Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using midazolam or fentanyl associated with propofol / Comparação do tempo de recuperação pós-anestésica em pacientes sedados para colonoscopia usando midazolam ou fentanil associados a propofol

ABSTRACT Objective: Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using two drug combinations: midazolam and propofol or fentanyl and propofol. Method: Fifty patients ASA I and II, from 18 to 65 years of age, candidates for elective colonoscopy under sedation administered by an anesthesiologist, were randomized in two groups: Group A (midazolam and propofol) and Group B (fentanyl and propofol). Each patient was evaluated as for the length of the exam (Exam length), length of stay in the post-anesthesia care unit 1 and 2 (LSPACU1 and LSPACU2) and hospital discharge. Episodes of awakening, and of movement, drop in SpO2 < 90%, need for mechanical ventilation, propofol consumption, heart rate (HR) and mean blood pressure (MBP) were also evaluated. Results: Patients of group B had a recovery time in LSPACU1 statistically shorter than that for those in group A. In both groups, LSPACU1 was considered inversely proportional to LSPACU2. Hospital discharge time was similar between groups. Patients of group B had a significant decrease in MBP during and at the end of the exam, when compared to the initial measurement and that during sedation. Nevertheless, this variation was lower than 20%. No adverse event was observed. All patients were discharged on the same day, with no unexpected hospitalization. Conclusions: The combined use of fentanyl and propofol for colonoscopy sedation had a post-anesthesia recovery time in LSPACU1 shorter than that with the combination of midazolam and propofol. Nevertheless hospital discharge time was similar between groups.

RESUMO Objetivo: Comparar o tempo de recuperação pós-anestésica de pacientes sedados para colonoscopia usando duas combinações de fármacos: midazolam e propofol ou fentanil e propofol. Método: Cinquenta pacientes ASA I e II, entre 18 e 65 anos, candidatos a colonoscopia eletiva sob sedação administrada por anestesiologista, foram randomizados em dois grupos: Grupo A (midazolam e propofol) e Grupo B (fentanil e propofol). Cada paciente foi avaliado quanto ao tempo de realização do exame (TExame), tempo de permanência na sala de recuperação pós-anestésica 1 e 2 (TSRPA 1 e TSRPA2) e a alta domiciliar. Episódios de despertar, movimentação, queda de SpO2 < 90%, necessidade de assistência ventilatória, consumo de propofol, frequência cardíaca (FC) e pressão arterial média (PAM) também foram avaliados. Resultados: Pacientes do grupo B apresentaram tempo de recuperação na SRPA1 inferior estatisticamente ao grupo A. Em ambos os grupos o TSRPA1 foi considerado inversamente proporcional ao TSRPA2. O tempo de alta domiciliar foi semelhante entre os grupos. Pacientes do grupo B apresentaram redução significativa na PAM no tempos exame e final, em relação ao inicial e sedação. Entretanto, essa variação foi inferior a 20%. Não foram observados eventos adversos. Todos os pacientes evoluíram com alta domiciliar no mesmo dia, sem ocorrência de internação não prevista. Conclusões: O uso combinado de fentanil e propofol para sedação em colonoscopia produziu tempo de recuperação pós-anestésica na SRPA1 inferior a combinação midazolam e propofol. No entanto, o tempo de alta domiciliar foi semelhante entre os grupos.

[Antimicrobial effects of fentanyl and bupivacaine]. / Efeitos antimicrobianos do fentanil e da bupivacaína: estudo in vitro.

STUDY OBJECTIVE: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. DESIGN: In vitro prospective study. SETTING: University Clinical Microbiology Laboratory. MEASUREMENTS: In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37°C. MAIN RESULTS: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). CONCLUSIONS: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.

Antimicrobial effects of fentanyl and bupivacaine: an in vitro study / Efeitos antimicrobianos do fentanil e da bupivacaína: estudo in vitro

Abstract Study objective: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. Design: In vitro prospective study. Setting: University Clinical Microbiology Laboratory. Measurements: In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37 °C. Main results: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). Conclusions: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.

Resumo Objetivo: O objetivo do presente estudo foi comparar os efeitos antimicrobianos da bupivacaína e citrato de fentanil e revelar o impacto no potencial do efeito antimicrobiano no caso de uso combinado. Desenho: Estudo prospectivo in vitro. Local: Laboratório de Microbiologia Clínica da Universidade. Medidas: Em nosso estudo, os efeitos antimicrobianos in vitro do citrato de fentanil na concentração de 0,05 mg.mL-1 - Grupo F e da bupivacaína na concentração de 5 mg.mL-1 - Grupo B foram testados em culturas de Staphylococcus aureus ATCC 29213 (do inglês American Type Culture Collection 29213), Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 e Candida albicans ATCC 10231. As culturas de S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 e Escherichia coli ATCC 25922 foram semeadas em placas de ágar Mueller Hinton (Oxoid, Reino Unido), e a cultura de Candida albicans ATCC 10231 foi realizada em placa de ágar Sabouraud dextrose (Oxoid, Reino Unido) durante 18-24 horas a 37 °C. Principais resultados: Com relação ao diâmetro da zona de inibição, os valores de S. aureus ATCC 29213, P. aeruginosa ATCC 27853 e C. albicans ATCC10231 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo F do que no Grupo B (p < 0,001). Os valores do diâmetro da zona de inibição das culturas de E. coli ATCC 25922 e K. pneumomiae ATCC 13883 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo B do que no Grupo F (p < 0,001, E. coli na 12ª hora p = 0,005) Conclusões: A preferência atual e frequente pela adição de fentanil aos Anestésicos Locais (AL) para a realização de anestesia regional se deve sobretudo à possibilidade de redução da dose do anestésico local, a melhora na qualidade da analgesia e a satisfação do paciente. No entanto, ao considerar estudos em que o fentanil antagonizou o efeito antimicrobiano dos AL, pode-se pensar que esse fato contribua para aumento de complicação infecciosa. O citrato de fentanil usado em nosso estudo, contendo ácido clorídrico e hidróxido de sódio como agentes conservantes, ampliou o espectro de efeitos antimicrobianos dos AL, não teve efeito antagônico e demonstrou efeito antimicrobiano sinérgico contra a E. coli. Acreditamos que a adição de fentanil aos anestésicos locais traria importante contribuição na prevenção das crescentes complicações por infecção da anestesia regional.

