ABSTRACT
Objetivos. Tanto para cirugía laparoscópica como para cirugía abierta la analgesia multimodal puede ayudar a controlar el dolor postoperatorio. La colocación de un catéter en la herida quirúrgica de manera intraoperatoria tras cirugía de colon podría optimizar el control del dolor con menor consumo de opiáceos y menos efectos secundarios. Método. Realizamos un estudio prospectivo, aleatorizado de pacientes reclutados para cirugía de colon laparoscópica en el Hospital de Galdakao-Usansolo de enero de 2012 a enero de 2013. Los pacientes fueron asignados aleatoriamente al grupo del catéter o al grupo de la analgesia postoperatoria estándar. Un miembro de la Unidad de dolor agudo monitorizó todos los pacientes a lo largo de 48 h tras la cirugía. Las variables principales analizadas fueron la escala numérica verbal y la cantidad de morfina intravenosa utilizada por cada paciente mediante PCA. Resultados. Se incluyeron 92 pacientes en el estudio, 43 en el grupo con catéter y 49 en el estándar. Se observaron diferencias estadísticamente significativas en el consumo de morfina entre ambos grupos a lo largo de todo el periodo. La cantidad total de morfina consumida en el grupo del catéter fue de 5,63 ± 5,02 mg y de 21,86 ± 17,88 mg en el grupo de analgesia estándar (p = 0,0001). Los pacientes con catéter presentaban menores valores en la escala numérica verbal. No se encontraron efectos adversos asociados a la colocación del catéter y la administración de anestésico local. El grupo de catéter presentó menor estancia hospitalaria respecto al otro grupo (p = 0,02). Conclusión. En los pacientes intervenidos de cirugía de colon laparoscópico una infusión continua de anestésico local a través de un catéter interfascial durante 48 h tras la cirugía reduce la percepción del dolor y el consumo de morfina intravenosa, disminuyendo la estancia hospitalaria (AU)
Objectives. For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects. Methods. We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion. Results. 92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63 ± 5.02 mg among wound catheter patients and 21. 86 ± 17.88 mg among control patients (P = .0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P = .02). Conclusions. In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48 h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays (AU)
Subject(s)
Humans , Male , Female , Analgesia/methods , Anesthesia, Local/methods , Anesthesia, Local , Pain Management/methods , Laparoscopy/methods , Morphine/therapeutic use , Catheters , Colon/pathology , Colon/surgery , Prospective Studies , Postoperative Care/methods , Length of Stay/trendsABSTRACT
OBJECTIVES: For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects. METHODS: We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion. RESULTS: 92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63±5.02mg among wound catheter patients and 21. 86±17.88mg among control patients (P=.0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P=.02). CONCLUSIONS: In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays.
Subject(s)
Colonic Diseases , Pain, Postoperative/drug therapy , Analgesia, Patient-Controlled , Analgesics, Opioid , Anesthetics, Local , Humans , Morphine , Pain Management , Pain Measurement , Prospective StudiesSubject(s)
Humans , Male , Female , Congresses as Topic/trends , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods , Manometry/methods , Manometry/standards , Manometry , Trachea , Trachea/injuries , Manometry/trends , Intubation, Intratracheal , Intubation, Intratracheal/trends , Airway Management/adverse effects , Airway Management , Airway Management/methodsSubject(s)
Anesthesia, General/methods , Chlorpheniramine/therapeutic use , Histamine Antagonists/therapeutic use , Histamine Release , Intraoperative Complications/prevention & control , Leukotriene Antagonists/therapeutic use , Mastocytosis, Systemic/complications , Perioperative Care/methods , Preanesthetic Medication , Aged , Analgesia/methods , Analgesics, Opioid , Androstanols/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal , Chlorpheniramine/administration & dosage , Cholecystectomy , Cholelithiasis/complications , Cholelithiasis/surgery , Contraindications , Female , Fentanyl/administration & dosage , Histamine Release/drug effects , Humans , Male , Mastocytosis, Systemic/physiopathology , Middle Aged , RocuroniumABSTRACT
