Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial.

BACKGROUND: Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS: The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS: This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION: # NCT04394169, registered on 5/19/2020.

Papel de la medicina perioperatoria en la prevención de la prótesis de rodilla dolorosa / Role of perioperative medicine in the prevention of painful knee replacement

La artroplastia total de rodilla es una de las cirugías realizadas con más frecuencia en ortopedia. No obstante, hasta un 20% de los pacientes mostrarán persistencia del dolor después del procedimiento. El dolor posquirúrgico persistente puede ser una continuación del dolor agudo tras la cirugía o aparecer después de un período asintomático durante más de 3 meses.En la actualidad, se han caracterizado los factores de riesgo que se asocian a dolor posquirúrgico persistente tras la artroplastia total de rodilla. Forman parte del contexto perioperatorio del paciente (preoperatorio, intraoperatorio y postoperatorio) y se pueden agrupar en diferentes dimensiones: genéticas, demográficas, clínicas, quirúrgicas, analgésicas, inflamatorias y psicológicas.Su identificación y prevención, mediante un abordaje multimodal y biopsicosocial, es esencial en el contexto de la medicina perioperatoria y ha demostrado que puede prevenir o mejorar el dolor tras la cirugía.(AU)

Perioperative medicine role in painful knee prosthesis prevention.

Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperative pain after arthroplasty have now been characterised within the patient's perioperative context (preoperative, intraoperative and postoperative), and can be grouped under genetic, demographic, clinical, surgical, analgesic, inflammatory and psychological factors. Identification and prevention of persistent postoperative pain through a multimodal and biopsychosocial approach is essential in the context of perioperative medicine, and has been shown to prevent or ameliorate postoperative pain.

Perioperative medicine role in painful knee prosthesis prevention. / Papel de la medicina perioperatoria en la prevención de la prótesis de rodilla dolorosa.

Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperative pain after arthroplasty have now been characterised within the patient's perioperative context (preoperative, intraoperative and postoperative), and can be grouped under genetic, demographic, clinical, surgical, analgesic, inflammatory and psychological factors. Identification and prevention of persistent postoperative pain through a multimodal and biopsychosocial approach is essential in the context of perioperative medicine, and has been shown to prevent or ameliorate postoperative pain.

Opioides fuertes y dolor crónico no oncológico en Cataluña. Análisis del patrón de prescripción por parte de los médicos de familia / Strong opioids and non-cancer chronic pain in Catalonia. An analysis of the family physicians prescription patterns

OBJETIVO: Conocer los patrones de prescripción de opioides fuertes en dolor crónico no oncológico por parte de médicos de familia. MATERIAL Y MÉTODOS: diseño: estudio descriptivo mediante cuestionario autoadministrado por correo electrónico. EMPLAZAMIENTO: todos los centros de salud de Cataluña. PARTICIPANTES: 3.602 médicos de familia socios de la Sociedad Catalana de Medicina Familiar y Comunitaria. INTERVENCIONES: administración de la encuesta por correo electrónico a los médicos de familia catalanes. MEDICIONES PRINCIPALESs: datos demográficos, número de pacientes que consultan por dolor crónico no oncológico tratados con opioides fuertes, opioides utilizados e indicación, patrones de prescripción, relación con la Unidad del Dolor. RESULTADOS: se obtuvieron 551 respuestas de 3.602 cuestionarios enviados (tasa de respuesta del 15,3%): 480 facultativos (87%) prescriben opioides fuertes para dolor músculo-esquelético; 268 (48,6%) prescriben fentanilo ultrarrápido; 434 (78,7%) disminuyen las dosis de benzodiacepinas al prescribir opioides fuertes. Los efectos adversos más habituales son estreñimiento y náuseas. Las principales dificultades observadas en la prescripción son su manejo (341, 71%) y la resistencia de pacientes y profesionales (87, 18,1%). La valoración de la interrelación con las Unidades de Dolor fue 2+/-1 (escala 1 al 5), siendo los problemas en la comunicación (271, 52,2%) y en la accesibilidad (141, 27,1%) los principales puntos de mejora. CONCLUSIONES: los patrones de prescripción se adecuan mayoritariamente a las guías clínicas en algunos aspectos (disminución de benzodiacepinas o titulación de dosis). Sin embargo, existen áreas de mejora como son el poco uso de laxantes o el uso de opioides ultrarrápidos para indicaciones no autorizadas y sin tratamiento opioide de base. Los médicos de familia demandan formación, perciben resistencias en su prescripción y creen necesario mejorar la relación con las Unidades del Dolor

