Analgesia preventiva con pregabalina en intervenciones de hernia con malla. Revisión al año / Preventive analgesia with pregabalin in mesh hernia repair. Review at 1 year

Objetivo: La analgesia preventiva consiste en la administración de fármacos para conseguir un estado analgésico previo al trauma quirúrgico que disminuya la respuesta sensitiva periférica y central al dolor, con la cual se intenta interrumpir el círculo inflamación dolor-hiperalgesia-aumento del estímulo doloroso. Pregabalina es un neuromodulador utilizado en el tratamiento del dolor neuropático; varios trabajos indican que se puede administrar en la prevención del dolor postoperatorio. El objetivo de este trabajo fue realizar un estudio comparativo de dolor postoperatorio en pacientes intervenidos de hernia por cirugía abierta con colocación de malla, tratados con pregabalina o sin ella. Material y métodos: Se realizó un estudio prospectivo, aleatorizado, que incluyó a140 pacientes intervenidos de hernia inguinal, crural o umbilical con malla, por cirugía abierta, con 112 varones y 28 mujeres. Grupo I: 70 de ellos fueron tratados con pregabalina75 mg noche durante 3 días antes de la intervención y 75 mg noche durante12 días después, incluido el día de la intervención. Grupo II: 70 sin pregabalina. No hubo diferencias entre ambos grupos en edad, que estaban comprendidos entre 18-79 años (edad media: 55,47 ± 13,38 años) ni tampoco en el grado ASA: entre I-III. La evaluación del dolor se basó en la escala analógica verbal y consumo de pirazolonas. Los controles se realizaron después de 1, 6 y 12 meses de la intervención. Se registraron los efectos adversos, el número de horas de sueño y la mejoría o no en la calidad del sueño. El análisis estadístico se realizó con el test de Kolmogorov-Smirnov del programa Statgraphics. Se consideró significativa una p < 0,05 (...) (AU)

Objective: Preventive analgesia consists of administrating drugs to achieve an analgesic state that decreases the peripheral and central sensory response to pain prior to surgical injury; thus, the aim is to break the cycle of inflammation-pain-hyperalgesia-increase of painful stimulus. Pregabalin is a neuro-regulator used in the treatment of neuropathic pain and several studies indicate that this drug can be administered to prevent postoperative pain symptoms. The aim of this study was to compare postoperative pain in patients undergoing open mesh hernia repair, treated either with or without pregabalin. Material and methods: A prospective randomized trial was conducted in 140 patients (112 men and 28 women) who underwent open inguinal, rural or umbilical hernia repair with mesh. Group I consisted of 70 patients treated with pregabalin 75 mg at night for 3days before the intervention and 75 mg at night for 12 days after the procedure, including the day of surgery. Group II consisted of 70 patients not administered pregabalin. There were no differences between the two groups in age, which ranged between 18 and79 years old (mean age 55.47 + 13.38), or in ASA grade (between I and III). Pain assessment was based on the visual analog scale (VAS) and pyrazolone consumption. The results were analyzed 1, 6, and 12 months after the intervention. Adverse effects, hours or sleep and quality of sleep were registered. The statistical analysis was performed using the Kolmogorov-Smirnov test with the Statgraphics program. P values of < 0.05 were considered statistically significant. Results: Analgesic results were as follows: group I: 1 month: good in 86%, medium in 14%and poor in 0%; 6 months: good in 89%, medium in 11% and poor in 0%; 12 months: good in 94%, medium in 6% and poor in 0%. Neuropathic pain occurred in 35% (75% pure and25% mixed) (...) (AU)

Estabilidad de parecoxib en dilución con otros fármacos y administración en perfusión continua IV para el control del dolor postoperatorio / Stability of parecoxib in dilution with other drugs and administered in continuous

