El tratamiento del dolor agudo pediátrico en España EN 2021: resultado de una encuesta nacional entre anestesiólogos pediátricos / The management of paediatric acute pain in Spain IN 2021: Results of a national survey among paediatric anaesthesiologists

Objetivo: Mejorar el conocimiento acerca de la práctica clínica habitual en el tratamiento del dolor agudo pediátrico en España.MétodosSe llevó a cabo una encuesta telemática a través de Internet en una muestra representativa de profesionales sanitarios involucrados en el tratamiento del dolor agudo pediátrico (concretamente anestesiólogos) en España. La encuesta incluyó 28 cuestiones acerca de su práctica clínica habitual en la valoración y el tratamiento del dolor agudo, así como aspectos formativos y organizativos en el dolor agudo pediátrico.ResultadosLa encuesta fue completada durante el mes de marzo de 2021 por 150 especialistas en anestesiología. Los encuestados presentaron una amplia experiencia en el tratamiento del dolor agudo pediátrico (media de años de experiencia: 14,3; DE: 7,8) y básicamente en dolor agudo postoperatorio (97% casos). Aunque el 80% de los mismos utilizaba de modo habitual escalas validadas de valoración de dolor agudo pediátrico, solo el 2,6% utilizaba las específicas adaptadas para pacientes con discapacidad cognitiva. La mayoría de los encuestados empleaba habitualmente fármacos analgésicos como el paracetamol (99%) o el metamizol (92%), pero solo el 84% los complementaba con alguna técnica de bloqueo loco-regional u otra medicación tipo antiinflamatorio no esteroideo (62%). Además, únicamente un 62,7% reconocía haber recibido formación específica en dolor agudo pediátrico, solo un 45% seguía protocolos institucionales hospitalarios y un escaso 28% lo hacía a través de unidades de dolor infantil.ConclusionesLa encuesta identificó importantes puntos de mejora en la formación y organización del tratamiento del dolor agudo de los pacientes españoles en edad pediátrica. (AU)

Objective: To improve knowledge about routine clinical practice in the management of paediatric acute pain in Spain.MethodsA telematic survey was conducted via the Internet on a representative sample of healthcare professionals involved in the management of paediatric acute pain (specifically anaesthesiologists) in Spain. The survey included 28 questions about their usual clinical practice in the assessment and treatment of acute pain, and also training and organisational aspects in paediatric acute pain.ResultsThe survey was completed during March 2021 by 150 specialists in anaesthesiology. The respondents widely experienced in the management of acute paediatric pain (mean years of experience: 14.3: SD: 7.8), essentially in acute postoperative pain (97% of cases). Although 80% routinely used validated paediatric acute pain assessment scales, only 2.6% used specific scales adapted for patients with cognitive impairment. Most of the respondents routinely used analgesic drugs such as paracetamol (99%) or metamizole (92%), but only 84% complemented these drugs with a loco-regional blocking technique or other non-steroidal anti-inflammatory drugs (62%). Furthermore, only 62.7% acknowledged having received specific training in paediatric acute pain, only 45% followed hospital institutional protocols, and a scant 28% did so through paediatric pain units.ConclusionsThe survey identified important points for improvement in the training and organisation of acute pain management in Spanish paediatric patients. (AU)

Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares / Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers

Objetivo mostrar la efectividad y seguridad del sevoflurano tópico tras la administración ambulatoria y prolongada en los pacientes con úlceras vasculares refractarias. Métodos estudio observacional retrospectivo de pacientes con úlceras vasculares dolorosas refractarias a terapias habituales y que fueron tratados con sevoflurano tópico durante al menos 36 meses. Se recogieron las variables: edad, sexo, antecedentes médicos, comorbilidad asociada, etiología de úlcera y tratamiento médico. Se analizó la mejoría clínica y la variación de la superficie de las úlceras vasculares. Para cuantificar la intensidad del dolor basal e irruptivo antes y después del tratamiento se utilizó la escala visual analógica. Resultados del total de pacientes tratados, 9 cumplían los criterios de inclusión. La edad media fue de 74,8 ± 7,5 años. Los casos 2 y 9 fallecieron durante el seguimiento. La acción analgésica del sevoflurano tópico fue rápida (3,1 ± 2,1 min), intensa (escala visual analógica: 7 ± 1,1 a 1,4 ± 1,1 puntos) y duradera (de 6 a 24 h). Salvo el caso 4, todos experimentaron una reducción de la superficie (15,1 ± 5,0 a 2,7 ± 4,2) de las úlceras vasculares y no se observó tolerancia a lo largo del tiempo. Conclusión la aplicación de sevoflurano tópico es una estrategia analgésica y reepitelizante para las úlceras vasculares que presenta un perfil correcto de seguridad (AU)

Objective To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. Methods Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. Results Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. Conclusion Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile (AU)

The management of paediatric acute pain in Spain IN 2021: Results of a national survey among paediatric anaesthesiologists.

OBJECTIVE: To improve knowledge about routine clinical practice in the management of paediatric acute pain in Spain. METHODS: A telematic survey was conducted via the Internet on a representative sample of healthcare professionals involved in the management of paediatric acute pain (specifically anaesthesiologists) in Spain. The survey included 28 questions about their usual clinical practice in the assessment and treatment of acute pain, and also training and organisational aspects in paediatric acute pain. RESULTS: The survey was completed during March 2021 by 150 specialists in anaesthesiology. The respondents widely experienced in the management of acute paediatric pain (mean years of experience: 14.3: SD: 7.8), essentially in acute postoperative pain (97% of cases). Although 80% routinely used validated paediatric acute pain assessment scales, only 2.6% used specific scales adapted for patients with cognitive impairment. Most of the respondents routinely used analgesic drugs such as paracetamol (99%) or metamizole (92%), but only 84% complemented these drugs with a loco-regional blocking technique or other non-steroidal anti-inflammatory drugs (62%). Furthermore, only 62.7% acknowledged having received specific training in paediatric acute pain, only 45% followed hospital institutional protocols, and a scant 28% did so through paediatric pain units. CONCLUSIONS: The survey identified important points for improvement in the training and organisation of acute pain management in Spanish paediatric patients.

Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers. / Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares.

OBJECTIVE: To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. METHODS: Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. RESULTS: Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. CONCLUSION: Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile.

