Bioceramic cement in the filling of bone defects in rats.

PURPOSE: To evaluate PBS®MCIMMO cement in the filling of bone defects. METHODS: Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. RESULTS: In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). CONCLUSION: The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.

Bioceramic cement in the filling of bone defects in rats

Abstract Purpose To evaluate PBS®MCIMMO cement in the filling of bone defects. Methods Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. Results In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). Conclusion The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.

Absorbable suture. Best aesthetic outcome in cesarian scar1.

PURPOSE: To compare two suture threads, poliglecaprone 25 and nylon, used as intradermal suture for skin closure in women undergoing their first cesarean section. METHODS: This is a randomized clinical trial. A total of 60 women undergoing their first cesarean section were enrolled and prospectively assessed. They were randomly allocated to group I (n=30), which received an intradermal suture with nylon 4.0 or to group II (n=30), which had an intradermal suture with poliglecaprone 25, 4.0. The main author took standardized photographs of the scar 6 months after the operation. Four independent raters, two senior obstetricians and two senior plastic surgeons (a male and a female physician from each specialty) assessed the photographs.The panelists rated the scar according to Trimbos scale, composed by the subscales hypertrophy, color and width of the scar. RESULTS: At baseline, patients in both groups were similar regarding age and body mass index. Five patients withdraw the study, four from group and one from group II. Scars of patients from group II were significantly less hypertrophic (p=0.001), thinner (p=0.019) and had more acceptable color (p=0.019). CONCLUSION: The intradermal suture with poliglecaprone 25 for skin closure after cesarean incision provides better aesthetic result.

Absorbable suture. Best aesthetic outcome in cesarian scar

Abstract Purpose: To compare two suture threads, poliglecaprone 25 and nylon, used as intradermal suture for skin closure in women undergoing their first cesarean section. Methods: This is a randomized clinical trial. A total of 60 women undergoing their first cesarean section were enrolled and prospectively assessed. They were randomly allocated to group I (n=30), which received an intradermal suture with nylon 4.0 or to group II (n=30), which had an intradermal suture with poliglecaprone 25, 4.0. The main author took standardized photographs of the scar 6 months after the operation. Four independent raters, two senior obstetricians and two senior plastic surgeons (a male and a female physician from each specialty) assessed the photographs.The panelists rated the scar according to Trimbos scale, composed by the subscales hypertrophy, color and width of the scar. Results: At baseline, patients in both groups were similar regarding age and body mass index. Five patients withdraw the study, four from group and one from group II. Scars of patients from group II were significantly less hypertrophic (p=0.001), thinner (p=0.019) and had more acceptable color (p=0.019). Conclusion: The intradermal suture with poliglecaprone 25 for skin closure after cesarean incision provides better aesthetic result.

Effect of Pycnogenol on the Healing of Venous Ulcers.

BACKGROUND: Venous ulcers are common complications of chronic venous insufficiency that result in severe physical and mental suffering to patients. The oral administration of diosmin/hesperidin has been used as adjuvant therapy in the treatment of chronic venous insufficiency. The purpose of this study was to evaluate and compare the effect of pycnogenol and diosmin/hesperidin on the healing of venous ulcers. METHODS: This longitudinal, prospective, randomized clinical trial was conducted with 30 adult patients with venous ulcers from a vascular surgery outpatient clinic of a university hospital. The patients were randomly allocated to 2 groups: Group 1 (n = 15) was treated with pycnogenol (50 mg orally, 3 times daily) and Group 2 (n = 15) was treated with diosmin/hesperidin (450/50 mg orally, twice daily). They were assessed every 15 days for 90 days. During follow-up visits, photo-documentation was obtained and the ulcer area and circumference of the affected limb were measured. Friedman's test and Mann-Whitney test were used to compare ulcer areas and circumference of affected limbs between and within groups at different time points. The level of significance was set at 5% (P < 0.05) for all tests. RESULTS: Both the pycnogenol and diosmin/hesperidin treatments had a similar effect on the healing of venous ulcers and led to a significant decrease in the circumference of affected limbs (P < 0.0001). CONCLUSION: The results suggest that pycnogenol has an adjuvant effect on the healing of venous ulcers, similar to diosmin/hesperidin.

The use of a biocompatible cement in endodontic surgery. A randomized clinical trial 1.

PURPOSE: To evaluate the clinical applicability of Pozzolana Biologic Silva cement (PBS(r)) in endodontic surgery. METHODS: Persistent apical periodontitis was diagnosed in 30 teeth of 12 patients by cone-beam computed tomography (CT). All patients had 2 or 4 affected teeth and underwent endodontic surgery with root-end filling. Patients with 2 affected teeth had one tooth (control) treated with mineral trioxide aggregate (MTA-Angelus(r)) as a root-end filling material, and the other tooth treated with PBS (experiment). When the patient had four affected teeth, two of them were treated with MTA and two with PBS. Six months after surgery, all patients were assessed by CT scan. Between-group comparisons of measurements were performed using the Wilcoxon test. RESULTS: Periradicular tissue regeneration was observed in all cases. Significant within-group differences in long axes of the lesion were found in the bucco-palatal direction (PBS group, p=0.0012; MTA group, p=0.024) and coronal-apical direction (PBS group, p=0.0007; MTA group, p=0.0015) between pre- and postoperative measurements. CONCLUSIONS: Pozzolana Biologic Silva cement can be used in the treatment of persistent periradicular lesions. The clinical use of PBS as a root-end filling material may be an alternative to MTA. PBS has additives, which provide enhanced strength.

