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

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

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

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

Analgesia in clinically relevant rodent models of sepsis.

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

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

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

Procedural sedation and analgesia in children.

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

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

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

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

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

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

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

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

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