Objetivo. Evaluar la estabilidad de parecoxib en un sistema de infusión continua elastomérica portátil IV para 24 horas, en dilución con opiáceos (cloruro mórfico, meperidina ó tramadol), antieméticos y suero fisiológico, durante las 24 horas del postoperatorio; así como, comprobar el resultado analgésico, la aparición de efectos secundarios y el grado de satisfacción de pacientes intervenidos de cirugía mayor susceptibles de tratamiento con dichos fármacos. Material y Métodos. El infusor es un dispositivo desechable y ligero con un depósito elastomérico para administrar medicación. Se realizaron varias pruebas mezclando parecoxib, opiáceos, antieméticos y suero fisiológico y se observó su estabilidad durante 24 horas. Procedimos a observar la mezcla en repetidas ocasiones y la dilución siempre permaneció estable, clara, sin partículas y transparente; por lo que se decidió utilizar dicha mezcla en el infusor IV para el tratamiento del dolor postoperatorio, siempre bajo la supervisión de un anestesiólogo. Se estudiaron un total de 118 pacientes, 46 mujeres (39%) y 72 hombres (61%), ASA I-IV, edad media 59,75 +/- 14,25 (18-89), 92 (78%) fueron intervenidos de cirugía general y 26 (22%) de urología. El llenado del infusor según ASA, edad y tipo de intervención del paciente, se realizó con: parecoxib 80 mg + metoclopramida Cl H 20 ó 30 mg + suero fisiológico en los 118 pacientes, se añadió cloruro mórfico en 65 pacientes, meperidina en 30 y tramadol en 23, a administrar en 24 horas tras la intervención quirúrgica. Se valoró la intensidad del dolor según EAV a la llegada a la Sala de Despertar y a las 24 horas, resultado analgésico, efectos secundarios y grado de satisfacción. Resultados. El resultado analgésico fue muy bueno en 60 pacientes (50,85%); bueno en 40 (33,90%); regular en 12 (10,17%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Los efectos secundarios aparecieron en 30 casos (25%): 4 con sudoración (3%), 1 con desorientación (0,8%) y 7 con somnolencia y mareo (6%) 3 de ellos con interrupción del tratamiento. En cuanto a las náuseas y/o vómitos: 18 pacientes necesitaron rescate antiemético, y en 3, hubo que suspender el tratamiento. El grado de satisfacción del paciente fue: muy satisfactorio en 56 pacientes (47,5%); satisfactorio en 46 (39%), deficiente en 10 (8,5%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Conclusiones. La posibilidad de utilizar parecoxib sólo o unido a otros fármacos en perfusión continua IV para el tratamiento del dolor agudo postoperatorio, es una opción a considerar

Objective. To evaluate the stability of parecoxib in a portable elastomeric pump system for IV infusion in dilution with opioids (morphine chloride, pethidine or tramadol), antiemetics and saline solution during 24 hours in the postoperative period; as well as to verify the analgesic result, the incidence of side effects and the degree of satisfaction in patients undergoing major surgery that were eligible for treatment with these drugs. Material and Methods. The infuser pump is a light disposable device with an elastomeric deposit to administer the medication. Several tests combining parecoxib, opioids, antiemetics and saline solution were carried out and its stability was demonstrated during 24 hours. The mixture was then observed in several occasions and was shown that the dilution always remained stable, clear, with no particles and transparent; therefore it was decided to use that combination in the IV infuser for the treatment of postoperative pain, always under the anaesthesiologist supervision. A total of 118 patients were studied, 46 women (39%) and 72 men studied (61%), ASA I-IV, mean age 59.75 +/- 14.25 (18-89); 92 (78%) underwent general surgery procedures and 26 (22%) urologic ones. The filling of infuser according to ASA, age and type of surgery of the patient, was made with: parecoxib 80 mg + metoclopramide CL H 20 or 30 mg + saline solution for the 118 patients, morphine chloride was added in 65 patients, petidine in 30 and tramadol in 23, during 24 hours after surgery. Pain was assessed using a VAS in both at arrival in the PACU and 24 hours after the surgical procedures. Analgesic outcome, side effects and degree of satisfaction were recorded. Results The analgesic outcome was very good in 60 patients (50.85%); good in 40 (33.90%); regular in 12 (10.17%) and the treatment was interrupted 6 (5%) due to side effects. Side effects were present in 30 (25%) cases: 4 with perspiration (3%), 1 with disorientation (0.8%) and 7 with somnolence and dizziness (6%) 3 of them with interruption of the treatment. For nausea and vomiting, 18 patients needed antiemetics rescue, and in 3 cases it was necessary to suspend the treatment. The degree of satisfaction reported by patients was: very satisfactory in 56 patients (47.5%); satisfactory in 46 (39%), inadequate in 10 (8.5%) and the treatment was suspended in 6 (5%) due to side effects. Conclusions. The possibility of using parecoxib alone or in combination with other drugs in continuous IV perfusion for acute postoperative pain is an important option to be considered

Chloral hydrate enhances ethanol-induced inhibition of methanol oxidation in mice.

Several studies indicated that chloral hydrate can prolong the disappearance time of ethanol from blood in mice. This seems to result from inhibition of the enzyme alcohol dehydrogenase by chloral hydrate and trichloroethanol, its main metabolite. We examined the effect of both these compounds on the disappearance time of methanol in mice. Also the effect of a combination of ethanol and chloral hydrate on the disappearance time of methanol was examined. Several groups of six mice each received methanol (1 g/kg i.p.) followed immediately by one of the following treatments: saline (10 ml/kg); chloral hydrate (0.4 g/kg); trichloroethanol (0.36 g/kg); ethanol (4 g/kg); or a combination of chloral hydrate (0.2 g/kg) and ethanol (4 g/kg). The concentrations of methanol in blood were measured at 1, 2, 4, and 8 h after its administration and were used to calculate some approximate indicators of methanol elimination in each group. The results show that all the above treatments do prolong the disappearance time of methanol in the blood of mice to varying extents. The ethanol-chloral hydrate combination produced the most pronounced effect.