OBJECTIVE: To identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. MATERIALS AND METHODS: Design A descriptive study based on a self-administered email questionnaire. LOCATION: All primary health care centres in Catalonia. PARTICIPANTS: 3,602 family doctors, all members of the Catalan Society of Family and Community Medicine. INTERVENTIONS: Email survey of Catalan family doctors. MAIN MEASUREMENTS: Demographic data, number of patients treated with potent opioids for chronic non-cancer pain, type of opioid used and indications, prescribing patterns and relationship with the Pain Management Unit. RESULTS: A total of 551 answers were obtained from 3,602 questionnaires sent (response rate of 15.3%), in which 480 physicians (87%) prescribed strong opioids for musculoskeletal pain, 268 (48.6%) prescribed ultra-rapid fentanyl and 434 (78.7%) reduced benzodiazepines dosage when prescribing potent opioids. The most common adverse effects were constipation and nausea. The main problems related with opioid prescription were improper use (341, 71%) and patient and/or practitioner reluctance (87, 18.1%). The assessment of the relationship with Pain Management Units was 2+/-1 (on a 1 to 5 scale), with communication (271, 52.2%) and accessibility (141, 27.1%) being the areas most in need of improvement. CONCLUSIONS: Opioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units

Strong opioids and non-cancer chronic pain in Catalonia. An analysis of the family physicians prescription patterns. / Opioides fuertes y dolor crónico no oncológico en Cataluña. Análisis del patrón de prescripción por parte de los médicos de familia.

OBJECTIVE: To identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. MATERIALS AND METHODS: Design A descriptive study based on a self-administered email questionnaire. LOCATION: All primary health care centres in Catalonia. PARTICIPANTS: 3,602 family doctors, all members of the Catalan Society of Family and Community Medicine. INTERVENTIONS: Email survey of Catalan family doctors. MAIN MEASUREMENTS: Demographic data, number of patients treated with potent opioids for chronic non-cancer pain, type of opioid used and indications, prescribing patterns and relationship with the Pain Management Unit. RESULTS: A total of 551 answers were obtained from 3,602 questionnaires sent (response rate of 15.3%), in which 480 physicians (87%) prescribed strong opioids for musculoskeletal pain, 268 (48.6%) prescribed ultra-rapid fentanyl and 434 (78.7%) reduced benzodiazepines dosage when prescribing potent opioids. The most common adverse effects were constipation and nausea. The main problems related with opioid prescription were improper use (341, 71%) and patient and/or practitioner reluctance (87, 18.1%). The assessment of the relationship with Pain Management Units was 2±1 (on a 1 to 5 scale), with communication (271, 52.2%) and accessibility (141, 27.1%) being the areas most in need of improvement. CONCLUSIONS: Opioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units.

Complicaciones de la analgesia continua invasiva para el control del dolor agudo postoperatorio en un hospital de tercer nivel. Incidencia de complicaciones técnicas y uso de métodos de analgesia alternativos / Complications of continuous catheter analgesia for postoperative pain management in a tertiary care hospital. Incidence of technical complications and alternative analgesia methods used

Antecedentes: La analgesia continua invasiva es el método de referencia para el manejo del dolor postoperatorio en cirugía mayor pero no está exenta de posibles complicaciones. Existe poca información sobre las complicaciones de las técnicas analgésicas continuas con catéter (TACC) y su impacto en el control del dolor. Material y métodos: Diseñamos un estudio prospectivo longitudinal incluyendo a pacientes tratados mediante cirugía que recibieron una TACC postoperatoria. Se registraron el tipo de analgesia, la intensidad del dolor mediante escala NRS, las características de las TACC, sus complicaciones técnicas y la satisfacción de los pacientes. Se aplicó estadística descriptiva y análisis comparativo mediante t de Student. Resultados: Se registraron datos de 106 pacientes. La duración de las TACC fue 47,52 ± 21,23 h; 52 pacientes (49,1%) fueron controlados en hospitalización convencional y 54 (50,9%) en unidades de críticos o alta dependencia. La tasa global de complicaciones técnicas fue del 9,43%. Las complicaciones más frecuentes fueron desplazamiento del catéter (2,38%), inflamación en el punto de inserción del catéter IV (2,38%) y dosificación excesiva de analgésicos (2,38%). El valor medio de NRS fue ≤ 3 durante la permanencia de la TACC. La intensidad máxima de dolor fue mayor en los pacientes con complicaciones técnicas (media ± desviación estándar [x̅ ± DE]: 4,4 ± 2,8 vs. 2,9 ± 1,9; p < 0,05). La satisfacción con la comodidad de la técnica y la satisfacción global con el tratamiento del dolor se redujeron significativamente en presencia de complicaciones. Conclusiones: La incidencia de complicaciones técnicas de las TACC fue del 9,43% y tuvieron un impacto negativo en el control del dolor postoperatorio y en la satisfacción de los pacientes