Los analgésicos opioides constituyen uno de los pilares fundamentales en el tratamiento farmacológico del dolor moderado-grave, especialmente en el dolor agudo y el crónico oncológico. La molécula de hidromorfona es estructuralmente muy similar a la morfina, se puede administrar tanto por vía enteral como por vía parenteral, y se une principal-mente a los receptores opioides μ y en menor grado a los receptores δ. La unión a receptores tipo u es la causa del efecto analgésico, así como de los efectos secundarios. La hidromorfona se encuentra disponible en presentaciones de liberación inmediata y prolongada durante 12 o 24 horas. Recientemente, se ha comercializado en España una preparación de liberación sostenida durante 24 horas que utilizan el sistema OROS Puhs-Pull®. En el tratamiento del dolor agudo, la evidencia clínica demuestra que la hidromorfona presenta una equivalencia analgésica similar a otros opiodes. Respecto al tratamiento del dolor oncológico, se ha evaluado respecto a otros opioides y con diferentes formulaciones, y se ha observado que es un fármaco equivalente a la morfina en cuanto a eficacia analgésica y efectos secundarios. En el tratamiento del dolor crónico no oncológico, no hay ensayos clínicos controlados que otorguen evidencia científica a la hidromorfona en estos pacientes. Como conclusión, la hidromorfona presenta un perfil farmacológico, propiedades analgésicas y efectos secundarios similares a la morfina, todavía persisten ciertas controversias en lo referente a las dosis equianalgésicas entre la hidromorfona y la morfina y entre la dosis oral y la parenteral (AU)
The analgesics opioids are one of the fundamental props in the pharmacological treatment of the moderate and severe pain, particularly in chronic oncology pain. The hydromorphone molecule is structurally very similar to morphine and it may be administered enterally or parenterally. It binds mainly to μ opioid receptors and to a lesser extent to δ receptors. The binding to the μ receptor is responsible for the analgesic effect as well as for the appearance of side effects. Hydromorphone is available in 12-hour and 24-hour slow-release presentations. A 24-hour sustained release preparation has recently come available on the market in Spain which uses the OROS push-pull system. In the treatment of the acute pain, the clinical evidence demonstrates that hydromorphone has similar analgesic equivalence to other opioids. Treatment of oncological pain has been evaluated compared to other opioids and with different formulations, demonstrating it to be a drug equivalent to morphine as regards its analgesic effectiveness and side effects. There are no controlled clinical trials on the use of hydromorphone in the treatment of chronic nononcological pain. Conclusions, hydromorphone has a pharmacological profile, analgesic properties and side effects similar to morphine, but there is still controversy as regards hydromorphone-morphine equivalent doses and the oral-parenteral dose (AU)
Subject(s)
Humans , Hydromorphone/pharmacokinetics , Pain/drug therapy , Analgesics, Opioid/pharmacokinetics , Analgesia/methods , Hydromorphone/administration & dosageABSTRACT
Acquired long QT syndrome is a rare condition whose diagnosis is of vital importance given the risk of torsade de pointes and sudden death. This syndrome may be triggered by various events in patients with a genetic predisposition. Patients usually have a normal baseline QT interval. Some of the factors that may prolong the interval are exposure to common drugs such as antibiotics or agents used for general anesthesia. Diagnosis of the condition is essential, as is knowledge of how to manage anesthesia and prevent ventricular fibrillation, which is the most feared complication. We report the case of a man with no relevant medical history who underwent emergency surgery for a peritonsillar abscess. The patient developed long QT syndrome, with several episodes of torsade de pointes and cardiorespiratory arrest.
