A prospective, comparative study of the analgesic effect between the WALANT technique and local anesthesia associated with sedation for hand surgery.

PURPOSE: The primary objective of this study was to compare the WALANT (wide awake, local anesthesia, no tourniquet) technique with local anesthesia associated with sedation in relation to pain intensity for minor hand surgical procedures. The secondary objective was to evaluate the need for analgesic complementation. METHODS: A prospective, randomized, comparative, and clinical study was carried out. The sample size in each group was determined after statistical evaluation of the results of a pilot project. The participants were allocated to one of two groups; those in group 1 were submitted to the WALANT technique, and those in group 2, to local anesthesia associated with sedation, for elective surgery. The surgical procedures were carpal tunnel syndrome, De Quervain's tenosynovitis, synovial cyst, finger cyst, and trigger finger. Pain intensity, need for complementation and evolution to complex regional pain syndrome were evaluated. RESULTS: There was no difference between groups in pain intensity after WALANT and need for intraoperative complementation. There was no significant difference in the amount of opioid applied postoperatively between the groups. There was no difference between groups regarding comfort during surgery. There was no difference in adverse effects and complications between the groups. Hematoma was the most frequent adverse event. No severe adverse events were observed. CONCLUSIONS: The WALANT technique promoted an analgesic effect similar to that of local anesthesia associated with sedation, without increasing adverse effects.

A prospective, comparative study of the analgesic effect between the WALANT technique and local anesthesia associated with sedation for hand surgery

Purpose: The primary objective of this study was to compare the WALANT (wide awake, local anesthesia, no tourniquet) technique with local anesthesia associated with sedation in relation to pain intensity for minor hand surgical procedures. The secondary objective was to evaluate the need for analgesic complementation. Methods: A prospective, randomized, comparative, and clinical study was carried out. The sample size in each group was determined after statistical evaluation of the results of a pilot project. The participants were allocated to one of two groups; those in group 1 were submitted to the WALANT technique, and those in group 2, to local anesthesia associated with sedation, for elective surgery. The surgical procedures were carpal tunnel syndrome, De Quervain's tenosynovitis, synovial cyst, finger cyst, and trigger finger. Pain intensity, need for complementation and evolution to complex regional pain syndrome were evaluated. Results: There was no difference between groups in pain intensity after WALANT and need for intraoperative complementation. There was no significant difference in the amount of opioid applied postoperatively between the groups. There was no difference between groups regarding comfort during surgery. There was no difference in adverse effects and complications between the groups. Hematoma was the most frequent adverse event. No severe adverse events were observed. Conclusions: The WALANT technique promoted an analgesic effect similar to that of local anesthesia associated with sedation, without increasing adverse effects.

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy.

BACKGROUND AND OBJECTIVES:: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING:: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS:: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS:: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS:: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION:: ClinicalTrials.gov NCT02839538.

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy / Estudo clínico randomizado do efeito analgésico da infiltração local versus bloqueio espinal para hemorroidectomia

ABSTRACT BACKGROUND AND OBJECTIVES: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION: ClinicalTrials.gov NCT02839538.

RESUMO CONTEXTO E OBJETIVO: A analgesia pós-operatória e a recuperação precoce são relevantes para a alta hospitalar. O objetivo primário deste estudo foi comparar a eficácia analgésica da infiltração perianal e da anestesia subaracnóidea para hemorroidectomia. O objetivo secundário foi comparar o tempo para alta, efeitos adversos e complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado prospectivo e comparativo, no Hospital Dr. Mário Gatti. MÉTODOS: Foram incluídos 40 pacientes com idades 18-60 anos, na categoria 1 ou 2 de status físico da Sociedade Americana de Anestesiologistas. O grupo local (LG) recebeu infiltração local (ropivacaína a 0,75%) sob anestesia geral; o espinal (SG) recebeu bloqueio subaracnóideo (2 ml de bupivacaína a 0,5%). A suplementação analgésica foi com fentanil para LG e lidocaína para SG. Foram avaliados: intensidade da dor no pós-operatório, relaxamento do esfíncter, força dos membros inferiores, tempo de alta, dose de analgésico em uma semana e efeitos adversos. RESULTADOS: Onze (52,4%) pacientes em LG necessitaram de complementação, e nenhum em SG. A intensidade da dor foi maior para LG até 120 minutos, sem diferenças em 150 ou 180 minutos. Não houve diferenças na necessidade de paracetamol ou tramadol. O tempo para a primeira complementação analgésica e a alta hospitalar foram maiores para SG. Os efeitos adversos foram náuseas, tonturas e retenção urinária. CONCLUSÕES: A intensidade da dor foi maior na LG que na SG nas primeiras 2 horas, porém sem diferenças após 150 e 180 minutos. O tempo para a primeira suplementação foi menor na LG; sem diferenças nas doses de paracetamol e tramadol e efeitos adversos. REGISTRO: ClinicalTrials.gov NCT02839538.