The use of a biocompatible cement in endodontic surgery. A randomized clinical trial 1

ABSTRACT PURPOSE: To evaluate the clinical applicability of Pozzolana Biologic Silva cement (PBS(r)) in endodontic surgery. METHODS: Persistent apical periodontitis was diagnosed in 30 teeth of 12 patients by cone-beam computed tomography (CT). All patients had 2 or 4 affected teeth and underwent endodontic surgery with root-end filling. Patients with 2 affected teeth had one tooth (control) treated with mineral trioxide aggregate (MTA-Angelus(r)) as a root-end filling material, and the other tooth treated with PBS (experiment). When the patient had four affected teeth, two of them were treated with MTA and two with PBS. Six months after surgery, all patients were assessed by CT scan. Between-group comparisons of measurements were performed using the Wilcoxon test. RESULTS: Periradicular tissue regeneration was observed in all cases. Significant within-group differences in long axes of the lesion were found in the bucco-palatal direction (PBS group, p=0.0012; MTA group, p=0.024) and coronal-apical direction (PBS group, p=0.0007; MTA group, p=0.0015) between pre- and postoperative measurements. CONCLUSIONS: Pozzolana Biologic Silva cement can be used in the treatment of persistent periradicular lesions. The clinical use of PBS as a root-end filling material may be an alternative to MTA. PBS has additives, which provide enhanced strength.

Portland cement versus MTA as a root-end filling material. A pilot study.

PURPOSE: To assess periradicular lesions clinically and by computed tomography (CT) after endodontic surgery using either Portland cement or mineral trioxide aggregate (MTA) as a root-end filling material. METHODS: Three patients diagnosed with periradicular lesions by cone-beam CT underwent endodontic surgery with root-end filling. Patient A was treated with MTA as the root-end filling material, patient B was treated with Portland cement and patient C had two teeth treated, one with MTA and the other with Portland cement. Six months after surgery, the patients were assessed clinically and by CT scan and the obtained results were compared. RESULTS: Periradicular tissue regeneration was observed in all cases, with no significant differences in bone formation when comparing the use of MTA and Portland cement as root-end filling materials. CONCLUSION: Both mineral trioxide aggregate and Portland cement were successful in the treatment of periradicular lesions.

Portland cement versus MTA as a root-end filling material. A pilot study

PURPOSE: To assess periradicular lesions clinically and by computed tomography (CT) after endodontic surgery using either Portland cement or mineral trioxide aggregate (MTA) as a root-end filling material. METHODS: Three patients diagnosed with periradicular lesions by cone-beam CT underwent endodontic surgery with root-end filling. Patient A was treated with MTA as the root-end filling material, patient B was treated with Portland cement and patient C had two teeth treated, one with MTA and the other with Portland cement. Six months after surgery, the patients were assessed clinically and by CT scan and the obtained results were compared. RESULTS: Periradicular tissue regeneration was observed in all cases, with no significant differences in bone formation when comparing the use of MTA and Portland cement as root-end filling materials. CONCLUSION: Both mineral trioxide aggregate and Portland cement were successful in the treatment of periradicular lesions. .

Portland cement with additives in the repair of furcation perforations in dogs.

PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.

Portland cement with additives in the repair of furcation perforations in dogs / Cimento Portland com aditivos na reparação de perfurações radiculares em cães

PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.

OBJETIVO: Avaliar o uso de cimentos Portland aditivados na reparação de perfurações radiculares e a biocompatibilidade destes materiais. MÉTODOS: Oitenta pré-molares, quatro da arcada dentária superior e quatro da arcada inferior de 10 cães machos, sem raça definida, com idade em torno de um a um ano e meio, pesando entre 10 e 15 kg foram submetidos a tratamento endodôntico, sendo realizadas perfurações nas furcas com broca de diamante 1016 HL. A cavidade envolveu dentina e cemento, como também periodonto e o osso alveolar. Na porção óssea da obturação, barreira de sulfato de cálcio foi utilizada evitando extravasamento do cimento para o espaço periodontal. Foi realizada a distribuição randomizada dos cimentos MTA (controle), Portland tipo II, Portland tipo V e Portland branco estrutural nas obturações. Os dentes foram restaurados com resina composta. Após 120 dias realizou-se eutanásia, retirada dos dentes, preparação e análise histológica. RESULTADOS: Entre os cimentos não houve diferença estatística significante quanto à neoformação óssea (p=0,879). CONCLUSÃO: Ocorreu biomineralização com os diferentes cimentos usados no estudo, sugerindo que estes são similares em termos de biocompatibilidade.

Root perforations treatment using mineral trioxide aggregate and Portland cements.

PURPOSE: Clinical, radiological and histological evaluation of root perforations treated with mineral trioxide aggregate (MTA) or Portland cements, and calcium sulfate barrier. METHODS: One molar and 11 premolar teeth of a male mongrel dog received endodontic treatment and furcations were perforated with a high-speed round bur and treated with a calcium sulfate barrier. MTA, Portland cement type II (PCII) and type V (PCV), and white Portland cement (WPC) were used as obturation materials. The teeth were restored with composite resin and periapical radiographs were taken. The animal was euthanized 120 days post-surgery for treatment evaluation. RESULTS: Right lower first premolar (MTA), right lower third premolar (PCV), left lower second premolar (MTA), and right lower second premolar (WPC): clinically normal, slightly radio-transparent area on the furcation, little inflammatory infiltrate, and new-bone formation. Left lower third premolar (PCII), right upper first premolar (WPC), right upper third premolar (PCII), and left upper first molar (PCV): clinically normal, radiopaque area on the furcation, and new-bone formation. Right upper second premolar (MTA), left upper second premolar (WPC), left upper third premolar (PCII): presence of furcation lesion, large radiolucent area, and intense inflammatory infiltrate. CONCLUSION: All obturation materials used in this study induced new-bone formation.