Subject(s)
Heart Arrest/etiology , Long QT Syndrome/etiology , Peritonsillar Abscess/surgery , Postoperative Complications/etiology , Torsades de Pointes/etiology , Ventricular Fibrillation/etiology , Adjuvants, Anesthesia/adverse effects , Adrenergic beta-Antagonists/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anesthetics, Inhalation/adverse effects , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/adverse effects , Anti-Infective Agents/pharmacology , Anti-Infective Agents/therapeutic use , Combined Modality Therapy , Drainage , Electric Countershock , Heart Arrest/therapy , Humans , Long QT Syndrome/drug therapy , Male , Methyl Ethers/adverse effects , Metronidazole/adverse effects , Metronidazole/pharmacology , Metronidazole/therapeutic use , Middle Aged , Peritonsillar Abscess/complications , Peritonsillar Abscess/drug therapy , Postoperative Complications/drug therapy , Quaternary Ammonium Compounds/adverse effects , Sevoflurane , Torsades de Pointes/drug therapy , Ventricular Fibrillation/therapyABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Mastocytosis, Systemic/surgery , Anesthetics/administration & dosage , Pain, Postoperative , Preoperative Care/methodsABSTRACT
El síndrome de QT largo adquirido es una entidadpoco frecuente, pero su diagnóstico es de vital importanciapor el riesgo que tiene de desencadenar una Torsiónde puntas y muerte súbita. Es una patología que se puedeproducir por diferentes causas en pacientes que tienenuna susceptibilidad genética. Estos pacientes habitualmentepresentan un intervalo QT normal de base.Algunos de los factores que pueden alargar el intervaloQT son fármacos de uso habitual, como son antibióticoso algunos de los fármacos empleados en la anestesiageneral. Por todo ello, es fundamental diagnosticarlo yconocer el manejo anestésico de este tipo de pacientes,así como la prevención y el tratamiento de la complicaciónmás temida que puede dar, que es la fibrilación ventricular.Presentamos el caso de un paciente sin antecedentesde interés que en el contexto del perioperatoriourgente de un absceso periamigdalino presentó un síndromede QT largo adquirido con varios episodios deTorsión de puntas y parada cardiorrespiratoria(AU)
Acquired long QT syndrome is a rare condition whosediagnosis is of vital importance given the risk of torsadede pointes and sudden death. This syndrome may betriggered by various events in patients with a geneticpredisposition. Patients usually have a normal baselineQT interval. Some of the factors that may prolong theinterval are exposure to common drugs such asantibiotics or agents used for general anesthesia.Diagnosis of the condition is essential, as is knowledge ofhow to manage anesthesia and prevent ventricularfibrillation, which is the most feared complication. Wereport the case of a man with no relevant medicalhistory who underwent emergency surgery for aperitonsillar abscess. The patient developed long QTsyndrome, with several episodes of torsade de pointesand cardiorespiratory arrest(AU)
Subject(s)
Humans , Male , Middle Aged , Long QT Syndrome/diagnosis , Long QT Syndrome/surgery , Anesthesiology/methods , Heart Arrest/complications , Neuromuscular Blockade/methods , Neostigmine/therapeutic use , Atropine/therapeutic use , Metronidazole/therapeutic use , Long QT Syndrome/complications , Heart Rate , Electrocardiography/methods , Catheterization, Central Venous/methodsABSTRACT
OBJECTIVE: To analyze the frequency and methods of sedation used in the context of regional anesthesia in adults by means of a national survey. MATERIAL AND METHODS: We carried out a survey of participants at the courses of an anesthesiology training organization (Fundación Europea de Enseñanza en Anestesiología), held in Spain in 2006. The survey questionnaires asked about indications for sedation used during surgery under regional anesthesia as well as the form of administration, follow-up, and complications. RESULTS: A total of 375 questionnaires were sent out and 185 responses were received (49.3%). Sedation is always used to accompany regional anesthesia by 69.2% of the respondents; 13.5% of them discuss the technique to be used with the patient and come to an agreement. The same type of sedation, regardless of the regional block performed, is used by 49.2% of respondents, and 64.3% use a scale to evaluate the level of sedation. The most favored sedation technique is continuous infusion, followed by target controlled infusion and boluses on demand. The most commonly used technique is sedation with bolus injections. Sixty percent use a single agent and 38.9% use combinations. The most commonly reported adverse effects are variability of patient response (53.5%) and respiratory complications (27%). In cases of ineffective regional blockade, 49.2% of those surveyed switch to general anesthesia. CONCLUSIONS: Sedation is very often used to complement regional anesthesia in adult patients. Even though continuous infusion is considered to be the most appropriate form of administration, the most commonly used form is injection of boluses. Sedation with a single drug is used more frequently than drug combinations. Variability of individual response is the complication most commonly reported by the respondents.