Uso de opioides en pacientes con enfermedad crónica avanzada en situación de últimos días / Use of opioids in patients with advanced chronic disease in the last days of life

Objetivo: Conocer el uso de opioides en el paciente con enfermedad crónica avanzada en los últimos días de vida. Métodos: Estudio retrospectivo, multicéntrico, descriptivo y analítico. Se recogieron datos de los servicios de Geriatría del Hospital Universitario La Paz, Medicina Interna del Complejo Hospitalario de Toledo, Unidad de Hospital a Domicilio del Hospital Marina Baixa de la Vila Joiosa y del Hospital Centro de Cuidados Laguna. Se incluyeron en el estudio los pacientes ingresados con enfermedad avanzada no oncológica fallecidos entre el 1 de marzo de 2019 y el 29 de febrero de 2020. Se estudiaron distintas variables: edad, sexo, enfermedad principal, motivo de ingreso, valoración por cuidados paliativos, uso previo de opioides, uso de opioides en situación de últimos días, opioide, dosis, vías de administración e indicación. Resultados: En el estudio se incluyeron 261 pacientes, 143 (55 %) mujeres y 118 (45 %) hombres, con una edad media de 84 años. La enfermedad principal más frecuente fue la demencia, seguido de insuficiencia cardiaca y patología respiratoria. El motivo de ingreso más frecuente fue deterioro debido a la enfermedad de base seguido de infección respiratoria y sepsis. En la situación de últimos días, la mayoría de los pacientes tenían pauta de opioide basal (94 % morfina) y de rescate (98 % morfina). La vía de administración más utilizada fue la subcutánea (98 %) y la indicación más frecuente fue la disnea (42 %). La mediana de dosis equivalente de morfina oral diaria por enfermedad principal y por motivo de ingreso fue de 30 mg/día. Conclusiones: El uso de opioides en las enfermedades crónicas avanzadas en situación de últimos días está ampliamente extendido. La morfina es el opioide más usado, independientemente de la enfermedad. La vía de administración más utilizada es la subcutánea. No encontramos diferencias entre pacientes con diferentes patologías. (AU)

Objective: To determine the use of opioids in patients with advanced chronic disease in the last days of life. Methods: A retrospective, multicenter, descriptive, analytical study. Data were collected from the Geriatrics Department of Hospital La Paz, Internal Medicine Department of Complejo Hospitalario de Toledo, Hospital at Home Unit of Hospital Marina Baixa in0 La Vila Joiosa, and Hospital Centro de Cuidados Laguna. The study included patients with advanced non-oncological disease who died between 1 March 2019 and 29 February 2020. Different variables were studied: age, sex, main disease, reason for admission, palliative care assessment, previous opioid use, opioid use in last days, opioid, dose, routes of administration, and indication. Results: The study included 261 patients, 143 (55 %) women and 118 (45 %) men, with a mean age of 84 years. The most frequent main disease was dementia, followed by heart failure and respiratory pathology. The most frequent reason for admission was deterioration due to the underlying disease followed by respiratory infection and sepsis. In the last-day situation, most patients had a baseline (94 % morphine) and rescue (98 % morphine) opioid regimen. The most common route of administration was subcutaneous (98 %) and the most common indication was dyspnea (42 %). The median daily oral morphine equivalent dose per main disease and reason for admission was 30 mg/day. Conclusions: The use of opioids in advanced chronic illness in the last days situation is widespread. Morphine is the most commonly used opioid regardless of disease. The most used route of administration is subcutaneous. We found no differences between patients with different pathologies. (AU)

Opioid consumption and prescription in Brazil: integrative review / Uso e prescrição de opioides no Brasil: revisão integrativa

ABSTRACT BACKGROUND AND OBJECTIVES: In the past twenty years, the number of deaths caused by opioid overdose has tripled in the United States. There is, in literature, a scarcity of up-to-date evidence regarding opioids consumption in the Brazilian scenario. The objectives of this study was to know, through a literary review, the pattern of opioid analgesics consumption in Brazil. METHODS: An integrative review of the literature, performed in the PubMed, BVS and Scielo databases from August 30 to October 22, 2020. The search strategy included the following terms, "Opioid-related disorders" or "Opioid epidemic" or "Opioid analgesics" and "Brazil". Inclusion criteria: published in the last five years; studies on humans. Exclusion criteria: studies not related to the objective of this review; letters, editorials, commentaries and secondary studies. RESULTS: The results showed patients' dissatisfaction with pain management when compared to patients from developed countries, the lack of knowledge and adequate public policies on the use of opioids among health professionals make them view opioids as the last treatment alternative. The practice of analgesic self-medication is frequent in patients with chronic diseases, which may be the cause of the low prescription of opioid analgesics by health professionals. CONCLUSION: It is noteworthy that there is a lack of data related to the prescription and use of opioids in Brazil. Further studies should be conducted to assess the use of opioids in general medical practice.

RESUMO JUSTIFICATIVA E OBJETIVOS: Nos últimos 20 anos, o número de mortes causadas por overdose de opioides triplicou nos Estados Unidos. São escassas na literatura evidências atualizadas sobre o consumo de opioides no cenário brasileiro. O objetivo deste estudo foi conhecer, por meio de revisão literária, o padrão de consumo de analgésicos opioides no Brasil. MÉTODOS: Revisão integrativa da literatura, realizada nas bases de dados Pubmed, BVS e Scielo, no período de 30 de agosto a 22 de outubro de 2020. A estratégia de busca incluiu os termos "Transtornos relacionados ao uso de opioides" ou "Epidemia de opioides" ou "Analgésicos opioides" e "Brasil". Critérios de inclusão: publicação nos últimos cinco anos; estudos em humanos. Critérios de exclusão: estudos não relacionados ao objetivo desta revisão; cartas, editoriais, comentários e estudos secundários. RESULTADOS: Os resultados mostraram a insatisfação dos pacientes com o manejo da dor quando comparados a pacientes de países desenvolvidos, a falta de conhecimento e de políticas públicas adequadas sobre o uso de opioides entre os profissionais de saúde faz com que estes vejam os opioides como a última alternativa de tratamento. A prática da automedicação analgésica é frequente em pacientes com doenças crônicas, o que pode ser a causa da baixa prescrição de analgésicos opioides pelos profissionais de saúde. CONCLUSÃO: Faltam dados relacionados à prescrição e uso de opioides no Brasil. Novos estudos devem ser realizados para avaliar o uso de opioides na prática médica geral.

