Bilateral Radioscopically Guided Erector Spinae Plane Block for Postoperative Analgesia in Spine Surgery: A Randomized Clinical Trial.

BACKGROUND: We compare two perioperative pain management procedures(a radioscopicallyguided erector spinae plane [ESP] block versus the standard wound infiltration technique with local anesthetics) in patients undergoing lumbosacral spine surgery. METHODS: A randomized, double-blind clinical trial was performed, in which adults at our hospital undergoing lumbosacral surgery without fixation were randomly assigned to receive either the standard wound infiltration technique, employing long-term anesthetics, or a radioscopicallyguided ESP block. Postoperative pain severity, morphine consumption, number of patients immobilized due to wound pain, length of hospitalization, and complications were recorded. RESULTS: Over the first 7 postoperative hours, pain relief was superior in the ESP block group among patients who underwent diskectomies or one-level decompression (p< 0.0001). Using an ESP block also was statistically superior at decreasing all postoperative variables recorded in patients scheduled for multilevel decompression: visual analog scale (VAS) pain severity over the first 7 hours after the procedure (p = 0.0004); number of patients with wound pain 1 (p = 0.049), 7 (p< 0.0001), and 24 hours (p = 0.007) after surgery; length of hospitalization (p = 0.0007), number of patients immobilized for wound pain (p = 0.0004) and rescue morphine consumption (p< 0.0001). CONCLUSION: The ESP block is a safe procedure that seems to outperform the infiltration wound technique for postoperative pain management in patients undergoing open spinal surgery. Future studies are needed to verify its effectiveness for arthrodesis/fixation and minimallyinvasive procedures, and for chronic spine pain relief.

Redox interactions of immune cells and muscle in the regulation of exercise-induced pain and analgesia: implications on the modulation of muscle nociceptor sensory neurons.

The mechanistic interactions among redox status of leukocytes, muscle, and exercise in pain regulation are still poorly understood and limit targeted treatment. Exercise benefits are numerous, including the treatment of chronic pain. However, unaccustomed exercise may be reported as undesirable as it may contribute to pain. The aim of the present review is to evaluate the relationship between oxidative metabolism and acute exercise-induced pain, and as to whether improved antioxidant capacity underpins the analgesic effects of regular exercise. Preclinical and clinical studies addressing relevant topics on mechanisms by which exercise modulates the nociceptive activity and how redox status can outline pain and analgesia are discussed, in sense of translating into refined outcomes. Emerging evidence points to the role of oxidative stress-induced signaling in sensitizing nociceptor sensory neurons. In response to acute exercise, there is an increase in oxidative metabolism, and consequently, pain. Instead, regular exercise can modulate redox status in favor of antioxidant capacity and repair mechanisms, which have consequently increased resistance to oxidative stress, damage, and pain. Data indicate that acute sessions of unaccustomed prolonged and/or intense exercise increase oxidative metabolism and regulate exercise-induced pain in the post-exercise recovery period. Further, evidence demonstrates regular exercise improves antioxidant status, indicating its therapeutic utility for chronic pain disorders. An improved comprehension of the role of redox status in exercise can provide helpful insights into immune-muscle communication during pain modulatory effects of exercise and support new therapeutic efforts and rationale for the promotion of exercise.

Effects of parasites and predators on nociception: decreases analgesia reduces overwinter survival in root voles (Rodentia: Cricetidae)

ABSTRACT Growing evidence suggests that parasite-infected prey is more vulnerable to predation. However, the mechanism underlying this phenomenon is obscure. In small mammals, analgesia induced by environmental stressors is a fundamental component of the defensive repertoire, promoting defensive responses. Thus, the reduced analgesia may impair the defensive ability of prey and increase their predation risk. This study aimed to determine whether coccidia infection increases the vulnerability to predation in root voles, Microtus oeconomus (Pallas, 1776), by decreased analgesia. Herein, a predator stimulus and parasitic infection were simulated in the laboratory via a two-level factorial experiment, then, the vole nociceptive responses to an aversive thermal stimulus were evaluated. Further, a field experiment was performed to determine the overwinter survival of voles with different nociceptive responses via repeated live trapping. The coccidia-infected voles demonstrated reduced predator-induced analgesia following exposure to predator odor. Meanwhile, pain-sensitive voles had lower overwinter survival than pain-inhibited voles in enclosed populations throughout the duration of the experiment. Our findings suggest that coccidia infection attenuates predator-induced analgesia, resulting in an increased vulnerability to predation.

Reproductive ecology and territorial behavior of Boana goiana (Anura: Hylidae), a gladiator frog from the Brazilian Cerrado

Anuran males and females adopt different reproductive and behavioral strategies in different contexts. We investigated the reproductive ecology and territorial behavior of the treefrog Boana goiana (B. Lutz, 1968) from the Brazilian Cerrado. We hypothesized that competitor density/proximity would increase the behavioral responses of B. goiana males, and that mating would be assortative. We also tested if the number of eggs correlates with female size and if there is a trade-off between clutch size and egg size. We conducted two territoriality experiments to test the effects of male size, competitor proximity and competitor density. Larger males called more in the presence of a second male. In the second experiment, the largest males emitted more calls and the distance to the nearest male increased as resident males called more. In both experiments, the number of calls was influenced by either male size or spacing between males. Some males behaved as satellites, probably to avoid fights. Our analyses indicate that females choose males with similar sizes to their own, corroborating our hypothesis of size-assortative mating. We found no relationships between female size and clutch size/volume, and between egg size and number of eggs per clutch. We also report multiple spawning for this species. The low incidence of physical combats and the spacing pattern indicate that this species relies almost solely on calls to resolve contests, which could be explained by low motivation, or simply because males avoid combats to decrease injury risks. Thus, acoustic or even multimodal communication seems crucial for social interactions of B. goiana.(AU)

Practices related to assessment of sedation, analgesia and delirium among critical care pediatricians in Brazil.