Subject(s)
Anesthesia, Conduction , Conscious Sedation/statistics & numerical data , Adjuvants, Anesthesia/administration & dosage , Adult , Conscious Sedation/adverse effects , Conscious Sedation/methods , Data Collection , Female , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/adverse effects , Infusions, Intravenous , Injections, Intravenous , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Male , Midazolam/administration & dosage , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Practice Patterns, Physicians'/statistics & numerical data , Spain , Surveys and QuestionnairesABSTRACT
OBJETIVO: Conocer la utilización y modo de empleo dela sedación para la anestesia regional en adultos a travésde una encuesta nacional.MATERIAL Y MÉTODO: Encuesta a los asistentes de loscursos de la Fundación Europea de Enseñanza en Anestesiologíacelebrados en España en 2006, sobre la indicación,forma de administración, seguimiento y complicaciones dela sedación empleada durante las intervenciones realizadasbajo anestesia regional.RESULTADOS: Se enviaron 375 encuestas y se recibieron185 respuestas (49,3%). El 69,2% de los encuestadosemplean siempre sedación acompañando a la anestesiaregional, un 13,5% consensúan la técnica con el paciente.Un 49,2% utilizan la misma sedación independientementedel bloqueo regional realizado. Un 64,3% utilizan algunaescala para valorar el grado de sedación. La técnica consideradaideal fue la infusión continua, seguida de los sistemasTCI y los bolos a demanda. La más empleada fue lasedación en bolos. El 60% utilizan monoterapia y el 38,9%asociaciones de fármacos. Los efectos adversos más frecuentementedescritos fueron la variabilidad en la respuestadel paciente (53,5%) y las complicaciones respiratorias(27%). Cuando el bloqueo regional no es efectivo, el 49,2%de los encuestados convierten la técnica a anestesia general.CONCLUSIONES: La sedación como complemento de laanestesia regional en pacientes adultos se emplea muy frecuentemente.Aunque la infusión continua es consideradala forma de administración más adecuada, se empleamayoritariamente sedación en bolos. La sedación con unúnico fármaco se emplea más frecuentemente que las asociaciones.La variabilidad en la respuesta individual es lacomplicación más observada por los encuestados (AU)
OBJECTIVE: To analyze the frequency and methods ofsedation used in the context of regional anesthesia inadults by means of a national survey.MATERIAL AND METHODS: We carried out a survey ofparticipants at the courses of an anesthesiology trainingorganization (Fundación Europea de Enseñanza enAnestesiología), held in Spain in 2006. The surveyquestionnaires asked about indications for sedation usedduring surgery under regional anesthesia as well as theform of administration, follow-up, and complications.RESULTS: A total of 375 questionnaires were sent out and185 responses were received (49.3%). Sedation is always usedto accompany regional anesthesia by 69.2% of therespondents; 13.5% of them discuss the technique to be usedwith the patient and come to an agreement. The same type ofsedation, regardless of the regional block performed, is usedby 49.2% of respondents, and 64.3% use a scale to evaluatethe level of sedation. The most favored sedation technique iscontinuous infusion, followed by target controlled infusionand boluses on demand. The most commonly used techniqueis sedation with bolus injections. Sixty percent use a singleagent and 38.9% use combinations. The most commonlyreported adverse effects are variability of patient response(53.5%) and respiratory complications (27%). In cases ofineffective regional blockade, 49.2% of those surveyed switchto general anesthesia.CONCLUSIONS: Sedation is very often used tocomplement regional anesthesia in adult patients. Eventhough continuous infusion is considered to be the mostappropriate form of administration, the most commonlyused form is injection of boluses. Sedation with a singledrug is used more frequently than drug combinations.Variability of individual response is the complication mostcommonly reported by the respondents (AU)
Subject(s)
Humans , Male , Female , Adult , Conscious Sedation , Anesthesia, Conduction/methods , Hypnotics and Sedatives/administration & dosage , Health Care SurveysABSTRACT