Aceite esencial de clavo en las consultas de urgencias por odontalgia aguda / Óleo essencial de cravo em consultas de emergência para dor dentária aguda / Clove essential oil in emergency consultations for acute dental pain

La odontalgia aguda es un motivo frecuente de consultas en urgencias de atención primaria, especialmente fuera del horario de trabajo de los odontólogos. Ante la aparición cada vez más frecuente de efectos secundarios asociados a la medicación utilizada habitualmente en los cuadros de odontalgia aguda, se planteó como objetivo comprobar si la aplicación tópica de aceite esencial de clavo (Syzygium aromaticum (L) Merill et L.M. Perry) resultaba al menos tan eficaz como el tratamiento habitual con analgésicos y/o antiinflamatorios. Participaron 96 pacientes, de los cuales 52 fueron tratados tópicamente con aceite esencial de clavo y 44 (grupo control) con metamizol o diclofenaco intramuscular. La intensidad del dolor fue evaluada por los pacientes a través de la escala analógica visual antes y después del tratamiento. Los resultados no mostraron diferencias entre ambos tratamientos en cuanto a la reducción del dolor, si bien con el aceite esencial se consiguió el efecto en menos de 5 minutos, en comparación con los 45-60 minutos necesarios con metamizol o diclofenaco. (AU)

A odontalgia aguda é motivo frequente de visitas às urgências, principalmente fora do horário de trabalho do dentista. Perante o aparecimento cada vez mais frequente de efeitos colaterais associados aos medicamentos comumente utilizados na situação de odontologia aguda, o objetivo foi verificar se a aplicação tópica do óleo essencial de cravinho (Syzygium aromaticum (L) Merill et LM Perry) foi pelo menos tão eficaz quanto o tratamento usual com analgésicos e/ou antiinflamatórios. Participaram 96 pacientes, dos quais 52 foram tratados topicamente com óleo essencial de cravinho e 44 (grupo controle) com metamizol ou diclofenac intramusculares. A intensidade da dor foi avaliada pelos pacientes por meio da escala visual analógica antes e após o tratamento. Os resultados não mostraram diferenças entre os dois tratamentos em termos de redução da dor, embora o óleo essencial tenha alcançado o efeito em menos de 5 minutos, em comparação com os 45-60 minutos necessários com metamizol ou diclofenac. (AU)

Acute dental pain is a frequent reason for consultations in primary care emergencies, especially outside the dentists’ working hours. Given the increasingly frequent appearance of side effects associated with the medication commonly used in acute toothache, the objective was to check whether the topical application of the essential oil of clove (Syzygium aromaticum (L) Merill et LM Perry) was at least as effective as the usual treatment with analgesics and/or anti-inflammatory drugs. Ninety-six patients participated: 52 were treated topically with clove essential oil and 44 (control group) with intramuscular metamizole or diclofenac. The intensity of pain was evaluated by the patients through the visual analog scale, before and after the treatment. The results did not show differences between the two treatments in terms of pain reduction, although the essential oil achieved the effect in less than 5 minutes, compared to the 45-60 minutes required with metamizole or diclofenac. (AU)

Bloqueo retrolaminar ecoguiado como analgesia para el manejo de neuralgia por herpes zóster: a propósito de un caso / Retrolaminar ultrasound guided block as analgesic treatment for post herpetic neuralgia: case report

Los bloqueos interfasciales (BIF) son el resultado de inyectar un anestésico local en el espacio comprendido entre dos fascias con el objetivo de distribuir el volumen y bloquear la transmisión nerviosa correspondiente. La introducción de los BIF como técnica anestésico-analgésica es relativamente reciente. Su amplia difusión y estandarización en estos últimos años ha venido de la mano del uso de ultrasonidos; como resultado ha aumentado la eficacia de los bloqueos y la seguridad en la práctica de los mismos. El bloqueo retrolaminar (RL) y el bloqueo del plano del erector espinal (ESP) comparten características similares y pueden considerarse una alternativa analgésica para los dolores relacionados con afectación de la pared torácica, siendo el bloqueo RL de gran valor en pacientes con riesgo de neumotórax o en quienes no se obtenga adecuada visualización de la sonoanatomía para el bloqueo ESP. Se describe el caso de un paciente con neuralgia aguda por herpes zóster, a quien se le realizó un bloqueo RL exitoso.(AU)

Interfacial plane blocks (IPB) are the result of the injection of an anesthetic locally in the space created between two fasciae with the purpose of distributing the volume of the medication and block the transmission of the corresponding nerves. The introduction of IPB as an analgesic anesthetic technic is relatively resent, and its widespread and standardization this last few years has come by hand of the ultrasound, as a result the safety and efficiency of the IPB has increased. The retrolaminar block (RB) and the Spinal erector plane block (SPB) share characteristics and could be considered as an alternative to manage the thoracic wall pain pathologies, keeping in mind that the RB is of choice for patients in danger of suffering a pneumothorax or in those in which there is an inappropriate anatomic visualization though the echography for the SPB. In this article a case of a patient with acute neuralgia due to herpes zoster who received a successful RB is described.(AU)

Evaluación del efecto analgésico transoperatorio del tramadol comparado con la lidocaína en caninos oncológico / Assessment of the adverse effect of tramadol compared to lidocaine in the oncologic intraoperative in canines

Introducción: El estudio y tratamiento del dolor ha sido una de las preocupaciones más importantes en los últimos 30 años en el ámbito médico mundial. Desde hace varias décadas a nivel internacional se realizan estudios sobre el efecto del tramadol y la lidocaína como analgésicos intraoperatorio, con el fin de obtener una adecuada analgesia durante el procedimiento quirúrgico y el periodo posoperatorio inmediato. Objetivo: Comparar el efecto analgésico del tramadol y la lidocaína durante el período transoperatorio en caninos programados para intervención quirúrgica. Método: Se realizó un estudio prospectivo, comparativo, con animales programados para tratamiento quirúrgico por presentar tumores periféricos. Se incluyeron 10 animales divididos en 2 grupos. El grupo control (G-C) que recibió lidocaína sin preservo (lidocaína SP) en infusión continua durante el procedimiento quirúrgico y el grupo 1 (G-1) que se le administró tramadol endovenoso previo al acto quirúrgico. Se evaluaron variables hemodinámicas y de oxigenación como indicadores indirectos de dolor transoperatorio. Resultados: La muestra fue homogénea para la edad y el sexo. El comportamiento de las variables hemodinámicas resultó más estable durante la infusión de lidocaína. La saturación periférica de oxígeno fue similar con ambos medicamentos, así como la temperatura. Conclusiones: La infusión intravenosa de lidocaína SP durante el periodo transoperatorio en caninos oncológico demostró una mejor efectividad analgésica en comparación con el tramadol aplicado preoperatoriamente, según los parámetros evaluados(AU)

