ABSTRACT
Objectives: To compare the possible benefits of the combination of dexamethasone-bupivacaine with articaine-epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine-epinephrine and submucosal reinforcement with 0.8 mg dexamethasone-5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine-epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients' scores on the VAS as well as their consumption of analgesic drugs after surgery.
ABSTRACT
Recently, it has been reported that topical irrigations of liquid sevoflurane on the bed of painful wounds produce a rapid, intense, and lasting analgesic effect. In this paper, A cohort of 112 patients with painful pressure ulcers who were refractory to opioids (or who exhibited undesirable adverse events to them) was treated with topical sevoflurane as per local institutional policy. These patients were recruited from an intensive care unit for a period of 3 years. The main aim was to determine the effectiveness of topical sevoflurane in reducing the pain of PUs and reducing the ulcer area. Study findings are reported and discussed herein and suggest that sevoflurane is a viable and promising treatment option for PUs.
Subject(s)
Administration, Intravenous , Administration, Topical , Analgesics, Opioid/therapeutic use , Pain/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Pressure Ulcer/drug therapy , Sevoflurane/therapeutic use , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Prospective Studies , SpainABSTRACT
La presencia de úlceras cutáneas, con tendencia a la cronicidad y con mala respuesta al arsenal terapéutico-analgésico clásico, conllevan un alto grado de dolor, discapacidad y merma en la calidad de vida. Presentamos el caso de una paciente terminal con un cuadro álgico debido a la presencia de múltiples úlceras vasculares en miembros inferiores de 3 meses de evolución y de difícil manejo por mala tolerancia a anticomiciales y opioides mayores. Las instilaciones tópicas de forma periódica del anestésico halogenado sevoflurano sobre el lecho ulceroso lograron un excelente control del dolor basal e irruptivo a los pocos minutos de su administración, y una progresiva mejoría en la cicatrización de las úlceras sin evidenciar efectos secundarios asociados
The presence of cutaneous ulcers, with a tendency to become chronic and without a response to the therapeutic-analgesic arsenal available, carry a heightened degree of pain and disability and significantly compromise patient quality of life. A case is reported of a terminally ill woman with a painful condition due to the presence of multiple vascular ulcers of 3 months onset in lower right limb, and difficult to manage because of poor tolerance to anticonvulsants and major opioids. Periodically administered topical applications of halogenated anaesthetic sevoflurane on the ulcer bed achieved good results in baseline and breakthrough pain management within a few minutes after application and a progressive improvement in the healing of ulcers without associated adverse effects
Subject(s)
Humans , Female , Middle Aged , Skin Ulcer/drug therapy , Anesthetics/administration & dosage , Administration, Topical , Palliative Care/methodsABSTRACT
PURPOSE: Results of efficacy and safety assessments of topical sevoflurane use in patients with long-term treatment-refractory vascular ulcers are reported. METHODS: Patients were randomly assigned to receive sevoflurane instillations (1 mL per cm2 of ulcer area 1-4 times daily) plus standard wound care (ulcer cleaning, debridement, and dressing changes) or standard care only. Topical sevoflurane was initiated during hospitalization, with self- or nurse-administered instillations continued after discharge. Study participants were evaluated at least once weekly for 1 month and then every 2 weeks for up to 90 days. The primary efficacy measures were debridement-related and overall pain (assessed using a 10-point visual analog scale), daily opioid use, and ulcer size; secondary measures were patient and clinician impressions of improvement and ulcer-related admissions during treatment. The primary safety endpoint was intolerable sevoflurane-related adverse effects. RESULTS: Compared with the group receiving standard care alone (n = 5), the sevoflurane group (n = 10) had significant (p = 0.001) reductions in mean ± S.D. scores for debridement-related pain on day 1 of treatment and at subsequent time points; the sevoflurane group also had significant reductions in overall pain, daily opioid use, and ulcer size. Outcomes in terms of patient- and clinician-rated improvement and emergency admissions also favored the sevoflurane group. Mild localized reddening in the area surrounding ulcers occurred in 4 sevoflurane-treated patients. CONCLUSION: Direct application of sevoflurane onto vascular ulcers resulted in an intense and long-lasting analgesia and was associated with a progressive reduction of ulcer size.