Root perforations treatment using mineral trioxide aggregate and Portland cements / Cimentos de agregado trióxido mineral e Portland no tratamento de perfurações radiculares

PURPOSE: Clinical, radiological and histological evaluation of root perforations treated with mineral trioxide aggregate (MTA) or Portland cements, and calcium sulfate barrier. METHODS: One molar and 11 premolar teeth of a male mongrel dog received endodontic treatment and furcations were perforated with a high-speed round bur and treated with a calcium sulfate barrier. MTA, Portland cement type II (PCII) and type V (PCV), and white Portland cement (WPC) were used as obturation materials. The teeth were restored with composite resin and periapical radiographs were taken. The animal was euthanized 120 days post-surgery for treatment evaluation. RESULTS: Right lower first premolar (MTA), right lower third premolar (PCV), left lower second premolar (MTA), and right lower second premolar (WPC): clinically normal, slightly radio-transparent area on the furcation, little inflammatory infiltrate, and new-bone formation. Left lower third premolar (PCII), right upper first premolar (WPC), right upper third premolar (PCII), and left upper first molar (PCV): clinically normal, radiopaque area on the furcation, and new-bone formation. Right upper second premolar (MTA), left upper second premolar (WPC), left upper third premolar (PCII): presence of furcation lesion, large radiolucent area, and intense inflammatory infiltrate. CONCLUSION: All obturation materials used in this study induced new-bone formation.

OBJETIVO: Avaliar clínica, radiológica e histologicamente perfurações radiculares tratadas com MTA e cimentos Portland, com barreira de sulfato de cálcio. MÉTODOS: A amostra foi constituída por 11 dentes pré-molares e um molar de cão macho, sem raça definida. Após tratamento endodôntico realizaram-se perfurações nas furcas com broca esférica de alta rotação e barreira de sulfato de cálcio. Foram utiliados os cimentos MTA, Portland tipo II (CPII), Portland tipo V (CPV) e Portland branco estrutural (CPB). Os dentes foram restaurados com resina composta e submetidos a radiografias periapicais. O animal foi confinado por 120 dias e submetido à eutanásia para avaliações. RESULTADOS: Primeiro pré-molar inferior direito (MTA), terceiro pré-molar inferior direito (CPV), segundo pré-molar inferior esquerdo (MTA) e segundo pré-molar inferior direito (CPB): clinicamente normal; leve área radiotransparente na furca; pequeno infiltrado inflamatório e neoformação óssea. Terceiro pré-molar inferior esquerdo (CPII), primeiro pré-molar superior direito (CPB), terceiro pré-molar superior direito (CPII) e primeiro molar superior esquerdo (CPV): clinicamente normal; área radiopaca na furca; neoformação óssea. Segundo pré-molar superior direito (MTA), segundo pré-molar superior esquerdo (CPB) e terceiro pré-molar superior esquerdo (CPII): clinicamente com lesão na furca; intensa área radiolucida; infiltrado inflamatório intenso. CONCLUSÃO: Todos os cimentos induziram a neoformação óssea.

Bloqueio interpleural em reconstrução mamária imediata pós-mastectomia, com retalho musculocutâneo transverso do reto abdominal. relato de três casos / Interplelural block for immediate breast reconstruction post-mastectomy, with transverse rectus abdominis myocutaneous flap. report of three cases

JUSTIFICATIVA E OBJETIVOS: O retalho musculocutâneo transverso do reto abdominal (TRAM) permite uma reconstrução completamente autóloga. É um procedimento complexo, de grande porte, exigindo analgesia eficiente. O objetivo deste estudo foi relatar o uso do bloqueio interpleural, associado à anestesia geral, para mastectomia e reconstrução imediata com retalho TRAM.RELATOS DOS CASOS: Foram avaliadas três pacientes com 37, 43 e 49 anos, apresentando neoplasia mamária. A indução anestésica foi realizada com etomidato (0,2 mg.kg-1), alfentanil (30 µg.kg-1) e rocurônio (0,6 mg.kg-1), sendo a manutenção obtida pela administração de isoflurano (0,5vol% a 3,0vol%). No bloqueio interpleural foram administradas ropivacaína a 0,75% (150 mg), morfina (3 mg) e clonidina (3 µg.kg-1), ao nível do EIC5, na linha axilar média, com agulha de Tuohy 17G; as pacientes foram colocadas na posição céfalodeclive (20º) imediatamente antes da realização do bloqueio, permanecendo por aproximadamente 10 minutos. A intensidade da dor pós-operatória foi analisada pela escala analógica verbal, nas primeiras 24 horas. Durante o intraoperatório foi administrado isoflurano em doses superiores a 0,5% e inferiores a 3%. Com a associação das técnicas anestésicas utilizadas, as pacientes se queixaram de dor leve nas primeiras 24 horas após o término do procedimento anestésico-cirúrgico, necessitando somente de anti-inflamatório não hormonal (dipirona).CONCLUSÃO: A técnica do bloqueio interpleural é segura e de fácil realização em cirurgias de mastectomia e reconstrução mamária imediata com retalho TRAM. Reduz o consumo de fármacos utilizados no intraoperatório e a solicitação de analgésicos no pós-operatório imediato.