OBJECTIVE: To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in pediatric intensive care units. METHODS: A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units. RESULTS: Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process. CONCLUSION: This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.

Practices related to assessment of sedation, analgesia and delirium among critical care pediatricians in Brazil / Práticas relacionadas à avaliação de sedação, analgesia e delirium entre pediatras intensivistas no Brasil

ABSTRACT Objective To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in pediatric intensive care units. Methods A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units. Results Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process. Conclusion This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.

RESUMO Objetivo Compreender o uso de ferramentas, protocolos e medidas de conforto relacionadas à sedação/analgesia, além de rastrear a presença de delirium em unidades de terapia intensiva pediátricas. Métodos Um inquérito com 14 questões foi distribuído, por meio de correio eletrônico, para médicos pediatras intensivistas brasileiros. Oito questões eram sobre os dados demográficos dos médicos e dos hospitais, e seis questões eram sobre as práticas na avaliação da sedação, analgesia e delirium em unidades de terapia intensiva pediátrica. Resultados Responderam ao inquérito 61 médicos dos 373 e-mails enviados (taxa de resposta de 16,3%). A maioria dos médicos era da Região Sudeste (57,2%) e 46,5% trabalhavam em hospitais públicos, sendo 28,6% sob administração direta do Estado. Dos respondedores, 57,1% utilizavam protocolos formais de sedação e analgesia, sendo a escala de Ramsay a mais utilizada (52,5%). Não utilizavam escores de rastreamento de delirium 48,2% dos médicos, e o Cornell Asssessment of Pediatric Delirium (23,2%) foi o mais utilizado. A maioria (85,7%) dos médicos não utilizou a prática da interrupção diária da sedação, e apenas 23,2% utilizavam medidas não farmacológicas para o conforto do paciente com frequência, com a participação heterogênea dos pais nesse processo. Conclusão Este estudo destaca a heterogeneidade nas práticas de avaliação da sedação/analgesia e insuficiência de rastreamento de delirium entre os intensivistas pediátricos brasileiros.

Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario / Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Results after implementation of a sedoanalgesia protocol for procedures in hospital environment. / Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Eficacia analgésica y seguridad de dosis única de morfina intratecal / Analgesic effectiveness and safety of single-dose intrathecal morphine

Introducción: el dolor posoperatorio del hemiabdomen superior es intenso y su control es imprescindible para evitar complicaciones. Objetivos: evaluar la eficacia analgésica y seguridad de dosis única de morfina intratecal en el posoperatorio de la cirugía de hemiabdomen superior de gran envergadura. Método: ensayo clínico aleatorizado a simple ciegas en 40 pacientes, tras intervenciones de hemiabdomen superior. Se emplearon dosis única de morfina intratecal (MIT) de 1 o 2 µg/kg de peso del paciente de acuerdo al grupo de tratamiento. Análisis estadístico con las pruebas Chi cuadrado (c2), exacta de Fisher, análisis de varianza univariado, la prueba de W de Mauchly y la prueba F univariada; nivel de significación de 0,05. Resultados: la administración de opioides durante el acto quirúrgico fue similar en ambos grupos (3,1 ± 2,2 mL vs 4,1 ± 2,7 mL). En el grupo de dosis de 2 µg/kg de peso de MIT a las 12 y 24 h los pacientes no refirieron dolor; existieron diferencias entre los tratamientos en cuanto al alivio del dolor (p< 0,001) y también entre los momentos en que se midió el mismo (p= 0,001). Se utilizó analgesia de rescate en 25 por ciento de los pacientes. Sólo se presentó como complicación la depresión respiratoria. Conclusiones: la dosis única de 2 μg /kg de morfina intratecal es un método eficaz para la analgesia posoperatoria en la cirugía de hemiabdomen superior, la incidencia de complicaciones fue baja y se demostró que ambas dosis son seguras(AU)

Introduction: The superior hemiabdomen postoperative pain is severe and essential to be managed in order to avoid complications. Objectives: To assess the analgesic effectiveness and safety of single-dose intrathecal morphine in the postoperative period of the upper hemiabdomen major surgery. Method: Single-blind randomized clinical trial in 40 patients, after upper hemiabdomen interventions. We used single doses of intrathecal morphine (ITM) of 1 or 2 mg/kg per patient weight according to the treatment group. The statistical analysis used the Chi-square test, Fisher's exact test, univariate analysis of variance, Mauchly's test and Univariate F-test; the significance level was 0.05. Results: Opioids administration during surgery was similar in both groups (3.1 ± 2.2 mL vs 4.1 ± 2.7 mL). In the 2 mg/kg of ITM dose group, the patients reported no pain after 12 and 14 hours; there were differences between treatments regarding pain relief (p< 0.001) and also between the time when it was measured (p= 0.001). Rescue analgesia was used in 25 percent of the patients. Respiratory depression was the only onset complication. Conclusions: ITM at a single dose of 2 μg/kg is an effective method for postoperative analgesia in upper hemiabdomen surgery, the incidence of complications was low and both doses proved safe(AU)