Avaliação do efeito da estimulação nervosa elétrica transcutânea (TENS) para analgesia após toracotomia / Assessing the effects of transcutaneous electrical nerve stimulation (TENS) in post-thoracotomy analgesia

JUSTIFICATIVA E OBJETIVOS: A estimulação nervosa elétrica transcutânea (TENS) é uma modalidade frequentemente usada para o tratamento da dor musculoesquelética, mas também pode ser indicada em caso de analgesia pós-operatória. O objetivo deste estudo foi avaliar o efeito analgésico da TENS após toracotomia. MÉTODO: Foram incluídos 30 pacientes entre 18 e 60 anos submetidos à toracotomia para ressecção de câncer pulmonar, no segundo dia após a operação, alocados em dois grupos, G1 e G2. Os pacientes do G1 foram submetidos ao tratamento com TENS; nos do G2 (sem TENS), os eletrodos foram colocados, porém o aparelho não foi ligado. A TENS foi mantida por uma hora. A avaliação do efeito analgésico ocorreu através da escala analógica visual em três momentos: antes da aplicação (M0), imediatamente após o término do procedimento (M1) e uma hora depois (M2), com o paciente em repouso, em elevação dos membros superiores, com mudança de decúbito e tosse. RESULTADOS: A intensidade da dor em repouso foi maior em G2 imediatamente após o término, mas não uma hora após o procedimento. Com elevação dos membros superiores, mudança de decúbito e tosse, não houve diferença entre os grupos. CONCLUSÕES: Com aplicação de TENS durante uma hora no segundo dia após toracotomia em pacientes que receberam fentanil (50 µg) associada à bupivacaína (5 mL) em repouso, houve diminuição da intensidade da dor imediatamente após o término da aplicação; com elevação dos membros superiores e mudança de decúbito e tosse não houve redução da intensidade da dor.

BACKGROUND AND OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat musculoskeletal pain, but it may also be indicated for postoperative analgesia. The objective of this study was to evaluate the analgesic effects of TENS on post-thoracotomy. METHODS: Thirty patients between 18 and 60 years of age undergoing thoracotomy for lung cancer resection on the second postoperative day were included in this study. Patients were divided into two groups (G1 and G2). G1 patients were treated with TENS; and in G2 (without TENS) electrodes were placed but the equipment was not turned on. TENS was maintained for one hour. The visual analogue scale was used to evaluate the analgesic effects on three moments: before TENS (M0), immediately after TENS (M1), and one hour later (M2), with the patient at rest, elevation of the upper limbs, change in decubitus, and coughing. RESULTS: The intensity of pain at rest was higher in G2 immediately after TENS, but not one hour after the procedure. There was no difference between both groups with elevation of the upper limbs, decubitus change, and coughing. CONCLUSIONS: With the use of TENS for one hour on the second post-thoracotomy day in patients who received fentanyl (50 µg) associated with bupivacaine (5 mL), a reduction in pain intensity was observed at rest immediately after TENS; with elevation of the upper limbs, change in decubitus, and coughing, a reduction in pain severity was not observed.