BACKGROUND AND OBJECTIVES: Transverse rectus abdominis myocutaneous flap allows for a totally autologous reconstruction (TRAM). It is a complex and major procedure requiring efficient analgesia. This study aimed at reporting the use of interpleural block associated to general anesthesia for mastectomy and immediate reconstruction with TRAM flap. CASES REPORTS: Three patients aged 37, 43 and 49 years with breast neoplasia were evaluated. Anesthesia was induced with used for interpleural block at the level of EIC5 on the medium axillary line with 17G Tuohy needle; patients were placed in the head-down position (20º) immediately before the block, remaining for approximately 10 minutes. Postoperative pain intensity was evaluated by the verbal analog scale in the first 24 hours. Isoflurane was administered in the perioperative period in doses above 0.5% and below 3%. With the association of the anesthetic techniques, patients reported mild pain during the first 24 hours after anesthetic-surgical procedure completion, needing only non-steroid anti-inflammatory drugs (dipirone).CONCLUSION: Interpleural block is a safe and easy technique for mastectomy and immediate breast reconstruction with TRAM flap. It decreases perioperative drugs consumption and the request for analgesia in the immediate postoperative period.etomidate (0.2 mg.kg-1), alfentanil (30 µg.kg-1) and rocuronium (0.6 mg.kg-1) and was maintained with isoflurane (0.5vol% to 3.0vol%). 0.75% ropivacaine (150 mg), morphine (3 mg) and clonidine (3 µg.kg-1) were used for interpleural block at the level of EIC5 on the medium axillary line with 17G Tuohy needle; patients were placed in the head-down position (20º) immediately before the block, remaining for approximately 10 minutes. Postoperative pain intensity was evaluated by the verbal analog scale in the first 24 hours. Isoflurane was administered in the perioperative period in doses above 0.5% and below 3%. With the association of the anesthetic techniques, patients reported mild pain during the first 24 hours after anesthetic-surgical procedure completion, needing only non-steroid anti-inflammatory drugs (dipirone).CONCLUSION: Interpleural block is a safe and easy technique for mastectomy and immediate breast reconstruction with TRAM flap. It decreases perioperative drugs consumption and the request for analgesia in the immediate postoperative period.

Analgesia em procedimentos cirúrgicos de abdômen superior com anestesia peridural / Analgesia in upper abdomen surgeries with epidural anesthesia

JUSTIFICATIVA E OBJETIVOS: A associação de agentes e técnicas anestésicas tem sido utilizada para diminuir os impulsos nociceptivos no peri e pós-operatório, minimizando a morbidade e a mortalidade. O objetivo deste estudo foi avaliar a analgesia no pós-operatório de cirurgias de colecistectomia por via subcostal. MÉTODO: Após aprovação pelo Comitê de Ética, participaram do estudo aleatorizado e prospectivo, 40 pacientes, de ambos os sexos, com idade variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidos à colecistectomia por via subcostal, sob anestesia geral associada à anestesia peridural. Foram administradas levobupivacaína a 0,5% (100 mg) com adrenalina 1:200.000 (5 ?g.mL-1) ou ropivacaína a 0,75% (150 mg), morfina (3 mg) e clonidina (3 ?g.kg-1) ou dextrocetamina (0,5 mg.kg-1), no espaço intercostal T12-L1. A anestesia geral foi realizada com etomidato (0,2 mg.kg-1), alfentanil (30 ?g.kg-1), rocurônio (0,6 mg.kg-1), oxigênio e isoflurano (0,5vol% a 3,0vol%). A intensidade da dor pós-operatória foi avaliada pela escala analógica visual, 6h, 12h, 18h e 24h após o término do ato operatório. RESULTADOS: O número de pacientes que apresentou dor pós-operatória no grupo ropivacaína, morfina e clonidina foram três até 6h, um entre 6-12h, um entre 12-18h e dois entre 18-24h; no grupo ropivacaína, morfina e dextrocetamina foram um até 6h, três entre 6-12h, dois entre 12-18h e um entre 18-24h; no grupo levobupivacaína, morfina e clonidina, foram de dois até 6h, dois entre 6-12h e um entre 12-18 e no grupo levobupivacaína, morfina e dextrocetamina, foi um até 6h, um entre 6-12h, três entre 12-18h e um entre 18-24h, com diferença estatisticamente significante entre o tempo de observação até 6h e os 12-18h e 18- 24h no grupo ropivacaína, morfina e dextrocetamina e entre o tempo de observação até 6h e o 18-24h no grupo levobupivacaína, morfina e dextrocetamina. CONCLUSÃO: A associação da cetamina ou da clonidina com o anestésico local, por via peridural, produziu analgesia mais longa com menor consumo do tramadol.