Introducción: La Organización Mundial de la Salud, define la calidad de vida como: "la percepción del individuo de su situación en la vida, dentro del contexto cultural y de valores en el que vive, y en relación con sus objetivos, expectativas, valores e intereses". Por lo tanto para una valoración completa de los beneficios producidos por un determinado tratamiento, es esencial medir su impacto en el estado de salud del paciente, lo que se denomina calidad de vida relacionada con la salud (CVRS). Objetivos: Describir las diferentes patologías de dolor crónico no maligno de los pacientes que acuden por primera vez a una unidad del dolor (UTD) a lo largo de 6 meses y el tratamiento recibido. Conocer los cambios en la CVRS, intensidad del dolor, estrategias de afrontamiento y ansiedad/depresión al cabo de 6 meses de seguimiento de estos pacientes. Conocer la relación entre CVRS, afrontamiento, ansiedad/depresión e intensidad del dolor en estos pacientes. Conocer los cambios en las puntuaciones que miden los parámetros anteriores según los grupos diagnósticos. Material y métodos: Estudio descriptivo con medidas repetidas a los 6 meses respecto a la población de pacientes que acuden a la UTD del Hospital de Galdakao (Bizkaia) durante el 2º semestre del 2005. Se administran varios cuestionarios, de calidad de vida (SF-36), de afrontamiento (CAD-R), ansiedad y depresión (HAD) y la intensidad del dolor (EVA). Al cabo de 6 meses se vuelven a administrar y se recogen los diferentes tratamientos realizados en la UTD. Todos los procedimientos fueron realizados con el paquete estadístico SAS System v9.1, se asumió significación estadística cuando p < 0.05. Resultados y conclusiones: La muestra la conforman 119 pacientes, de ellos 93 completaron los cuestionarios al inicio del estudio y al cabo de 6 meses, por lo que presentamos un 21.85 % de pérdidas. Los resultados del estudio muestran que los pacientes refieren una mejoría significativa en los dominios rol físico, dolor corporal y vitalidad del SF-36 al cabo de 6 meses de su paso por la UTD. Se observa una tendencia a que disminuya la intensidad del dolor y la sintomatología depresiva, sin embargo la sintomatología ansiosa tiende a aumentar. Las estrategias de afrontamiento más utilizadas por la muestra son las activas. Existe una asociación negativa entre el estado de salud con la sintomatología de ansiedad, depresión y la intensidad del dolor. Dentro de los grupos diagnósticos el grupo de fibromialgia y dolor osteoarticular es el que peor evoluciona, tanto en parámetros de intensidad de dolor, como en sintomatología ansiosa y depresiva (AU)
Introduction: The World Health Organisation (WHO) defines the quality of life (QOL) as a subjective evaluation of the characteristics of a person life, a composite variable referring to an individual's subjective overall satisfaction with life, a multidimensional construct primarily based on a person's subjective appraisal of their physical, functional, emotional and social well-being. Therefore health-related quality of life (HRQOL) refers to the extent to which one's usual or expected physical, emotional and social well-being are affected by a medical condition or its treatment. Objectives: Describe the different pathology of chronic no malign pain in patients who go for the first time to Unit of pain during 6 months and the treatment receive. Know the changes in health-related quality of life (HRQL), pain intensity, coping strategies and anxiety/depression after six months. Know the relation between HRQL, coping strategies, anxiety/depression and pain intensity in these patients. Know the changes in valúes which measures previous parameters in depending of diagnostic groups. Material and methods: This work is descriptive with measures repeated after 6 months about the population of patients that go to a Unit of pain Galdakao's Hospital during the second part of 2005. Several questionnaires are administrated about quality of life (SF-36), coping strategies (CAD-R), anxiety/depression (HAD) and intensity of pain (EVA). The questionnaire SF-36, CAD-R, HAD, and EVA were administered again and were collected the different treatment given by unit of pain. All proceedings were realized with the statistics packet SAS System v9.1, we assumed statistic signification with p< 0.05. Results and conclusions: The sample is composed of 119 patients, 93 completed the questionnaires, at the beginning and 6 months after, so we have 21.8% lost. In the SF-36 the improvement is significative in domains role physical, corporal pain, vitality, mental health and the standard physical component. In the HAD anxiety values, increase and depression values decrease in a no significative mode. Pain intensitivity is modérate, decreases in a no significative mode. Coping strategies more used are autoafirmation and the look for information, 6 months after, coping strategies active are more used. We can see the negative association between quality of life with anxiety and depression and pain intensitivity. The worst group responding to treatment by Unit of Pain is fibromyalgia patients (AU)