Introduction: Study and treatment of pain has been one of the most important concerns in the last thirty years in the worldwide medical field. For several decades, international studies have been carried out on the effect of tramadol and lidocaine as intraoperative analgesics, in order to achieve adequate analgesia during surgical procedures and the immediate postoperative period. Objective: To compare the analgesic effect of tramadol and lidocaine during the intraoperative period in canines scheduled for surgical intervention. Method: A prospective, comparative study was carried out with animals scheduled for surgical treatment due to peripheral tumors. Ten animals were included, divided into two groups: the control group, which received lidocaine without preservation in continuous infusion during the surgical procedure, and group 1, which was administered intravenous tramadol prior to the surgical act. Hemodynamic and oxygenation variables were assessed as indirect indicators of intraoperative pain. Results: The sample was homogeneous for age and sex. The behavior of the hemodynamic variables was more stable during the lidocaine infusion. Peripheral oxygen saturation was similar in both drugs, as well as temperature. Conclusions: Intravenous infusion of lidocaine without preservation during the intraoperative period in oncological canines showed better analgesic effectiveness compared to tramadol applied preoperatively, according to the parameters assessed(AU)

Medical treatment for acute renal colic. / Tratamiento médico del cólico renoureteral en su fase aguda.

INTRODUCTION: Renoureteral colic (CRU) is the most common urological emergency, with a wide spectrum of severity that generates high morbidity and high health costs. However, there is no homogeneous scheme of pharmacological treatment in its acutephase. AIMS: The main objective of our work is to evaluate the effectiveness and safety profile of the different drugs used in the treatment of CCR and to propose a practical treatment scheme. The secondary objectives are to evaluate the role of fluid therapy in CRU and the treatment of CRU in pregnant women. MATERIAL AND METHODS: We have carried out a literature search on PubMed using the MeSH terms "renalcolic", "treatment", "anti-inflammatory drugs", "antiemeticdrugs", "fluid therapy" and "pregnant". The most relevant clinical trials, meta-analyses and systematic reviews published from 1 January 2005 to 15 September 2020 in Spanish, English and French were reviewed. RESULTS: In the different studies reviewed, non-steroidalanti-inflammatory drugs (NSAIDs) show better pain control, with lower rescue doses and fewer side effects than treatment with opioids. However, fluid therapy has failed to demonstrate an impact on the treatment of CRU. CONCLUSIONS: The initial treatment for CRU is NSAIDs, reserving opioids for successive treatment lines. The control of vegetative cortex can be accomplished with Ondansetron as first choice.

INTRODUCCIÓN: El cólico renoureteral (CRU) es la urgencia urológica más frecuente, con un amplio espectro de gravedad que genera una alta morbilidad y elevados costes sanitarios. Sin embargo, no existe un esquema homogéneo de tratamiento farmacológico en su fase aguda. OBJETIVOS: El objetivo principal de nuestro trabajo es evaluar la efectividad y perfil de seguridad de los distintos fármacos empleados en el tratamiento del CRU y proponer un esquema práctico de tratamiento. Los objetivos secundarios son evaluar el papel de la fluidoterapia en el CRU y el tratamiento del CRU en embarazadas.MATERIAL Y MÉTODOS: Hemos realizado una búsqueda bibliográfica en PubMed utilizando los términos MeSH "renal colic", "treatment", "anti-inflammatory- drugs", "antiemetic drugs", "fluid therapy" y "pregnant". Se revisaron ensayos clínicos, metaanálisis y revisiones sistemáticas de mayor relevancia, publicados desde el 1 de enero de 2005 hasta el 15 de septiembre de 2020, escritos en lengua española, inglesa y francesa. RESULTADOS: En los diferentes estudios revisados los antiinflamatorios no esteroideos (AINES) muestran un mejor control del dolor, con menores dosis de rescate y menos efectos secundarios que el tratamiento con opioides. Sin embargo, la fluidoterapia no ha logrado demostrar una repercusión en el tratamiento del CRU. CONCLUSIONES: El tratamiento de primera elección para el CRU son los AINES, reservando los opioides para sucesivas líneas de tratamiento. El control del cortejo vegetativo se puede realizar con ondansetrón comoprimera elección.

Potencial analgésico da aromaterapia em dores articulares crônicas: uma revisão integrativa / The origins of meditation and the spread of the practice in healthcare

A aromaterapia consiste no uso terapêutico de concentrados voláteis extraídos de partes de espécies de plantas, os óleos essenciais, aplicados principalmente topicamente ou por inalação. Recentemente, foi identificada como uma promissora modalidade terapêutica para o controle da dor em pacientes com doenças articulares crônicas. Desta forma, este estudo avaliou o potencial analgésico da aromaterapia na dor articular crônica. Foi feita uma revisão integrativa da literatura com artigos publicados entre 2015 e 2020 nas bases de dados Science Direct, Cochrane Library, e Pubmed Nove estudos experimentais de massagem com aromaterapia foram elegíveis, com investigações conduzidas predominantemente com pacientes com osteoartrite do joelho. Os óleos essenciais mais comumente empregados foram lavanda, gengibre e alecrim, em diferentes variações de frequência e período de intervenção. Embora a escassez de estudos dentro dessa temática, a síntese dos conhecimentos permitiu verificar o grande potencial da aromaterapia não só como analgésico em patologias articulares, mas também, melhora na qualidade de vida, rigidez matinal, capacidade física e diminuição da demanda de analgésicos. Pode vir a ser uma ferramenta terapêutica amplamente recomendada, principalmente na atenção primaria a saúde, pela acessibilidade, segurança e custo-benefício

