The association of caffeine and nandrolone decanoate modulates aversive memory and nociception in rats.

Caffeine and anabolic-androgenic steroids (AAS) are commonly used to improve muscle mass and athletic performance. Nandrolone Decanoate (ND) is one of the most abused AAS worldwide, leading to behavioral changes in both humans and rodents. Caffeine, the most widely consumed psychostimulant globally, is present in various thermogenic and gym supplements. Low and moderate doses of caffeine antagonize adenosine receptors and have been linked to improved memory and pain relief. We have previously demonstrated that consuming caffeine prevents the risk-taking behavior triggered by nandrolone. In this study, we aimed to investigate the long-term effects of ND and caffeine, either alone or in combination, on passive avoidance memory and nociception. We used the step-down and hot-plate tasks in male and female Lister Hooded rats. Our results confirmed the antinociceptive effect of caffeine and indicated that chronic administration of the ND-caffeine association promotes the evocation of aversive memory in female rats.

Innovative vs classical methods for drying heterotrophic Chlorella vulgaris: Impact on protein quality and sensory properties.

Drying is a necessary step in the microalgae production chain to reduce microbial load and oxidative degradation of the end product. Depending on the differences in applied temperature and treatment time, the process of drying can have a substantial impact on protein quality and aroma, important characteristics determining the incorporation potential in food products. In this study, we compared the drying of heterotrophic Chorella vulgaris with both innovative (agitated thin film drying (ATFD), pulse combustion drying (PCD) and solar drying (SolD)) and commonly used drying techniques (spray drying (SprD) and freeze drying (FD)). To evaluate the impact on protein quality, we evaluated techno-functional properties, in vitro digestibility (INFOGEST) as well as protein denaturation using differential scanning calorimetry (DSC). A sensory analysis was performed by a trained expert panel, combined with headspace solid-phase microextraction (HS-SPME) - gas chromatography-mass spectrometry (GC-MS) to determine volatile organic compounds (VOCs). ATFD was found to increase techno-functional properties such as gelling, water holding and solubility as well as in vitro protein digestibility. These observations could be related to induced cell disruption and protein denaturation by ATFD. Sensory analysis indicated an increased earthy off-flavor after ATFD. Interestingly, the high-temperature PCD led to an increase in cacao odor while low-temperature FD resulted in lower flavor, odors and VOCs. These results demonstrate that protein quality and sensorial properties of C. vulgaris can be steered through the type of drying, which could help in the selection of application-specific drying methods. Overall, this work could promote the incorporation of microalgal single cell proteins in different innovative food products.

Extending records of albinism and skin disorders in American cownose rays to southeastern Brazil.

Albinism is a genetic condition expressed as a lack of integumentary and retinal melanin. Although documented across many vertebrate species, albinism and other skin disorders are rarely observed in elasmobranchs (sharks and rays). The present study describes the first confirmed case of albinism in American cownose ray (Rhinoptera bonasus), and three other juveniles of the species with undetermined skin disorders observed in São Paulo, southeastern Brazil. Pigmentation disorders have already been observed in American cownose rays from the North Atlantic, including two cases of leucism and a possible albinism. Based on the results, it was discussed the possible consequences of albinism for the ray survival as well as the possible causes for the undetermined skin disorders.

Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit.

The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.

Como eu faço o ecocardiograma na anemia falciforme / My approach to imaging in sickle cell anemia

RESUMO: A doença falciforme (DF) notabiliza-se como problema global de saúde pública, caracterizando-se pela mudança da hemácia para a forma de foice, além da anemia crônica verifica-se alteração da reologia dos glóbulos vermelhos, ocasionando um cenário de inflamação e estresse oxidativo, fazendo da DF uma enfermidade multissistêmica. O débito cardíaco (DC) encontra-se elevado, acarretando aumento das câmaras cardíacas globalmente e hipertrofia miocárdica tipo excêntrica. Essas alterações cardíacas eram atribuídas apenas a reações adaptativas ao estado anêmico crônico. Estudos recentes reconhecem de maneira patente a associação com hipertensão pulmonar (HP), disfunção diastólica do ventrículo esquerdo, arritmias e morte súbita; e, nesse contexto, surge recentemente a hipótese da existência de uma cardiomiopatia falcêmica, caracterizada por disfunção diastólica e fisiologia restritiva. O ecocardiograma configura como instrumento fundamental na determinação dos volumes cavitários, da função diastólica e da estimativa da pressão pulmonar, e constitui recurso valioso no diagnóstico e na condução terapêutica na síndrome torácica aguda. A utilização do strain miocárdico, as variáveis rotacionais, o trabalho miocárdico e a ecocardiografia 3D podem ser utilizados na tentativa de auxiliar a identificação precoce dos pacientes que estão sob maior risco de desenvolverem complicações e morte relacionada à DF.