Cambio de paradigma en el paciente diabético a partir del bloqueo del tobillo / Change of paradigm in diabetic patients starting from the ankle block

Introducción: la complicación más temida de la diabetes mellitus es el pie diabético y como consecuencia nefasta de éste, la amputación de todo un miembro con la carga psicológica y social que lleva aparejada. El bloqueo a nivel del tobillo a pesar de ser una técnica sencilla, no es de práctica habitual en pacientes con deterioro del estado físico. Objetivos: identificar la eficacia del bloqueo de tobillo para los procederes quirúrgicos del pie en los pacientes diabéticos con compromiso de su estado físico. Métodos: se realizó un estudio analítico observacional longitudinal de cohorte prospectivo en una población de pacientes diabéticos en el Hospital General Docente Dr. Antonio Agostinho Neto de Guantánamo, que fueron intervenidos quirúrgicamente en el pie por lesiones infecciosasa, los que se les realizó bloqueo troncular del pie a nivel del tobillo. De un universo de 48 pacientes, a través de una determinación probabilística, se tomó una muestra de 32 durante el período febrero de 2014 a febrero de 2016. Resultados: predominaron las intervenciones de carácter urgente localizadas en el ante pie como amputación de artejos. Las complicaciones de la aplicación de la técnica de bloqueo de tobillo fueron mínimas, con sólo un fallo de la técnica; se mantuvo adecuado control clínico hemodinámico, se garantizó 100 por ciento de analgesia posoperatoria. Conclusiones: el bloqueo del pie a nivel del tobillo con fines quirúrgicos, resulta eficaz en las lesiones del pie en pacientes diabéticos; ya que mejora la calidad de vida de éstos al brindarle una técnica anestésica adecuada en manos eficientes(AU)

Introduction: the most feared complication of diabetes mellitus (DM) is the diabetic foot and, as a threatening consequence of this, the amputation of the whole limb, with all the psychological and social significance it brings. Ankle-level block, despite being a simple technique, is not standard practice for patients with impaired physical condition. Objectives: to identify the effectiveness of the ankle block for surgical procedures of the foot in diabetic patients with compromised physical condition. Methods: A longitudinal, observational, analytic, prospective, cohort study was carried out in a population of diabetic patients in Dr. Antonio Agostinho Neto General Teaching Hospital of Guantanamo, who were surgically intervened for infectious foot lesions and performed ankle-level foot-trunk block. From a sample group of 48 patients, through a probabilistic determination, a sample of 32 was taken during the period from February 2014 to February 2016. Results: There was a predominance of urgent interventions located on the instep and knuckles amputation. Complications were minimal as related to the application of the ankle block technique, with only one failure of the technique; adequate hemodynamic clinical control was maintained, 100 percent of postoperative analgesia was ensured. Conclusions: the ankle-level foot block for surgical purposes is effective in diabetic patients' foot lesions, as it improves their quality of life by providing adequate anesthetic technique in efficient hands(AU)

Critical Analysis of Sedation and Analgesia in Severe Head Trauma / Análise crítica da sedação e analgesia no traumatismo craniano grave

Introduction Head injury is a direct determinant of morbidity, disability, and mortality in the young population. Sedatives and analgesics are commonly used in patients with brain injury to retrieve an ICP, CMRO2, and CBF, preserving the cerebral regulation system and self-avoiding hypotension. Objective The objective of this paper is to review on this topic, linking themain drugs, side effects, costs, anxiolytic properties, anticonvulsants, and correlating them with complacency and brain metabolism. Methods We perform a literature review using PubMed database, MEDLINE, EMBASE, Science Direct, The Cochrane Database, Google Scholar, and Clinical trials.We selected papers from the period between 1958 and 2014, which totaled 254 papers. Of these, we selected 129 papers based on keywords, inclusion, and exclusion criteria. Evidence Review The volume of the brain decreases due to dislocation of the CBV out of the skull. The main sedatives and analgesics are propofol, midazolam, etomidate, ketamine, barbiturates, dexedetomedina, morphine, fentanyl, alfentanil, sulfenatil, and remifentanil. We hereby discuss the algorithm for a fast intubation sequence and the algorithm for intracranial hypertension treatment regarding the systematic sedation therapy. A range of sedatives and analgesic agents are available for sedation. Each class has its own positive and negative effects on neurotrauma patients. Conclusions The correct analysis of sedation and analgesia in neurotrauma, rapid sequence intubation, and management ofmedications in intracranial hypertension can lead to an ideal management of brain injury.