Anestesia total intravenosa con remifentanilo vs fentanilo como base analgésica en cirugía torácica electiva / Intravenous total anesthesia with remifentanil and fentanyl as analgesic base in elective thoracic surgery

Introducción: Mantener una oxigenación adecuada durante la ventilación a un solo pulmón es el problema fundamental al que se enfrenta el anestesiólogo durante la cirugía torácica, es por ello que se mantiene una constante búsqueda del método anestésico ideal que ayude a lograr dicho objetivo. Objetivos: Evaluar los resultados de dos técnicas de anestesia total intravenosa con remifentanilo y fentanilo como base analgésica e identificar la aparición de complicaciones durante la intervención quirúrgica. Métodos: Se realizó un estudio causiexperimental prospectivo, en el Hospital Docente Clínico Quirúrgico Dr. Salvador Allende, entre enero 2013 a diciembre 2015 en 40 pacientes ASA II o III que requirieron procedimientos intratorácicos. Estos se dividieron en dos grupos. A (remifentanilo-propofol) y B (fentanilo-propofol). Se estudiaron variables hemodinámicas, de oxigenación durante la ventilación unipulmonar, el tiempo de recuperación anestésica (ventilación espontánea, apertura ocular, extubación) y la analgesia posoperatoria. Resultados: No existieron variaciones significativas en la hemodinamia, ni en la oxigenación de los enfermos con el empleo de ambas técnicas anestésicas; sin embargo, el despertar y recuperación posoperatoria a corto plazo fue mejor en el grupo A. La intensidad del dolor posoperatorio según la escala visual análoga fue menor en el grupo B. Conclusiones: Ambas técnicas son efectivas para procedimientos quirúrgicos torácicos. Con mínima interferencia en la hemodinámia y parámetros de oxigenación(AU)

Introduction: Maintaining adequate oxygenation during single-lung ventilation is a fundamental concern faced by the anesthesiologist during thoracic surgery; therefore, a constant search is maintained for the ideal anesthetic method that helps achieve this goal is maintained. Objectives: To evaluate the outcomes of two total intravenous anesthesia techniques with remifentanil and fentanyl as analgesic base and to identify the onset of complications during surgery. Methods: A prospective and quasi-experimental study was carried out at Dr. Salvador Allende Clinical-Surgical Hospital, between January 2013 and December, with 40 ASA II or III patients who required intrathoracic procedures. These were divided into two groups: A (remifentanil-propofol) and B (fentanyl-propofol). Hemodynamic variables and others of oxygenation during one-lung ventilation were studied, together with anesthetic recovery time (spontaneous ventilation, ocular opening, extubation) and postoperative analgesia. Results: There were no significant variations in the hemodynamics or oxygenation of patients with the use of both anesthetic techniques; however, awakening and short-term postoperative recovery was better in group A. Postoperative pain intensity, based on the analogue-visual scale, was lower in group B. Conclusion: Both techniques are effective for thoracic surgical procedures, with minimal effect in hemodynamics and oxygenation parameters(AU)

Effects of duloxetine, fluoxetine and pregabalin on fentanyl-induced hyperalgesia in rattus novergicus / Efeitos da duloxetina, fluoxetina e pregabalina sobre a hiperalgesia induzida por fentanil em rattus novergicus

ABSTRACT BACKGROUND AND OBJECTIVES: Opioids are drugs used to relieve pain, but may cause increased pain sensitivity, known as opioid-induced hyperalgesia, which adversely affects pain management. This study aimed to check if fentanyl, an opioid widely used in the clinical practice, produces hyperalgesia that can be attenuated by duloxetine, fluoxetine and pregabalin. METHODS: Thirty male Wistar rats were divided into six groups. The animals in group 1 received 1mL of 0.9% saline solution intraperitoneally (IP) and gavage; group 2 received fentanyl at a dose of 100µg.kg-1 IP and 0.9% saline solution per gavage; groups 3, 4 and 5 received fentanyl at the dose of 100µg.kg-1 IP, and gavage with duloxetine, 40mg.kg-1, fluoxetine, 40mg.kg-1 and pregabalin, 40mg.kg-1, respectively. Under general anesthesia with isoflurane, all animals were submitted to plantar surgical incision. The application of Von Frey filaments assessed hyperalgesia at the second hour, one, three, five and seven days after treatment. RESULTS: Two hours after the procedure, no differences were observed between G1 and G2, although G3, G4, and G5 showed less hyperalgesia. On day one and day three, a greater hyperalgesic effect was observed in G2 when compared to G1, G3, G4 and G5. On day five, there was a hyperalgesic effect on G2, and on day seven, there were no differences among the groups. CONCLUSION: The results suggest that fentanyl induces hyperalgesia and the efficacy of duloxetine, fluoxetine, and pregabalin in reducing it.