ABSTRACT: Sickle cell disease (SCD) is recognized as a global problem in public health, characterized by the alteration in the red blood cells to the sickle form. Moreover, chronic anemia can also be observed through the change in the rheology of the red blood cells, leading to a scenario of inflammation and oxidative stress, making SCD a multisystem disease. Cardiac output (CO) proved to be high, leading to an overall increase in the heart chambers and an eccentric myocardial hypertrophy. These heart alterations were attributed only to adaptive reactions to chronic anemia. Recent studies have more clearly recognized an association with pulmonary hypertension (PH), left ventricular diastolic dysfunction, arrhythmias, and sudden death. Moreover, what has also arisen in this context is the hypothesis of the existence of a sickle-cell cardiomyopathy, characterized by diastolic dysfunction and restrictive physiology. The echocardiogram represents a key tool in determining cavitary volumes, diastolic dysfunction, and the estimation of pulmonary pressure, as well as constitutes a valuable resource in the diagnosis and therapeutic treatment of acute chest syndrome. The myocardial strain, rotational variables, myocardial work, and 3D echocardiography can be applied in an attempt to aid in the early detection of patients who are at a higher risk of developing complications and evolving to death related to SCD.

Diet-Induced Microbiome's Impact on Heart Failure: A Double-Edged Sword.

Heart failure (HF) is a debilitating disease with a significant clinical and economic impact worldwide. Multiple factors seem to increase the risk of developing HF, such as hypertension, obesity and diabetes. Since chronic inflammation plays a significant role in HF pathophysiology and gut dysbiosis is associated with low-grade chronic inflammation, the risk of cardiovascular diseases is likely modulated by the gut microbiome (GM). Considerable progress has been made in HF management. However, there is a need to find new strategies to reduce mortality and increase the quality of life, mainly of HFpEF patients, since its prevalence continues to rise. Recent studies validate that lifestyle changes, such as diet modulation, represent a potential therapeutic approach to improve several cardiometabolic diseases, although their effects on the GM and its indirect cardiac impact still warrant further research. Hence, in this paper, we aim to clarify the link between HF and the human microbiome.

Physiotherapeutic interventions in the treatment of patients with diabetic foot ulcers: a systematic literature review.

BACKGROUND: Diabetic foot ulcers are chronic wounds that are difficult to heal, with a high rate of recurrent hospitalizations. Due to its multifactorial complexity, treatment must be considered as multidisciplinary, with adjuvant therapy required to aid the healing process. OBJECTIVES: To identify physiotherapeutic interventions for the treatment of diabetic foot ulcers through a systematic literature review. DATA SOURCES: PubMed, Cochrane Library, SciELO and Web of Science were searched in April 2020. STUDY SELECTION OR ELIGIBILITY CRITERIA: The inclusion criteria for this review were: randomised controlled trial published in the last 5 years; written in Portuguese, English or Spanish; subjects aged> 18 years with a diagnosis of diabetic foot ulcers; and physiotherapeutic intervention in combination with multidisciplinary wound management. The methodological quality was assessed using the PEDro scale. RESULTS: Eight studies were included. Physiotherapists can treat diabetic foot ulcers using therapeutic exercises, electrotherapy, manual therapy and assistive technologies. All physiotherapeutic interventions were adjuvant to standard treatment for wounds provided by other health professionals. The main outcomes were wound size and healing time, with highly favourable results obtained for the experimental groups compared with the control groups. CONCLUSIONS: Therapeutic exercise, electrotherapy, manual therapy and assistive technologies are physiotherapeutic modalities that, when combined with standard treatment, have been shown to be beneficial in the healing of diabetic foot ulcers.

