Do we still need central blocks while we have erector spinae plane block? Case of 2. 5 month old infant / Ainda precisamos de bloqueios centrais enquanto temos o bloqueio do eretor da espinha? Caso de criança de 2, 5 meses de idade

Abstract Erector spinae plane block is gaining popularity both for its ease of application and as its comparable effect on postoperative analgesia with central regional techniques like paravertebral block or epidural anesthesia. Its use for many indications has been reported in the literature for pediatric patients. We would like to share our experiences in a 2.5-month infant scheduled for thoracotomy for a giant congenital cyst. Single shot erector spinae plane block was done at T4 level before the start of the surgery for both surgical and postoperative analgesia. No complication was seen during both surgery and follow up period. Erector spinae plane block with the combination of paracetamol was adequate for pain relief.

Resumo O bloqueio do plano do músculo eretor da espinha tem ganhado popularidade, tanto pela facilidade de aplicação quanto pelo efeito comparável em analgesia pós-operatória com técnicas regionais centrais, como o bloqueio paravertebral ou a anestesia peridural. Seu uso tem sido relatado na literatura para muitas indicações em pacientes pediátricos. Gostaríamos de compartilhar nossas experiências no caso de um bebê de 2,5 meses de idade programado para toracotomia para excisão de um cisto congênito gigante. O bloqueio do plano do eretor da espinha dorsal com injeção única foi realizado no nível de T4 antes do início da cirurgia para analgesia cirúrgica e pós-operatória. Nenhuma complicação foi observada durante a cirurgia e o período de acompanhamento. O bloqueio do plano do eretor da espinha com a combinação de paracetamol foi adequado para o alívio da dor.

Efectividad Analgésica de Paracetamol Post-Cirugía Mucogingival: Ensayo Clínico Aleatorizado Paralelo / Analgesic Effectiveness of Paracetamol Post-Mucogingival Surgery: Parallel Randomized Clinical Trial

RESUMEN: El objetivo de este trabajo fue determinar la efectividad analgésica de paracetamol post-cirugía mucogingival. El estudio, prospectivo, longitudinal, comparativo y experimental, se desarrolló en la Clínica Odontológica de la Universidad Privada Antenor Orrego (Trujillo, Perú) con los pacientes de la asignatura Periodoncia II. Se incluyeron 39 pacientes, quienes fueron distribuidos de manera aleatoria en 2 grupos de 19 y 20 cada uno, según los criterios establecidos. La medicación se inició 20 minutos después de concluida la cirugía, y se mantuvo por 24 horas. Para determinar la efectividad analgésica se usó la escala visual analógica (0-100 mm) y se recogió la información que fue procesada, utilizando la prueba de U Mann-Whitney con un nivel de significancia del 5 %. No existe diferencia en cuanto a la efectividad analgésica post-cirugías mucogingivales entre paracetamol y el control a las 2 horas (p=0.415), 8 horas (p=0.279) y 24 horas (p=0.736). Paracetamol es efectivo como analgésico post-cirugía mucogingival.

ABSTRACT: The objective of this study was to determine the analgesic effectiveness of paracetamol after mucogingival surgery. This prospective, longitudinal, comparative and experimental study was developed in the Stomatology Clinic of the Universidad Privada Antenor Orrego (Trujillo, Perú) with the patients of the Periodontics II subject. We included 39 patients, who were randomly distributed into 2 groups of 19 and 20 each, according to the established criteria. The medication was started 20 minutes after the surgery was completed, and was maintained for 24 hours. To determine the analgesic effectiveness, the analogue visual scale (0-100 mm) was used and the information that was processed was collected, using the U Mann-Whitney test with a level of significance of 5 %. There is no difference in terms of analgesic effectiveness post-mucogingival surgery between paracetamol and control at 2 hours (p = 0.415), 8 hours (p = 0.279) and 24 hours (p = 0.736). Paracetamol is effective as a mucogingival post-surgery analgesic.

Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy / Adição de dexmedetomidina à bupivacaína em bloqueio paravertebral guiado por ultrassom potencializa o alívio da dor pós-operatória em pacientes submetidos à toracotomia

Abstract Background and objective: Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method: 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results: No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion: The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.

Resumo Justificativa e objetivo: O bloqueio paravertebral torácico é uma técnica regional opcional para o alívio da dor pós-toracotomia, deste modo diminui o consumo de opioides, náuseas e vômitos no pós-operatório, tontura, depressão respiratória e custos com saúde. O objetivo deste estudo foi investigar os efeitos de bupivacaína isolada e bupivacaína + dexmedetomidina no escore de dor pós-operatória e no consumo de analgésicos em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom. Material e método: Noventa e três pacientes, ASA I-II, com idades entre 18 e 65 anos, foram incluídos no estudo e programados para cirurgia torácica. Antes da indução anestésica, o procedimento de bloqueio paravertebral foi realizado por um anestesista com o uso de ultrassom. Os casos foram estratificados aleatoriamente em três grupos. O procedimento de bloqueio paravertebral foi realizado com injeção de 20 mL de bupivacaína a 0,5% no Grupo B (n = 31) e de 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 µg) no Grupo BD. O Grupo C recebeu morfina intravenosa via analgesia controlada pelo paciente sem bloqueio paravertebral. Os escores de dor pós-operatória foram registrados na sala de recuperação e no pós-operatório usando a escala VAS. Parâmetros hemodinâmicos, efeitos adversos e consumo de morfina também foram registrados. Resultados: Não houve diferença significativa entre os grupos B e C em relação a efeitos adversos intraoperatórios, como bradicardia e hipotensão, enquanto esses efeitos adversos foram significativamente maiores no Grupo BD (p = 0,04). Os escores VAS em repouso e movimento foram significativamente menores no Grupo BD em relação ao Grupo C (p < 0,001). O consumo total de morfina foi significativamente menor nos grupos B e BD em comparação com o Grupo C (p < 0,001). No Grupo BD, a frequência cardíaca e a pressão arterial média foram menores, mas esse resultado não foi clinicamente significativo (p < 0,05). Conclusão: A adição de dexmedetomidina à bupivacaína reduz os escores de dor pós-operatória e o consumo de morfina em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom.

Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy / Efeito do acetaminofeno versus fentanil intravenosos na dor pós litotripsia transuretral

Abstract Background: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. Methods: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000 mg acetaminophen (propacetamol) or 2 mcg.kg-1 fentanyl intravenously, 15 min before the end of surgery. The postoperative pain was evaluated every 6 h for 24 h using the Visual Analog Scale. Total morphine dose taken in 24 h and hemodynamic status were evaluated. Results: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24 h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18 h after surgery (p < 0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. Conclusions: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).

Resumo Justificativa: A dor pós-operatória é a complicação mais comum no período pós-operatório. Este estudo foi realizado para avaliar o efeito de acetaminofeno versus fentanil no alívio da dor pós-operatória em pacientes submetidos a cirurgias urológicas. Métodos: Este ensaio clínico foi realizado com pacientes cujas idades variou entre 18 e 65 anos. Os pacientes foram randomicamente designados para receber 2.000 mg de acetaminofeno (propacetamol) ou 2 mcg.kg-1 de fentanil por via intravenosa 15 min antes do final da cirurgia. A dor pós-operatória foi avaliada a cada 6 horas por 24 horas, utilizando a escala visual analógica. A dose total de morfina administrada em 24 horas e o estado hemodinâmico foram avaliados. Resultados: Oitenta pacientes foram incluídos no estudo. O escore médio de dor em 6, 12, 18 e 24 horas após a cirurgia foi menor no grupo acetaminofeno que no grupo fentanil, mas a diferença não foi estatisticamente significativa, exceto em 12 e 18 horas após a cirurgia (p < 0,05). A quantidade de morfina administrada foi maior no grupo fentanil que no grupo acetaminofeno, mas a diferença não foi estatisticamente significativa. O estado hemodinâmico, incluindo pressão arterial sistólica e diastólica e frequência cardíaca, foi quase o mesmo nos dois grupos, mas a média de SpO2 foi significativamente maior no grupo acetaminofeno que no grupo fentanil. Conclusões: Este estudo indicou que acetaminofeno intravenoso é tão eficaz quanto fentanil intravenoso no alívio da dor após cirurgias urológicas (litotripsia transuretral).

Impact of non-adherent Ibuprofen foam dressing in the lives of patients with venous ulcers / Impacto do curativo de espuma não aderente com Ibuprofeno na vida dos pacientes com úlcera venosa

ABSTRACT Objective : to evaluate pain in patients with lower limb venous ulcer who used non-adherent Ibuprofen foam dressing (IFD). Methods : we conducted a prospective study of patients with lower limb venous ulcers treated from April 2013 to August 2014. We used the Numerical Scale and McGill Pain Questionnaire, performing the assessments at the moment of inclusion of the patient in the study and every eight days thereafter, totaling five consultations. We divided the patients into two groups: 40 in the Study Group (SG), who were treated with IFD, and 40 in the Control Group (CG), treated with primary dressing, according to tissue type and exudate. Results : at the first consultation, patients from both groups reported intense pain. On the fifth day, SG patients reported no pain and the majority of CG reported moderate pain. Regarding the McGill Pain Questionnaire, most patients of both groups reported sensations related to sensory, affective, evaluative and miscellaneous descriptors at the beginning of data collection; after the second assessment, there was slight improvement among the patients in the SG. After the third consultation, they no longer reported the mentioned descriptors. CG patients displayed all the sensations of these descriptors until the fifth visit. Conclusion : non-adherent Ibuprofen foam dressing is effective in reducing the pain of patients with venous ulcers.

RESUMO Objetivo: avaliar a dor em pacientes portadores de úlcera venosa de membros inferiores que utilizaram curativo de espuma não aderente com Ibuprofeno (CEI). Métodos: estudo prospectivo de pacientes portadores de úlceras venosas de membros inferiores tratados no período de abril de 2013 a agosto de 2014. Foram utilizados os questionários Escala Numérica e Questionário de Dor de McGille, as avaliações eram feitas no momento da inclusão do paciente no estudo e a cada oito dias, totalizando cinco consultas. Os pacientes foram divididos em dois grupos: 40 no Grupo Estudo (GE), que foram tratados com CEI, e 40 no Grupo Controle (GC), tratados com curativo primário, conforme o tipo de tecido e exsudato. Resultados: na primeira consulta os pacientes de ambos os grupos relataram dor intensa. No quinto dia os pacientes do GE relataram ausência de dor e a maioria do GC relatou dor moderada. Com relação ao Questionário de Dor de McGill, a maioria dos pacientes de ambos os grupos, no início da coleta de dados, relataram sensações relacionadas aos descritores sensorial, afetivo, avaliativo e miscelânea, sendo que entre os pacientes do GE houve discreta melhora após a segunda consulta. Após a terceira consulta já não referiram os descritores citados. Os pacientes do GC manifestaram todas as sensações desses descritores até quinta a consulta. Conclusão: o curativo de espuma não aderente com Ibuprofeno é eficaz na redução da dor de pacientes portadores de úlceras venosas.

