ABSTRACT
INTRODUCTION: Obesity has become a worldwide public health problem and is directly linked to loss of quality of life, complications and comorbidities. One of them is chronic pain, especially in the knees, which increases significantly and proportionally with weight gain. In patients with severe obesity, with indication for bariatric surgery, the presence of chronic pain disables and often prevents their participation in a pre-surgical rehabilitation programme. As an analgesic therapy, photobiomodulation (PBM) has been studied with safety, efficacy, well-tolerated used and low costs. Thus, this study aims to evaluate the use of PBM for the treatment of chronic knee pain in obese patients undergoing a pre-surgical rehabilitation programme for bariatric surgery. METHODS AND ANALYSES: This is a double-blinded, randomised, placebo-controlled clinical, superiority, trial protocol. The PBM will be applied in bilateral knees and lumbar paraspinal points levels referring to the roots of innervation of the knee. The outcomes evaluated will be pain intensity, functionality, quality of life and clinical signs of neurological sensitization of chronic knee pain pathways. ETHICS AND DISSEMINATION: This protocol has already been approved by the Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás/EBSERH-Ethics Committee and it is following SPIRIT guidelines. The results will be statistically analysed and subsequently published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Clinical Trials Platform (https://clinicaltrials.gov/) with the number NCT05816798.
Subject(s)
Bariatric Surgery , Chronic Pain , Low-Level Light Therapy , Randomized Controlled Trials as Topic , Humans , Double-Blind Method , Chronic Pain/etiology , Chronic Pain/therapy , Low-Level Light Therapy/methods , Obesity/complications , Quality of Life , Knee Joint , Pain Measurement , Adult , Arthralgia/etiology , Arthralgia/therapyABSTRACT
OBJETIVOS: Os autores apresentam os resultados da dissecção do feixe vascular do músculo gastrocnêmio medial (MGM) e de suas artérias perfurantes, com o objetivo de contribuir anatomicamente para seu estudo. MÉTODOS: Foram dissecadas 13 peças englobando o joelho e perna (oito à direita e cinco à esquerda), de 13 cadáveres adultos (oito masculinos e cinco femininos), todos frescos. Foi realizado estudo anatômico e radiológico detalhado avaliando o padrão de distribuição, trajeto, número e comprimento da irrigação do MGM e de suas artérias perfurantes. RESULTADO: Foi observado que a artéria sural medial (ASM) divide-se em dois troncos intramusculares principais (medial e lateral) e que em 90 por cento dos casos as perfurantes provêm do tronco lateral. Em 38,5 por cento dos casos, foi identificada uma perfurante, ao passo que duas perfurantes são observadas em 46,1 por cento dos casos. Todas as artérias perfurantes estavam entre 5,7cm e 14,0cm da prega poplítea e entre 16,5cm e 34,0cm do maléolo medial. CONCLUSÃO: A irrigação do MGM pela ASM e suas artérias perfurantes faz-se adequada para sua utilização como retalho miocutâneo no membro inferior.
OBJECTIVES: The authors present the results of dissecting the vascular bundle of the medial gastrocnemius muscle (MGM) and its perforating arteries with the purpose of giving their contribution to anatomical studies. METHODS: 13 pieces of knee and leg (eight right and five left) of 13 fresh adult cadavers (eight male and five female) to evaluate the distribution, path, number and length of irrigation of the MGM and its perforating arteries. RESULTS: They observed that the medial sural artery (ASM) is divided into two main intramuscular branches (medial and lateral), and in 90 percent of the cases, the perforating arteries come from the lateral branch. In 38.5 percent of the cases, they identified one perforating artery, and two perforating arteries were seen in 46.1 percent of the cases. All of the perforating arteries were at a distance of 14.0 cm from the popliteal fold and between 16.5 cm and 34.0 cm from the medial malleolus. CONCLUSION: MGM irrigation by ASM and its perforating arteries is adequate for the use of the muscle as a myocutaneous flap of in the lower limb.