RESUMO JUSTIFICATIVA E OBJETIVOS: Opioides são fármacos utilizados para o alívio da dor, porém, podem causar aumento da sensibilidade dolorosa, denominada hiperalgesia induzida por opioides, que afeta negativamente o tratamento da dor. O objetivo deste estudo foi avaliar se o fentanil, opioide amplamente utilizado na prática clínica, produz hiperalgesia que pode ser atenuada pela duloxetina, fluoxetina e pregabalina. MÉTODOS: Trinta ratos Wistar machos, foram divididos em 6 grupos. No grupo 1, os animais receberam 1mL de solução fisiológica (SF) a 0,9% por via intraperitoneal (IP) e por gavagem; no grupo 2, fentanil na dose de 100µg.kg-1 IP e SF a 0,9% por gavagem; nos grupos 3, 4 e 5 os animais receberam fentanil na dose de 100µg.kg-1 IP e, por gavagem, receberam respectivamente duloxetina, 40mg.kg-1, fluoxetina, 40mg.kg-1 e pregabalina, 40mg.kg-1. A avaliação da hiperalgesia e sua atenuação foi feita pela aplicação de filamentos de Von Frey, na 2ª hora e nos dias 1, 3, 5 e 7, após o tratamento. RESULTADOS: Na 2ª hora pós-procedimento não foram observadas diferenças entre G1 e G2, entretanto, G3, G4 e G5 se mostraram com menor hiperalgesia. No 1º e 3º dias foi observado maior efeito hiperalgésico em G2 quando comparado com G1, G3, G4 e G5. No 5º dia foi observado efeito hiperalgésico no G2, e no 7º dia não houve diferenças entre os grupos. CONCLUSÃO: Os resultados sugerem que o fentanil induz hiperalgesia e eficácia da duloxetina, fluoxetina e pregabalina na sua redução.

Efecto del fentanilo intratecal en hiperlagesia secundaria posoperatoria de cirugía ligamento cruzado anterior de rodilla / Effect of Intrathecal fentanyl on secondary hyperalgesia, in patients undergoing anterior cruciate ligament repair

BACKGROUND AND OBJECTIVES: Fentanyl addition is a common practice when administering spinal anesthesia. Intrathecal fentanyl has been associated to increased postoperative pain and increase morphine consumption, but considered to be related to acute opioid tolerance. This prospective, randomized, blind study evaluates the effect of intrathecal fentanyl in the development of secondary hyperalgesia, measured with Von Frey filaments, in patients undergoing anterior cruciate ligament repair. METHODS: 46 patients having anterior cruciate ligament repair, received intrathecal hyperbaric bupivacaine 13.5 mg with fentanyl 20 mcg or no fentanyl addition. Light touch pain threshold was measured with von Frey filaments before anesthesia, at 6 and 24 hours post anesthesia in the non-operated thigh and in the forearm. Visual analogue pain scores and morphine consumption were also measured at the same time. RESULTS: Baseline thresholds to mechanical stimuli were similar in both groups. In the forearm, analysis showed a decreased threshold for the non-fentanyl group at 24 h p = 0.036. In the lower extremity, control and treatment group showed lower thresholds (secondary hyperalgesia) p = 0.002 but no difference between them p = 0.795. VAS score and morphine consumption did not differ among groups. CONCLUSIONS: Spinal fentanyl added to hyperbaric bupivacaine showed no evidence of an augmented state of hyperalgesia after ACL repair, neither by pain threshold modification nor clinical outcomes. On the contrary, at 24 h, fentanyl may have a protective effect at levels above the spinal block.

ANTECEDENTES Y OBJETIVOS: El uso de fentanilo es una práctica común en la administración de anestesia espinal. Su aplicación se ha asociado a un aumento del dolor post operatorio y a un aumento en el uso de morfina; por otro lado, se ha vinculado a una tolerancia aguda a opioides. El siguiente estudio prospectivo, randomizado y ciego, evalúa los efectos del fentanilo intratecal en la aparición de hiperalgesia secundaria, medida a través de filamentos Von Frey, en pacientes operados de ligamento cruzado anterior. METODOLOGÍA: Se incluyeron a 46 pacientes operados de ligamento cruzado anterior (LCA) con una dosis intratecal de bupivacaína hiperbárica de 13,5 mg; con y sin la adición de fentanilo de 20 mcg. Se midió el umbral del dolor mecánico, a través de filamentos Von Frey, antes de la anestesia, a las 6 y 24 horas postanestesia en el muslo no operado y en el antebrazo. Al mismo tiempo, se midió la puntuación del dolor en la escala verbal numérica (EVN) y el consumo de morfina. RESULTADOS: Los umbrales basales ante la estimulación mecánica resultaron similares en ambos grupos. En el antebrazo, el análisis mostró una disminución del umbral en el grupo de pacientes sin fentanilo, a las 24 h, p = 0,036 comparado con uso de fentanilo. En el muslo, el grupo control y tratamiento mostró umbrales más bajos (hiperalgesia secundaria) p = 0,002; no obstante, no se mostraron diferencias entre ellos. No se mostraron diferencias entre las puntuaciones de la EVN y el consumo de morfina en los dos grupos. CONCLUSIÓN: No hay evidencia que la adición de fentanilo espinal, a la dosis de bupivacaína hiperbárica, haya contribuido a un aumento en la hiperalgesia tras la reparación del LCA, medido por la modificación del umbral del dolor, ni en los resultados clínicos. Al contrario a las 24 h fentanilo puede tener un efecto protector de la hiperalgesia secundaria sobre el nivel del bloqueo espinal.

[Comparison of fentanyl and dexmedetomidine as an adjuvant to bupivacaine for unilateral spinal anesthesia in lower limb surgery: a randomized trial]. / Comparação de fentanil e dexmedetomidina como adjuvante à bupivacaína para raquianestesia unilateral em cirurgia de membros inferiores: estudo randômico.

BACKGROUND AND OBJECTIVES: One of the disadvantages of unilateral spinal anesthesia is the short duration of post-operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery. METHODS: In this double-blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1mL bupivacaine 0.5% (5mg). In groups BD, BF and BS, 5µg of dexmedetomidine, 25µg of fentanyl and 0.5mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90min. RESULTS: The duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169min) and BD (92 and 166min) groups than the BS (84 and 157min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24h after surgery, than the BS (1.6) group. CONCLUSIONS: The addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine.