Adenosine receptors participate in anabolic-androgenic steroid-induced changes on risk assessment/anxiety-like behaviors in male and female rats.

Anabolic-androgenic steroids (AAS) and caffeine can induce several behavioral alterations in humans and rodents. Administration of nandrolone decanoate is known to affect defensive responses to aversive stimuli, generally decreasing inhibitory control and increasing aggressivity but whether caffeine intake influences behavioral changes induced by AAS is unknown. The present study aimed to investigate behavioral effects of caffeine (a non-selective antagonist of adenosine receptors) alone or combined with nandrolone decanoate (one of the most commonly AAS abused) in female and male Lister Hooded rats. Our results indicated that chronic administration of nandrolone decanoate (10 mg/kg, i.m., once a week for 8 weeks) decreased risk assessment/anxiety-like behaviors (in the elevated plus maze test), regardless of sex. These effects were prevented by combined caffeine intake (0.1 g/L, p.o., ad libitum). Overall, the present study heralds a key role for caffeine intake in the modulation of nandrolone decanoate-induced behavioral changes in rats, suggesting adenosine receptors as candidate targets to manage impact of AAS on brain function and behavior.

Chronic wound assessment: Cultural and linguistic adaptation for European Portuguese of RESVECH-2 scale.

INTRODUCTION: In order to assess and to follow up the evolution of chronic wounds, it is advisable to apply measurement scales. This procedure allows clinicians to verify the appropriateness of their activities and whether the healing process is evolving as expected. AIM: To conduct a cross-cultural adaptation and psychometric analysis of Portuguese version of RESVECH 2.0. METHODS: A quantitative and correlational study was designed and, to perform the cross-cultural adaptation of RESVECH 2.0, we followed the classic sequential approach for linguistic equivalence to European Portuguese. The study occurred at a Portuguese oncology hospital and the sample encompassed 281 patients with multiple chronic wounds. RESULTS: RESVECH 2.0 is a practical measurement instrument, easy to use, and well accepted by nurses to know all kinds of wounds' etiologies. The reliability test revealed an acceptable internal consistency and high proportion of agreement between two raters assessing the same patient. Construct validity was considered average/good and the principal component factor analysis with varimax rotation obtained six factors corresponding to 59.5% of explained variance. When comparing the domains from RESVECH 2.0 with those from BWAT we found statistically significant correlations. CONCLUSION: The adapted version of RESVECH 2.0 scale presents a good internal consistency and is valid for the Portuguese language and culture, being useful and effective in clinical practice.

Retinal Toxicity Induced by Chemical Agents.

Vision is an important sense for humans, and visual impairment/blindness has a huge impact in daily life. The retina is a nervous tissue that is essential for visual processing since it possesses light sensors (photoreceptors) and performs a pre-processing of visual information. Thus, retinal cell dysfunction or degeneration affects visual ability and several general aspects of the day-to-day of a person's lives. The retina has a blood-retinal barrier, which protects the tissue from a wide range of molecules or microorganisms. However, several agents, coming from systemic pathways, reach the retina and influence its function and survival. Pesticides are still used worldwide for agriculture, contaminating food with substances that could reach the retina. Natural products have also been used for therapeutic purposes and are another group of substances that can get to the retina. Finally, a wide number of medicines administered for different diseases can also affect the retina. The present review aimed to gather recent information about the hazard of these products to the retina, which could be used to encourage the search for more healthy, suitable, or less risky agents.

Drying Microalgae Using an Industrial Solar Dryer: A Biomass Quality Assessment.