Aromatherapy consists of the therapeutic use of volatile concentrates extracted from parts of plant species, essential oils, applied mainly topically or by inhalation. It has recently been identified as a promising therapeutic modality for pain control in patients with chronic joint diseases. Thus, this study evaluated the analgesic potential of aromatherapy in chronic joint pain. An integrative literature review was carried out with articles published between 2015 and 2020 in the Science Direct, Cochrane Library, and Pubmed databases. Nine experimental studies of aromatherapy massage were eligible, with investigations conducted predominantly with patients with knee osteoarthritis. The essential oils most commonly used were lavender, ginger and rosemary, in different variations of frequency and period of intervention. Although the scarcity of studies on this theme, the synthesis of knowledge has allowed to verify the great potential of aromatherapy not only as an analgesic in joint pathologies, but also, improvement in quality of life, morning stiffness, physical capacity and decreased demand for analgesics. It can become a widely recommended therapeutic tool, especially in primary health care, due to accessibility, safety and cost-benefit.

Automedicación con AINE en futbolistas profesionales de los equipos de primera división del DMQ / Self-medication with nsaids in professional soccer players of the first division teams of the DMQ / Automedicação com nsaids em jogadores profissionais de futebol das equipes da primeira divisão do DMQ

INTRODUCCIÓN: varios estudios a cargo de la Federación Internacional de Fútbol han identificado el abuso de AINE (Analgésicos Antinflamatorios No Esteroideo) en los futbolistas indicando que casi el 40% de los jugadores del mundial de 2010 tomaron medicamentos para el dolor antes de cada partido. OBJETIVO: identificar el nivel de conocimiento sobre AINE que presentan los futbolistas profesionales de las plantillas de primera división, a través del análisis y realidad de cada equipo. MÉTODO: se aplicaron encuestas validadas por los departamentos médicos de cada club y a través de preguntas abiertas, cerradas y formato de opción múltiple, se determinó que: la edad de los futbolistas profesionales en estudio oscila entre los 15 y 34 años. RESULTADOS: respecto al conocimiento del grupo farmacológico que contrarresta síntomas de dolor, fiebre e inflamación; se determinó que existe gran confusión e ignorancia en relación a la identificación de medicamentos y su conceptualización. Así mismo, respecto a principios activos que tratan dolor, fiebre e inflamación, se notó preferencia por Ibuprofeno, Paracetamol y Diclofenaco. Y que menos del 50% del total de futbolistas reconocen los efectos adversos de los fármacos en estudio. CONCLUSIÓN: existen falencias respecto al conocimiento de medicamentos (AINE), y que debido a la premura con la que requieren volver a las canchas, éstos profesionales del deporte, suelen confiar en personas que no se encuentran capacitados en medicina o en temas farmacológicos.

INTRODUCTION: several studies conducted by the International Football Federation have identified the abuse of NSAIDs (Non-Steroidal Anti-Inflammatory Analgesics) in soccer players, indicating that almost 40% of the 2010 World Cup players took pain medication before each match. OBJECTIVE: to identify the level of knowledge about NSAIDs presented by professional footballers of the first division squads, through the analysis and reality of each team. METHOD: surveys validated by the medical departments of each club were applied and through open and closed questions and multiple choice format, it was determined that: the age of the professional soccer players in the study ranges between 15 and 34 years. RESULTS: regarding the knowledge of the pharmacological group that counteracts symptoms of pain, fever and inflammation; It was determined that there is great confusion and ignorance in relation to the identification of drugs and their conceptualization. Likewise, with respect to active principles that treat pain, fever and inflammation, a preference was noted for Ibuprofen, Paracetamol and Diclofenac. And that less than 50% of all footballers recognize the adverse effects of the drugs under study. CONCLUSION: there are shortcomings regarding the knowledge of medications (NSAIDs), and that due to the haste with which they need to return to the courts, these sports professionals often trust people who are not trained in medicine or pharmacological issues.

INTRODUÇÃO: vários estudos realizados pela Federação Internacional de Futebol identificaram o uso abusivo de NSAIDs (Analgésicos Antiinflamatórios Não Esteróides) em jogadores de futebol, indicando que quase 40% dos jogadores da Copa do Mundo de 2010 tomavam analgésicos antes de cada partida. OBJETIVO: identificar o nível de conhecimento sobre os AINE apresentado por futebolistas profissionais das equipes da primeira divisão, por meio da análise e da realidade de cada equipe. MÉTODO: foram aplicadas pesquisas validadas pelos departamentos médicos de cada clube e por meio de questões abertas e fechadas e no formato de múltipla escolha, determinou-se que: a idade dos jogadores profissionais de futebol em estudo varia entre 15 e 34 anos. RESULTADOS: quanto ao conhecimento do grupo farmacológico que neutraliza os sintomas de dor, febre e inflamação; Constatou-se que existe grande confusão e desconhecimento em relação à identificação dos medicamentos e sua conceituação. Da mesma forma, no que diz respeito aos princípios ativos que tratam a dor, febre e inflamação, foi observada uma preferência para ibuprofeno, paracetamol e diclofenaco. E que menos de 50% de todos os jogadores de futebol reconhecem os efeitos adversos das drogas em estudo. CONCLUSÃO: há lacunas no conhecimento sobre medicamentos (NSAIDs) e que, devido à pressa com que precisam retornar às quadras, esses profissionais do esporte costumam confiar em pessoas sem formação em medicina ou farmacologia.

