Effect of endovenous lidocaine on analgesia and serum cytokines: double-blinded and randomized trial.

STUDY OBJECTIVE: This trial aimed to compare postoperative analgesia, opioid consumption, duration of ileus and hospital stay, and cytokine levels in patients undergoing laparoscopic cholecystectomies who received intravenous lidocaine in comparison with a control group. DESIGN: Prospective, longitudinal, double-blind, and randomized study. SETTING: Operating room and postoperative recovery area. PATIENTS: Forty-four American Society of Anesthesiologists I and II patients older than 17 years, undergoing laparoscopic cholecystectomy, under general anesthesia. INTERVENTIONS: The first group received intravenous lidocaine during the procedure until 1 hour postoperatively, whereas the second group received saline. Both groups received dipyrone and morphine patient-controlled analgesia. MEASUREMENTS: Pain was assessed by Visual Numeric Scale at rest and when coughing at different times after the end of the surgery. Blood samples were taken at the end of procedure and 24 hours later. The total morphine patient-controlled analgesia demand, the time for the first flatus, and the length of hospital stay were also recorded. MAIN RESULTS: Groups were similar in relation to sex (P= .2), age (P= .5), weight (P= .08), and length of surgery (P= .6). No differences were observed regarding the intensity of postoperative pain between the groups, either at rest (P= .76) or when coughing (P= .31), in morphine consumption (P= .9), and in the duration of ileus (P= .5) or length of hospital stay (P= .9). The inflammatory markers interleukin (IL)-1 (P= .02), IL-6 (P< .01), interferon-γ (P< .01), and tumor necrosis factor α (P< .01) showed significant reduction in the lidocaine group against the placebo group, except IL-10 (P= .01), that, because of its anti-inflammatory effects, increased its concentration. CONCLUSIONS: Intravenous lidocaine was not able to reduce postoperative pain, opioid consumption, and duration of ileus or length of hospital stay. However, its anti-inflammatory effect was noticeable.

Síndrome Complexa de Dor Regional do tipo I do membro superior: tratamento baseado no Estresse Muscular de Tração e Compressão Ativa / Complex Regional Pain Syndrome type I of the upper limb - treatment based on Stress Loading Program: a case study

O cotidiano de uma pessoa que sofre de Síndrome Complexa de Dor Regional de tipo I (SCDR I) passa a ser limitado, pois essa síndrome gera sinais e sintomas localizados no membro acometido, podendo também se estabelecer em outros locais. Tendo isso em vista, este estudo objetiva apresentar as contribuições da Terapia Ocupacional e do Programa de Reabilitação Baseado no Estresse Muscular de Tração e Compressão Ativa para um sujeito com SCDR I no membro superior, atendido pelo Grupo de Dor do Hospital Universitário de Santa Maria (HUSM), RS. A presente pesquisa é caracterizada como um estudo de caso, experimental, que se ocupa dos períodos pré e pós-intervenção terapêutica ocupacional. Os instrumentos utilizados para coleta de dados foram os protocolos de Disfunção Ombro, Braço, Mão (DASH), a Classificação Internacional de Incapacidade, Funcionalidade e Saúde (CIF), a Medida Canadense de Desempenho Ocupacional (COPM), a Goniometria e a Escala Visual Analógica (EVA). Findas as avaliações, o sujeito foi exposto ao tratamento de exercícios ativos resistivos compressivos e, após a conclusão do tratamento, foi reavaliado. Observou-se, então, que o tratamento aplicado contribuiu para a diminuição do quadro doloroso e para a melhoria na Amplitude de Movimento (ADM) do sujeito. A utilização do protocolo de estresse e compressão ativa contribuiu significativamente para a redução da dor, o ganho de ADM e a melhora do desempenho ocupacional.

Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery.

OBJECTIVE: To evaluate the impact of Cell Saver autologous blood transfusion system (CS) on the use of packed red blood cells (pRBC) in coronary artery bypass grafting (CABG) surgery. METHODS: We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB), divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC) in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. RESULTS: There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008) between the groups without-CS (21/44 cases; 47.7%) and with-CS (4/43 cases; 9.3%). There was also a statistically significant difference (P=0.000117) in the volumes of pRBC between the groups without-CS (198.651258.65 ml) and with-CS (35.061125.67 ml). On the other hand, in the early postoperative period (up to 24h) there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. CONCLUSION: Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery / Impacto da transfusão autóloga no uso de concentrado de hemácias em cirurgias de revascularização do miocárdio

OBJECTIVE: To evaluate the impact of Cell Saver autologous blood transfusion system (CS) on the use of packed red blood cells (pRBC) in coronary artery bypass grafting (CABG) surgery. METHODS: We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB), divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC) in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. RESULTS: There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008) between the groups without-CS (21/44 cases; 47.7%) and with-CS (4/43 cases; 9.3%). There was also a statistically significant difference (P=0.000117) in the volumes of pRBC between the groups without-CS (198.651258.65ml) and with-CS (35.061125.67ml). On the other hand, in the early postoperative period (up to 24h) there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. CONCLUSION: Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

OBJETIVO: Avaliar o impacto do sistema de autotransfusão com hemoconcentração (SAH) no uso de concentrado de hemácias (CH) em cirurgias de revascularização do miocárdio (CRM). MÉTODOS: Foi desenvolvido um estudo transversal, que incluiu 87 pacientes submetidos a CRM eletiva primária com miniCEC, sendo 44 sem uso do SAH e 43 pacientes com uso do SAH. Foi investigada a necessidade de uso e o volume de CH em cada grupo, bem como fatores de risco cardiovascular, variáveis pré-operatórias e parâmetros cirúrgicos transoperatórios por meio de coleta de dados em prontuários. Não houve randomização ou intervenção na seleção dos grupos. Na análise estatística foram utilizados os testes t de Student, teste U de Mann-Whitney, teste do qui-quadrado, com um nível de significância de 5%. RESULTADOS: Em relação a fatores de risco cardiovascular e variáveis pré e transoperatórias, não houve diferença estatística significativa entre os dois grupos. Quando se avaliou o uso absoluto de CH no transoperatório, houve diferença estatística significativa (P=0,00008) entre os grupos sem-SAH (21/44 casos; 47,7%) e com-SAH (4/43 casos; 9,3%). Na análise dos volumes de CH utilizado no transoperatório, também houve diferença significativa (P=0,000117) entre os volumes utilizados no grupo sem-SAH (198,651258,65 ml) e com-SAH (35,061125,67 ml). Já no pós-operatório imediato (até 24 horas), não houve diferença tanto no uso absoluto como nos volumes de CH entre os grupos que usaram ou não o SAH. CONCLUSÃO: A autotransfusão de hemácias possibilitada pelo uso do SAH determina menor uso de CH homólogo no transoperatório de CRM com uso de miniCEC.