A non-hepatotropic parasite infection increases mortality in the acetaminophen-induced acute liver failure murine model: possible roles for IL-5 and IL-6

We evaluated the effects of a non-hepatotropic parasite infection (Taenia crassiceps) on the outcome of acetaminophen-induced acute liver failure in mice. Uninfected and T. crassiceps infected mice orally received either 300 mg/kg acetaminophen or water as vehicle (n = 5 per group). Survival analysis, hepatocyte necrosis, alanine aminotransferase (ALT) levels, CYP2E1 protein, interleukin (IL-) 5, and IL-6 were assessed for all groups. All infected mice died within 16 h after exposure to acetaminophen (Tc+APAP group), whereas only one-third of uninfected animals exposed to acetaminophen (APAP group) died. Uninfected (Control group) and infected (Tc group) mice that received the vehicle showed no liver damage. Tc+APAP mice exhibited massive liver necrosis characterised by marked balloning degeneration of hepatocytes and higher serum ALT compared to Control, Tc, and APAP animals. Liver tissue from Tc+APAP mice also displayed increased expression of CYP2E1 protein and higher mRNA and protein levels of IL-5 and IL-6 compared to the other groups. These findings suggest that non-hepatotropic parasite infections may increase mortality following acute liver failure by promoting hepatocyte necrosis via IL-5 and IL-6-dependent CYP2E1 overproduction. This study identifies new potential risk factors associated with severe acute liver failure in patients.

Mechanical Antiallodynic Effect of Intrathecal Nefopam in a Rat Neuropathic Pain Model

Nefopam has a pharmacologic profile distinct from that of opioids or other anti-inflammatory drugs. Several recent studies demonstrate that nefopam has a mechanism of action similar to those of anti-depressants and anticonvulsants for treating neuropathic pain. The present study investigates the mechanical antiallodynic effect of nefopam using immunohistochemical study and western blot analysis in a rat neuropathic pain model. Twenty-eight male Sprague-Dawley rats were subjected to left fifth lumbar (L5) spinal nerve ligation and intrathecal catheter implantation, procedures which were not performed on the 7 male Sprague-Dawley rats in the sham surgery group (group S). Nefopam, either 10 or 100 microg/kg (group N10 or N100, respectively), and normal saline (group C) were intrathecally administered into the catheter every day for 14 days. The mechanical allodynic threshold of intrathecal nefopam was measured using a dynamic plantar aesthesiometer. Immunohistochemistry targeting cluster of differentiation molecule 11b (CD11b) and glial fibrillary acidic protein (GFAP) was performed on the harvested spinal cord at the level of L5. Extracellular signal-regulated kinase 1/2 (ERK 1/2) and cyclic adenosine monophosphate response element binding protein (CREB) were measured using western blot analysis. The N10 and N100 groups showed improved mechanical allodynic threshold, reduced CD11b and GFAP expression, and attenuated ERK 1/2 and CREB in the affected L5 spinal cord. In conclusion, intrathecal nefopam reduced mechanical allodynia in a rat neuropathic pain model. Its mechanical antiallodynic effect is associated with inhibition of glial activation and suppression of the transcription factors' mitogen-activated protein kinases in the spinal cord.

Assessment of quality of prescription by dental students

Objective: The main objective of this study was to evaluate changes in prescribing pattern of Dentistry students throughout academic course. Methods: A case of non-complicated dental extraction was presented to all students that had completed their pharmacology coursework (from 4th semester to the last semester). The students were grouped according to year of study and were asked to prescribe paracetamol for pain control. A maximal score of 5 points was calculated from three subscores for identification of professional and patient (1.0 point), drug concentration, dosage, and quantity (1.5 points); and drug information, instructions, and warnings (2.5 points). The data were expressed as medians [95% confidence intervals (CIs)] and were compared using the Kruskal-Wallis test followed by Dunn's post hoc test. A p<0.05 value was considered statistically significant. A total of 92 students participated the study (2nd year, N=12; 3rd year, N=32; 4th year, N=28; 5th year, N=20). Results: The quality of prescription showed improvement between 2nd-year students [2.0 (1.5-2.5)] and 4th-year students [3.2 (2.9-3.5), p<0.05]; 4th- and 5th-year students [3.6 (3.5-3.8)] performed similarly. Lack of information about pharmacological treatment, side effects, and administration route were the major deficiencies observed. Conclusion: Although Dentistry students present a general improvement in their prescribing performance, deficiencies remain even in advanced students. The data suggest that the teaching of good prescription practices should extend throughout the later phases of preprofessional dental education. .

Comparison of Postoperative Analgesic Efficacy of Penile Block, Caudal Block and Intravenous Paracetamol for Circumcision: A prospective Randomized Study

Purpose To evaluate the postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol administration following circumcision. Materials and Methods In this prospective randomized study a total of 159 patients underwent circumcision under general anesthesia at urology clinic of Ufuk University Faculty of Medicine and Sorgun State Hospital between May 2012 and September 2012. The patients were randomized to three groups to receive penile block (Group 1), caudal block (Group 2) and intravenous paracetamol administration (group 3). Pain measurement of the patients was done via CHEOPS scoring system at 30,60,120 and 180 minutes postoperatively and compared. Statistical tests were performed with a conventional statistics program and statistical significance was set at a p value of < 0.05. Results The mean age of the patients was 5.7 years. Patients in group 1 had significantly lower pain score at 30 minutes compared to other two groups. At 60 minutes groups 1 and 2 had significantly lower score compared to group 3. At 120 and 180 minutes no difference between the groups was observed. No significant major complications were observed in all 3 groups. Conclusion Penile block and caudal block provide similar pain scores and painless postoperative periods after circumcision under general anesthesia. Intravenous paracetamol is insufficient at the early postoperative period. The three procedures were shown to be safe for analgesia following circumcision. .