Background: Continuous invasive analgesia remains the gold-standard method for managing acute post-operative pain after major surgery. However, this procedure is not exempt from complications that may have detrimental effects on the patient and affect the post-operative recovery process. Data of the complications of continuous catheter analgesic techniques (CCATs) and their impact on pain relief are scarce in the literature. Material and methods: We conducted a prospective longitudinal study and patients who underwent a surgical procedure and received continuous invasive analgesia after surgery were included. Post-operative analgesic strategy, pain scores (NRS), CCAT's characteristics and technical complications were recorded. Patient satisfaction was determined. Descriptive statistics and Student's t-tests were applied for the comparative analyses. Results: We collected data from 106 patients. Mean duration of the CCAT was 47.52±21.23hours and 52 patients (49.1%) were controlled in conventional hospitalisation units whereas 54 patients (50.9%) were controlled on intensive or high-dependency care units. The overall incidence of technical complications was 9.43%. The most common complications were catheter displacement (2.38%), inflammation at the IV catheter insertion point (2.38%) and excessive dosing of analgesic drugs (2.38%). Mean NRS scores were ≤3 during the permanence of CCATs. Maximum pain intensity was significantly higher in patients who suffered technical complications (mean±standard deviation [x̅ ± SD]: 4.4 ± 2.8 vs. 2.9 ± 1.9; P<0.05). Satisfaction levels with the technique and overall satisfaction with the pain management strategy were negatively impacted by the occurrence of complications. Conclusions: The incidence of technical complications of CCATs was 9.43% and had a negative impact in pain control and patient's satisfaction

Complications of continuous catheter analgesia for postoperative pain management in a tertiary care hospital. Incidence of technical complications and alternative analgesia methods used. / Complicaciones de la analgesia continua invasiva para el control del dolor agudo postoperatorio en un hospital de tercer nivel. Incidencia de complicaciones técnicas y uso de métodos de analgesia alternativos.

BACKGROUND: Continuous invasive analgesia remains the gold-standard method for managing acute post-operative pain after major surgery. However, this procedure is not exempt from complications that may have detrimental effects on the patient and affect the post-operative recovery process. Data of the complications of continuous catheter analgesic techniques (CCATs) and their impact on pain relief are scarce in the literature. MATERIAL AND METHODS: We conducted a prospective longitudinal study and patients who underwent a surgical procedure and received continuous invasive analgesia after surgery were included. Post-operative analgesic strategy, pain scores (NRS), CCAT's characteristics and technical complications were recorded. Patient satisfaction was determined. Descriptive statistics and Student's t-tests were applied for the comparative analyses. RESULTS: We collected data from 106 patients. Mean duration of the CCAT was 47.52±21.23hours and 52 patients (49.1%) were controlled in conventional hospitalisation units whereas 54 patients (50.9%) were controlled on intensive or high-dependency care units. The overall incidence of technical complications was 9.43%. The most common complications were catheter displacement (2.38%), inflammation at the IV catheter insertion point (2.38%) and excessive dosing of analgesic drugs (2.38%). Mean NRS scores were ≤3 during the permanence of CCATs. Maximum pain intensity was significantly higher in patients who suffered technical complications (mean±standard deviation [x̅ ± SD]: 4.4 ± 2.8 vs. 2.9 ± 1.9; P<0.05). Satisfaction levels with the technique and overall satisfaction with the pain management strategy were negatively impacted by the occurrence of complications. CONCLUSIONS: The incidence of technical complications of CCATs was 9.43% and had a negative impact in pain control and patient's satisfaction.