Subject(s)
Anesthetics, Inhalation/administration & dosage , Pain Management/methods , Pain/drug therapy , Sevoflurane/administration & dosage , Skin Ulcer/drug therapy , Administration, Cutaneous , Aged , Aged, 80 and over , Chronic Disease/drug therapy , Female , Humans , Male , Middle Aged , Pain/diagnosis , Pain/etiology , Pain Measurement , Prospective Studies , Skin Ulcer/complications , Treatment OutcomeABSTRACT
BACKGROUND: We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). METHODS: This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The experimental group (EG) washed their hands with soap and water, together with using hand sanitizer, and the control group followed their usual handwashing procedures. Absenteeism rates due to URIs were compared between the 2 groups through a multivariate Poisson regression analysis. The percent of days missed in both groups were compared with a z test. RESULTS: Overall, 1271 cases of school absenteeism due to URIs were registered. Schoolchildren from the EG had a 38% lower risk of absenteeism due to URIs, incidence rate ratio: 0.62, 95% confidence interval: 0.55-0.70, and a decrease in absenteeism of 0.45 episodes/child/academic year, p < .001. Pupils missed 2734 school days due to URIs and the percentage of days absent was significantly lower in the EG, p < .001. CONCLUSIONS: Use of hand sanitizer plus handwashing with soap accompanied by educational support is an effective measure to reduce absenteeism due to URIs.
Subject(s)
Absenteeism , Hand Hygiene/methods , Hand Hygiene/statistics & numerical data , Health Education/methods , Respiratory Tract Infections/prevention & control , Child , Child, Preschool , Female , Hand Disinfection/methods , Humans , Male , Schools , Socioeconomic Factors , SpainABSTRACT
El presente estudió evaluó la relación entre la escoliosis y un conjunto de variables de tipo cronológico, motriz (zurdo o diestro) y de transporte de material escolar (mochila o trolley) en una población masculina en el ámbito educativo. La selección definitiva de la muestra, compuesta por 682 participantes, con edad comprendida entre 612 años y pertenecientes a Granada (España) y alrededores se realizó por muestreo, atendiendo a una composición natural de los grupos. Se seleccionaron varios instrumentos de medición (Inventario de Lateralidad Manual de Edinburgh, test de Adams y cuestionario) para recoger las variables seleccionadas. Los resultados indicaron que el 9,4% (n=64) eran escolióticos, el 10 % (n=73) eran zurdos y el 58,2% empleaba la mochila como medio de transporte de material escolar. No se encontraron diferencias estadísticamente significativas entre la desviación del raquis y las variables de tipo dominancia lateral y transporte de material escolar, no sucediendo lo mismo con la variable cronológica (p=0,03); del mismo modo, se encontró asociación entre la edad y el transporte de material (p=0,00), motivada por movimientos socioculturales (actitudes, costumbres, hábitos, etc.). Como principales conclusiones, cabe resaltar la nula relación entre la escoliosis y la dominancia lateral izquierda, así como el material con el que se transportan los utensilios escolares; sin embargo, no descartamos que en edades más avanzadas pueda invertirse esta situación, por lo que surge la necesidad de desarrollar programas de prevención de la patología del raquis en escolares y adultos, y aplicarles las pautas de ergonomía correctas enfocadas a incrementar la calidad de vida(AU)
This research study evaluated the relationship between scoliosis and a set of variables related to age, motor skills (left-handed or right-handed) and the method of transporting school supplies (backpack or trolley) among a school-aged male population. The final selection of the sample - comprising 682 participants between 6 and 12 years old and residents in Granada (Spain) - was conducted by sampling in response to a natural composition of the groups. Several measurement instruments (such as Edinburgh Handedness Inventory, Adam's test and a questionnaire) were applied in order to collect the selected variables. The results indicated that 9.4% (n = 64) of the boys suffered from scoliosis, 10% (n= 73) were left-handed and 58.2% used a backpack for the transportation of school supplies. No statistically significant difference was found between the deviation of the spine and lateral dominance nor between the transportation of school supplies and deviation of the spine; however the results showed a connection between age and incidence of scoliosis (p= 0.03) as well as between age and the method of transporting school supplies (p= 0.00), mainly due to sociocultural habits. In conclusion, there is no connection between suffering scoliosis and left-handedness, nor between the method of transporting school supplies and the incidence of scoliosis. However, these results could vary at older ages and, therefore, programs aimed at teaching good ergonomic guidelines and preventing the pathology of the spine in schoolchildren and adults are highly encouraged in order to improve their quality of life(AU)