Efeitos antinociceptivos, analgésicos e histopatológicos de dexmedetomidina e bupivacaína intratecal em rato / Anti-nociceptive, analgesic and pathohistological effects of intrathecal dexmedetomidine and bupivacaine in rats / Efectos antinociceptivos, analgésicos e histopatológicos de dexmedetomidina y bupivacaína intratecal en ratones

JUSTIFICATIVA E OBJETIVOS: Este estudo investigou os efeitos analgésicos e nociceptivos da adição de dexmedetomidina à bupivacaína em anestesia do neuroeixo usando os testes de retirada da cauda (tail-flick [TF]) e da placa quente (hot-plate [HP]) e microscopia de luz para as alterações histopatológicas de nervos espinhais e raízes nervosas. MÉTODOS: Quarenta ratos Sprague-Dawley anestesiados, machos, foram cateterizados intratecalmente. Os valores basais dos testes TF e HP foram medidos antes e depois do cateterismo. Trinta e seis ratos cateterizados com sucesso foram distribuídos em quatro grupos. O Grupo B recebeu 10 µg de bupivacaína, o Grupo BD3 recebeu 10 µg de bupivacaína + 3 µg de dexmedetomidina, o Grupo BD10 recebeu 10 µg de bupivacaína + 10 µg de dexmedetomidina e o Grupo Controle recebeu 10 µL de líquido cefalorraquidiano artificial. Os testes TF e HP foram feitos entre cinco e 300 minutos a partir da administração das drogas. Vinte e quatro horas após a administração, os ratos foram sacrificados e retiradas as medulas espinhais e raízes nervosas para investigação patológica. RESULTADOS: Os valores basais dos testes TF e HP não foram estatisticamente diferentes entre os grupos (6,8 ± 0,15 s). As latências de TF e HP no Grupo Controle não apresentaram alteração significativa durante o estudo. Os resultados dos testes TF e HP mostraram que a adição de 3 e 10 µg de dexmedetomidina causou um aumento dose-dependente na duração e amplitude do efeito analgésico e nociceptivo de bupivacaína (TF: 37,52 ± 1,08%, 57,86 ± 1,16%, respectivamente; HP: 44,24 ± 1,15%, 68,43 ± 1,24%, respectivamente). CONCLUSÕES: Não houve alterações histopatológicas aparentes em pelo menos 24 horas após a administração intratecal da dose única de dexmedetomidina (3 µg e 10 µg). Dexmedetomidina adicionado à bupivacaína para raquianestesia melhora a analgesia e prolonga a duração do bloqueio.

BACKGROUND AND OBJECTIVES: This study investigates analgesic and nociceptive effects of adding dexmedetomidine to bupivacaine neuraxial anesthesia through Tail-flick (TF) and Hot-plate (HP) tests and the pathohistological changes on spinal nerves and nerve roots through light microscopy. METHODS: Forty anesthetized, male Sprague-Dawley rats were intrathecally catheterized. Basal values of TF and HP tests were measured before and after catheterization. Thirty-six successfully catheterized rats were assigned to four groups. Group B received 10 µg bupivacaine, Group BD3 received 10 µg bupivacaine + 3 µg dexmedetomidine, Group BD10 received 10 µg bupivacaine + 10 µg dexmedetomidine and Control group received 10 µL volume of artificial cerebrospinal fluid. TF and HP tests were performed between the 5th and 300th minutes of drug administration. Twenty-four hours after administration of drugs, rats were sacrificed and spinal cord and nerve roots were removed for pathological investigation. RESULTS: Baseline values of the TF and HP tests were not statistically different among the groups (6.8 ± 0.15 s). TF and HP latencies in the Control group did not change significantly during the study. TF and HP test results showed that adding 3 and 10 µg dexmedetomidine caused a dosedependent increase in duration and amplitude of analgesic and nociceptive effect of bupivacaine (TF: 37.52 ± 1.08%, 57.86 ± 1.16% respectively, HP: 44.24 ± 1.15%, 68.43 ± 1.24% respectively). CONCLUSIONS: There were no apparent pathohistological changes at least 24 hours after the intrathecal administration of a single dose of dexmedetomidine 3 µg and 10 µg. Dexmedetomidine added to bupivacaine for spinal block improves analgesia and prolongs block duration.

JUSTIFICATIVAS Y OBJETIVOS: Este estudio investigó los efectos analgésicos y nociceptivos de la adición de dexmedetomidina a la bupivacaína en anestesia del neuro eje, usando los test de retirada de la cola (tail-flick [TF]) y de la placa caliente (hot-plate [HP]) y microscopía de luz para las alteraciones histopatológicas de nervios espinales y raíces nerviosas. MÉTODOS: Cuarenta ratones anestesiados, Sprague-Dawley machos, fueron cateterizados intratecalmente. Los valores basales de los testes TF y HP fueron medidos antes y después del cateterismo. Treinta y seis ratones cateterizados con éxito fueron distribuidos en cuatro grupos. El Grupo B recibió 10 µg de bupivacaína, el Grupo BD3 recibió 10 µg de bupivacaína + 3 µg de dexmedetomidina, el Grupo BD10 recibió 10 µg de bupivacaína + 10 µg de dexmedetomidina y el Grupo Control recibió 10 µL de líquido cefalorraquídeo artificial. Los test TF y HP se hicieron entre cinco y 300 minutos a partir de la administración de los fármacos. Veinte y cuatro horas después de la administración, los ratones fueron sacrificados y se les retiraron las médulas espinales y las raíces nerviosas para investigación patológica. RESULTADOS: Los valores basales de los test TF y HP no fueron estadísticamente diferentes entre los grupos (6,8 ± 0,15 s). Las latencias de TF y HP en el Grupo Control no tenían ninguna alteración significativa durante el estudio. Los resultados de los test TF y HP mostraron que la adición de 3 y 10 µg de dexmedetomidina causó un aumento dosis dependiente en la duración y en la amplitud del efecto analgésico y nociceptivo de bupivacaína (TF: 37,52 ± 1,08%, 57,86 ± 1,16%, respectivamente; HP: 44,24 ± 1,15%, 68,43 ± 1,24%, respectivamente). CONCLUSIONES: No hubo alteraciones histopatológicas aparentes en por lo menos 24 horas después de la administración intratecal de la dosis única de dexmedetomidina (3 µg y 10 µg). Dexmedetomidina añadido a la bupivacaína para raquianestesia mejora y prolonga la duración del bloqueo.