Pharmacodynamic and metabolic interactions between ethanol and two industrial solvents (methyl n-butyl ketone and methyl isobutyl ketone) and their principal metabolites in mice.

MnBK and MiBK prolong the duration of ketamine-, pentobarbital-, thiopental- and ethanol-induced loss of righting reflex (LRR) in mice. In equimolar doses, (5 mmol/kg i.p.), both isomers were equipotent with respect to the enhancement of ketamine-, pentobarbital-, and thiopental-induced LRR. However, MnBK was significantly more effective (twice as effective) than its isomer with respect to enhancing ethanol-induced LRR. An attempt to explain the difference in effectiveness between the two isomers was carried out. The effects of both ketones and their principal metabolites, (2-hexanol (2-HOL), 2,5-hexanedione (2,5-HD), 4-methyl-2-pentanol (4-MPOL) and 4-hydroxy 4-methyl-2-pentanone (HMP)) on ethanol-induced LRR and ethanol elimination were studied in mice. The ketones and their metabolites were dissolved in corn oil and injected intraperitoneally 30 min before 4 g/kg ethanol for LRR and 2 g/kg for ethanol elimination. Ethanol-induced LRR was significantly prolonged by the following dosages (mmol/kg), MnBK, 5; MiBK, 5; 2-HOL, 2.5; 4-MPOL, 2.5; and HMP, 2.5; 2,5-HD, 2.5, however exerted no effect. Concentrations of ethanol in blood or brain upon return of the righting reflex were similar in solvent-treated and control animals. The mean elimination rate of ethanol was slower in groups pretreated with MnBK or 2-HOL as compared to control animals. Ethanol elimination in animals pretreated with MiBK, HMP, 4-MPOL, or 2,5-HD was similar to that in control animals. These ketones are known to have some central depressant action on their own. This by itself could lead to prolongation of ethanol-induced LRR. However, MnBK, as well as one of its principal metabolites, (2-HOL), markedly reduced ethanol elimination. This could explain the observation that MnBK has a greater potentiating effect on ethanol-induced LRR that its isomer, MiBK, which does not affect ethanol elimination.

Muscular structural changes following fadenoperation.

The authors describe the macroscopic, histological, and ultrastructural findings observed in an experimental animal model of the fadenoperation . Grossly, muscular fibrosis and musculo-scleral adhesions were well established after the second postoperative month. Histologic findings demonstrated the development of a granulomatous, foreign body reaction around the musculo-scleral fixation suture, collagenization of the muscle tissue from the first postoperative month and degenerative phenomena in the muscle fibers. Electron transmission microscopic study showed atrophy and angulation with distortion of the myofibrillar matrix, along with alteration of the Z bands of muscle fibers, mitochondrial alteration, and dilatation of the sarcotubular system. All these experimental findings suggest the relative irreversible effects of the fadenoperation after the early postoperative period and for the first time, demonstrated that this surgical technique alters the muscle structure.

Fundus changes following faden operation.

A faden operation was performed in 187 eyes that were studied by indirect binocular ophthalmoscopy at regular intervals after the surgical procedure. Of these eyes, 29 (15.5%) showed ocular fundus abnormalities, with 28 cases of chorioretinal scars at the level of the muscle scleral anchorage and one case of Herpburn-Amalric triangular syndrome of choroidal ischemia. No case of retinal tears was found in this series. Fundus changes are by far the most frequent complication of the faden operation, and to our knowledge, this has not been previously described. The findings of the present study suggest (1) the necessity of routine ophthalmoscopic controls in the postoperative stage regarding those eyes in which the faden operation has been performed, and (2) that the faden operation on the lateral rectus muscle is seriously contraindicated because of the high risk of irreversible macular damage consecutive to these chorioretinal lesions.

Anterior chamber metastasis from neuroblastoma.

An apparently normal 10-day-old girl had, since birth, a gray-white vascularized tumor in the inferior quadrants of the right anterior chamber. General physical examination revealed abdominal distension, hepatomegaly, splenomegaly, and a deeply located abdominal mass. Multiple subcutaneous nodules scattered all around the body's surface could be palpated. Surgical exploration confirmed the presence of a left adrenal neuroblastoma. Six months after a complete resection of the abdominal tumor and general radiotherapy and chemotherapy, the right anterior chamber mass regressed almost completely, leaving only a calcified residue. The child is living and well six years after the diagnosis of neuroblastoma. This is the first case known to us in the literature of a congenital anterior chamber metastasis, as well as the first case reported of an anterior segment metastasis from a neuroblastoma.