Comparison of fentanyl and dexmedetomidine as an adjuvant to bupivacaine for unilateral spinal anesthesia in lower limb surgery: a randomized trial / Comparação de fentanil e dexmedetomidina como adjuvante à bupivacaína para raquianestesia unilateral em cirurgia de membros inferiores: estudo randômico

Abstract Background and objectives One of the disadvantages of unilateral spinal anesthesia is the short duration of post-operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery. Methods In this double-blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5 µg of dexmedetomidine, 25 µg of fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24 h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90 min. Results The duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169 min) and BD (92 and 166 min) groups than the BS (84 and 157 min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24 h after surgery, than the BS (1.6) group. Conclusions The addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine.

Resumo Justificativa e objetivos Uma das desvantagens da raquianestesia unilateral é a curta duração da analgesia pós-operatória, que pode ser abordada pela adição de adjuvantes aos anestésicos locais. O objetivo deste estudo foi comparar os efeitos da adição de dexmedetomidina, fentanil ou solução salina à bupivacaína sobre as propriedades da raquianestesia unilateral em pacientes submetidos à cirurgia de panturrilha. Métodos Neste ensaio clínico duplo-cego, 90 pacientes submetidos à cirurgia eletiva de panturrilha foram randomicamente divididos em três grupos. A quantidade de anestésico para a raquianestesia nos três grupos foi de 1 mL de bupivacaína a 0,5% (5 mg). Nos grupos BD, BF e BS, 5 µg de dexmedetomidina, 25 µg de fentanil e 0,5 mL de solução salina foram adicionados, respectivamente. Foram calculados a duração dos bloqueios motor e sensorial em ambos os membros e o escore de dor durante 24 horas após a cirurgia. As alterações hemodinâmicas também foram medidas durante a anestesia por até 90 minutos. Resultados A duração de ambos os bloqueios, motor e sensorial, foi significativamente maior no membro dependente nos grupos BF (96 e 169 min) e BD (92 e 166 min) do que no grupo BS (84 e 157 min). Os escores da escala visual analógica foram significativamente menores nos grupos BF (1,4) e BD (1,3) do que no grupo BS (1,6) nas 24 horas após a cirurgia. Conclusões A adição de fentanil e dexmedetomidina à bupivacaína em raquianestesia unilateral pode aumentar a duração dos bloqueios sensorial e motor no membro dependente e prolongar a duração da dor pós-operatória. Contudo, fentanil é mais eficaz do que dexmedetomidina.

Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy / Efeito do acetaminofeno versus fentanil intravenosos na dor pós litotripsia transuretral

Abstract Background: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. Methods: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000 mg acetaminophen (propacetamol) or 2 mcg.kg-1 fentanyl intravenously, 15 min before the end of surgery. The postoperative pain was evaluated every 6 h for 24 h using the Visual Analog Scale. Total morphine dose taken in 24 h and hemodynamic status were evaluated. Results: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24 h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18 h after surgery (p < 0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. Conclusions: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).

Resumo Justificativa: A dor pós-operatória é a complicação mais comum no período pós-operatório. Este estudo foi realizado para avaliar o efeito de acetaminofeno versus fentanil no alívio da dor pós-operatória em pacientes submetidos a cirurgias urológicas. Métodos: Este ensaio clínico foi realizado com pacientes cujas idades variou entre 18 e 65 anos. Os pacientes foram randomicamente designados para receber 2.000 mg de acetaminofeno (propacetamol) ou 2 mcg.kg-1 de fentanil por via intravenosa 15 min antes do final da cirurgia. A dor pós-operatória foi avaliada a cada 6 horas por 24 horas, utilizando a escala visual analógica. A dose total de morfina administrada em 24 horas e o estado hemodinâmico foram avaliados. Resultados: Oitenta pacientes foram incluídos no estudo. O escore médio de dor em 6, 12, 18 e 24 horas após a cirurgia foi menor no grupo acetaminofeno que no grupo fentanil, mas a diferença não foi estatisticamente significativa, exceto em 12 e 18 horas após a cirurgia (p < 0,05). A quantidade de morfina administrada foi maior no grupo fentanil que no grupo acetaminofeno, mas a diferença não foi estatisticamente significativa. O estado hemodinâmico, incluindo pressão arterial sistólica e diastólica e frequência cardíaca, foi quase o mesmo nos dois grupos, mas a média de SpO2 foi significativamente maior no grupo acetaminofeno que no grupo fentanil. Conclusões: Este estudo indicou que acetaminofeno intravenoso é tão eficaz quanto fentanil intravenoso no alívio da dor após cirurgias urológicas (litotripsia transuretral).

[Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy]. / Efeito do acetaminofeno versus fentanil intravenosos na dor pós litotripsia transuretral.

BACKGROUND: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. METHODS: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000mg acetaminophen (propacetamol) or 2mcg.kg-1 fentanyl intravenously, 15min before the end of surgery. The postoperative pain was evaluated every 6h for 24h using the Visual Analog Scale. Total morphine dose taken in 24h and hemodynamic status were evaluated. RESULTS: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18h after surgery (p<0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. CONCLUSIONS: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).

