The influence of the choice of preemptive analgesia on long-term postsurgical pain after tibial plateau leveling osteotomy in dogs.

OBJECTIVE: To evaluate the prevalence of chronic postsurgical pain (CPSP) after tibial plateau leveling osteotomy (TPLO) in dogs and to determine the influence of preemptive locoregional analgesia on CPSP. STUDY DESIGN: Retrospective study. ANIMALS: One hundred twenty client-owned dogs. METHODS: Medical records of dogs that underwent TPLO between 2012 and 2016 were reviewed for demographic information and type of preemptive analgesia. Owners were contacted to retrospectively assess the quality of life of their dogs by using the Helsinki Chronic Pain Index (HCPI) before and 6 months after surgery and at the time of questioning. An HCPI score > 12 was considered indicative of CPSP. Medical records were reviewed for demographic information and type of preemptive analgesia. A cumulative logit model was used to assess correlation of type of perioperative analgesia, HCPI, and demographic data. RESULTS: The HCPI score was consistent with CPSP in 41 of 101 dogs with long-term follow-up (2.9 ± 1.5 years after surgery). Chronic postsurgical pain was documented in 11 of 32 and 13 of 28 dogs that received a spinal or epidural injection, respectively, or in 28 of 80 and 25 of 67 dogs with sciatic-femoral block at 6 months or with long-term follow-up after TPLO, respectively (P > .05). A negative correlation was found between HCPI and both weight and age 6 months after surgery. Only weight remained negatively correlated 2.9 years after surgery. CONCLUSION: Forty-one percent of dogs that were evaluated exhibited HCPI values compatible with CPSP long-term after TPLO, regardless of the type of preemptive analgesia. Increased body weight was a negative prognostic factor for CPSP development. CLINICAL SIGNIFICANCE: Additional studies are required to evaluate CPSP development after TPLO.

Revisión narrativa del dolor agudo poscraneotomía. Concepto y estrategias de prevención y tratamiento del dolor / Narrative review of acute post-craniotomy pain. Concept and strategies for prevention and treatment of pain

El objetivo de esta revisión narrativa es confirmar si el dolor agudo tras craneotomía es frecuente y presenta una intensidad entre moderada-severa. Además, pretende informar de la importancia de tratar no solo el dolor tras craneotomía, sino prevenirlo para disminuir la incidencia de la cronificación del dolor. Debemos conocer que entre las opciones actuales no solo disponemos de los analgésicos convencionales para el postoperatorio (antiinflamatorios no esteroideos, paracetamol, inhibidores de la ciclooxigenasa 2 y opiáceos). La realización de un bloqueo nervioso del cuero cabelludo previo a la incisión quirúrgica o tras la cirugía, el uso de dexmedetomidina intraoperatoria y la administración perioperatoria de pregabalina son alternativas que están ganando fuerza. El manejo del dolor poscraneotomía debe basarse, por tanto, en una analgesia multimodal durante todo el perioperatorio, enmarcándose dentro del concepto actual del protocolo enhaced recovery after surgery

The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents with moderate to severe intensity. We also highlight the importance of not only treating post-craniotomy pain, but also of preventing it in order to reduce the incidence of chronic pain. Physicians should be aware that conventional postoperative analgesics (non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids) are not the only options available. Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine, and the perioperative administration of pregabalin are just some alternatives that are gaining ground. The management of post-craniotomy pain should be based on perioperative multimodal analgesia in the framework of an "enhaced recovery after surgery" (ERAS) approach

Evaluation of the compliance between EEG monitoring (Bispectral IndexTM) and Ramsey Sedation Scale to measure the depth of sedation in the patients who underwent procedural sedation and analgesia in the emergency department.

BACKGROUND: This study aimed to investigate the compliance between electroencephalogram monitoring (Bispectral Index, BIS) and Ramsay Sedation Scale (RSS) to measure the depth of sedation in patients who underwent procedural sedation and analgesia (PSA) in an emergency department. This study also aimed to investigate the usefulness of this compliance for early diagnosis of complications. METHODS: A total of 54 consecutive patients during PSA in the emergency department were included in this study. The BIS and RSS scores at regular intervals and also all complications and interventions of these patients were evaluated. The compliance between the BIS and the RSS score was evaluated. The BIS scores of cases with complication and without complication were compared. RESULTS: The BIS and RSS scores exhibited a high correlation was detected between the average BIS and RSS scores at each time interval (r=-0.989, p<0.001). The BIS scores of the complicated and uncomplicated cases were different at 15 min after the procedure (p=0.019). The cases were divided into two groups according to the BIS scores <70 and ≥70; complication rates were higher in the BIS score <70 group during the procedure (p=0.037). CONCLUSION: In our study, a high correlation was detected between BIS monitoring and RSS scores. BIS monitoring for PSA can be used as a full-time, objective, and an alternative technique for person-dependent clinical scales and also as an indicator for early diagnosis of complications.