BACKGROUND AND OBJECTIVES: The association of anesthetic agents and techniques has been used to decrease peri and postoperative nociceptive impulses, thus minimizing morbidity and mortality. This study aimed at evaluating postoperative analgesia of subcostal cholecystectomy surgeries. METHOD: After the Ethics Committee approval, participated in this randomized and prospective study 40 patients of both genders, with ages varying from 18 to 50 years, weight between 50 and 100 kg, physical status ASA I and II, submitted to subcostal cholecystectomy under general anesthesia associated to epidural anesthesia. Patients received 0,5% levobupivacaine (100 mg) with 1:200000 epinephrine (5 ?g.mL-1) or 0.75% ropivacaine (150 mg), morphine (3 mg) and clonidine (3 ?g.kg-1) or dextroketamine (0,5 mg.kg-1), in intercostal space T12-L1. General anesthesia was induced with etomidate (0,2 mg.kg-1), alfentanil (30 ?g.kg-1), rocuronium (0,6 mg.kg-1), oxygen and isoflurane (0.5vol% to 3.0vol%). Postoperative pain intensity was evaluated by the analog visual scale 6h, 12h, 18h and 24h after surgery completion. RESULTS: Number of patients with postoperative pain in the ropivacaine, morphine and clonidine group was three until 6h, one between 6-12h, one between 12-18h and two between 18-24h; in the ropivacaine, morphine and dextroketamine group they were one up to 6h, three between 6-12h, two between 12-18h and one between 18-24h; in the levobupivacaine, morphine and clonidine group they were two up to 6h, two between 6-12h, and one between 12-18h and in the levobupivacaine, morphine and dextroketamine group they were one up to 6h, one between 6-12h, three between 12-18h and one between 18-24h, with statistically significant difference between observation times up to 6h and 12-18h and 18-24h in the ropivacaine, morphine and dextroketamine group and between observation times up to 6h and 18-24h in the levobupivacaine, morphine and dextroketamine group. CONCLUSION: The association of ketamine or clonidine to local epidural anesthetics has induced longer analgesia with lower tramadol consumption.

Analgesia em procedimentos cirúrgicos de abdômen superior com bloqueio interpleural / Analgesia in upper abdominal surgery with interpleural block

JUSTIFICATIVA E OBJETIVOS: Pesquisas empregando bloqueio interpleural com anestésico local, opioide e agonista Alfa2-adrenérgico ou bloqueador do receptor N-metil-D-aspartato (NMDA), observaram a ocorrência de analgesia pós-operatória em cirurgias de abdômen superior. O objetivo deste estudo foi observar a presença de dor no pós-operatório de cirurgias de colecistectomia por via subcostal.MÉTODO: Após aprovação pelo Comitê de Ética, participaram do experimento aleatório e prospectivo, 40 pacientes, de ambos os sexos, com idade variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidos à colecistectomia por via subcostal, sob anestesia geral associada ao bloqueio interpleural. Foram administradas levobupivacaína a 0,5% (100 mg) com adrenalina 1:200.000 (5 µg.mL-1) ou ropivacaína a 0,75% (150 mg), morfina (3 mg) e clonidina (3 µg.kg-1) ou cetamina (0,5 mg.kg-1), ao nível EIC7, na linha axilar média, com agulha de Tuohy 17G, por via interpleural. A indução da anestesia geral foi realizada com a injeção de etomidato (0,2 mg.kg-1), alfentanil (30 µg.kg-1) e rocurônio (0,6 mg.kg-1) e a manutenção com oxigênio e isoflurano (0,5 vol% a 3,0 vol%). A analgesia pós-operatória, analisada pela escala analógica visual (EAV), foi observada às 6h, 12h, 18h e 24h após o término do ato operatório.RESULTADOS: Apresentaram dor pós-operatória: grupo RMC (ropivacaína, morfina e clonidina), um até 6h, seis entre 6 e 12h e um entre 18 e 24h; grupo RMK (ropivacaína, morfina e cetamina), quatro até 6h, quatro entre 6 e 12h, um entre 12 e 18h e um entre 18 e 24h; grupo LMC (levobupivacaína, morfina e clonidina), quatro até 6h e quatro entre 6 e 12h; grupo LMK (levobupivacaína, morfina e cetamina, cinco até 6h, quatro entre 6 e 12h e um entre 12 e 18h. Aplicando o teste Exato de Fisher observou-se diferença estatística significante entre o tempo de observação até 6h e os demais no grupo RMC; entre o tempo de observação até 6h e os 12-18h e 18-24h nos grupos RMK e LMK. Não ocorreram complicações relacionadas ao bloqueio interpleural.CONCLUSÃO: A necessidade de associar opioide ao analgésico comum para abolir a dor, em cirurgias de colecistectomia por via subcostal, ocorreu em número reduzido de pacientes.

BACKGROUND AND OBJECTIVES: Researches using interpleural block with local anesthetics, opioid and alpha2-adrenergic agonist or N-Methyl-D-aspartate (NMDA) receptor blocker have shown the presence of postoperative analgesia in upper abdominal surgeries. This study aimed at observing the presence of pain in the postoperative period of subcostal cholecystectomies. METHOD: After The Ethics Committee approval, participated in this randomized, prospective study 40 patients of both genders, aged 18 to 50 years, weighing between 50 and 100 kg, physical status ASA I and II, submitted to subcostal cholecystectomy under general anesthesia associated to interpleural block. The following drugs were administered: 0.5% levobupivacaine (100 mg) with 1:200.000 epinephrine (5 µg.mL-1) or 0.75% ropivacaine (150 mg), morphine (3 mg) and clonidine (3 µg.kg-1) or ketamine (0,5 mg.kg-1), at EIC7, in the medium axillary line with 17G Tuohy needle by interpleural route. General anesthesia was induced with etomidate (0.2 mg.kg-1), alfentanil (30 µg.kg-1) and rocuronium (0.6 mg.kg-1) and was maintained with oxygen and isoflurane (0.5 vol% at 3.0 vol%). Postoperative analgesia, evaluated by the visual analog scale (VAS), was observed at 6h, 12h, 18h and 24h after surgery completion.RESULTS: Postoperative pain was observed: one patient up to 6h, six between 6 and 12h and one between 18 and 24h in the RMC group (ropivacaine, morphine and clonidine); four patients up to 6h, four between 6 and 12h, one between 12 and 18h and one between 18 and 24h in the RMK group (ropivacaine, morphine and ketamine); four patients up to 6h, and four between 6 and 12h in the LMC group (levobupivacaine, morphine and clonidine); five patients up to 6h, four between 6 and 12h, and one between 12 and 18h in the LMK group (levobupivacaine, morphine and ketamine). Fisher's Exact test has shown statistically significant difference between 6h observation time and the others in the RMC group; between 6h observation time and 12-18h and 18-24h in RMK and LMK groups. There were no interpleural block-related complications.CONCLUSION: Only a small number of patients needed the association of opioid to normal analgesics to abolish pain in subcostal cholecystectomy surgeries.