Efecto de la premeditación de Fentanilo-acepromacina y Fentanilo-xilacina sobre la presentación de vómito posoperatorio en perros / Effect of premedication with fentanyl-acepromazine and fentanyl-xylazine over postsurgical vomiting in dogs / Efeito da pré-medicação com fentanil-acepromazina e fentanil-xilazina sobre o vômito pós-cirúrgico em cães

Resumen La inclusión de opioides durante la preanestesia y anestesia, potencialmente puede incrementar la presentación de vómito y náuseas posoperatorias, acrecentando el riesgo de presentación de sangrado, dehiscencias, neumonía por aspiración o esofagitis. En éste estudio se evaluó la presentación de vómito, salivación excesiva y anorexia durante 24 horas del periodo posanestésico en 100 perros ASA I y II. El grupo A (n: 40) fue premedicado con una mezcla de acepromacina a 0.08 mg/kg i.v. y fentanilo a 5 μg/kg i.v. y el grupo X (n: 60) con xilacina a 0.3 mg/kg i.v. más fentanilo a 5 μg/kg i.v. La inducción anestésica para ambos grupos se realizó con propofol a 4 mg/kg y el mantenimiento con isoflurano a 1,5-3%. La presentación general de vómito post-anestesia fue del 12%. Entre ambos grupos no se encontraron diferencias significativas en la incidencia de vómito a las 2 (p= 0,837), a las 6 (p= 0,439) y a las 24 horas (p= 0,639). No hubo diferencias significativas entre grupos para la presentación de salivación excesiva o anorexia. Se encontró una asociación entre vómito post-anestésico y cirugía del aparato reproductivo en hembras (p= 0,02). Se concluye que un único bolo de fentanilo a 5 μg/kg con acepromacina a 0,08 mg/kg o xilacina 0,3 mg/kg durante la premedicación anestésica, no incrementa la presentación de vómito en las primeras 24 horas del postquirúrgico en perros.

Abstract Opioid inclusion in pre-anesthesia and anesthesia may increase postperative vomiting and nausea, increasing the risk of bleeding, dehiscence, aspiration pneumonia or esophagitis. Therefore, the purpose of this study was to monitor vomiting, excessive salivation and anorexia during 24 hours of the post-surgical period on 100 dogs ASA I and II. Group A (n: 40) was pre-medicated with acepromazine at 0.08 mg/kg with fentanyl at 5 μg/kg i.v; group X (n: 60) with xylazine at 0.3 mg/kg i.v. with fentanyl at 5 μg/kg i.v. Anesthesia induction was made with propofol at 4 mg/kg and maintained with isofluorane at 1.5-3% for both groups. The overall vomiting produced was 12% and there were no significant differences in vomiting manifestation at 2 (p=0.837), 6 (p=0.439) and 24 hours (p= 0.639) between the groups. In the same way, there were no major differences neither for excessive salivation nor anorexia. There was a significant association between postanesthesia vomiting and reproductive surgery in female dogs (p=0.02). As a conclusion, a single bolus of fentanyl at 5 μg/kg with acepromazine at 0.08 mg/kg or xylazine 0.3 mg/kg in pre-anesthesia does not increase post-surgery vomiting in dogs in the first 24 hours.

Resumo A inclusão de opioides durante a pré-anestesia e anestesia, potencialmente podem incrementar a apresentação de vomito e náuseas pós-operatórias, acrescentando o risco de apresentação de sangrado, deiscências, pneumonia por aspiração e esofagites. Neste estudo se avalio a apresentação de vomito, salivação excessiva e anorexia durante 24 horas do período pós-anestésico em 100 cães ASA I e II. O grupo A (n: 40) foi medicado com uma mistura de acepromazina 0.08 mg/kg IV e fentanilo 5 μg/kg IV e no grupo X (n: 60), xilacina 0.3 mg/kg IV e fentanilo 5 μg/kg IV. A indução anestésica para ambos grupos se realizou com propofol 4 mg/kg e manutenção com isoflurano 1,5-3%. A apresentação geral de vomito pós-anestésico foi do 12%. Entre ambos grupos não se encontraram diferencias significativas na incidência de vomito nas 2 (p= 0,837), 6 (p= 0,439) e 24 horas (p= 0,639). Não teve diferenças significativas entre grupos na apresentação de salivação excessiva ou anorexia. Se achou uma associação entre vomito pós-anestésico e cirurgia do trato reprodutivo em fêmeas (p= 0,02). Como conclusão uma única doses de fentanilo 5 μg/kg com acepromacina 0,08 mg/kg ou xilacina 0,3 mg/kg durante a pré-medicação anestésica, não incrementa a apresentação de vomito nas primeiras 24 horas do pós-cirúrgico em cães.

Spinal anesthesia with bupivacaine and fentanyl associated with femoral nerve block in postoperative analgesia in the reconstruction of the anterior cruciate ligament / Raquianestesia com bupivacaína e fentanil associada ao bloqueio do nervo femoral na analgesia pós-operatória na reconstrução do ligamento cruzado anterior

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate postoperative analgesia and the need for tramadol in patients undergoing reconstruction of the anterior cruciate ligament with spinal anesthesia, fentanyl and femoral nerve block. METHODS: 166 patients were divided into four groups (G). All patients received spinal anesthesia with 15mg of isobaric bupivacaine at 0.5%. In the G2 and G3 groups, 25µg of fentanyl was associated with bupivacaine and in groups G3 and G4 femoral nerve block was associated with 100mg of bupivacaine at 0.5%, without vasoconstrictor. Patients received timed dipyrone and ketoprofen and were instructed to request tramadol if the pain was ≥4 on the numerical scale. After 6, 12 and 24 hours of spinal anesthesia, the score was recorded on the numerical scale, the request of tramadol and adverse events. RESULTS: Mean pain scores at 6 and 24 hours were not different. In the 12-hour evaluation, there was a difference only in G4 in relation to G1 (p=0.01). Tramadol was requested by 46.7% in G1, 52.9% in G2, 18.6% in G3 and 36.4% in G4 (p=0.009), with a difference between G1 and G3 and also between G2 and G3. CONCLUSION: The association of spinal anesthesia and femoral nerve block in G4 provided lower pain scores in the evaluation at 12 hours after anesthesia. On the other hand, the highest indices were observed in G2, spinal anesthesia with fentanyl. Pain scores at 6 and 12 hours were similar. The highest consumption of analgesics occurred in those who reported more pain in G2.