Analgesia in clinically relevant rodent models of sepsis.

Postoperative analgesia in rodent sepsis models has been considerably neglected in the past. However, intentions to model clinical practice, increasing awareness of animal ethics, efforts to apply the 3Rs (replacement, reduction, refinement), and stricter legislation argue for a change in this respect. In this review, we describe different concepts of analgesia in rodent models of sepsis focusing on opioid agonists as well as non-opioid analgesics. Advantages and pitfalls in study design and side-effects are discussed. Score sheets should be used to adapt analgesia or to terminate experiments using humane endpoints. Further research is needed to differentiate behavioral changes caused by sepsis and pain or as a consequence of analgesia. Information on the efficacy of analgesia in sepsis models is scarce. Hence, studies are needed to identify the best ways to reduce suffering of research animals and thereby optimize the clinically relevant rodent models of sepsis.

Controversias sobre el manejo de la fluidoterapia en cirugía abdominal / Controversies in fluid management during abdominal surgery

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Experiencia con la utilización del ócido nitroso en procesos dolorosos en urgencias / Experience with the use of nitrous oxide in painful procedures in the emergency department

Fundamento. El óxido nitroso (N2O) es un gas con efecto analgésico, ansiolítico y amnésico que se utiliza mezclado con 50% de oxígeno en técnicas diagnóstico-terapéuticas que provocan dolor y/o ansiedad. Objetivo. 1) Evaluar la efectividad del N2O en procedimientos dolorosos realizados en urgencias. 2) Describir los efectos secundarios detectados. Método. Estudio prospectivo descriptivo de una serie de casos recogidos desde el 1/05/08 al 31/12/08 en los cuales se utilizó N2O. Resultados. Se recogieron 74 casos, 48 (64%) de ellos eran del sexo masculino, siendo la mediana de edad de 7,5 años. Fue utilizado en los siguientes procedimientos: punciones lumbares (33; 45%), reducción de fracturas (16; 22%), venopunciones (10; 13%), drenaje de abscesos (9; 12%) y sutura de heridas (6; 8%). En 60 casos (81%) se asoció con analgesia local, en 11 (15%) con analgesia sistémica y en 3 (4%) se utilizó el N2O como único analgésico. La efectividad se valoró según el análisis de la conducta del paciente durante el procedimiento; se clasificó cualitativamente como mala en 4 casos (5%), aceptable en 16 (22%) y buena o muy buena en 54 (73%). Cabe decir que los casos valorados como malos o aceptables se trataban de procedimientos muy dolorosos. La valoración del efecto analgésico por parte del equipo médico fue muy satisfactoria en 60 casos (81%). Se constataron efectos secundarios en 10 casos (13,5%): mareo (3), vómitos (2), ansiedad (2), euforia (2) y cefalea (1). En todos los casos estos efectos se resolvieron en pocos minutos. Conclusiones. 1) Según nuestra experiencia, el N2O es un método analgésico y ansiolítico coadyuvante efectivo en muchos procedimientos dolorosos realizados en urgencias pediátricas. 2) Los efectos secundarios en nuestra serie son leves. 3) El equipo médico está muy satisfecho, aunque se deben consensuar las indicaciones para optimizar su uso(AU)