Fibrosis retroperitoneal asociada a uso crónico de ergotamina. Tratamiento con colchicina y esteroides: Caso clínico / Retroperitoneal fibrosis associated with chronic use of ergotamine: Report of one case

Retroperitoneal fibrosis (RPF) associated with chronic use of ergotamine is a very rare disorder. We report a 45-year-old woman who presented with a RPf after using, almost daily for 23 years, ergotamine tartrate for migraine relief. FRP presented as a chronicinflammatory state, anemia, abdominal and lumbosacral pain and a hypogastric mass. A CT-Scan showed a periaortic mass and left hydronephrosis. A percutaneous biopsy was obtained and the patient was subjected to a surgical ureterolysis and tissue resection. The biopsy confirmed the presence of RPf. Due to persistent symptoms and increase in the volume of periaortic tissue, treatment with colchicine 1 mg/day and defazacort 30 mg/day was started, resulting in a rapid di-sappearance of symptoms, disappearance ofinflammation and a significant reduction in the volume of the periaortic tissue. The patient remains in complete remission after 29 months of follow up.

Comparação da eficácia de doses iguais de acetaminofeno retal e oral em crianças / Comparison of antipyretic effectiveness of equal doses of rectal and oral acetaminophen in children

OBJETIVO: Comparar uma dose de acetaminofeno oral e retal e avaliar a aceitabilidade do acetaminofeno retal, uma vez que o acetaminofeno oral e retal é amplamente usado como agente antipirético em crianças com febre e a eficiência comparativa dessas duas preparações não está bem estabelecida. MÉTODOS: Neste estudo prospectivo de grupos paralelos, foram incluídas 60 crianças admitidas na emergência ou clínica ambulatorial pediátrica em um hospital terciário, com idade entre 6 meses e 6 anos e com temperatura retal acima de 39 °C. Os pacientes foram distribuídos aleatoriamente em dois grupos de mesmo tamanho. O grupo 1 recebeu 15 mg/kg de acetaminofeno retal, e o grupo 2 recebeu a mesma dose oralmente. A temperatura foi registrada no tempo zero e 1 e 3 horas após administração da droga. RESULTADOS: No primeiro grupo, a redução média de temperatura, 1 e 3 horas após administração do acetaminofeno, foi de 1,07±0,16 (p < 0,001) e 1,74±0,25 °C (p < 0,001), respectivamente, e no segundo grupo foi de 1,98±0,19 (p < 0,001) e 1,70±0,14 °C (p < 0,001), respectivamente (p > 0,05). CONCLUSÃO: As preparações oral e retal de acetaminofeno têm eficácia antipirética equivalente em crianças. A via retal mostrou ser tão aceitável quanto a oral entre os pais.

OBJECTIVE: To compare a dose of oral and rectal acetaminophen and to evaluate acceptability of rectal acetaminophen, since oral and rectal acetaminophen is widely used as an antipyretic agent in febrile children and the comparative effectiveness of these two preparations is not well established. METHODS: In this prospective parallel group designed study, 60 children who presented to the emergency department or outpatient pediatric clinic at a tertiary hospital and aged from 6 months to 6 years with rectal temperature over 39 °C were enrolled. Patients were randomly assigned to two equal-sized groups. Group 1 received 15 mg/kg acetaminophen rectally and group 2 received the same dose orally. Temperature was recorded at baseline and 1 and 3 hours after drug administration. RESULTS: In the first group, mean decrease in temperature, 1 and 3 hours after administration of acetaminophen was 1.07±0.16 (p < 0.001) and 1.74±0.25 °C (p < 0.001), respectively, and in the second group it was 1.98±0.19 (p < 0.001) and 1.70±0.14 °C (p < 0.001), respectively (p > 0.05). CONCLUSION: Rectal and oral acetaminophen preparations have equal antipyretic effectiveness in children. The rectal route proved to be as acceptable as the oral one among parents.

Evaluation of gastric tolerability, antinociceptive and antiinflammatory activity of combination NSAIDs in rats.