Efecto analgésico del bloqueo PENG (grupo de nervios pericapsulares) en pacientes con fractura de cadera / Analgesic effect of the PENG BLOCK (pericapsular nervous group) in patients with hip fracture

Ultrasound regional blockade emerged that blocks the branches of the femoral nerve, obturator and accessory obturator that innervate the anterior hip capsule, the PENG block (group of pericapsular nerves), which by its Recent description does not have enough evidence in medical practice. To verify the analgesic effect of the PENG block in patients with hip fracture and its analgesic permanence during the first 10 hours after the block in patients admitted with a diagnosis of hip fracture, at the General Interzonal Hospital of Acute "Dr Oscar E Alende "From Mar del Plata, Argentina, in the months of May to November 2019. A prospective descriptive observational study was carried out with a total of 53 patients, hospitalized patients with a diagnosis of hip fracture, with standardized intravenous analgesic scheme and who have not yet undergone hip surgery. Pain was evaluated with the EVA scale (visual analog scale) prior to the blockage, and then at 30 min and 10 hours after the blockade, 15 ml of 1% lidocaine and 15 ml of bupivacaine at 0 were used. 25%, convex or linear ultrasound probe according to patient weight and 100 mm needle. In order to reproduce and evaluate the pain, the patients had a 30º flexion of the hip. Prior to the blockade, 66% of the patients had severe pain and 34% moderate pain, none presented mild pain or absence, both at thirty minutes and ten hours after the blockade, no patient presented severe pain and all patients presented analgesia with a decrease in more than three points on the VAS scale, in some cases reaching a decrease of 10 points on that scale. The PENG block is a regional anesthesia technique that provides very good analgesia to patients with hip fractures, therefore, it is an excellent saving strategy for systemic analgesics. Knowing the analgesia provided by the blockade at 30 min and at 10 h, it could be performed both in the preoperative period for the transfer and mobilization of the patient, as well as in the postoperative period, which could save the use of opioids and decrease hospital stay.

INTRODUCCIÓN La fractura de cadera es una emergencia ortopédica común en ancianos asociada a gran morbimortalidad, una adecuada analgesia regional perioperatoria determina un ahorro en el uso de analgésicos sistémicos. Recientemente, en el año 2018, surgió un nuevo bloqueo regional ecoguiado muy prometedor que bloquea las ramas del nervio femoral, obturador y obturador accesorio que inervan la capsula anterior de la cadera, el bloqueo PENG (grupo de nervios pericapsulares), el cual por su reciente descripción no cuenta con la suficiente evidencia en la práctica médica. OBJETIVOS: Comprobar el efecto analgésico del bloqueo PENG en pacientes con fractura de cadera y su permanencia analgésica durante las 10 primeras horas posteriores al bloqueo en los pacientes internados con diagnóstico de fractura de cadera, en el Hospital Interzonal General de Agudos "Dr. Oscar E Alende" de Mar del Plata, Argentina, en los meses de mayo a noviembre del 2019. MATERIALES Y MÉTODOS: Se realizó un estudio observacional descriptivo prospectivo con un total de 53 pacientes, se incluyeron pacientes internados con diagnóstico de fractura de cadera, con esquema analgésico endovenoso estandarizado y que aún no hayan sido sometido a cirugía de cadera. Se evaluó el dolor con la escala EVA (escala análoga visual) previo al bloqueo, y luego a los 30 min y a las 10 Hs de haber realizado el bloqueo, para este se utilizaron 15 ml lidocaína 1% y 15 ml de bupivacaína al 0,25%, sonda ecográfica convexa o lineal según el peso del paciente y aguja 100 mm. Para reproducir y evaluar el dolor se les realizo a los pacientes una flexión de 30º de la cadera. RESULTADOS: Previo al bloqueo el 66% de los pacientes tuvieron dolor severo y 34% dolor moderado, ninguno presentaba dolor leve o ausencia del mismo, tanto a los treinta minutos como a las diez horas posteriores al bloqueo ningún paciente presento dolor severo y todos los pacientes presentaron analgesia con una disminución en más de tres puntos en la escala de EVA, llegando en algunos casos a una disminución de 10 puntos de dicha escala. CONCLUSIONES: El bloqueo PENG es una técnica de anestesia regional que brinda muy buena analgesia a los pacientes con fractura de cadera, por consiguiente, es una excelente estrategia ahorradora de analgésicos sistémicos. Conociendo la analgesia que brinda el bloqueo a los 30 min y a las 10 h de realizado, se podría realizar dicho bloqueo tanto en el preoperatorio para el traslado y movilización del paciente, como en el post-operatorio, lo que podría ahorrar el uso de opioides y disminuir la estancia hospitalaria.

Avaliação de anti-inflamatórios não esteroidais no tratamento da dor de ovinos submetidos à implantação de cânula ruminal e orquiectomia / Assessment of nonsteroidal anti-inflammatory drugs in treatment of pain in sheep submitted to ruminal cannulation and orchiectomy

O presente trabalho objetivou comparar o efeito do flunixin meglumine, cetoprofeno e meloxicam no tratamento da dor pós-operatória de ovinos submetidos à implantação de cânula ruminal e orquiectomia. Foram utilizados 32 ovinos, machos, pesando em média 35,5±3,5kg, distribuídos em três grupos: GFlu (flunixin meglumine 1,1mg/kg i.v.), GCet (cetoprofeno 3,0mg/kg i.v.) e GMel (meloxicam 0,5mg/kg i.v.). Exame clínico e coletas de sangue foram realizados no M0 (pré-avaliação), M1 (10 minutos após a pré-avaliação), M2 (início da sutura para fixação da cânula ruminal), M3 (logo após o término da cirurgia) e em duas, 12, 23, 25, 48 e 72 horas após a cirurgia (M2h, M12h, M23h, M25h, M48h e M72h), quando foram avaliados cortisol, glicose, proteína total, albumina, γ-glutamiltransferase (GGT), aspartato aminotransferase (AST), creatina quinase (CK), ureia, creatinina e hemograma. Nos M2h, M12h, M23h, M25h e M48h, foi realizada avaliação comportamental. O GFlu apresentou maior concentração de cortisol no M12h e no M48h e maior escore de dor na fístula e no testículo no M12h, quando comparado ao GMel. Os animais do GCet apresentaram menor interação com outros membros da baia no M23h. A ação analgésica do meloxicam foi maior em animais submetidos à implantação de cânula ruminal e orquiectomia, quando comparado ao flunixin meglumine e ao cetoprofeno.(AU)