JUSTIFICATIVA Y OBJETIVOS: La estimulación nerviosa eléctrica transcutánea (TENS), es una modalidad frecuentemente usada para el tratamiento del dolor musculoesquelético, pero también puede ser indicada en caso de analgesia postoperatoria. El objetivo de este estudio fue evaluar el efecto analgésico de la TENS después de la toracotomía. MÉTODO: Se incluyeron 30 pacientes entre 18 y 60 años, sometidos a la toracotomía para la resección de cáncer pulmonar, en el segundo día después de la operación. Los pacientes del G1 se sometieron al tratamiento con TENS; en los del G2 (sin TENS), se colocaron los electrodos, pero el aparato no se encendió. La TENS se mantuvo durante una hora. La evaluación del efecto analgésico se dio a través de la escala analógica visual en tres momentos: antes de la aplicación (M0), inmediatamente después del término del procedimiento (M1) y una hora después (M2), con el paciente en reposo, la elevación de los miembros superiores, el cambio de decúbito y con tos. RESULTADOS: La intensidad del dolor en el estado de reposo fue más elevada en el G2, inmediatamente después del término, pero no una hora después del procedimiento. Con la elevación de los miembros superiores, el cambio de decúbito y la tos, no hubo diferencia entre los grupos. CONCLUSIONES: Con la aplicación de TENS durante una hora en el segundo día después de la toracotomía en pacientes que recibieron fentanil (50 µg), asociada a la bupivacaína (5 mL) en reposo, se registró una reducción en la intensidad del dolor inmediatamente después del término de la aplicación. Pero con la elevación de los miembros superiores, el cambio de decúbito y la tos, no hubo reducción en la intensidad del dolor.

Assessing the effects of transcutaneous electrical nerve stimulation (TENS) in post-thoracotomy analgesia.

BACKGROUND AND OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat musculoskeletal pain, but it may also be indicated for postoperative analgesia. The objective of this study was to evaluate the analgesic effects of TENS on post-thoracotomy. METHODS: Thirty patients between 18 and 60 years of age undergoing thoracotomy for lung cancer resection on the second postoperative day were included in this study. Patients were divided into two groups (G1 and G2). G1 patients were treated with TENS; and in G2 (without TENS) electrodes were placed but the equipment was not turned on. TENS was maintained for one hour. The visual analogue scale was used to evaluate the analgesic effects on three moments: before TENS (M0), immediately after TENS (M1), and one hour later (M2), with the patient at rest, elevation of the upper limbs, change in decubitus, and coughing. RESULTS: The intensity of pain at rest was higher in G2 immediately after TENS, but not one hour after the procedure. There was no difference between both groups with elevation of the upper limbs, decubitus change, and coughing. CONCLUSIONS: With the use of TENS for one hour on the second post-thoracotomy day in patients who received fentanyl (50 µg) associated with bupivacaine (5 mL), a reduction in pain intensity was observed at rest immediately after TENS; with elevation of the upper limbs, change in decubitus, and coughing, a reduction in pain severity was not observed.

Review of the use of gabapentin in the control of postoperative pain.

BACKGROUND AND OBJECTIVES: Gabapentin has been used as adjuvant in the treatment of postoperative pain with a neuropathic component. It is responsible for the inhibition of central sensitization, decreasing postoperative pain. CONTENTS: All clinical, randomized studies that evaluated the effects of gabapentin on postoperative pain in humans between 2002 and 2007 for a total of 26 studies were selected. In 17 studies, patients received a single preoperative dose, which ranged from 300 to 1,200 mg, 30 minutes to two hours before surgery in the remaining studies, the administration of the drug was initiated one to 24 hours before the procedure and continued for 10 days, in doses that ranged from 1,200 to 1,800 mg.day(-1). To measure pain severity, the Visual Analog or Numeric Rating Scale was used. In 75% of patients who received a single dose of gabapentin, scores were lower, and the same was seen in 55.6% of patients who received the drugs pre- and postoperatively. Opioid consumption was reduced in 82.4% of patients who received a single dose, and in 77.8% of patients who received pre- and postoperative gabapentin. Among the studies using a single dose of gabapentin, four did not describe adverse effects; 52.9% showed no differences, 11.8% detected more nausea or vomiting, 5.9% experienced more dizziness, 5.9% more sedation, less nausea or vomiting in one, and less urinary retention in one. Among the studies with pre- and postoperative administration of gabapentin, four did not describe adverse effects; 22.2% showed no differences, 11.1% had more nausea or vomiting, 22.2% more dizziness, and 11.1% more sedation. CONCLUSIONS: Gabapentin, used before as well as before and after surgery, decreased pain severity and the need of analgesic supplementation.

Tratamento da dor nas pneumopatias / Treatment of chest pain

Revisäo da literatura em relaçäo a conceitos básicos sobre a nocicepçäo, principais causas de dor torácica, fisiopatologia da dor de origem pulmonar e sua abordagem terapêutica. O tratamento discute as principais drogas empregadas no controle da dor, princípios gerais de utilizaçäo, mecanismos de açäo e efeitos colaterais. A indicaçäo e limitaçäo dos métodos físicos, os bloqueios anestésicos, bem como a neurocirurgia funcional, säo discutidos