Introdução Traumatismo Craniano (TCE) é determinante direto na morbidade, incapacidade e mortalidade na população jovem. Sedativos e analgésicos são comumente usados em pacientes com lesão cerebral com o objetivo de recuperar PIC, CMRO2 e FBC, preservando o sistema de autorregulação cerebral, evitando hipotensão. Objetivo O objetivo deste trabalho é fazer uma revisão sobre este tema, correlacionando as principais drogas, efeitos colaterais, custos, propriedades ansiolíticas, anticonvulsivantes, correlacionando com complacência e metabolismo cerebral. Métodos Revisão da literatura utilizando base de dados PubMed, MEDLINE, EMBASE, Science Direct, The Cochrane Detabase, Google Scholar, ensaios clínicos. Os trabalhos selecionados de 1958 a 2014. Somou-se 254 trabalhos. Foram selecionados 129, através de palavras-chave, inclusão e critérios de exclusão. Evidência Revisão O volume do cérebro é reduzido devido o deslocamento do volume cerebral. Os principais sedativos e analgésicos são: propofol, midazolam, etomidato, cetamina, barbitúricos, a dexmedetomidina, morfina, fentanil, alfentanil, sulfato, remifentanil. Discute-se algoritmo para a sequência rápida de intubação e algoritmo para tratamento de hipertensão intracraniana. Uma série de sedativos e analgésicos agentes estão disponíveis para sedação. Cada classe tem seu próprio efeitos positivos e negativos em pacientes no neurotrauma. Conclusões e Relevância O presente trabalho contribui com a análise correta da sedação e analgesia em neurotrauma, sequência rápida de intubação e administração de medicamentos para analgesia e sedação em hipertensão intracraniana, e um ideal manejo na lesão cerebral.

Effects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery.

This study aimed to discuss the effects of 3 different analgesia methods on serum IL-6 and IL-10 in patients after cesarean delivery. Thirty full-term women, who underwent cesarean delivery, were randomly assigned to 3 analgesia groups (10 cases each) as follows: intramuscular injection of 100 mg pethidine (NC group), patient controlled epidural analgesia (PCEA) of 5 mg morphine plus 150 mg ropivacaine (MR group), and patient controlled intravenous analgesia (PCIA) of 150 mg sufentanil plus 5 mg droperidol (SF group). An electronic analgesia pump was available in all 3 groups. At 4, 12, 24, and 48 h after surgery, visual analogue scale (VAS) pain scores were evaluated, IL-6 and IL-10 serum levels were measured, and adverse reactions were documented. The MR and SF groups responded well to analgesia. VAS scores at 12 and 24 h in these 2 groups were significantly lower than those in the NC group (P < 0.05). IL-6 and IL-10 levels were elevated to varying degrees postoperatively in all 3 groups. In the MR and SF groups, no significant difference occurred at each time point (P > 0.05), but compared with the NC group, significant differences were observed at 12 and 24 h (P < 0.05). Both PCIA and PCEA produced good analgesic effect, decreased postoperative level of serum IL-6, promoted release of anti-inflammatory factor IL-10, maintained balance in postoperative serum IL-6 level, and reduced the postoperative inflammatory response. Adverse reactions were significantly higher with epidural morphine than with intravenous sufentanil.

Analgesia multimodal con la asociación de ketamina, dipirona y tramadol en cirugía de urgencia / Multimodal analgesia with ketamine, dipyrone and tramadol association in emergency surgery

Introducción: el dolor posoperatorio es frecuente en pacientes con afecciones que requieren cirugía de urgencia; su tratamiento satisfactorio constituye uno de los retos más importantes a que nos enfrentamos. Objetivo: comparar la analgesia multimodal mediante la asociación de las drogas tramadol, dipirona y ketamina, con la terapia tramadol-dipirona, en el paciente intervenido quirúrgicamente de urgencia.Métodos: estudio prospectivo, comparativo y transversal a 100 pacientes distribuidos de forma aleatoria en dos grupos de 50 cada uno, grupo I (grupo control): dipirona 1,2 g más tramadol 100 mg, diluidos en cloruro de sodio al 0,9 por ciento, 200 mL a pasar en 20 min por vía intravenosa, y grupo II (grupo estudio): dipirona 1,2 g más tramadol 100 mg, diluidos en cloruro de sodio al 0,9 por ciento, 200 mL a pasar en 20 min por vía intravenosa; además recibieron un bolo de ketamina de 0,3 mg/kg de peso corporal del paciente, seguido de infusión continua de este fármaco a una velocidad de infusión de 0,8 mg/kg/h hasta el fin de la cirugía. Resultados: la intensidad del dolor fue menor en el grupo en estudio, motivo por el cual se utilizó menos la analgesia de rescate, no así en el grupo control en que el 90 por ciento de los casos necesitó analgesia de rescate. Los efectos adversos que aparecieron fueron náuseas y vómitos en el grupo I, y mareo en el grupo II; no se registraron complicaciones en ninguno de los dos grupos. Conclusiones: la analgesia multimodal con la asociación de dipirona, tramadol y ketamina resulta ser un método analgésico superior en comparación a la analgesia dipirona-tramadol en el control del dolor posoperatorio de los pacientes intervenidos quirúrgicamente de urgencia(AU)