This study aimed to compare the effect of flunixin meglumine, ketoprofen, and meloxicam in the treatment of postoperative pain in sheep submitted to ruminal cannulation and orchiectomy. 32 sheep were submitted to implantation of rumen cannula and orchiectomy, divided into three groups: GFlu (Flunixin meglumine 1,1mg/kg i.v.); GCet (Ketoprofen 3,0mg/kg i.v.); GMel (Meloxicam 0,5mg/kg i.v.). Clinical examination and blood samples were performed at M0 (pre-evaluation), M1 (10 minutes after pre-evaluation), M2 (beginning ruminal cannula), M3 (immediately post-surgery), and M2h, M12h, M23h, M25h, M48h and M72h (2h, 12h, 23h, 25h, 48h and 72 hours post-surgery) with the evaluation of cortisol, glucose, total protein, albumin, γ-glutamyl transferase (GGT), aspartate aminotransferase (AST), creatine kinase (CK), urea, creatinine and blood count. At M2h, M12h, M23h, M25h and M48h a behavioral evaluation was performed. The GFlu showed higher concentration of cortisol at M12h and M48h and greater pain score related with fistula and testis procedures at M12h when compared to GMel. Animals in the GCet group presented lower interaction with other animals in the same M23h paddock. The analgesia provided by Meloxicam was higher than flunixin meglumine and ketoprofen in animals submitted to placement of ruminal cannula and orchiectomy.(AU)

Trends in hospital consumption of analgesics after the implementation of a pain performance improvement plan / Tendências no consumo hospitalar de analgésicos após a implantação de plano de melhoria do controle da dor

Abstract Background: Pain management committee established a pain performance improvement plan in 2012. Objectives: The aim of the study was to assess the trends in analgesic consumption in a tertiary teaching hospital and the associated economic impact. Methods: A descriptive, retrospective study was conducted between 2011 and 2015. The analysis included: anti-inflammatory and antirheumatic products non-steroids, opioid analgesics and other analgesics and antipyretics. Data are converted into DDD/100 bed-days to analyze consumption trends. Main outcome measure: assessment of the analgesic consumption after the implementation of a pain performance improvement plan. Results: Overall, non-steroidal anti-inflammatory and antirheumatic products consumption decreased in 24.8 DDD/100 bed-days (-28.3%), accounting for most of the total analgesic consumption decrease (-13%) and total cost (-44.3%). Opioid consumption increased markedly from 22.3 DDD/100 bed-days in 2011 to 26.5 DDD/100 bed-days in 2015 (+18.9%). In 2011, the most consumed opioid was morphine (8.6 DDD/100 bed-days). However, there was an increasing trend in fentanyl consumption (from 8.1 to 12.1 DDD/100 bed-days in 2015), which resulted in fentanyl replacing morphine from the most consumed opioid in 2015 (12.1 DDD/100 bed-days). In 2015, the group of other analgesics and antipyretics represented 46.2% of the total analgesic consumption. Acetaminophen was the most commonly consumed analgesic drug (53.2 DDD/100 bed-days in 2015) and had the highest total cost, it represented 55.4% of the overall cost in 2015. Conclusion: Opioid consumption showed an increasing trend during the 5 year period, with fentanyl replacing morphine as the most used opioid. In general, analgesics diminished use was due to the decreasing trend of consumption of non-steroidal anti-inflammatory and antirheumatic products.

Resumo Justificativa: A Comissão para o Manejo da Dor estabeleceu um plano de melhoria no controle da dor em 2012. Objetivo: Avaliar as tendências do consumo de analgésicos em um hospital de ensino terciário e o impacto econômico associado. Métodos: Estudo descritivo, retrospectivo, feito entre 2011 e 2015. A análise incluiu: produtos anti-inflamatórios e antirreumáticos não esteroides, analgésicos opioides e outros analgésicos e antipiréticos. Os dados foram convertidos em DDD/100 leitos-dia para analisar as tendências de consumo. Principal medida do desfecho: avaliação do consumo de analgésicos após o estabelecimento de um plano de melhoria no controle da dor. Resultados: O consumo total de produtos anti-inflamatórios e antirreumáticos não esteroides diminuiu em 24,8 DDD/100 leitos-dia (-28,3%), representando a maior parte da redução total do consumo de analgésicos (-13%) e o custo total (-44,3%). O consumo global de opioides aumentou acentuadamente de 22,3 DDD/100 leitos-dia em 2011 para 26,5 DDD/100 leitos-dia em 2015 (+18,9%). Em 2011, o opioide mais consumido foi a morfina (8,6 DDD/100 leitos-dia). No entanto, houve uma tendência crescente no consumo de fentanil (de 8,1 para 12,1 DDD/100 leitos-dia em 2015), o que resultou na substituição de morfina por fentanil como o opioide mais consumido em 2015 (12,1 DDD/100 leitos-dia). Em 2015, o grupo dos outros analgésicos e antipiréticos representou 46,2% do consumo total de analgésicos. Acetaminofeno foi o analgésico mais consumido (53,2 DDD/100 leitos-dia em 2015) e teve o maior custo total, representou 55,4% do custo total em 2015. Conclusão: O consumo de opioides mostrou uma tendência crescente durante o período de cinco anos, fentanil substituiu morfina como o opioide mais usado. Em geral, o uso diminuído de analgésicos foi devido à tendência decrescente do consumo de produtos anti-inflamatórios e antirreumáticos não esteroides.

[Trends in hospital consumption of analgesics after the implementation of a pain performance improvement plan]. / Tendências no consumo hospitalar de analgésicos após a implantação de plano de melhoria do controle da dor.

BACKGROUND: Pain management committee established a pain performance improvement plan in 2012. OBJECTIVE: The aim of the study was to assess the trends in analgesic consumption in a tertiary teaching hospital and the associated economic impact. METHODS: A descriptive, retrospective study was conducted between 2011 and 2015. The analysis included: anti-inflammatory and antirheumatic products non-steroids, opioid analgesics and other analgesics and antipyretics. Data are converted into DDD/100 bed-days to analyze consumption trends. MAIN OUTCOME MEASURE: assessment of the analgesic consumption after the implementation of a pain performance improvement plan. RESULTS: Overall, non-steroidal anti-inflammatory and antirheumatic products consumption decreased in 24.8 DDD/100 bed-days (-28.3%), accounting for most of the total analgesic consumption decrease (-13%) and total cost (-44.3%). Opioid consumption increased markedly from 22.3 DDD/100 bed-days in 2011 to 26.5 DDD/100 bed-days in 2015 (+18.9%). In 2011, the most consumed opioid was morphine (8.6 DDD/100 bed-days). However, there was an increasing trend in fentanyl consumption (from 8.1 to 12.1 DDD/100 bed-days in 2015), which resulted in fentanyl replacing morphine from the most consumed opioid in 2015 (12.1 DDD/100 bed-days). In 2015, the group of other analgesics and antipyretics represented 46.2% of the total analgesic consumption. Acetaminophen was the most commonly consumed analgesic drug (53.2 DDD/100 bed-days in 2015) and had the highest total cost, it represented 55.4% of the overall cost in 2015. CONCLUSION: Opioid consumption showed an increasing trend during the 5 year period, with fentanyl replacing morphine as the most used opioid. In general, analgesics diminished use was due to the decreasing trend of consumption of non-steroidal anti-inflammatory and antirheumatic products.