Background. Nitrous oxide (N2O) is a gas with analgesic, ansiolytic and amnesic effect. 50% nitrous oxide oxygen mixture is used in procedures that cause pain or anxiety. Objective. 1) To evaluate the efficacy of N2O in painful procedures in a pediatric emergency department. 2) To determine the adverse effects of this treatment. Method. Prospective descriptive study from May 2008 to December 2008. Results. 74 cases were analyzed; 48 (64%) were male and the median age was 7.5 years. The procedures performed with N2O inhalation were: lumbar punctures (33; 45%), reduction of fractures (16; 22%), venipunctures (10; 13%), abscess drainage (9; 12%) and laceration repairs (6; 8%). Local analgesia was given in 60 (81%) cases; systemic analgesia in 11 (15%) and N2O alone in 3 (4%). A behavioral scale was used to evaluate efficacy; it was bad in 4 cases (5%), acceptable in 16 (22%) and good or very good in 54 (73%). All cases assessed as bad o acceptable were very painful procedures. Medical staff was very satisfied with the sedation effect in 60 cases (81%). Adverse effects were observed in 10 cases (13.5%): dizziness (3), emesis (2), anxiety (2), euphoria (2) and headache (1). All these side effects resolved in a few minutes. Conclusions. 1) In our experience, the N2O is an effective analgesic and ansiolytic coadjuvant method to provide analgesia in a variety of procedures; 2) Side effects are infrequent and minor; 3) Medical staff was very satisfied; however, it is necessary to define specific indications for an optimum use(AU)

Envejecimiento y dolor / Pain in the elderly

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Dolor y ansiedad en cirugía pediátrica / Pain and anxiety in pediatric surgery

Introducción. El dolor postoperatorio es una complicación muy frecuente en el paciente pediátrico, tanto en el postquirúrgico inmediato como en los días posteriores. El dolor peri-quirúrgico enlentece y dificulta la evolución postquirúrgica de los pacientes. Para prevenir esta complicación el paciente pediátrico debe ser analgesiado con eficacia y seguridad. El objetivo de este trabajo fue determinar la influencia dela ansiedad presente en el paciente pediátrico previo a la cirugía con respecto a la sensación dolorosa y a la duración e intensidad de la analgesiaperioperatorias. Material y métodos. Se realizó un estudio observacional descriptivo prospectivo en pacientes pediátricos sometidos a cirugía en nuestro centro hospitalario. Se emplearon variables: demográficas, clínicas, quirúrgicas, anestésicas, álgicas, postoperatorias, régimen de ingreso. Los datos se expresan como el valor medio ±sem o ±DE, frecuencia y porcentaje de incidencia de N casos. Las comparaciones entre grupos se realizaron mediante los test de t-student, ANOVA de una y varias vías, chi-cuadrado, correlaciones bivariadas, regresiones lineales y logísticas y función del tipo de variable. Resultados. Se estudiaron 77 pacientes con una edad media de 5años y peso medio de 22 kg. La técnica anestésica más usada fue la anestesia general. Sólo el 40% de los pacientes fue premedicado con midazolam. Se observó que la intensidad de dolor era leve en la fase previa a la cirugía y que tras ésta era moderado. La ansiedad fue más elevada antes de la cirugía y en el postoperatorio inmediato en la sala de recuperación postanestésica (URPA), disminuyendo posteriormente, sobretodo en los pacientes de cirugía mayor ambulatoria. La intensidad del dolor y la ansiedad aparecieron relacionadas positivamente en los tres periodos de seguimiento. Conclusiones. El dolor y la ansiedad periquirúrgicos en los niños están infratratados. Se deberían confeccionar protocolos de tratamiento, adaptados a las características de esta población, en función de sus necesidades y de los diferentes tipos de cirugía a los que pueden ser sometidos (AU)

Introduction. Postsurgery pain is a common complaint in children and significant postoperative pain may last for weeks. Severe perisurgery pain may aggravate long-lasting negative effects. In order to prevent harmful effects, children should be provided with effective-secure analgesia. The aim of this work was to determine current practice of postsurgerypain management in children. Material and methods. An observational prospective study in pediatric patients undergoing surgery in our hospital was performed. Children’s(<14 years old) having elective major surgery and outpatient surgery were collected prospectively. Clinical stage, surgery and anaesthesia procedures, postsurgery analgesia and perioperative complications were recorded. Pain control was measured by an analogic visual scale(AVS) before surgery, in post-anaesthesia recovery unit (PARU), in onedayunit (ODU) and 24 h after surgery (24hU). Statistical analysis: mean values ± sem or SD, frequency and percentage of incidence of N cases,t-test, ANOVA of one and several ways, chi-square, correlations of two variables, linear and logistic regressions depending of variables’ types. Results. 77 patients with mean age of 5 years old and mean weight of 22 kg were studied. The most frequently employed anesthetic technique was the general one. Forty per cent of the patients were pre-medicated with midazolam. Little pain before surgery is observed and after surgery it is moderate. Anxiety is higher after surgery and immediately after it in the recovery room or the Post Anesthesia Care Unit (PACU),subsequently it diminishes, especially patients with same-day admission surgery. Positive correlations between pain and anxiety intensities were found in each determination done. Conclusions. Is observed that pain and anxiety round surgery in children had insufficient treatment, reason why we think we should make treatment protocols, adapted at this population, its necessities and the different types of procedures they can be subjected (AU)