Introduction: the postoperative pain is frequent in the patients with affections that require urgency surgery. Its satisfactory treatment constitute one of the most important challenges that we face today. Objective: to compare multimodal analgesia by associating drugs as dipyrone, tramadol, and ketamine with tramadol-dipyrone therapy in patient emergency surgeries. Methods: a randomized prospective, comparative, cross-sectional study was conducted in 100 patients. They were distributed into two groups of 50 each: Group I (control group) had dipyrone 1.2 g plus 100 mg tramadol, diluted in sodium chloride 0.9 %, 200 mL in 20 min intravenously; group II (study group) had dipyrone 1.2 g plus 100 mg tramadol, diluted in sodium chloride 0.9 percent, 200 mL in 20 min intravenously. They also received a bolus of ketamine 0.3 mg/kg of patient body weight, followed by continuous infusion of this drug to an infusion rate of 0.8 mg / kg / h to the end of the surgery. Results: the pain intensity was smaller in the study group, thus less rescue analgesia was used, but subjects in the group control that 90 percent of the cases needed rescue analgesia. Side effects were nausea and vomiting in group I, and dizziness in group II. No complications occurred in either group.. Conclusions: multimodal analgesia with the association of dipyrone, tramadol, and ketamine turns out to be a superior analgesic method in comparison to dipyrone-tramadol analgesia for controlling postoperative pain in patient emergency surgeries(AU)

Bloqueo continuo del plexo braquial en el posoperatorio inmediato / Continuous brachial plexus block in immediate postoperative

Objetivo: evaluar el período posoperatorio inmediato en pacientes con lesiones traumáticas quirúrgicas del miembro superior que han recibido dos métodos de anestesia-analgesia. Métodos: se estudiaron 240 pacientes, todos ASA I-II-III según la clasificación del estado físico de la Sociedad Americana de Anestesiología. Se dividieron en dos grupos iguales, grupo G: anestesia general endotraqueal más fentanil y analgesia con dipirona 1,2 g IM cada 6 h, y grupo B: anestesia regional por técnicas continuas de bloqueo del plexo braquial con 100 mg de bupivacaína y analgesia regional con igual anestésico local cada 6 h. Resultados: las complicaciones respiratorias se presentaron solamente en el grupo G (p= 0,01), mientras que las cardiovasculares se observaron 5,3 veces más en el grupo G (p= 0,000). Las náuseas y vómitos se manifestaron en más de la mitad de los pacientes (55 por ciento) del grupo G y solo en seis (5 por ciento) del grupo B (p= 0,000). La retención de orina y la oliguria se observó en tres y cuatro pacientes respectivamente, todos masculinos y del grupo G (p= 0,000). La tendencia a la hiperglucemia apareció en el grupo G en 27 pacientes (22,5 por ciento) y solo en cinco (4,2 por ciento) del grupo B (p= 0,000). Las molestias por la manipulación de la vía aérea superior, se presentaron en 79 pacientes (65,8 por ciento) del grupo G; mientras que las molestias por el catéter solo se refirió en 16 pacientes (13,3 por ciento) del grupo B. El grupo G a las 24 h llegó a tener 69 pacientes (57,5 por ciento) en el nivel de analgesia no satisfactoria (p= 0,01).Conclusiones: el método de anestesia-analgesia regional por bloqueo continuo del plexo braquial tuvo menor incidencia de complicaciones en el posoperatorio inmediato y mejor calidad de analgesia(AU)

Objective: to evaluate the immediate postoperative period in surgical patients with traumatic injuries of the upper limb who have undertaken two methods of anesthesia-analgesia. Methods: 240 patients were studied, all ASA I-II-III according to the classification of the American Society of Anesthesiologists for physical state. They were divided into two equal groups. Group G had general endotracheal anesthesia and analgesia with fentanyl plus dipyrone 1.2 g IM every 6 h, and group B who had regional anesthesia techniques for continuous brachial plexus block with 100 mg of bupivacaine and regional analgesia with equal local anesthetic every 6 h. Results: respiratory complications occurred only in group G (p= 0.01), cardiovascular complications were observed 5.3 times more in G group (p= 0.000). Nausea and vomiting were expressed in more than half of patients (55 percent) in group G and only in six (5 percent) from group B (p= 0.000). Urine retention and oliguria were observed in three and four patients respectively, all male from group G (p= 0.000). Hyperglycemia tendency appeared in group G in 27 patients (22.5 percent) and in only five (4.2 percent) from group B (p= 0.000). Discomfort by manipulating the upper airway occurred in 79 patients (65.8 percent) from group G; nuisance due to the catheter was only referred in 16 patients (13.3 percent) from group B. 24 hours after surgery, Group G had 69 patients (57.5 percent) in unsatisfactory analgesia level (p= 0.01). Conclusions: the method of regional anesthesia-analgesia by continuous brachial plexus block had lower incidence of complications in the immediate postoperative period and better quality of analgesia(AU)

Analgesia multimodal con la asociación de ketamina, dipirona y tramadol en cirugía de urgencia / Multimodal analgesia with ketamine, dipyrone and tramadol association in emergency surgery