Background : Non-steroidal antiinflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs in clinical practice. Presently, several varieties of fixed dose combinations (FDCs) of NSAIDs are available over the counter and are being prescribed too. There is paucity of literature regarding comparative efficacy of these combinations against their individual component. Various clinical studies have documented increased incidence of gastric ulcerations with usage of more than one NSAID simultaneously. Objectives : To study gastric tolerability, antinociceptive and antiinflammatory activity of combination NSAIDs in rats. Materials and Methods : Gastric tolerability of different NSAIDs was observed after administration of drugs for 7 days orally. On 7 th day, 4 h after drug administration, rats were sacrificed and stomach mucosa was examined for ulcerations. Analgesic or antinociceptive activity of single and combination NSAIDs was evaluated using Writhing test model. For induction of writhing, 4% normal saline (hypertonic saline) was injected (0.1 ml/10 gm) intraperitoneally. Evaluation of antiinflammatory activity for FDCs of NSAIDs was done by using rat paw edema model with the aid of plethysmometer. Paw edema was induced by injecting 0.1 ml of 1% formalin in sub-planter region of hind paw. Results : Analgesic activity was found to be enhanced or significant only in the group pretreated with combination of nimesulide with ibuprofen as compared to ibuprofen-alone group (P = 0.01). Decrease in mean paw edema (antiinflammatory activity) was not significant in rats pretreated with combination NSAIDs as compared to NSAID-alone group. Mean gastric ulcer index was significant in groups pretreated with diclofenac alone (P = 0.03) and in combination groups of nimesulide with diclofenac and ibuprofen with paracetamol as compared to control (P = 0.03, P = 0.007). Conclusion : Addition of ibuprofen to paracetamol and combining diclofenac to nimesulide, significantly increased severity of gastric ulcerations. Fixed dose combination does not possess additional analgesic activity over their individual components, only exception being combination of nimesulide with ibuprofen, which has additional analgesic activity over ibuprofen alone, and this combination was not found to be ulcerogenic. Antiinflammatory activity of ibuprofen, paracetamol and nimesulide was significantly enhanced after addition of diclofenac.

Antipyretic effect of ketoprofen.

OBJECTIVE: The aim of this study was to investigate the efficacy and side effect profile of ketoprofen as well as compliance with respect to the taste of the drug and compare these parameters with those of acetaminophen and ibuprofen. METHODS: A total of 301 patients between 1-14 years of age who applied to emergency rooms of three medical centers with the complaint of fever that required antipyretic therapy were included in the study. Fever was measured with the aid of a tympanic thermometer (Braun Kronberg 6014) and followed for 4-6 hours. The measurement was repeated at 30, 60, 120 minutes, and again 4-6 hours after the initial assessment. RESULTS: The mean age of the patients was 47.8+/-41.1 months. The patients randomly received 15 mg/kg/dose of acetaminophen (n=112 group 1), 0.5 mg/kg/dose of ketoprofen (n=105, group 2), or 10 mg/kg/dose of ibuprofen (n=84, group 3). Fever was 38.4+/-0.7 degrees C, 38.4+/-0.7 degrees C, and 38.5+/-0.5 degrees C at 30 minutes; 38.0+/-0.7 degrees C, 37.9+/-0.7 degrees C, and 38.0+/-0.6 degrees C at 60 minutes (p>0.05), 37.7+/-0.6 degrees C, 37.6+/-0.7 degrees C, and 37.7+/-0.5 degrees C at 120 minutes (p>0.05); 37.5+/-0.7 degrees C, 37.3+/-0.6 degrees C, and 37.4+/-0.6 degrees C at 4-6 hours after admission (p>0.05). The fever was significantly lower at 30, 60, and 120 minutes in all group s (p<0.05). Early vomiting after medication (<6 hours) was observed in 3.8%, 13.5%, and 9.6% whereas late vomiting (6-48 hours) occurred in 1.3%, 2.7%, and 5.8% respectively (p>0.05). Bad taste was expressed by 5.1%, 12.2%, and 5.8% early (<6 hours), and 3.9%, 8.1%, and 3.8% late (6-48 hours) (p>0.05). There were no differences between age groups for antipyretic effect, taste and adverse effect in three drugs (p>0.05). CONCLUSION: All three drugs were similar in terms of efficacy, adverse effects, and compliance within 48 hours of therapy. These results suggest that ketoprofen may be used for antipyresis as an alternative to acetaminophen and ibuprofen.

Biodistribution of samarium-153-EDTMP in rats treated with docetaxel / Biodistribuição de EDTMP-153-samário em ratos tratados com docetaxel

PURPOSE: Many patients with metastatic bone disease have to use radiopharmaceuticals associated with chemotherapy to relieve bone pain. The aim of this study was to assess the influence of docetaxel on the biodistribution of samarium-153-EDTMP in bones and other organs of rats. METHODS: Wistar male rats were randomly allocated into 2 groups of 6 rats each. The DS (docetaxel/samarium) group received docetaxel (15 mg/kg) intraperitoneally in two cycles 11 days apart. The S (samarium/control) group rats were not treated with docetaxel. Nine days after chemotherapy, all the rats were injected with 0.1ml of samarium-153-EDTMP via orbital plexus (25µCi). After 2 hours, the animals were killed and samples of the brain, thyroid, lung, heart, stomach, colon, liver, kidney and both femurs were removed. The percentage radioactivity of each sample ( percent ATI/g) was determined in an automatic gamma-counter (Wizard-1470, Perkin-Elmer, Finland). RESULTS: On the 9th day after the administration of the 2nd chemotherapy cycle, the rats had a significant weight loss (314.50±22.09g) compared (p<0.5) to pre-treatment weight (353.66± 22.8). The percent ATI/g in the samples of rats treated with samarium-153-EDTMP had a significant reduction in the right femur, left femur, kidney, liver and lungs of animals treated with docetaxel, compared to the control rats. CONCLUSION: The combination of docetaxel and samarium-153-EDTMP was associated with a lower response rate in the biodistribution of the radiopharmaceutical to targeted tissues. Further investigation into the impact of docetaxel on biodistribution of samarium-153-EDTMP would complement the findings of this study.