Analgesia preventiva comparando ketorolac Vrs dexketoprofeno en histerectomías abdominales / Preventive analgesia comparing ketorolac dexketoprofeno Vrs in abdominal histerectomías

Dentro de las técnicas de analgesia preventiva para tratar el dolor postoperatorio, esta incluido el uso de drogas antiinflamatorias no esteroideas (AINES). El presente estudio fue diseñado para comparar la eficacia analgésica del Ketorolaco versus Dexketoprofeno aplicado preoperatoriamente para I alivio del dolor postoperatorio. Se estudiaron 56 pacientes, ASA I-II, adultas con edades entre 27-60 años, sometidas a Histerectomía abdominal, en el Hospital Escuela Oscar Danilo Rosales Argüello, León. En el período de julio 2006 a enero 2007. Se dividieron en dos grupos de forma aleatoria, correspondiendo 28 pacientes para cada grupo. A las pacientes del grupo A, se les administró previo al acto de la inducción Ketorolac Trometemina 30 mg. por vía intravenosa. A las del grupo B, se les administro Dexketoprofeno Trometanol 50 mg por vía intravenosa, también previo al acto de la inducción anestésica. Todas las pacientes recibieron anestesia general balanceada. Durante las primeras doce horas del período postoperatorio fue medida la intensidad del dolor cada 6 horas, resultando en tres evaluaciones, la primera se realizo en sala de recuperación, correspondia a la primera hora y las segunda y tercera en sala general de ginecología (6-12 horas)...

Procedural sedation and analgesia in children.

Procedural sedation and analgesia for children--the use of sedative, analgesic, or dissociative drugs to relieve anxiety and pain associated with diagnostic and therapeutic procedures--is now widely practised by a diverse group of specialists outside the operating theatre. We review the principles underlying safe and effective procedural sedation and analgesia and the spectrum of procedures for which it is currently done. We discuss the decision-making process used to determine appropriate drug selection, dosing, and sedation endpoint. We detail the pharmacopoeia for procedural sedation and analgesia, reviewing the pharmacology and adverse effects of these drugs. International differences in practice are described along with current areas of controversy and future directions.

Guidelines: In-office use of conscious sedation in periodontics.

In this time of heightened awareness of periodontal diseases and the potential consequences of untreated disease, a deterrent in the delivery of periodontal care continues to be patient anxiety concerning treatment and the fear of pain. These guidelines are intended for periodontists in the in-office use of enteral, inhalation, and/or parenteral conscious sedation in the delivery of care. The definitions, educational guidelines, and policies presented in these guidelines are consistent with the most current American Dental Association (ADA) documents Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists and the Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry available from the American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611 or http://www.ada.org, and for Revisions to Anesthesia Care Standards Comprehensive Accreditation Manual for Ambulatory Care, effective January 1, 2001, Joint Commission on Accreditation of Health Care Organizations, available through http://www.jcaho.org/standard/anesamb.html. This paper replaces the former position paper entitled "Guidelines for the Use of Conscious Sedation in Periodontics."

[Ten-year trend of analgesic drug use (1984 to 1995): results of three MONICA-based surveys in Augsburg)]. / Trends der Schmerzmitteleinnahme über einen Zeitraum von 10 Jahren (1984 bis 1995). Ergebnisse der drei MONICA-Augsburg-Surveys.