Técnica de microindentación ósea y algometría de presión aplicada al recambio protésico de rodilla y dolor en punta de vástago tibial. Resultados preliminares en un grupo de 20 pacientes / Bone microindentation and pressure algometry applied to revision total knee replacement and tibial end-of-stem pain. Preliminary results in a group of twenty patients

Objetivos. Valorar la relación entre la aparición de dolor en punta de vástago tibial con una disminución de la resistencia ósea preoperatoria mediante microindentación ósea. En segundo lugar, conocer la utilidad potencial de la algometría de presión en el diagnóstico y seguimiento de este grupo de pacientes. Material y método. Se realizó un estudio de correlación intra- e interobservador preliminar, para validar el método de la algometría en un grupo de 50 voluntarios sanos. Posteriormente se realizó un estudio prospectivo en un grupo de 20 pacientes con una media de edad de 74 años (57-84), sometidos a cirugía protésica de rodilla con utilización de un vástago tibial no cementado. Se realizaron mediciones de microindentación y algometría preoperatoriamente y después de un año. Para el análisis estadístico se utilizó el coeficiente de correlación intraclase y la t de Student para datos apareados. Resultados. En el trabajo preliminar, los valores de correlación intra- e interobservador obtenidos fueron excelentes; 0,91 (0,84-0,95) y 0,86 (0,74-0,92), respectivamente. En el grupo prospectivo no se observaron modificaciones significativas en los valores de microindentación (p = 0,11) ni algometría (p = 0,6) después de un año. Se observó una correlación significativa entre los valores de la algometría y las escalas de EVA (p = 0,002) y funcional (p = 0,02) en el control anual. Conclusiones. La algometría de presión fue una herramienta útil en el seguimiento de estos pacientes. La microindentación no fue adecuada para identificar pacientes en situación de riesgo de presentar dolor en punta de vástago tibial (AU)

Objectives. To study the relationship between the appearance of end-of-stem pain with a preoperative decrease in local bone strength by using the bone microindentation technique. The potential usefulness of pressure algometry in the diagnosis and monitoring of this group of patients is also determined. Material and method. A preliminary intra- and inter-rater correlation study was performed in a group of 50 healthy volunteers in order to validate the algometry technique. A prospective study was then conducted on 20 patients with a mean age of 74 years (range 57-84) undergoing knee prosthetic surgery with use of a cementless tibial stem. Bone microindentation and pressure algometry measurements were made preoperatively, and after one year of follow-up. The statistical analysis was performed using the Intraclass correlation coefficient and the Student t test for paired data. Results. The intra and inter-rater correlation values were excellent; 0.91 (0.84-0.95) and 0.86 (0.74-0.92), respectively. No significant variations were found in the microindentation (P=.11) or in the pressure algometry (P=.6) values after one year of follow-up. Nevertheless, a significant correlation was observed between the values for pressure algometry and the EVA (P=.002) and functional scale (P=.02) at the end of follow-up. Conclusions. Pressure Algometry is a useful tool to evaluate this group of patients. Bone microindentation does not seem to be useful in identifying patients with increased risk of developing tibial end-of-stem pain (AU)

[Bone microindentation and pressure algometry applied to revision total knee replacement and tibial end-of-stem pain. Preliminary results in a group of twenty patients]. / Técnica de microindentación ósea y algometría de presión aplicada al recambio protésico de rodilla y dolor en punta de vástago tibial. Resultados preliminares en un grupo de 20 pacientes.

OBJECTIVES: To study the relationship between the appearance of end-of-stem pain with a preoperative decrease in local bone strength by using the bone microindentation technique. The potential usefulness of pressure algometry in the diagnosis and monitoring of this group of patients is also determined. MATERIAL AND METHOD: A preliminary intra- and inter-rater correlation study was performed in a group of 50 healthy volunteers in order to validate the algometry technique. A prospective study was then conducted on 20 patients with a mean age of 74 years (range 57-84) undergoing knee prosthetic surgery with use of a cementless tibial stem. Bone microindentation and pressure algometry measurements were made preoperatively, and after one year of follow-up. The statistical analysis was performed using the Intraclass correlation coefficient and the Student t test for paired data. RESULTS: The intra and inter-rater correlation values were excellent; 0.91 (0.84-0.95) and 0.86 (0.74-0.92), respectively. No significant variations were found in the microindentation (P=.11) or in the pressure algometry (P=.6) values after one year of follow-up. Nevertheless, a significant correlation was observed between the values for pressure algometry and the EVA (P=.002) and functional scale (P=.02) at the end of follow-up. CONCLUSIONS: Pressure Algometry is a useful tool to evaluate this group of patients. Bone microindentation does not seem to be useful in identifying patients with increased risk of developing tibial end-of-stem pain.

Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design.

BACKGROUND: The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double-blind, double-dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery. METHODS: Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 µg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded. RESULTS: Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47-2.61)] and 2.5 [1.08 (1.07-4.85)] µg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3-18)] compared with 20 min [12.5 (7-34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1-16)] vs. 2 h [1 (1-5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups. CONCLUSION: During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.

[Comparison of 2 methods of clinical data collection, one using the PAINOUT questionnaire (a European database for the management of postoperative pain)]. / Comparación de dos métodos para la recogida de datos clínicos utilizando el cuestionario de PAINOUT (base de datos europea para la gestión del dolor postoperatorio).

OBJECTIVE: To compare postoperative pain intensity and incidence of adverse events when the evaluation is performed by a visual numerical scale completed by the patient (PAINOUT), or using a verbal numerical scale completed by ward nurses or the staff of the acute pain unit. METHODS: Fifty-two postsurgical patients of both sexes (age range 31-80 years) admitted to the general surgery ward were sequentially recruited and evaluated on postoperative day 1. All patients were assessed using both questionnaires, which measure postoperative outcomes using scales of 0 to 10; values > or =4 were considered clinically relevant. The test and Cohen coefficient were used for statistical analysis. RESULTS: Using the PAINOUT questionnaire, the mean maximum intensity of referred pain was 5.40 (range, 0-10) and the minimum intensity was 1.83 (range, 0-5). Mean values obtained with the verbal numerical scales used by staff on the ward and in the pain clinic were 3.76 (range, 0-10) and 0.97 (range, 0-5), respectively. The differences between the 2 methods of pain assessment were statistically (P = .006) and clinically significant. When evaluating nausea with PAINOUT questionnaire, all patients provided a response; in 88.5% the intensity was less than 4. Six patients reported nausea on the PAINOUT but not in the UDA questionnaire. Moreover, 61% of patients reported drowsiness/sedation in PAINOUT instrument, whereas none reported that effect on the verbal scale. CONCLUSIONS: The intensity of pain and adverse events is significantly higher when the patient evaluates and records its intensity on visual numerical scales compared with verbal numerical scales.

Comparación de dos métodos para la recogida de datos clínicos utilizando el cuestionario de PAINOUT (base de datos europea para la gestión del dolor postoperatorio) / Comparison of 2 methods of clinical data collection, one using the PAINOUT

Objetivo: Comparar la intensidad del dolor postoperatorio y la incidencia de efectos adversos cuando la evaluación se realiza mediante una escala numérica visual completada por el propio paciente (PAINOUT) y una escala numérica verbal utilizada por el personal de la unidad de hospitalización/unidad de dolor agudo (UH/UDA). Métodos: Participaron 52 pacientes postquirúrgicos de ambos sexos, rango de edad 31-80 años, reclutados secuencialmente en la UH de cirugía general y evaluados durante las primeras 24 horas del postoperatorio utilizando los dos cuestionarios. Ambos tienen un rango del 0- 10 y valores >=4 fueron considerados clínicamente relevantes. Resultados: En PAINOUT, la media de la intensidad máxima de dolor referido fue de 5,40 (rango 0-10) y la de la intensidad mínima de 1,83 (0-5); en la escala verbal numérica UH/UDA los valores fueron 3,76 (rango 0-10) y 0,97 (0-5), respectivamente. Las diferencias entre los dos métodos de evaluación del dolor fueron estadísticamente (p = 0,006) y clínicamente significativas. Al evaluar las náuseas mediante el PAINOUT, todos los pacientes registraron una respuesta por escrito y en el 88,5% de los pacientes la intensidad fue < 4; seis pacientes refirieron náuseas en el PAINOUT, pero no en el cuestionario UH/UDA. Además, un 61% de pacientes registró cansancio/sedación >= 4 en PAINOUT y ninguno en la evaluación UH/UDA. Conclusiones: La intensidad del dolor y los EA son significativamente mayores cuando el propio paciente evalúa y registra su intensidad mediante escalas numéricas visuales comparadas con las escalas numéricas verbales(AU)