INTRODUCCIÓN: el dolor posoperatorio es frecuente en pacientes con afecciones que requieren cirugía de urgencia; su tratamiento satisfactorio constituye uno de los retos más importantes a que nos enfrentamos. OBJETIVO: comparar la analgesia multimodal mediante la asociación de las drogas tramadol, dipirona y ketamina, con la terapia tramadol-dipirona, en el paciente intervenido quirúrgicamente de urgencia. MÉTODOS: estudio prospectivo, comparativo y transversal a 100 pacientes distribuidos de forma aleatoria en dos grupos de 50 cada uno, grupo I (grupo control): dipirona 1,2 g más tramadol 100 mg, diluidos en cloruro de sodio al 0,9 %, 200 mL a pasar en 20 min por vía intravenosa, y grupo II (grupo estudio): dipirona 1,2 g más tramadol 100 mg, diluidos en cloruro de sodio al 0,9 %, 200 mL a pasar en 20 min por vía intravenosa; además recibieron un bolo de ketamina de 0,3 mg/kg de peso corporal del paciente, seguido de infusión continua de este fármaco a una velocidad de infusión de 0,8 mg/kg/h hasta el fin de la cirugía. RESULTADOS: la intensidad del dolor fue menor en el grupo en estudio, motivo por el cual se utilizó menos la analgesia de rescate, no así en el grupo control en que el 90 % de los casos necesitó analgesia de rescate. Los efectos adversos que aparecieron fueron náuseas y vómitos en el grupo I, y mareo en el grupo II; no se registraron complicaciones en ninguno de los dos grupos. CONCLUSIONES: la analgesia multimodal con la asociación de dipirona, tramadol y ketamina resulta ser un método analgésico superior en comparación a la analgesia dipirona-tramadol en el control del dolor posoperatorio de los pacientes intervenidos quirúrgicamente de urgencia.

INTRODUCTION: the postoperative pain is frequent in the patients with affections that require urgency surgery. Its satisfactory treatment constitute one of the most important challenges that we face today. OBJECTIVE: to compare multimodal analgesia by associating drugs as dipyrone, tramadol, and ketamine with tramadol-dipyrone therapy in patient emergency surgeries. METHODS: a randomized prospective, comparative, cross-sectional study was conducted in 100 patients. They were distributed into two groups of 50 each: Group I (control group) had dipyrone 1.2 g plus 100 mg tramadol, diluted in sodium chloride 0.9 %, 200 mL in 20 min intravenously; group II (study group) had dipyrone 1.2 g plus 100 mg tramadol, diluted in sodium chloride 0.9 %, 200 mL in 20 min intravenously. They also received a bolus of ketamine 0.3 mg/kg of patient body weight, followed by continuous infusion of this drug to an infusion rate of 0.8 mg / kg / h to the end of the surgery. RESULTS: the pain intensity was smaller in the study group, thus less rescue analgesia was used, but subjects in the group control that 90 % of the cases needed rescue analgesia. Side effects were nausea and vomiting in group I, and dizziness in group II. No complications occurred in either group.. CONCLUSIONS: multimodal analgesia with the association of dipyrone, tramadol, and ketamine turns out to be a superior analgesic method in comparison to dipyrone-tramadol analgesia for controlling postoperative pain in patient emergency surgeries.

Bloqueo continuo del plexo braquial en el posoperatorio inmediato / Continuous brachial plexus block in immediate postoperative

OBJETIVO: evaluar el período posoperatorio inmediato en pacientes con lesiones traumáticas quirúrgicas del miembro superior que han recibido dos métodos de anestesia-analgesia. MÉTODOS: se estudiaron 240 pacientes, todos ASA I-II-III según la clasificación del estado físico de la Sociedad Americana de Anestesiología. Se dividieron en dos grupos iguales, grupo G: anestesia general endotraqueal más fentanil y analgesia con dipirona 1,2 g IM cada 6 h, y grupo B: anestesia regional por técnicas continuas de bloqueo del plexo braquial con 100 mg de bupivacaína y analgesia regional con igual anestésico local cada 6 h. RESULTADOS: las complicaciones respiratorias se presentaron solamente en el grupo G (p= 0,01), mientras que las cardiovasculares se observaron 5,3 veces más en el grupo G (p= 0,000). Las náuseas y vómitos se manifestaron en más de la mitad de los pacientes (55 %) del grupo G y solo en seis (5 %) del grupo B (p= 0,000). La retención de orina y la oliguria se observó en tres y cuatro pacientes respectivamente, todos masculinos y del grupo G (p= 0,000). La tendencia a la hiperglucemia apareció en el grupo G en 27 pacientes (22,5 %) y solo en cinco (4,2 %) del grupo B (p= 0,000). Las molestias por la manipulación de la vía aérea superior, se presentaron en 79 pacientes (65,8 %) del grupo G; mientras que las molestias por el catéter solo se refirió en 16 pacientes (13,3 %) del grupo B. El grupo G a las 24 h llegó a tener 69 pacientes (57,5 %) en el nivel de analgesia no satisfactoria (p= 0,01). CONCLUSIONES: el método de anestesia-analgesia regional por bloqueo continuo del plexo braquial tuvo menor incidencia de complicaciones en el posoperatorio inmediato y mejor calidad de analgesia.