BACKGROUND AND OBJECTIVE: Use of drugs, especially analgesics, is thought to be responsible for the rising cost of the health system in Germany, but there are no published population data for analgesic intake in Germany. Data derived from the three MONICA surveys (Monitoring of Trends and Determinants of Cardiovascular Diseases) in Augsburg and its adjacent districts were analysed for the prevalence of analgesic usage between 1984 and 1995 (the first such survey for Germany). PATIENTS AND METHODS: A total of 5,899 males and 6,005 females (aged 25-64 years), representative of the population, were selected and examined in 1984/85, 1989/90 and 1994/95 (participation rate of those selected, 75-79%). Using a standardized protocol, all analgesic drugs taken during the previous 7 days were recorded and classified. The analysis was standardized for age and classified according to sex. RESULTS: Strong analgesics were not significantly used under the ambulatory conditions of this survey and were therefore excluded from the analysis. Intake prevalence of mild to moderately strong analgesics varied from 5.9-8.9% in males and 9.9-13.4% in females. Prevalence was significantly at its lowest in 1989/90, but similar at the beginning and end of the 10-year period. Changes in prevalence of analgesic usage were similar to those of on-demand medication. Salicylic acid preparations containing higher dosages of the active ingredient were the drugs most commonly used, followed by aniline preparations, heteroaryl- as well as aryl-acetate and propionic acid derivates, pyrazole derivates, oxicam and anthranylic acid derivates. CONCLUSION: The prevalence of taking mild of moderately strong analgesics was at a similar low level at the beginning and end of the 10-year period.

Analgesia previa en colecistectomía convencional Ketorolaco versus Diclofenac: Hospital Escuela Antonio Lenín Fonseca: Octubre-diciembre 2000 / Previous analgesia in conventional cholecystectomy ketorolaco versus diclofenac. Hospital Escuela Antonio Lenín Fonseca: October-December 2000

Se realizó un estudio en el Hospital Escuela Antonio Lenín Fonseca, en el período comprendido entre octubre-diciembre del 2000, el cual es analítico, en el que se compara la eficacia de la analgesia previa para un esquema de tratamiento con ketorolaco y un esquema de tratamiento con diclofenaco En este estudio se encontró que los pacientes que se incluyeron tenían edades predominantes de 40-49 años, la mayoría del sexo femenino, con un peso que oscilabaentre los 60-69 kilos. La mayoría de las colecistectomías fueron realizadas en un lapso de tiempo de 1-2 horas, con un tiempo anestésico de 1 hora a hora y nedia. Entre los pacientes aue se estudiaron se encontraron 9 pacientes con HTA al momento de su ingreso a sala de operaciones. Se encontró una analgesia previa efectiva en los pacientes en estudio, pero sin diferencia significativa para ambosesquemas de tratamiento. Se utilizó analgesia complementaria en la menor parte de los casos. No se observaron efectos indeseables con ambos grupos de tratamiento. Se observó una analgesia previa mayor de 4 horas en la mayoría de los pacientes...

Estudio comparativo entre dipirona y tramadol para tratamiento del dolor en pacientes quemados Hospital Antonio Lenin Fonseca: agosto 2000 - diciembre 2000 / Comparative study between dipyrone and tramadol for the treatment of pain in burned patients Hospital Antonio Lenin Fonseca: agosto 2000 - december 2000

Se realizó un ensayo clínico controlado a doble ciego en pacientes con diagnóstico de quemadura ingresados en la sala de Quemados del Hospital Escuela Antonio Lenín Fonseca en el período de Agosto a Diciembre del 2000. Dicho estudio con el objetivo de comparar la eficacia de Dipirina y Tramadol en el control del dolor. Se estudio un total de 20 pacientes de los cuales 10 fueron tratados con Dipirona (grupo 1) y 10 pacientes tratados con Tramadol (grupo 2). Entre los resultados obtenidos del estudio encontramos: el grupo de edad másfrecuente fue de 15 a 24 años y predominó el sexo masculino para ambos grupos deestudio. En la medición inicial de la intensidad del dolor, previo a la administración del analgésico predominó el dolor de intensidad moderada para ambos grupos. Al evaluar la respuesta analgésica a los 20 minutos se demostró que tanto lospacientes tratados con Dipirona como Tramadol presentaron mejoría del dolor. En la evaluación final a los 40 minutos los 10 pacientes tratados con tramadol refirieron ausencia de dolor. El grupo tratado con Dipirona un 60 porciento refirió ausencia de dolor, el 40 porciento restante presentaron una mejoría significativa del dolor. Al realizar el análisis estadístico se demostró que no hubo diferencias significativas en los niveles de intensidad del dolor entre ambos grupos tanto a los 20 como a los 40 minutos con lo que se confirmó que ambos analgésicos fueron eficaces en esta muestra de estudio...