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar a analgesia pós-operatória e a necessidade de tramadol nos pacientes submetidos à operação de reconstrução do ligamento cruzado anterior com raquianestesia, fentanil e bloqueio do nervo femoral. MÉTODOS: Cento e sessenta e seis pacientes foram divididos em quatro grupos (G). Todos os pacientes receberam raquianestesia com 15mg de bupivacaína isobárica a 0,5%. Nos grupos G2 e G3 foi associado 25µg de fentanil à bupivacaína e nos grupos G3 e G4 foi associado bloqueio do nervo femoral com 100mg de bupivacaína a 0,5% sem vasoconstritor. Os pacientes receberam dipirona e cetoprofeno de horário e eram orientados a solicitar tramadol caso a dor estivesse ≥4 na escala numérica. Após 6, 12 e 24 horas da raquianestesia foi registrado o escore na escala numérica, a solicitação de tramadol e eventos adversos. RESULTADOS: Os escores médios de dor 6 e 24 horas não foram diferentes. Na avaliação 12 horas houve diferença apenas no G4 em relação ao G1 (p=0,01). O tramadol foi solicitado por 46,7% no G1, 52,9% no G2, 18,6% no G3 e 36,4% no G4 (p=0,009), com diferença entre G1 e G3 e também entre G2 e G3. CONCLUSÃO: A associação de raquianestesia e bloqueio do nervo femoral no G4 proporcionou menores escores de dor na avaliação 12 horas após a anestesia, por outro lado os índices mais elevados foram observados na raquianestesia com fentanil do G2. As avaliações de dor em 6 e 12 horas foram semelhantes. O maior consumo de analgésicos ocorreu naqueles que relataram mais dor no G2.

Propofol-fentanil en bolo frente a ketofol en infusión continua para sedoanalgesia en colonoscopia electiva / Propofol-fentanyl bolus versus ketofol continuous infusion for sedation-analgesia in elective colonoscopy

Introducción: La colonoscopia se practica con frecuencia y la sedación consciente es útil para realizarla. Objetivos: Comparar propofol-fentanil en bolo con ketofol en infusión continua para colonoscopia. Método: Se realizó un estudio cuasiexperimental en 150 pacientes divididos en dos grupos. En el grupo propofol-fentanil se realizó inducción con fentanil 1,5-3 µg/kg más propofol 0,5-1,5 mg/kg y mantenimiento con bolos de propofol 0,4-0,5 mg/kg. En el grupo Ketofol se empleó una solución que se obtuvo al asociar 50 mL de propofol (1 por ciento) y 0,5 mL de ketamina (5 por ciento); dosis de carga de 1,1 mg/kg y mantenimiento con infusión continua manual. Se estudiaron variables hemodinámicas y respiratorias, nivel de sedación, satisfacción del paciente y del colonoscopista, tiempo de recuperación y eventos adversos. Resultados: La presión arterial media y la SpO2 mostraron diferencias entre los grupos y en los diferentes momentos, con cifras más bajas en el grupo propofol-fentanil. La frecuencia cardiaca no varió entre los grupos. La satisfacción de pacientes y los técnicos en endoscopias fue alta en ambas estrategias. Los pacientes del grupo propofol-fentanil tuvieron tiempo de recuperación superior (27 min). Menos de la mitad de los pacientes presentaron eventos adversos. El dolor, la insatisfacción y la depresión respiratoria fueron los más frecuentes. Conclusiones: Ketofol resultó superior a la asociación propofol-fentanil con mejor estabilidad hemodinámica y respiratoria, niveles de sedación más estables, satisfacción de pacientes y gastroenterólogos, tiempos de recuperación más breves, eventos adversos escasos y leves(AU)

Introduction: Colonoscopy is performed frequently, for which conscious sedation is useful. Objectives: To compare propofol-fentanyl bolus with ketofol continuous infusion for colonoscopy. Methods: A quasi-experimental study was performed in 150 patients divided into two groups. In the propofol-fentanyl group, induction was performed with fentanyl at doses 1.5-3 µg/kg plus propofol at doses 0.5-1.5 mg/kg and maintenance with propofol boluses at doses 0.4-0.5 mg/kg. In the ketofol group, a solution was used as obtained by associating 50 mL of propofol (1 percent) and 0.5 mL of ketamine (5 percent); loading dose of 1.1 mg/kg and maintenance with manual continuous infusion. Hemodynamic and respiratory variables were studied, together with sedation level, patient and colonoscopy technician satisfaction, recovery time and adverse events. Results: Mean arterial pressure and SpO2 showed differences between groups and at different times, with lower figures in the propofol-fentanyl group. The heart rate did not vary between the groups. Patients and endoscopy technician satisfaction was high in both strategies. Patients in the propofol-fentanyl group had longer recovery time (27 min.). Less than half of the patients presented adverse events. Pain, dissatisfaction and respiratory depression were the most frequent. Conclusions: Ketofol was higher to the propofol-fentanyl association with better hemodynamic and respiratory stability, more stable sedation levels, patient and gastroenterologist satisfaction, shorter recovery times, limited and mild adverse events(AU)

Fentanil y bupivacaína al 0, 5 porciento en ancianos con fractura de cadera operados con anestesia subaracnoidea / Fentanyl and 0, 5 percent bupivacaine in elderly patients with hip fracture operated on under subarachnoid anesthetic