Boas práticas do enfermeiro quanto a avaliação e controle da dor em pacientes oncológicos / [Good nurse practices regarding pain assessment and control in cancer patients]

Introdução: A dor é uma experiência sensorial desagradável, associada a um dano tissular real ou potencial ou descrita em termos desse dano. Quando a avaliação da dor não é realizada de forma sistematizada, a dor pode ser subestimada. A avaliação inadequada e o desconhecimento sobre as estratégias disponíveis para o seu controle são fatores que podem dificultar o manejo desse sintoma. Objetivo: Compilar em quadros as boas práticas do enfermeiro na avaliação e controle da dor dos pacientes oncológicos adultos e idosos, de modo a fundamentar ações que poderão ser seguidas pelos enfermeiros para um manejo da dor com qualidade. Método: Revisão de literatura sistemática com metassumarização qualitativa. Resultados: Compilação das ações preconizadas aos enfermeiros nos artigos revisados. Discussão: Dentre os achados, como método avaliativo estão às escalas unidimensionais e instrumentos multidimensionais, como controle é importante o conhecimento de métodos farmacológicos, e não farmacológicos, e também nesse manejo, deve-se estar incluído a educação quanto ao autogerenciamento da dor pelo paciente. Considerações finais: Deve-se realizar uma avaliação e controle da dor de forma contínua e sistematizada, adequando-se à individualidade de cada paciente. Em todo esse processo o enfermeiro se torna indispensável no manejo desse sintoma incapacitante.

Introduction: Pain is an unpleasant sensory experience associated with actual or potential tissue damage or described in terms of that damage. When pain assessment is not performed in a systematic way, pain can be underestimated. Inadequate assessment and lack of knowledge about the strategies available for its control are factors that may hinder the management of this symptom. Objective: To compile the good practices of the nurse in the evaluation and control of the pain of adult and elderly cancer patients, in order to support actions that nurses can follow for quality pain management. Method: Review of systematic literature with qualitative metassumarization. Results: Compilation of the actions recommended to the nurses in the reviewed articles. Discussion: Among the findings, as an evaluation method are the one-dimensional scales and multidimensional instruments, as control is important knowledge of pharmacological and non-pharmacological methods, and also in this management, education should be included regarding self-management of pain by the patient. Final considerations: An evaluation and control of pain should be carried out in a continuous and systematized manner, adapting to the individuality of each patient. Throughout this process the nurse becomes indispensable in the management of this incapacitating symptom.

Polygala anatolica Boiss. et Heldr.: is a potential remedy for inflammation and pain? / Polygala anatolica Boiss. et Heldr.: ¿es un remedio potencial para la inflamación y el dolor?

Species of Polygala genus have been used for the treatment of inflamation and pain in Turkish traditional medicine. The aim of the present study is to assess the anti-inflammatory and analgesic activities of P. anatolica. n-Hexane, ethyl acetate and methanol extracts of the aerial parts and roots of P. anatolica were investigated for their anti-inflammatory and analgesic effects. The methanol extracts prepared from the aerial parts and roots of P. anatolica were found to be active in carrageenan- and PGE2-induced paw edema models and in Whittle method. Methanolic extract of the aerial part inhibited serotonin-induced hind paw edema, while the root extract did not exert inhibitory effect in the same model. In addition, Fr. B and C obtained from the methanol extract of P. anatolica aerial parts showed significant anti- inflammatory activity. Morover, the analgesic effect of the methanol extracts prepared from the roots and aerial parts and Fr.B and Fr.C were found to be statistically significant without inducing ulceration. The methanol extract obtained from the aerial parts of the plant and its saponoside and flavonoid fractions showed anti-inflammatory and analgesic activities in the trials.

Las especies del género Polygala se han utilizado para el tratamiento de la inflamación y el dolor en la medicina tradicional turca. El objetivo del presente estudio es evaluar las actividades antiinflamatorias y analgésicas de P. anatolica. Se investigaron los extractos de n-hexano, acetato de etilo y metanol de las partes aéreas y raíces de P. anatolica por sus efectos antiinflamatorios y analgésicos. Los extractos de metanol preparados a partir de las partes aéreas y raíces de P. anatolica se encontraron activos en modelos de edema de pata inducidos por carragenina y PGE2 por el método de Whittle. El extracto metanólico de la parte aérea inhibió el edema de la pata trasera inducido por serotonina, mientras que el extracto de raíz no ejerció un efecto inhibidor en el mismo modelo. En suma, la fracción B y C obtenidos a partir del extracto metanólico de partes aéreas de P. anatolica mostraron actividad antiinflamatoria significativa. Además, el efecto analgésico de los extractos de metanol preparados a partir de las raíces y las partes aéreas y la fracción B y C resultaron ser estadísticamente significativas sin inducir la ulceración. El extracto de metanol obtenido de las partes aéreas de la planta y sus fracciones de saponósidos y flavonoides mostraron actividades antiinflamatorias y analgésicas en los ensayos.

Recomendaciones para la prescripción segura de opioides en el manejo del dolor crónico no oncológico.

El tratamiento del dolor crónico severo es una meta histórica de la medicina. Los opioides naturales (como la morfina) se han usado por muchos años y la aparición reciente de opioides sintéticos se ha sumado a esta opción terapéutica, sin embargo, el potencial adictivo de estas sustancias obliga a la reglamentación de su uso. Las agencias médicas internacionales recomiendan prudencia en el uso terapéutico de opioides.The treatment of chronic and severe pain is a principal goal of medicine. Natural opioids have been used for several years, and the recent development of synthetic opioids has increased therapeutic options; however, the addictive potential of these substances obliges the regulation of their use. International agencies recommend prudent rules in the therapeutic use of opioids.