OBJETIVO: Muitos pacientes com metástases ósseas são tratados com radiofármacos associados com quimioterapia para alívio da dor óssea. O objetivo do trabalho foi estudar a influência do docetaxel na biodistribuição do EDTMP-153-samário nos ossos e outros órgãos de ratos. MÉTODOS: Ratos Wistar foram aleatoriamente alocados em 2 grupos de 6 animais cada. O grupo DS (docetaxel/samário) recebeu docetaxel (15 mg/kg) intraperitoneal em dois ciclos com 11 dias de intervalo. Os ratos do grupo S (samário/controle) não foram tratados com docetaxel. Nove dias após a quimioterapia, todos os animais receberam 0,1ml de EDTMP-153-samário via plexo orbital (25µCi). Após 2 horas, os animais foram mortos e feitas biópsias de cérebro, tireóide, pulmão, coração, estômago, cólon, fígado, rim e fêmures. O percentual de radioatividade por grama ( por centoATI/g) de tecido de cada biópsia foi determinado em contador gama automático (Wizard-1470, Perkin-Elmer, Finland). RESULTADOS: No 9º após 2º ciclo de docetaxel os ratos tiveram perda de peso significante, passando de 353,66± 22,8g (controle/pré-tratamento) para 314,50±22,09g (p<0,5). Os por cento ATI/g nos órgãos dos ratos tratados com EDTMP-153-samário e docataxel tiveram redução significante nos fêmures direito e esquerdo, rim, fígado e pulmão, quando comparados com os não tratados com docetaxel. CONCLUSÃO: A combinação de docetaxel com EDTMP-153-samário foi associada com resposta mais baixa na biodistribuição do radiofármaco em órgãos alvo. Futuras investigações sobre o impacto do docetaxel na biodistribuição do EDTMP-153-samário poderão complementar os achados teste estudo.

Dexmedetomidine in anesthesia of children submitted to videolaparoscopic appendectomy: a double-blind, randomized and placebo-controlled study / Dexmedetomidina na anestesia de crianças submetidas à apendicectomia por videolaparoscopia: um estudo duplo cego randomizado e placebo-controlado

OBJECTIVES: To evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine. METHODS: Randomized, double-blind and placebo-controlled study involving 26 children submitted to videolaparoscopic appendectomy carried out at Hospital São Lucas (PUCRS) between May 2004 and February 2005. Patients were assigned to two groups: (a) Dexmedetomidine group (n=13): infusion of 1µg/kg over 10 minutes and maintenance dose of 0.5µg/kg/h) as an adjuvant to inhaled isoflurane anesthesia; (b) Control group (n=13): normal saline infusion at a similar rate and volume of the dexmedetomidine infusion. During the different surgical and anesthetic periods, groups were compared regarding heart rate, systolic and diastolic arterial blood pressures as well as need of supplemental fentanyl infusion. Student's t test, ANOVA, and Finner's procedure were used for statistical analysis. RESULTS: During the strongest nociceptive stimuli (airway access and abdominal catheter placement), the heart rate and systolic blood pressure increased significantly (p<0.001) in the control group compared to the dexmedetomidine group. Compared to baseline levels, the hemodynamic responses to nociceptive stimuli were more stable when dexmedetomidine was used in combination with inhaled isoflurane anesthesia. The need for supplemental doses of fentanyl and the hemodynamic parameters were similar for both groups. CONCLUSION: Dexmedetomidine combined with inhaled isoflurane for anesthesia of children submitted to videolaparoscopic appendectomy, efficiently blocks the hemodynamic responses to nociceptive stimuli. When compared to placebo, the use of dexmedetomidine did not change the need for supplemental doses of fentanyl for maintenance of hemodynamic parameters during the intraoperative period.

OBJETIVOS: Avaliar a resposta hemodinâmica aos estímulos nocicepticos em crianças submetidas à apendicectomia por videolaparoscopia sob anestesia balanceada com isoflorane e dexmedetomidina. MÉTODOS: Estudo randomizado, duplo cego e placebo controlado envolvendo 26 crianças submetidas à apendicectomia por videolaparoscopia no Hospital São Lucas da PUCRS entre maio de 2004 a fevereiro 2005. Os pacientes foram alocados: a) Grupo Dexmedetomidina (n=13), administrada 1µg/kg em 10 minutos e manutenção de 0,5µg/kg/h como coadjuvante à anestesia inalatória com isoforane; b) Grupo Controle (n=13), que recebia solução fisiológica com volume e velocidade de infusão semelhante ao grupo anterior. Durante os diferentes tempos cirúrgicos e anestésicos os grupos foram comparados em relação à freqüência cardíaca, pressão arterial sistólica e diastólica, assim como necessidade de doses suplementares de fentanil. Os grupos foram comparados pelo teste T, Qui quadrado, a ANOVA e Finner. RESULTADOS: Nos momentos de maior estímulo doloroso (entubação, colocação dos trocateres abdominais), a freqüência cardíaca e tensão arterial sistólica aumentaram significativamente (p<0,001) no grupo placebo em comparação ao grupo dexmedetomidina. Houve maior estabilidade hemodinâmica aos estímulos nociceptivos quando a dexmedetomidina foi empregada na complementação anestésica ao isoforane. A necessidade de doses adicionais de fentanil na manutenção dos parâmetros hemodinâmicos estáveis foi semelhante entre os dois grupos. CONCLUSÃO: A dexmedetomidina, utilizada como coadjuvante ao isoforane na anestesia de crianças submetidas à apendicectomia por videolaparoscopia, bloqueia de forma efetiva a resposta hemodinâmica aos estímulos nociceptivos. No entanto, quando comparada ao placebo a dexmedetomidina não modificou a necessidade de doses complementares de fentanil para manutenção de parâmetros hemodinâmicos estáveis, durante o periodo intraoperatório.