Subject(s)
Humans , Sickness Impact Profile , Pain/epidemiology , Pain/therapy , Pain Clinics/statistics & numerical data , Quality of Life , Depression/epidemiology , Anxiety/epidemiology , Diagnosis-Related Groups , Health SurveysABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Intubation, Intratracheal/instrumentation , Laryngoscopes , Intubation, Intratracheal/adverse effects , Laryngoscopy/methodsABSTRACT
En nuestro país, más de 4 millones y medio sufren dolor crónico y de este porcentaje, más de la mitad sufren dolor intenso. La artritis reumatoide y la artrosis son las principales causas de este dolor según la Encuesta Europea del Dolor. La elección del fármaco analgésico adecuado para el control del dolor moderado-severo es importante para aumentar la calidad de vida de estos pacientes cada vez más longevos. Como nueva opción terapéutica tenemos a la Oxicodona, según la OMS la clasifica como un fármaco que se utilizaría en el segundo escalón cuando se combina con AINES (ampliamente utilizado en EEUU desde 1950), ya que le proporciona un efecto techo (1) y como tercer escalón cuando se utiliza sola, tanto la oxicodona de liberación. controlada como la de liberación inmediata (2). La oxicodona se usa desde 1917 y ha sido utilizada en humanos de forma intravenosa, intramuscular, intranasal, subcutánea, rectal, epidural y oral. La vía transdérmica ha sido testada en animales. Hoy en día la oxicodona de liberación prolongada es utilizada en el dolor crónico y la de liberación inmediata es usada más para el tratamiento del dolor agudo y el dolor irruptivo. La oxicodona parenteral (no disponible en nuestro país todavía) parece ser una buena alternativa cuando no es posible utilizar la vía oral
Chronic pain is suffered by over 4 and a half million persons in Spain, and over half of these persons suffer intense pain. According to the European Pain Questionnaire, rheumatoid arthritis and arthrosis are the principal cause of this type of pain. It is important to choose a suitable analgesic drug for moderatesevere pain control, thus increasing the quality of life of these patients who are increasingly long living. Oxycodone offers a new therapeutic option. It is classified by the WHO as a drug to be used as a step two drug when combined with a NSAID (widely used in the US since 1950), since it has a ceiling effect (1), and as a step three drug when used alone, in both controlled-release and immediate-release formulations alike. (2) Oxycodone has been used since 1917 and has been given to humans in intravenous, intramuscular, intranasal, subcutaneous, rectal, epidural and oral routes. Transdermal administration has been tested in animals. Nowadays controlled-release oxycodone is used in chronic pain and immediate-release oxycodone is used more to treat acute pain and breakthrough pain. Parenteral oxycodone (not yet available in this country) appears to offer a good alternative when it is not possible to use the oral route
Subject(s)
Humans , Oxycodone/pharmacokinetics , Pain, Intractable/drug therapy , Arthritis, Rheumatoid/complications , Osteoarthritis/complications , Drug Interactions , Neuralgia/drug therapyABSTRACT
Few pharmacologically new anesthetics have appeared in recent years, but great progress has been made toward improving some existing ones. Such is the case with propofol. New formulations have been developed to reduce or avoid adverse side effects associated with the original drug produced by Astra-Zeneca. The unwanted effects for which solutions have been sought are pain upon intravenous injection of the drug, elevated serum concentrations of triglycerides, and the risk of bacterial contamination. Some new formulations contain excipients with bactericidal action, such as propofol with ethylenediaminetetraacetic acid or metabisulfite, and others use lipuro rather than intralipid. Other more advanced products are propofol in cyclodextrin or IDD-D propofol, which makes use of nanoparticle technology. A grasp of the pharmacokinetics and pharmacodynamics of the original formulation must be the basis for understanding the differences between these new products.