OBJECTIVE: to evaluate the immediate postoperative period in surgical patients with traumatic injuries of the upper limb who have undertaken two methods of anesthesia-analgesia. METHODS: 240 patients were studied, all ASA I-II-III according to the classification of the American Society of Anesthesiologists for physical state. They were divided into two equal groups. Group G had general endotracheal anesthesia and analgesia with fentanyl plus dipyrone 1.2 g IM every 6 h, and group B who had regional anesthesia techniques for continuous brachial plexus block with 100 mg of bupivacaine and regional analgesia with equal local anesthetic every 6 h. RESULTS: respiratory complications occurred only in group G (p= 0.01), cardiovascular complications were observed 5.3 times more in G group (p= 0.000). Nausea and vomiting were expressed in more than half of patients (55 %) in group G and only in six (5 %) from group B (p= 0.000). Urine retention and oliguria were observed in three and four patients respectively, all male from group G (p= 0.000). Hyperglycemia tendency appeared in group G in 27 patients (22.5 %) and in only five (4.2 %) from group B (p= 0.000). Discomfort by manipulating the upper airway occurred in 79 patients (65.8 %) from group G; nuisance due to the catheter was only referred in 16 patients (13.3 %) from group B. 24 hours after surgery, Group G had 69 patients (57.5 %) in unsatisfactory analgesia level (p= 0.01). CONCLUSIONS: the method of regional anesthesia-analgesia by continuous brachial plexus block had lower incidence of complications in the immediate postoperative period and better quality of analgesia.

Analgesia preventiva con drogas antiinflamatorias no esteroideas en procedimientos quirúrgicos abdominales de urgencia / Preventive analgesia with nonsteroidal anti-inflammatory drugs in emergency abdominal surgical procedures

Introducción: el arsenal de fármacos con los que cuenta el médico para aliviar el dolor es muy amplio. Muchos de ellos están al alcance de la mano y sólo hace falta tener los conocimientos para utilizarlos correctamente: Los AINEs constituyen los fármacos más utilizados.Objetivo: elaborar protocolos de analgesia preventiva para el paciente que se someterá a procedimientos quirúrgicos abdominal de urgencia. Método: estudio prospectivo de corte longitudinal, comparativo, a doble ciego en 120 pacientes intervenidos de urgencia. Variables: Edad, diagnóstico preoperatorio, antecedentes patológicos personales, duración de la intervención quirúrgica, evaluación del dolor postoperatorio, satisfacción del paciente. Método del Nivel Matemático Estadístico: Los datos obtenidos a través de un modelo recolector de datos (fueron procesados programas estadísticos SPSS versión 11,0 para Windows comprendió estudios de frecuencia, porcentaje y media, los resultados fueron presentados en tablas de contingencia, con una confiabilidad del 95,0 por ciento. Se utilizó el Chi cuadrado (X²). Resultados: la analgesia preventiva con metimazol y diclofenaco es eficaz, segura y reduce las necesidades de anestésicos. Conclusiones: el uso de diclofenaco y metimazol como analgésico en el periodo posoperatorio inmediato da resultados satisfactorios, su uso combinado hace más eficaz la analgesia posoperatoria. El diclofenaco presentó su efecto analgésico en mayor tiempo. Se requirió dosis de rescate en la mayoría de los pacientes del Grupo I, a diferencia de los pacientes del resto de los grupos(AU)

Introduction: the arsenal of drugs a doctor can use to relieve pain is very wide. Many of them are at hand and it is only required to have the knowledge to use them properly. NSAIDs are the most commonly used drugs. Objective: to elaborate preventive analgesia protocols for the patient who is going to undergo emergency abdominal surgical procedures. Method: a prospective longitudinal, comparative, double-blind study of 120 emergency patients operated on. Variables: age, preoperative diagnosis, personal pathological antecedents, duration of surgery, postoperative pain evaluation, patient satisfaction. Method of the Mathematical Statistical Level: the data obtained through a data collector model were processed by statistical programs SPSS version 11.0 for Windows, involved studies of frequency, percentage and mean, results were presented in contingency tables, with a reliability index of 95.0 percent. Chi-square (x2) was used. Results: preventive analgesia with methimazole and diclofenac is effective, safe and reduces the need for anesthetics. Conclusions: the use of methimazole and diclofenac as analgesics in the immediate postoperative period gives satisfactory results; its combined use makes postoperative analgesia more effective. Diclofenac presented its analgesic effect in greater time. Rescue dose was required in most of the Group 1 patients, in contrast to patients in the rest of the groups(AU)

Analgesia multimodal para el dolor posoperatorio del paciente con apendicectomía de urgencia / Multimodal analgesia for postoperative pain in patients undergoing emergency appendectomy

Introducción: el dolor agudo es frecuente en los pacientes con afecciones que requieren intervención quirúrgica de urgencia. Su tratamiento satisfactorio es uno de los retos más importantes, presentando ventajas la terapéutica multimodal del dolor posoperatorio al empleo de una sola droga analgésica.Objetivo: comparar el uso de la analgesia multimodal con la monoterapia analgésica en el manejo del dolor posoperatorio de pacientes con apendicectomía de urgencia. Métodos: se realizó un estudio comparativo en 40 pacientes que fueron distribuidos de forma aleatoria en dos grupos de 20 pacientes cada uno. Después de la inducción de la anestesia los pacientes del grupo I recibieron dipirona intravenosa y los del grupo II recibieron además tramadol y ketamina. Se estudió calidad de la analgesia, necesidad de analgesia de rescate, complicaciones y efectos adversos. Resultados: la intensidad del dolor fue menor en el grupo II. La analgesia de rescate solo fue necesaria en el grupo I. Los efectos adversos fueron náuseas, vómitos y mareos en el grupo I. No se registraron complicaciones en los grupos en estudio.Conclusiones: la analgesia multimodal resulta un método que proporciona mayor control del dolor posoperatorio que la monoterapia analgésica en pacientes con apendicectomía de urgencia(AU)