Analgesia em procedimentos cirúrgicos de câncer de mama com bloqueio interpleural / Analgesia in breast neoplasm surgery with interpleural block

JUSTIFICATIVA E OBJETIVOS: A anestesia geral é a técnica mais utilizada para a realização dos procedimentos cirúrgicos de tratamento do câncer de mama, sendo também empregadas anestesia regional e a associação de ambas as técnicas. Os objetivos deste estudo foram observar a presença de dor pós-operatória, a necessidade de analgésicos e o tempo de permanência hospitalar.MÉTODO: Após aprovação pelo Comitê de Ética em Pesquisa, participaram deste estudo aleatório e prospectivo, 40 pacientes do sexo feminino, com idade variando de 25 a 55 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidas à mastectomia ou quadrantectomia com axilectomia, sob bloqueio interpleural associado à anestesia geral. As pacientes foram divididas em quatro grupos de 10. LMC: levobupivacaína - morfina - clonidina; RMC: ropivacaína - morfina - clonidina; LMK: levobupivacaína - morfina - cetamina; RMK - ropivacaína - morfina - cetamina. A indução da anestesia geral foi realizada com a administração de etomidato (0,2 mg.kg-1), alfentanil (30 µg.kg-1) e rocurônio (0,6 mg.kg-1) e a manutenção com oxigênio e isoflurano (0,5 vol% a 3,0 vol%). O bloqueio interpleural foi executado no EIC5, linha axilar média, com agulha de Tuohy 17G, sendo administradas levobupivacaína a 0,5% (100 mg) com adrenalina 1:200.000 (5 µg.mL-1) ou ropivacaína 0,75% (150 mg), morfina (3 mg) e clonidina (150 µg) ou cetamina (0,5 mg.kg-1). A analgesia pós-operatória, analisada pela escala analógica visual (EAV), foi observada às 6h, 12h, 18h e 24h após o término do ato operatório.RESULTADOS: Quinze pacientes apresentaram dor pós-operatória leve, sendo: nos grupos LMC e RMC, uma entre 6 e 12h, uma entre 12 e 18h e duas entre 18 e 24h; no grupo LMK, duas até 6h, duas entre 6 e 12h e uma entre 12 e 18h; no grupo RMK, duas até 6h e quatro entre 6 e 12h. Utilizando o teste do Qui-quadrado observou-se diferença estatística significante entre o grupo LMC e os grupos LMK e RMK, assim como entre o grupo RMC e os grupos LMK e RMK. Aplicando o teste Exato de Fisher observou-se diferença estatística significante entre o tempo de observação até 6h e o tempo de 18-24h nos grupos LMC e RMC. Não ocorreram complicações relacionadas ao bloqueio interpleural. Foi necessário administrar somente dipirona para tratamento da dor pós-operatória.CONCLUSÃO: As pacientes que apresentaram dor pós-operatória necessitaram somente de analgésico comum (dipirona), sendo que todas tiveram alta hospitalar com 24h de pós-operatório.

BACKGROUND AND OBJECTIVES: General anesthesia is the most widely used technique for breast cancer surgical procedures, being also used regional anesthesia and the association of both techniques. This study aimed at observing the presence of postoperative pain, the need for analgesics and hospital stay length.METHOD: After the Research Ethics Committee approval, participated in this randomized prospective study 40 female patients aged 25 to 55 years, weighing between 50 and 100 kg, physical status ASA I and II, submitted to mastectomy or quadrantectomy with axillectomy, under interpleural block associated to general anesthesia. Patients were distributed in four groups of 10: LMC: levobupivacaine - morphine - clonidine; RMC: ropivacaine - morphine - clonidine; LMK: levobupivacaine - morphine - ketamine; RMK: ropivacaine - morphine - ketamine. General anesthesia was induced with etomidate (0.2 mg.kg-1), alfentanil (30 µg.kg-1) and rocuronium (0.6 mg.kg-1) and was maintained with oxygen and isoflurane (0.5 vol% at 3.0 vol%). Interpleural block was induced in EIC5, median axillary line, with Tuohy 17G needle, with 0.5% levobupivacaine (100 mg) with epinephrine 1:200,000 (5 µg.mL-1) or 0.75% ropivacaine (150 mg), morphine (3 mg) and clonidine (150 µg) or ketamine (0,5 mg.kg-1). Postoperative analgesia evaluated by the visual analog scale (VAS) was observed at 6h, 12h, 18h and 24h after surgery completion.RESULTS: Fifteen patients referred mild postoperative pain being: in groups LMC and RMC, one between 6 and 12 h, one between 12 and 18 h and two between 18 and 14 h; in group RMK, two up to 6 h and four between 6 and 12 h. Using Chi-square test, there has been statistically significant difference between group LMC and groups LMK and RMK, as well as between group RMC and groups LMK and RMK. Fisher's Exact test has shown statistically significant difference between observation time up to 6 h and time of 18-24 h in groups LMC and RMC. There were no interpleural block-related complications. Only dipirone was needed to treat postoperative pain.CONCLUSION: Patients with postoperative pain only needed common analgesics (dipirone) and all were discharged 24 hours after surgery completion