Microalgae are considered a promising resource of proteins, lipids, carbohydrates, and other functional biomolecules for food and feed markets. Competitive drying solutions are required to meet future demands for high-quality algal biomass while ensuring proper preservation at reduced costs. Since often used drying methods, such as freeze or spray drying, are energy and time consuming, more sustainable processes remain to be developed. This study tested an indirect and hybrid solar dryer as an alternative to conventional freeze drying of industrially produced Tetraselmis chui and Nannochloropsis oceanica wet paste. The effects of the drying method on biomass quality parameters, including biochemical profiles, functional properties, and microbial safety, were assessed. No significant differences were found between the applied drying technologies for total proteins, carbohydrates, lipids, and fatty acid profiles. On the other hand, some pigments showed significant differences, displaying up to 44.5% higher contents in freeze-dried samples. Minor differences were also registered in the mineral profiles (<10%). Analyses of microbial safety and functional properties of the solar-dried biomass appear adequate for food and feed products. In conclusion, industrial solar drying is a sustainable technology with a high potential to preserve high-quality microalgal biomass for various markets at expected lower costs.

Insights into the role of complement regulatory proteins in HPV mediated cervical carcinogenesis.

The persistent infection of high-risk Human papillomavirus (HR-HPV) induced cervical cancer remains a challenge in women worldwide including India. Recent advances in cancer research have paved the way for advanced cancer treatment modalities including immunotherapy by manipulating the function or number of cytotoxic T cells. It is well established that anaphylatoxins like C3a and C5a of complement system influence tumor growth by evading apoptosis leading to progression of cancer. The role of the complement system, particularly the complement regulatory proteins (CRPs) which are important determinants of immune response play a crucial role in carcinogenesis. In a tumor microenvironment (TME) assisted suppression of immune effector cells may be achieved through CRPs. However, recent advances in pharmacogenomics including drug designing and combination of these approaches have provided a holistic understanding of signaling pathways and their crosstalk, to regulate cellular communications.This review describes the role of complement system; particularly CRPs in HPV induced cervical carcinogenesis which may be used for designing anti- HPV or cervical cancer therapeutics.

[Efficiency of public spending on primary health care in the municipalities of Rio de Janeiro, Brazil: robust scores and their determinants]. / Eficiência do gasto público em atenção primária em saúde nos municípios do Rio de Janeiro, Brasil: escores robustos e seus determinantes.

Health services, the access to which is a right of all citizens and the duty of the state, must be efficiently provided, as public resources are scarce and there is a growing demand called for by the population. In this context, the objective was to evaluate the efficiency of public spending on Primary Health Care in the municipalities of Rio de Janeiro (n = 70) in 2015. Initially, the jackstrap procedure was used to identify possible outliers, and Data Envelopment Analysis was then applied to calculate robust efficiency scores. In the second stage, the efficiency scores were regressed into non-discretionary variables using the Tobit method, that may affect the efficiency of municipalities. The results show that 63.9% of municipalities efficiently applied ABS resources, however, given the expenses incurred, ABS outputs could have been, on average, 6% higher. In addition, no evidence was found that wealthier, more socially developed and/or populous municipalities, were more (or less) efficient in public spending on ABS than not.

Os serviços de saúde, cujo acesso é um direito de todos e dever do Estado, devem ser prestados com eficiência, pois os recursos públicos são escassos e há uma crescente demanda por parte da população. Nesse contexto, o objetivo deste artigo é avaliar a eficiência dos gastos públicos em atenção básica em saúde (ABS) nos municípios do Rio de Janeiro (n = 70) em 2015. Para isso, primeiramente, usa-se o procedimento jackstrap para identificar possíveis outliers e aplica-se a técnica de análise envoltória de dados para calcular escores robustos de eficiência. Em seguida, esses escores são regredidos, por meio de um modelo tobit, em variáveis ​​não discricionárias que possam afetar a eficiência dos municípios. Os resultados encontrados revelam que 63,9% dos municípios avaliados aplicaram eficientemente os recursos em ABS, mas que, diante dos gastos efetuados, os outputs em ABS poderiam ter sido em média 6,0% maiores. Além disso, não foram encontradas evidências de que municípios mais ricos, socialmente desenvolvidos e/ou populosos tenham sido mais (ou menos) eficientes com relação ao gasto público em ABS do que aqueles não o são.

Astrocytes as a target for Nogo-A and implications for synapse formation in vitro and in a model of acute demyelination.