Introduction: Acute pain is common among patients with disorders requiring emergency surgery, and its relief is one of the greatest challenges in such circumstances. Multimodal postoperative pain relief therapy has proven to be more effective than the use of a single analgesic. Objective: compare the use of multimodal analgesia with analgesic monotherapy for the management of postoperative pain in patients undergoing emergency appendectomy. Methods: a comparative study was conducted of 40 patients randomly distributed into two groups, each composed of 20 patients. After the induction of analgesia, patients in Group I received intravenous dipyrone, and those in Group II additionally received tramadol and ketamine. The following parameters were observed: quality of analgesia, need of rescue analgesia, complications and adverse effects. Results: pain intensity was lower in Group II. Rescue analgesia was required only in Group I. The adverse effects were nausea, vomiting and dizziness in Group I. No complications occurred in the study groups. Conclusions: multimodal analgesia is more effective than analgesic monotherapy as a method to control postoperative pain in patients undergoing emergency appendectomy(AU)

Eficacia del bloqueo caudal versus bloqueo subaracnoideo bajo sedación en el paciente pediátrico / Caudal against spinal block effcacy under sedation of the pediatric patient

Antecedentes: esta incrementado el uso de anestesia regional en pediatría, única o combinada con sedación ó anestesia general, para aumentar la analgesia postoperatoria, disminuir la utilización de fármacos sistémicos, los riesgos de la anestesia general y costos hospitalarios. Objetivo: determinar la eficacia de la analgesia quirúrgica y postoperatoria con bloqueo caudal versus el bloqueo subaracnoideo en pediatría. Materiales y Pacientes: Estudio descriptivo prospectivo, incluyendo 40 pacientes. Los criterios de inclusión fueron: edad de 1-15 años, indicación de cirugía en región inguinal y miembros inferiores, sexo indistinto, riesgos potencial al uso de anestesia general ASA I y II. Las variables para medir eficacia del procedimiento: analgesia quirúrgica, analgesia postoperatoria, recuperación del bloqueo motor, efectos secundarios y tipo de cirugía. Resultados: A 20 se les aplicó bloqueo caudal y a 20 bloqueo subaracnoideo. La eficacia de la analgesia quirúrgica en el bloqueo caudal fue en 16(80%) y en 20(100%) con subaracnoideo. La analgesia postoperatoria fue de 12-18 hrs en el bloqueo caudal y más de 24 hrs en el subaracnoideo. La recuperación inmediata del bloqueo motriz se presentó en los 20(100%) pacientes con bloqueo caudal y en 3(15%) con subaracnoideo. Ningún efecto secundario en el bloqueo caudal y con el bloqueo subaracnoideo 2(10%) presentaron náuseas y vómitos. En las cirugías ortopédicas el bloqueo caudal falló en 4(20%) y no se observaron fallas con el bloqueo subaracnoideo. Conclusión: Ambos bloqueos son eficaces para anestesia quirúrgica y seguros para el paciente pediátrico, pero en este grupo de pacientes el bloqueo subaracnoideo es más eficaz para la analgesia postoperatoria y para cirugía ortopédica...

Analgesia e anestesia em procedimentos ortopédicos de pequenos animais / Analgesia and anesthesia in small animal orthopedic procedures

A dor é uma experiência sensorial e emocional desagradável que causa alterações fisiológicas no animal, prejudicando a qualidade de vida e prolongando o período de recuperação. Constantemente, os veterinários são desafiados a avaliar e tratar a dor de origem ortopédica. Em muitos casos, a correção cirúrgica da doença ortopédica não é uma opção, assim, um protocolo para anestesia e analgesia perioperatória deve ser cuidadosamente planejado. Em casos de pacientes politraumatizados, a conduta anestésica inclui a avaliação e tratamento do choque e possíveis lesões em outros sistemas. O objetivo do presente trabalho é descrever os principais fármacos e cuidados na anestesia e analgesia de doenças ortopédicas em cães e gatos, destacando o uso de analgésicos e o manejo anestésico desses pacientes.(AU)

Pain is an unpleasant sensory and emotional experience that causes physiological changes in animals, impairing the quality of life and prolonging the recovery period. Veterinarians are constantly challenged to assess and treat pain from orthopedic surgery. In many cases, surgical correction of orthopedic disease is not an option, so a protocol for anesthesia and perioperative analgesia should be carefully planned. In cases of patients with multiple trauma, anesthesia includes the evaluation and treatment of shock and possible injury to other systems. The aim of this paper is to describe the main drugs and care in anesthesia and analgesia for orthopedic diseases in dogs and cats, highlighting the use of analgesics and anesthetic management of these patients.(AU)