Fundamento: el paciente anciano tiene mayor riesgo de presentar inestabilidad hemodinámica y complicaciones anestésicas durante el perioperatorio. Objetivo: describir la estabilidad hemodinámica en los ancianos operados de fractura de cadera utilizando anestesia subaracnoidea, en el hospital Ernesto Guevara de la Serna, entre enero- diciembre de 2015. Métodos: se realizó un estudio longitudinal, prospectivo, en el lugar y período señalados. El universo de estudio estuvo constituido por todos los pacientes ancianos con fractura de cadera, a los cuales se les practicó cirugía para corrección de la misma, y la muestra por 47 pacientes con estado físico ASA II y III, operados utilizando anestesia subaracnoidea con dosis de bupivacaína 0,5 por ciento 8 mg más fentanil 25 mcg. Se utilizó la estadística descriptiva a través del análisis porcentual. Resultados: predominaron los pacientes del sexo femenino en el 70,21 por ciento, el 63,82 por ciento pertenecieron al grupo de edad entre 76 y 85 años; fueron más frecuentes los pacientes con estado físico ASA II con el 68,1 por ciento; el 87,23 por ciento presentó estabilidad de la tensión arterial, la frecuencia cardiaca se mantuvo normal en el 83 por ciento, el efecto secundario más frecuente fue el prurito leve, el cual se presentó en el 100 por ciento de los casos, seguido de la somnolencia en el 74,4 por ciento. Conclusiones: la mayoría de los pacientes ancianos que fueron operados de fractura de cadera con anestesia subaracnoidea, utilizando la asociación de fentanil 25 mcg más bupivacaína al 0,5 por ciento 8 mg, mostraron estabilidad hemodinámica en cuanto a tensión arterial y frecuencia cardíaca. La totalidad de los casos refirieron prurito facial leve como efecto adverso(AU)

Background: the elderly patient is at a greater risk of hemodynamic instability and anesthetic complications during the perioperative period. Objective: to describe the hemodynamic stability in the elderly operated on for hip fracture using subarachnoid anesthetic, at the Ernesto Guevara de la Serna Hospital from January through December 2015. Methods: a prospective longitudinal study was carried out at the place and during the period herein mentioned. The study universe consisted of all the elderly patients with hip fracture, who underwent surgery to correct it. The sample was made up of 47 patients with ASA 2 and 3 physical statuses, who were operated on using subarachnoid anesthetic with doses of bupivacaine, 0,5 percent 8 mg plus fentanyl, 25 mcg. Descriptive statistics was used by means of percentage analysis. Results: female patients prevailed in 70,21 percent; 63,82 percent belonged to the 76 to 85 age group; patients with ASA 2 physical status were more frequent with 68,1 percent; 87,23 percent showed stability of blood pressure; heart rate remained normal in 83 percent; the most common side effect was mild pruritus, which occurred in 100 percent of the cases, followed by drowsiness in 74,4 percent. Conclusions: most of the elderly patients who were operated on for hip fracture under subarachnoid anesthetic using the combination of fentanyl, 25 mcg plus 0,5 percent bupivacaine, 8 mg showed hemodynamic stability in terms of blood pressure and heart rate. All cases reported mild facial pruritus as an adverse effect(AU)

Combinación de bupivacaína hiperbárica y fentanil como anestesia espinal en pacientes con fractura de cadera / Combination of hyperbaric bupivacaine and fentanyl as spinal anesthesia in patients with hip fracture

Se realizó un estudio observacional, descriptivo y comparativo de 54 pacientes con fractura de cadera, atendidos en el Servicio de Anestesiología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2011 hasta diciembre de 2013, con vistas a evaluar la calidad de la analgesia con las combinaciones de bupivacaína hiperbárica a 0,4 por ciento más fentanil. La muestra fue dividida en 2 grupos: los del A recibieron bupivacaína hiperbárica a 0,4 por cientomás fentanil; los del B, bupivacaína hiperbárica a 0,4 por ciento solamente. Se observó que el tiempo de inicio y duración del bloqueo fue mejor en los integrantes del grupo A; asimismo, las variaciones hemodinámicas y respiratorias, así como los efectos adversos no mostraron diferencias entre los grupos. La analgesia posoperatoria fue superior en el primer grupo, de manera que esta técnica resultó efectiva(AU)

An observational, descriptive and comparative study of 54 patients with hip fracture, assisted in the Anesthesiology service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2011 to December, 2013, aimed at evaluating the quality of the analgesia with the combinations of hyperbaric bupivacaine at 0.4 percent plus fentanyl. The sample was divided into 2 groups: those of the group A received hyperbaric bupivacaine at 0,4 percent plus fentanil; those of the group B, just received hyperbaric bupivacaine at 0,4 percent. It was observed that the beginning and duration time of the blockade was better in the members of group A; also, hemodynamic and respiratory variations, as well as the adverse effects showed no differences between the groups. The postoperative analgesia was higher in the first group, so this technique was effective(AU)

Combinación de bupivacaína hiperbárica y fentanil como anestesia espinal en pacientes con fractura de cadera / Combination of hyperbaric bupivacaine and fentanyl as spinal anesthesia in patients with hip fracture

Se realizó un estudio observacional, descriptivo y comparativo de 54 pacientes con fractura de cadera, atendidos en el Servicio de Anestesiología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2011 hasta diciembre de 2013, con vistas a evaluar la calidad de la analgesia con las combinaciones de bupivacaína hiperbárica a 0,4 por ciento más fentanil. La muestra fue dividida en 2 grupos: los del A recibieron bupivacaína hiperbárica a 0,4 por ciento más fentanil; los del B, bupivacaína hiperbárica a 0,4 por ciento solamente. Se observó que el tiempo de inicio y duración del bloqueo fue mejor en los integrantes del grupo A; asimismo, las variaciones hemodinámicas y respiratorias, así como los efectos adversos no mostraron diferencias entre los grupos. La analgesia posoperatoria fue superior en el primer grupo, de manera que esta técnica resultó efectiva

An observational, descriptive and comparative study of 54 patients with hip fracture, assisted in the Anesthesiology service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2011 to December, 2013, aimed at evaluating the quality of the analgesia with the combinations of hyperbaric bupivacaine at 0.4 percent plus fentanyl. The sample was divided into 2 groups: those of the group A received hyperbaric bupivacaine at 0,4 percent plus fentanil; those of the group B, just received hyperbaric bupivacaine at 0,4 percent. It was observed that the beginning and duration time of the blockade was better in the members of group A; also, hemodynamic and respiratory variations, as well as the adverse effects showed no differences between the groups. The postoperative analgesia was higher in the first group, so this technique was effective

Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review / Bloqueio do nervo femoral versus fentanil por via venosa em pacientes adultos com fraturas de quadril - revisão sistemática

Abstract Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. Conclusion: The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.