Central nervous system (CNS) function depends on precise synaptogenesis, which is shaped by environmental cues and cellular interactions. Astrocytes are outstanding regulators of synapse development and plasticity through contact-dependent signals and through the release of pro- and antisynaptogenic factors. Conversely, myelin and its associated proteins, including Nogo-A, affect synapses in a inhibitory fashion and contribute to neural circuitry stabilization. However, the roles of Nogo-A-astrocyte interactions and their implications in synapse development and plasticity have not been characterized. Therefore, we aimed to investigate whether Nogo-A affects the capacity of astrocytes to induce synaptogenesis. Additionally, we assessed whether downregulation of Nogo-A signaling in an in vivo demyelination model impacts the synaptogenic potential of astrocytes. Our in vitro data show that cortical astrocytes respond to Nogo-A through RhoA pathway activation, exhibiting stress fiber formation and decreased ramified morphology. This phenotype was associated with reduced levels of GLAST protein and aspartate uptake, decreased mRNA levels of the synaptogenesis-associated genes Hevin, glypican-4, TGF-ß1 and BDNF, and decreased and increased protein levels of Hevin and SPARC, respectively. Corroborating these findings, conditioned medium from Nogo-A-treated astrocytes suppressed the formation of structurally and functionally mature synapses in cortical neuronal cultures. After cuprizone-induced acute demyelination, we observed reduced immunostaining for Nogo-A in the visual cortex accompanied by higher levels of Hevin expression in astrocytes and an increase in excitatory synapse density. Hence, we suggest that interactions between Nogo-A and astrocytes might represent an important pathway of plasticity regulation and could be a target for therapeutic intervention in demyelinating diseases in the future.

Effect of an Educational Nursing Intervention on the Mental Adjustment of Patients with Chronic Arterial Hypertension: An Interventional Study.

The objective of this analytical and interventional prospective quantitative study was to assess the effect of an educational intervention performed by nurses for mental adjustment to chronic disease in patients with hypertension. A convenience sample was studied, composed of 329 participants with chronic hypertension, followed in a primary healthcare unit in the Central Region of Portugal. Data collection was carried out by applying the Mental Adjustment to Disease Scale (MADS) before and 1 month after the educational nursing intervention between September 2017 and February 2018. Prior to the application of the educational intervention, 43.5% of the participants were classified as "unadjusted" in at least one of the subscales of MADS. After the educational intervention, 21.3% of the participants classified as "unadjusted" became "adjusted" in all MADS subscales. The success rate of the intervention varied from 26.9% (in the fatalism subscale) to 44.6% (for the anxious concern subscale). Participants were more likely to be mentally "unadjusted" to hypertension if they lived with other family members, had an active professional situation before the diagnosis of hypertension, still had an active professional situation now, were under 65 years old, had a shorter time to diagnosis (1-2 years), and measured blood pressure less regularly. The educational intervention performed by nurses is relevant for the mental adjustment of hypertensive patients, contributing to increased knowledge, as well as improvement in preventive and self-care practices, facilitating the experience of the health/disease transition process.

Genetic diversity in two threatened species of guitarfish (Elasmobranchii: Rhinobatidae) from the Brazilian and Argentinian coasts: an alert for conservation

The guitarfishes Pseudobatos horkelii and Pseudobatos percellens meet the criteria for threatened status as Critically Endangered (CR) and Endangered (EN), respectively. Both species occur in the Southern Atlantic Ocean. Considering the lack of data on the genetic structure of these species, the present study evaluated the genetic variability and population structure of the P. horkelii and P. percellens in the southern region of Brazil and the northern coast of Argentina, based on sequences of mitochondrial DNA, Control Region (D-loop). Samples of P. horkelii (n = 135) were analyzed in six localities situated in Northern Argentina, along the Brazilian states' coast. The mean of nucleotide diversity was 0.0053, the ΦST was 0.4277 and demographic analysis of P. horkelii suggests the existence of stability of the populations, with D = 0.9929, FS = 2.0155, SSD = 0.0817, R = 0.2153. In P. percellens (n = 101) were analyzed from six Brazilian localities along the coast of Santa Catarina, Paraná, and São Paulo. The mean nucleotide diversity was 0.0014 and ΦST value of 0.2921, the demographic analysis indicates a high migration rate of P. percellens among the localities evaluated, with D = 0.5222, FS = 0.3528, SSD = 0.01785, R = 0.3890.(AU)