Comparative study between target-controlled-infusion and continuous-infusion anesthesia in dogs treated with methotrimeprazine and treated with propofol and remifentanil

PURPOSE: To compare two propofol infusion techniques in bitches subjected to ovaryhisterectomy by estimating the efficiency of the propofol target-dose, evaluating the cardiorespiratory and hemogasimetric attributes, and the bispectral scale index (BIS) as well as the recovery period characteristics. METHODS: Twenty anesthetized bitches were divided into two groups of 10 each (G1, G2). Animals of G1 were pre-treated with methotrimeprazine and anesthetized with target-controlled propofol infusion by means of a Harvard infusion pump combined to remifentanil through a syringe pump. RESULTS: Bradycardia and light hypotension, hemogasimetric and respiratory stability besides a good myorelaxation, more evident during continuous infusion and good hypnosis. CONCLUSIONS: Dosis used in both techniques, after methotrimeprazine pre-treatment and combined to the opioid, were efficient for the surgery. The target-controlled anesthesia required a smaller anesthetic consumption (propofol) with faster recovery periods.

OBJETIVO: Comparar duas técnicas de infusão de propofol em cadelas submetidas à ovariohisterectomia, estudando a eficácia da dose alvo de propofol, avaliando os atributos cardiorrespiratórios, hemogasométricos e escala do índice bispectral, (BIS) bem como as características do período de recuperação. MÉTODOS: Foram anestesiadas 20 cadelas, distribuídos em dois grupos (GI e GII). Em GI, os animais foram pré-tratados com levomepromazina e anestesiados com propofol por infusão alvo controlada, através de bomba de infusão Harvard pump, associado com remifentanila, através de bomba de seringa. Em GII, os animais receberam o mesmo tratamento de GI, só que ao invés de receberem o propofol por infusão alvo controlada, receberam o propofol em infusão contínua de velocidade fixa. RESULTADOS: Bradicardia e discreta hipotensão, estabilidade hemogasométrica e respiratória, além de um bom miorrelaxamento, mais evidente na infusão contínua e boa hipnose. CONCLUSÕES: As doses de propofol utilizadas em ambas as técnicas, após o pré-tratamento de levomepromazina e associadas ao opióide, foram eficazes para a realização cirúrgica. A técnica de anestesia alvo controlada obteve um menor consumo de anestésico (propofol) com períodos mais rápidos de recuperação.

Comparison of Parecoxib and Proparacetamol in Endoscopic Nasal Surgery Patients

PURPOSE: The aim of the study was to compare the efficacy of parecoxib for postoperative analgesia after endoscopic turbinate and sinus surgery with the prodrug of acetaminophen, proparacetamol. MATERIALS AND METHODS: Fifty American Society of Anesthesiology (ASA) physical status I-II patients, receiving functional endoscopic sinus surgery (FESS) and endoscopic turbinectomy, were investigated in a prospective, randomized, double-blind manner. After local infiltration with 1% mepivacaine, patients were randomly allocated to receive intravenous (IV) administration of either 40mg of parecoxib (n=25) or 2g of proparacetamol (n=25) 15 min before discontinuation of total IV anaesthesia with propofol and remifentanil. A blinded observer recorded the incidence and severity of pain at admission to the post anaesthesia care unit (PACU) at 10, 20, and 30 min after PACU admission, and every 1 h thereafter for the first 6 postoperative h. RESULTS: The area under the curve of VAS (AUC(VAS)) calculated during the study period was 669 (28-1901) cm·min in the proparacetamol group and 635 (26-1413) cm·min in the parecoxib group (p=0.34). Rescue morphine analgesia was required by 14 patients (56%) in the proparacetamol group and 12 patients (48%) in the parecoxib (p> or=0.05), while mean morphine consumption was 5-3.5mg and 5-2.0mg in the proparacetamol groups and parecoxib, respectively (p> or=0.05). No differences in the incidence of side effects were recorded between the 2 groups. Patient satisfaction was similarly high in both groups, and all patients were uneventfully discharged 24h after surgery. CONCLUSION: In patients undergoing endoscopic nasal surgery, prior infiltration with local anaesthetics, parecoxib administered before discontinuing general anaesthetic, is not superior to proparacetamol in treating early postoperative pain.

Oral administration of intravenous solution of midazolam mixed in syrup of paracetamol is an effective way of premedicating children undergoing surgery under general anaesthesia.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of injection midazolam administered by oral route mixed in paracetamol syrup as a premedication in children undergoing surgery. METHODS: 60 children undergoing elective hernia repair under general anaesthesia were randomized into two groups: the study group (group A) was given oral midazolam 0.5 mg/kg (mixed in paracetamol syrup) and the control group (group B) was given just the paracetamol syrup before bringing them inside the operating theater. They were evaluated for ease of separation from their parents, ease of i.v. cannulation and induction, and for recovery time from anaesthesia. RESULTS: it was found that in group A - 96.7% of children showed satisfactory parent child separation while in group B - only 53.3% of children showed satisfactory separation (P < 0.05). Similarly in group A - 73.3 % of children shad satisfactory induction while in group B only 33.3% of children had satisfactory induction. The recovery time from general anaesthesia did not differ in the two groups. No significant peri operative complications directly related to oral midazolam was noted. CONCLUSION: It was concluded that injection midazolam mixed in syrup paracetamol administered orally is a convenient and efficient method of premedicating children undergoing general anaesthesia. Parent-child separation and induction of anaesthesia was smooth and the recovery uneventful in children premedicated with oral midazolam.