artroscópica del hombro. El punto final principal fue la puntuación de la escala analógica visual (VAS) a las 24 horas y el consumo acumulado de morfina a las 24 horas. Los resultados secundarios fueron complicaciones de náuseas/vómitos, sedación y mareos. Después de realizar pruebas de sesgo de publicación y heterogeneidad entre los estudios, se agregaron datos para modelos de efectos aleatorios cuando fue necesario. Resultados: En última instancia, se incluyeron en el metaanálisis cinco estudios clínicos (grupo de gabapentina n = 4 y grupo de pregabalina n = 1). Los gabapentinoides se asociaron con puntuaciones de dolor reducidas a las 24 horas. Del mismo modo, los gabapentinoides se asociaron con una reducción en el consumo acumulado de morfina a las 24 horas. Además, los gabapentinoides pueden reducir significativamente la aparición de náuseas/vómitos. No hubo diferencias significativas en la ocurrencia de sedación y mareos. Conclusiones: El uso preoperatorio de gabapentinoides fue capaz de reducir el dolor postoperatorio, el consumo total de morfina y las complicaciones relacionadas con la morfina después de la cirugía artroscópica del hombro. Otros estudios deben determinar la dosis óptima y si la pregabalina es superior a la gabapentina en el control del dolor agudo después de la cirugía de hombro.

Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

Síndrome de piernas inquietas en niños: caracterización clínica / Characterization of restless leg syndrome in children

El Síndrome de piernas inquietas (SPI) o Enfermedad de Willis­Ekbom, es una condición neurológica que afecta al 2-4% de los niños en edad escolar. Etiológicamente se ha relacionado al metabolismo del hierro y a factores genéticos entre otros. En niños aun es una patología poco diagnosticada. Trabajo observacional descriptivo, en el cual se realiza caracterización clínica, según criterios internacionales, en 14 pacientes menores de 18 años, 9 varones. Edad promedio 8 años. Sintomatología inicial variada, desde resistencia a ir a la cama, hasta dibujar sus molestias. En 10 se comprobó déficit de hierro. En 11 pacientes se realizó un polisomnograma, 10 de ellos con un índice elevado de movimientos periódicos de extremidades. El uso de pregabalina y aporte de hierro fue el tratamiento más utilizado. Dos pacientes tenían padres diagnosticados con SPI.

Abstract. The Restless Legs Syndrome (RLS) or Willis-Ekbom Disease is a neurological condition that affects 2-4% of school-age children. Its etiology has been related to the metabolism of iron and genetic factors among others. In children it is still a frequently undiagnosed disorder. This is a descriptive observational report, in which clinical characterization is carried out according to international criteria in 14 patients under 18 years old, 9 boys. Average age is 8 years old. The initial symptomatology was varied, from resistance to comply with bedtime, to drawing their discomfort. In 9, iron deficiency was found. A polysomnogram was performed in 11 patients, 10 of which had a high periodic limb movements index. The use of pregabalin and supplementary iron were the most used treatments. Two patients had parents diagnosed with RLS.

Effectiveness of Pregabalin for Treatment of Burning Mouth Syndrome

Treatment of burning mouth syndrome (BMS) is challenging because there is no consensus regarding pharmalogical or nonpharmalogical therapies. The use of anticonvulsants is controversial. We present nine patients BMS who respond to pregabalin. They were diagnosed secondary BMS except two. Etiologic regulations were made firstly in patients with secondary BMS but symptoms did not decrease. We preferred pregabalin in all patients and got good results. Furthermore the addition of pregabalin to the treatment of two patients who did not respond adequately to duloxetine provided good results. We are only aware that pregabalin may reduce symptoms as a result of case reports. We believe that the diagnosis of pathologic etiology with appropriate diagnostic tests will result in better outcomes in treatment.

Comparative Evaluation of Pregabalin and Clonidine as Preemptive Analgesics for the Attenuation of Postoperative Pain Following Thoracolumbar Spine Surgery

STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled study.PURPOSE: To compare clonidine and pregabalin with placebo for the attenuation of postoperative pain after thoracolumbar spinal surgery and instrumentationOVERVIEW OF LITERATURE: Spine surgery is associated with moderate to severe postoperative pain that needs to be controlled to improve patient’s outcome. Alpha 2 agonists (e.g., clonidine) and gabapentenoids (e.g., pregabalin) are successfully used as part of a multimodal analgesic regimen.METHODS: Total 75 patients were enrolled and randomly allocated into three groups. Group P received pregabalin (150 mg), group C received clonidine (150 mcg), and group N received placebo 90 minutes preoperatively. A standard anesthesia protocol comprising fentanyl, thiopentone, vecuronium, nitrous oxide, and oxygen in isoflurane was used for all patients. Postoperative recovery profile, pain, time for first analgesic, 24-hour analgesic requirement, sedation, and hemodynamic parameters were noted.RESULTS: Recovery profile was similar in all three groups; however, the patients in group P and C were more sedated (p<0.05). Group N patients had a higher Visual Analog Scale (VAS) score (p<0.05) and the time for first analgesic was also lower (p=0.02). Postoperative (24-hour) analgesic requirement was maximum in group N, followed by that in group C and group P. The VAS score was highest in the control group; however, after 12 hours, it was similar in all groups.CONCLUSIONS: Postoperative pain and analgesic requirement is significantly attenuated by preoperative administration of a single dose of clonidine (150 mcg) or pregabalin (150 mg); pregabalin was more effective. Thus, their use offers a reasonable strategy for pain management in patients undergoing spine surgery.

Analgesia preventiva con pregabalina en pacientes postoperados de colecistectomía laparoscópica / Preventive analgesia with pregabalin in patients after laparoscopic cholecystectomy

Resumen Antecedentes: La analgesia preventiva es la administración de un fármaco analgésico con el objetivo de atenuar el dolor postoperatorio, la hiperalgesia y alodinia. Está justificado su uso con la finalidad de ofrecer analgesia y disminuir la ansiedad a los pacientes sometidos a procedimientos laparoscópicos. Objetivo: Evaluar si la pregabalina en dosis de 1 mg/kg de peso es eficaz para analgesia preventiva en pacientes postoperados de colecistectomía laparoscópica. Métodos: Se realizó un ensayo clínico controlado ciego simple que incluyó 60 pacientes programados para colecistectomía laparoscópica divididos en 2 grupos de manera aleatoria, donde al grupo 1 se administró placebo y al grupo 2 se le administró pregabalina una dosis diaria 72 horas previas a la intervención quirúrgica. La intensidad del dolor se evaluó mediante la Escala Numérica Analógica a la hora, 2, 6,12 y 24 horas postoperatorias, así como el nivel de ansiedad prequirúrgico con la Escala de Hamilton. Resultados: Se demostró disminución del dolor en los pacientes del grupo de pregabalina desde la primera hora (p = 0.002), posteriormente fue más notorio el descenso del dolor en comparación con los pacientes a los que se les dio placebo, con valor estadísticamente significativo (p < 0.001), lo mismo sucedió con el nivel de ansiedad evaluada con la Escala de Hamilton (p < 0.005). Conclusión: El uso de pregabalina para analgesia preventiva resulta ser eficaz en la ansiedad preoperatoria y el periodo posquirúrgico, y con mínimos efectos adversos, en los pacientes operados de colecistectomía laparoscópica.

Abstract Background: Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures. Objective: To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients. Methods: A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the emergency nurses association scale at 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale. Results: Pain reduction was demonstrated in patients in the pregabalin group from the 1st h (p = 0.002), later the decrease in pain was more noticeable compared to patients who were given placebo (p < 0.001), the same happened with the anxiety level evaluated with the Hamilton scale (p < 0.005). Conclusion: The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.

Comparative clinical study between preoperative oral administration of paracetamol, celecoxib and pregabalin on postoperative pain in gynecological laparoscope

Background: Since the introduction of laparoscopic surgeries, postoperative pain has been generally reduced. However, it can still peak, especially during the early postoperative period and becomes the main cause of overnight hospital stay and prolonged convalescence after this day-case surgical procedure. Thus, optimizing postoperative pain relief, not only to sub-serve reduction of its intensity but to also enhance the recovery and shorten length of stay became the broader target of multimodal pain control regimens nowadays. That is why; searching for a drug that would be effective in reducing pain, safe from major adverse effects and can meanwhile possess an opioid-sparing potentiality would be a merit so as to improve the success rate of ambulatory day-care surgeries. Objective: To study the analgesic effects of preemptive single oral dose of paracetamol, celecoxib and pregabalin in patients undergoing gynecological laparoscope. Method: Preoperative evaluation, preparation and premedication was assessment, and routine laboratory investigations was done. Postoperative pain, Level of Sedation was measured. Results: There was statistical significant difference between the three groups regarding VAS. There was statistical significant difference between the three groups regarding the total pethidine consumption. Regarding postoperative level of sedation, blood glucose there was no statistical significant difference between the three groups. Conclusion: Oral pregabalin in a dose of 150 mg 2 hour before surgery, is significantly attenuating pain intensity and total meperidine consumption during the first 6 hours postoperatively