Resumo Justificativa: As fraturas de quadril são uma questão importante de saúde pública e estão associadas a altas taxas de mortalidade e perda de funcionalidade. As fraturas de quadril referem-se a uma fratura que ocorre entre a borda da cabeça femoral e 5cm abaixo do trocanter menor e são comuns em emergências ortopédicas. O número de fraturas do fêmur proximal provavelmente aumentará à medida que a população envelhece. O custo médio da assistência médica durante a hospitalização inicial para fratura de quadril pode ser estimado em US$ 7.000 por paciente. As fraturas do fêmur são dolorosas e requerem analgesia adequada imediata. O tratamento da dor causada por fraturas de fêmur é difícil porque há um número limitado de analgésicos disponíveis, muitos dos quais têm efeitos colaterais que podem limitar o seu uso. Os opioides são os fármacos mais usados, mas podem trazer algumas complicações. Nesse contexto, os bloqueios do nervo femoral podem ser uma opção segura. É uma técnica de anestesia regional específica usada em medicina de emergência para proporcionar anestesia e analgesia do membro afetado. Objetivo: Comparar a eficácia analgésica de fentanil versus bloqueio do nervo femoral antes do posicionamento para fazer raquianestesia em pacientes com fratura de fêmur avaliados com escalas de dor. Métodos: Revisão sistemática da literatura científica. Estudos descritos como ensaios clínicos randomizados que comparam bloqueio do nervo femoral e fentanil tradicional foram incluídos. Dois autores da revisão (MR e FH) avaliaram de forma independente os estudos potencialmente elegíveis para inclusão. A metodologia da avaliação baseou-se na ferramenta desenvolvida pela Colaboração Cochrane para avaliação de viés dos ensaios clínicos randomizados. As bases de dados Biblioteca Cochrane, PubMed, Medline e Lilacs foram consultadas para todos os artigos publicados, sem restrições de língua ou de tempo. Resultados: Dois estudos foram incluídos nesta revisão. O bloqueio do nervo pareceu ser mais eficaz do que fentanil por via intravenosa para a prevenção da dor em pacientes com fratura femoral. Também reduziu o uso de analgesia adicional e diminuiu o risco de complicações sistêmicas. O bloqueio femoral reduziu o tempo de administração da raquianestesia ao paciente a ser submetido à cirurgia e facilitou a posição sentada para esse fim. Conclusão: O uso de bloqueio do nervo femoral pode reduzir o nível de dor e a necessidade de analgesia adicional. Há menos eventos adversos sistêmicos associados a esse procedimento, que não oferece maiores riscos. Mais estudos são necessários para conclusões adicionais.

Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review.

BACKGROUND: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. OBJECTIVE: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. METHODS: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. RESULTS: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. CONCLUSION: The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.

[Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review]. / Bloqueio do nervo femoral versus fentanil por via venosa em pacientes adultos com fraturas de quadril ­ revisão sistemática.

BACKGROUND: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. OBJECTIVE: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. METHODS: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. RESULTS: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. CONCLUSION: The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.

The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study / Efeito de feniramina sobre a tosse induzida por fentanil: estudo clínico, randômico, duplo-cego e controlado com placebo

Abstract Background and objectives: There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. Methods: This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. Results: Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p = 0.0007 and p = 0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p = 0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (p < 0.0001 and p = 0.009, respectively). There was no significant change in cough severity between pheniramine group and lidocaine group (p = 0.856). Conclusion: Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough.

Resumo Justificativa e objetivos: Há muitos estudos sobre a redução da frequência e da gravidade da tosse induzida por fentanil durante a indução da anestesia. Propomos que maleato de feniramina, um anti-histamínico, pode suprimir essa tosse. Nosso objetivo foi observar o efeito de feniramina sobre a tosse induzida por fentanil durante a indução da anestesia. Métodos: Este é um estudo clínico prospectivo, de três braços paralelos, randômico e duplo-cego, de 120 pacientes com estado físico ASA III e IV (de acordo com a Sociedade Americana de Anestesiologistas), ≥ 18 anos e programados para cirurgia cardíaca aberta eletiva sob anestesia geral. Os pacientes foram divididos aleatoriamente em três grupos de 40 pacientes cada, com números aleatórios gerados por computador: grupo placebo, grupo feniramina e grupo lidocaína. Resultados: A incidência de tosse diferiu significativamente entre os grupos. No grupo placebo, 37,5% dos pacientes apresentaram tosse, enquanto que a frequência foi significativamente reduzida no grupo feniramina (5%) e no grupo lidocaína (15%) (teste exato de Fischer, p = 0,0007 e p = 0,0188, respectivamente). Não houve alteração significativa na incidência de tosse entre os grupos feniramina (5%) e lidocaína (15%) (teste exato de Fischer, p = 0,4325). A gravidade da tosse também alterou entre os grupos. Testes post hoc com Bonferroni mostraram que a média da gravidade da tosse no grupo placebo diferiu significativamente das médias dos grupos feniramina e lidocaína (p < 0,0001 e p = 0,009, respectivamente). Não houve alteração significativa na gravidade da tosse entre o grupo feniramina e grupo lidocaína (p = 0,856). Conclusão: Feniramina por via intravenosa tem a mesma eficácia que lidocaína na prevenção da tosse induzida por fentanil. Os resultados enfatizam que feniramina é um medicamento conveniente para diminuir essa tosse.