As raias violas Pseudobatos horkelii e Pseudobatos percellens, são listados como "Criticamente em Perigo" (CR) e "Em Perigo" (EN), respectivamente. Ambas as espécies ocorrem no Sul do Oceano Atlântico. Considerando a falta de dados sobre a estrutura genética dessas espécies, o presente estudo avaliou a variabilidade genética e a estrutura populacional de P. horkelii e P. percellens na região sudeste do Brasil e litoral norte da Argentina, com base em sequências de DNA mitocondrial, região de controle (D-loop). Amostras de 135 indivíduos de P. horkelii analisados em seis localidades, situadas no norte da Argentina e ao longo da costa dos estados brasileiros. A média da diversidade nucleotídica foi de 0.0053, o índice ΦST foi de 0.4277 e a análise demográfica de P. horkelii, indicou a existência de estabilidade das populações, com D = 0.9929, Fus = 2.0155, SSD = 0.0817, R = 0.2153. Em 101 exemplares de P. percellens, foram analisados em seis localidades brasileiras ao longo do litoral de Santa Catarina, Paraná e São Paulo. A diversidade nucleotídica média foi de 0.0014 e o valor ΦST de 0.2921, a análise demográfica indicou uma alta taxa de migração de P. percellens entre as localidades analisadas, com D = 0.5222, FS = 0.3528, SSD = 0.01785, R = 0.3890.(AU)

Anti-Biofilm action of biological silver nanoparticles produced by aspergillus tubingensis and antimicrobial activity of fabrics carrying it

Biological silver nanoparticles (AgNPs) were synthesized using the marine endophytic fungus Aspergillus tubingensis and inhibited Bacillus subtilis biofilm formation at low concentrations. Cotton and polyester fabrics impregnated with AgNPs were analyzed by transmission electron microscopy (TEM), and the concentration of AgNPs in both fabrics was determined using inductivelycoupled plasma atomic emission spectrometry (ICP-AES). The fabrics carrying the AgNPs inhibited the Staphylococcus aureus and Escherichia coli growth by 100%. Both fabrics impregnated one time with AgNPs inhibited yeasts' clinical species' growth, Candida albicans, Candida glabrata, and Candida parapsilosis, from 80.1% to approximately 98.0%. Besides the anti-biofilm effect, the AgNPs impregnation process on cotton and polyester fabrics was highly efficient, and both fabrics presented antimicrobial effects against clinically relevant bacteria and yeast species. The results evidence that functionalized textiles containing these biological AgNPs can play an essential role in combating pathogenic microorganisms. Thereby offering an alternative to design effective solutions, mainly for hospital garments and biomedical devices, to avoid microorganisms transmissions and hospitalacquired nosocomial infections.

Perineural dexamethasone in ultrasound-guided interscalene brachial plexus block with levobupivacaine for shoulder arthroscopic surgery in the outpatient setting: randomized controlled trial / Dexametasona perineural em bloqueio de plexo braquial interescalênico com levobupivacaína guiado por ultrassonografia para artroscopia de ombro em regime ambulatorial: ensaio clínico controlado e randomizado

Abstract Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. Conclusion: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

Resumo Justificativa e objetivos: Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial. Métodos: Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA). Resultados: Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p< 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72vs. 0,02 ± 0,17; p< 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4%vs.0%; p< 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante. Conclusão: A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.

[Perineural dexamethasone in ultrasound-guided interscalene brachial plexus block with levobupivacaine for shoulder arthroscopic surgery in the outpatient setting: randomized controlled trial]. / Dexametasona perineural em bloqueio de plexo braquial interescalênico com levobupivacaína guiado por ultrassonografia para artroscopia de ombro em regime ambulatorial: ensaio clínico controlado e randomizado.

BACKGROUND AND OBJECTIVES: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. METHODS: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). RESULTS: Seventy-four patients were recruited and 71 completed the study (Group C, n=37; Group D, n=34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440±0 min vs. 1267±164 min, p<0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08±1.72 vs. 0.02±0.17, p <0.001) and a greater number of patients (68.4% vs. 0%, p <0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. CONCLUSION: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.