Objetive: To compare postoperative pain intensity and incidence of adverse events when the evaluation is performed by a visual numerical scale completed by the patient (PAINOUT), or using a verbal numerical scale completed by ward nurses or the staff of the acute pain unit. Methods: Fifty-two postsurgical patients of both sexes (age range 31-80 years) admitted to the general surgery ward were sequentially recruited and evaluated on postoperative day 1. All patients were assessed using both questionnaires, which measure postoperative outcomes using scales of 0 to 10; values >= 4 were considered clinically relevant. The test and Cohen coefficient were used for statistical analysis. Results: Using the PAINOUT questionnaire, the mean maximum intensity of referred pain was 5.40 (range, 0-10) and the minimum intensity was 1.83 (range, 0-5). Mean values obtained with the verbal numerical scales used by staff on the ward and in the pain clinic were 3.76 (range, 0-10) and 0.97 (range, 0-5), respectively. The differences between the 2 methods of pain assessment were statistically (P = .006) and clinically significant. When evaluating nausea with PAINOUT questionnaire, all patients provided a response; in 88.5% the intensity was less than 4. Six patients reported nausea on the PAINOUT but not in the UDA questionnaire. Moreover, 61% of patients reported drowsiness/sedation in PAINOUT instrument, whereas none reported that effect on the verbal scale. Conclusions: The intensity of pain and adverse events is significantly higher when the patient evaluates and records its intensity on visual numerical scales compared with verbal numerical scales(AU)

[Acute coronary syndrome during a cesarean section in a healthy young woman]. / Síndrome coronario agudo durante una cesárea en mujer joven sana.

Acute coronary syndrome (ACS) during pregnancy and delivery is a rare event that is usually related to prior disease or family history. Factors that contribute to the appearance of ACS during delivery in women with healthy coronary arteries include high doses of drugs to suppress contractions or increase uterine muscle tone and cardiovascular instability of any kind. Clinical and electrocardiographic abnormalities (eg, ST segment depression) that are suggestive of ACS have been reported to occur during cesarean section but without subsequent enzyme or echocardiographic abnormalities.

Magnetoencephalographic pattern of epileptiform activity in children with early-onset autism spectrum disorders.

OBJECTIVE: To provide further data around magnetoencephalographic (MEG) findings in early-onset autism spectrum disorders (ASD). METHODS: Thirty-six children (mean age 7 years) diagnosed of PDD (DSM-IV, ICD-10) were studied. There were 22 children with autistic disorder, 9 with Asperger's syndrome, and 5 with pervasive developmental disorder not otherwise specified (PDD-NOS). According to the Childhood Autism Rating Scale (CARS), the autistic disorder was mild to moderate in 11, and severe in 11. Neuroimaging studies using three-dimensional MRI as well as simultaneous MEG-EEG and fusion techniques through magnetic source imaging (MSI) were performed, with the aid of anesthesia in non-cooperative patients. RESULTS: Most patients had no EEG abnormalities. All ASD children showed common specific abnormalities in the shape of low amplitude monophasic and biphasic spikes (isolated or short bursts) as well as acute waves, predominantly distributed in the perisylvian areas. In Asperger's syndrome, epileptiform spikes were mostly found in the right hemisphere. No lateralized epileptiform activity was observed in non-Asperger's autistic patients. CONCLUSIONS: MEG epileptiform activity is frequently documented in children with early-onset ASD. SIGNIFICANCE: Subclinical epileptiform activity is present especially in the perisylvian regions for many patients with ASD.

Síndrome coronario agudo durante una cesárea en mujer joven sana / Acute coronary syndrome during a cesarean section in a healthy young woman

El síndrome coronario agudo (SCA) durante la gestacióny el parto es una entidad muy poco frecuente quesuele estar relacionado con patología previa o antecedentes familiares. Puede contribuir a la aparición del SCA durante el parto en una mujer con arterias coronarias sanas, las dosis altas de tocolíticos o de uterotónicos y la inestabilidad cardiovascular de cualquier etiología. Se han descrito alteraciones clínicas y electrocardiográficas, como la depresión del segmento ST, durante la cesárea sugestiva de SCA, sin alteraciones enzimáticas ni ecocardiográficas posteriores

Acute coronary syndrome (ACS) during pregnancyand delivery is a rare event that is usually related toprior disease or family history. Factors that contributeto the appearance of ACS during delivery in womenwith healthy coronary arteries include high doses ofdrugs to suppress contractions or increase uterine muscletone and cardiovascular instability of any kind. Clinicaland electrocardiographic abnormalities (eg, STsegment depression) that are suggestive of ACS havebeen reported to occur during cesarean section butwithout subsequent enzyme or echocardiographicabnormalities