Cuidador familiar de paciente com afecção neurológica / Family care providers of neurologically affected patients

Pesquisa qualitativa, exploratória que teve como objetivo identificar e conhecer o significado de ser cuidador familiar de paciente com afecção neurológica. Foram entrevistados vinte e um cuidadores familiares, de ambos os gêneros, no Hospital das Clínicas da Universidade do Vale do Sapucaí em seus respectivos domicílios. A coleta de dados foi realizada mediante entrevista semiestruturada, gravada e transcrita literalmente. As diretrizes metodológicas do Discurso do Sujeito Coletivo foram utilizadas para a seleção das ideias centrais e das expressões-chave correspondentes, a partir das quais foram extraídos os discursos dos cuidadores. Identificaram-se as seguintes representações sobre o evento ser cuidador: "cuidar", "carinho e responsabilidade", "ato de amor", "missão e vocação", "obrigação" e "dificuldade". Confirmam-se neste estudo os sentimentos positivos e negativos inerentes às tarefas do cuidador familiar.

This is a qualitative exploratory research that aimed to identify and learn the meaning of being a family care provider of a neurologically affected patient. Twenty-one family care providers of both sexes were interviewed at the clinical hospital of University Vale do Sapucaí and at their homes. Data collection was carried out through semi-structured interviews, which were recorded and transcribed. The methodological guidelines of the Collective Subject Discourse were used to select the central ideas and corresponding key expressions, from which the care providers' discourses were extracted. The following representations were identified about the event of being a care provider: "to provide care", "affection and responsibility", "act of love", "mission and vocation", "obligation" and "difficulty". In this study, the positive and negative senses inherent in the task of family care provider were confirmed.

Comparative study of anti-emetics and their association, in the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgeries.

BACKGROUND AND OBJECTIVES: Prophylaxis of postoperative nausea and vomiting has been the subject of several studies. The objective of the present study was to compare anti-emetics, and their association, in the prevention of postoperative nausea and vomiting. METHODS: Seventy patients, ASA I and II, underwent epidural block associated with general anesthesia for gynecologic surgeries. Patients in the Metochlopramide Group (MG) received 20 mg of the drug; the Dexamethasone Group (DeG) received 8 mg; the Droperidol Group (DrG) received 1.25 mg; the Ondansetron Group (OG) received 8 mg; the Dexamethasone-Ondansetron Group (DeOG) received 8 mg and 4 mg, respectively; the Droperidol-Ondansetron Group (DrOG) received 1.25 mg and 4 mg, respectively; the Dexamethasone-Droperidol-Ondansetron Group (DeDrOG) received 8 mg, 0.625 mg, and 4 mg. The presence of nausea and vomiting was evaluated at 6, 12, 24, and 36 hours after the end of the surgery. RESULTS: The total incidence of episodes of nausea per group is as follows: 4 in DeDrOG, 6 in OG, 6 in DrOG, 11 in DeG, 11 in DeOG, 18 in MG, and 22 in DrG. The Chi-square and Fisher exact tests indicated statistically significant differences between DrG and DeG, DOG, DrOG, DeOG, and DeDrOG; between MG and OG, DrOG, and DeDrOG; and between DeOG and DeDrOG. And the incidence of vomiting was: 3 in OG, 3 in DeDrOG, 6 in DrOG, 7 in DeG, 7 in DeOG, and 10 in DrG, and 13 in G. There was a statistically significant difference between DrG and OG and DeDrOG; and between MG and OG and DeDrOG. CONCLUSIONS: The association dexamethasone-droperidol-ondansetron and ondansetron alone were more effective in the prophylaxis of nausea and vomiting.

Estudo comparativo de antieméticos e suas associações, na prevenção de náuseas e vômitos pós-operatórios, em pacientes submetidas a procedimentos cirúrgicos ginecológicos / Estudio comparativo de antieméticos y sus asociaciones, en la prevención de náusea y vómito postoperatorios, en pacientes sometidas a procedimientos quirúrgicos ginecológicos / Comparative study of anti-emetics and their association, in the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgeries

JUSTIFICATIVA E OBJETIVOS: A profilaxia de náuseas e vômitos pós-operatórios foi objeto de muitos estudos. O objetivo desta pesquisa foi comparar antieméticos e associações na prevenção de náuseas e vômitos pós-operatórios. MÉTODO: Setenta pacientes, ASA I e II, foram submetidas a procedimentos cirúrgicos ginecológicos, sob bloqueio peridural associado à anestesia geral. No Grupo Metoclopramida (GM), administrou-se 20 mg; no Grupo Dexametasona (GDe), injetou-se 8 mg; no Grupo Droperidol (GDr) administrou-se 1,25 mg; no Grupo Ondansetron (GO) injetou-se 8 mg; no Grupo Dexametasona-Ondansetron (GDeO) administrou-se, respectivamente, 8 mg e 4 mg; no Grupo Droperidol-Ondansetron (GDrO) injetou-se 1,25 mg e 4 mg; no Grupo Dexametasona-Droperidol-Ondansetron (GDeDrO) administrou-se 8 mg, 0,625 mg e 4 mg. A presença de náuseas e vômitos foi observada nos momentos de 6, 12, 24 e 36 horas após o término do ato operatório. RESULTADOS: A incidência total de episódios de náuseas foi de quatro no GDeDrO, seis no GO, seis no GDrO, 11 no GDe, 11 no GDeO, 18 no GM e 22 no GDr. Aplicando-se o teste do Qui-quadrado ou o teste de Fisher, ocorreu diferença estatística significativa entre o GDr e os grupos GDe, GDO, GDrO, GDeO, GDeDrO; entre o GM e os grupos GO, GDrO e GDeDrO; entre o GDeO e o grupo GDeDrO. A incidência total de episódios de vômitos foi de três no GO, três no GDeDrO, seis no GDrO, sete no GDe, sete no GDeO, desz no GDr e 13 no G. Verificou-se diferença estatística significativa entre o GDr e os grupos GO e GDeDrO; entre o GM e os grupos GO e GDeDrO. CONCLUSÕES: A associação dexametasona-droperidol-ondansetron e o ondansetron foram mais eficazes na profilaxia de náuseas e vômitos.

BACKGROUND AND OBJECTIVES: Prophylaxis of postoperative nausea and vomiting has been the subject of several studies. The objective of the present study was to compare anti-emetics, and their association, in the prevention of postoperative nausea and vomiting. METHODS: Seventy patients, ASA I and II, underwent epidural block associated with general anesthesia for gynecologic surgeries. Patients in the Metochlopramide Group (MG) received 20 mg of the drug; the Dexamethasone Group (DeG) received 8 mg; the Droperidol Group (DrG) received 1.25 mg; the Ondansetron Group (OG) received 8 mg; the Dexamethasone-Ondansetron Group (DeOG) received 8 mg and 4 mg, respectively; the Droperidol-Ondansetron Group (DrOG) received 1.25 mg and 4 mg, respectively; the Dexamethasone-Droperidol-Ondansetron Group (DeDrOG) received 8 mg, 0.625 mg, and 4 mg. The presence of nausea and vomiting was evaluated at 6, 12, 24, and 36 hours after the end of the surgery. RESULTS: The total incidence of episodes of nausea per group is as follows: 4 in DeDrOG, 6 in OG, 6 in DrOG, 11 in DeG, 11 in DeOG, 18 in MG, and 22 in DrG. The Chi-square and Fisher exact tests indicated statistically significant differences between DrG and DeG, DOG, DrOG, DeOG, and DeDrOG; between MG and OG, DrOG, and DeDrOG; and between DeOG and DeDrOG. And the incidence of vomiting was: 3 in OG, 3 in DeDrOG, 6 in DrOG, 7 in DeG, 7 in DeOG, and 10 in DrG, and 13 in G. There was a statistically significant difference between DrG and OG and DeDrOG; and between MG and OG and DeDrOG. CONCLUSIONS: The association dexamethasone-droperidol-ondansetron and ondansetron alone were more effective in the prophylaxis of nausea and vomiting.

JUSTIFICATIVA Y OBJETIVOS: La profilaxis de náusea y vómito postoperatorios fue objeto de muchos estudios. El objetivo de esta investigación fue comparar antieméticos y asociaciones en la prevención de náusea y vómito postoperatorios. MÉTODO: Setenta pacientes, ASA I y II, fueron sometidas a procedimientos quirúrgicos ginecológicos, bajo bloqueo epidural asociado a la anestesia general. En el Grupo Metoclopramida (GM), se administró 20 mg; en el Grupo Dexametasona (GDe), se inyectó 8 mg; en el Grupo Droperidol (GDr) se administró 1,25 mg; en el Grupo Ondansetron (GO) se inyectó 8mg; en el Grupo Dexametasona-Ondansetron (GDeO) se administró respectivamente 8 mg y 4mg; en el Grupo Droperidol-Ondansetron (GDrO) se inyectó 1,25 mg y 4 mg; en el Grupo Dexametasona-Droperidol-Ondansetron (GDeDrO) se administró 8mg, 0,625 mg y 4mg. La presencia de náuseas y vómitos fue observada en los momentos de 6, 12, 24 y 36 horas después del término de la operación. RESULTADOS: La incidencia total de episodios de náuseas fue de 4 en el GDeDrO, 6 en el GO, 6 en el GDrO, 11 en el GDe, 11 en el GDeO, 18 en el GM y 22 en el GDr. Al aplicar el test del Chi-cuadrado o el test de Fisher, se comprobó la diferencia estadística significativa entre el GDr y los grupos GDe, GDO, GDrO, GDeO, GDeDrO; entre el GM y los grupos GO, GDrO y GDeDrO; entre el GDeO y el grupo GDeDrO. La incidencia total de episodios de vómitos fue de 3 en el GO, 3 en el GDeDrO, 6 en el GDrO, 7 en el GDe, 7 en el GDeO, 10 en el GDr y 13 en el G. Se comprobó así mismo, la diferencia estadística significativa entre el GDr y los grupos GO y GDeDrO; entre el GM y los grupos GO y GDeDrO. CONCLUSIONES: La asociación dexametasona-droperidol-ondansetron y el ondansetron fueron más eficaces en la profilaxis de náuseas y vómitos.