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1.
Croat Med J ; 62(2): 137-145, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33938653

RESUMEN

AIM: To explore the effects of an anterior quadratus lumborum block (QLB) on opioid consumption, pain, nausea, and vomiting (PONV) after ambulatory laparoscopic cholecystectomy. METHODS: This randomized controlled study recruited 70 patients scheduled for ambulatory laparoscopic cholecystectomy from January 2018 to March 2019. The participants were randomly allocated to one of the following groups: 1) anterior QLB (n=25) with preoperative ropivacaine 3.75 mg/mL, 20 mL bilaterally; 2) placebo QLB (n=22) with preoperative isotonic saline, 20 mL bilaterally; and 3) controls (n=23) given only standard intravenous and oral analgesia. The primary endpoint was opioid analgesic consumption. The secondary endpoints were pain (numeric rating scale 0-10) and PONV (scale 0-3, where 0=no PONV and 3=severe PONV). Assessments were made up to 48 hours postoperatively. RESULTS: The groups did not significantly differ in opioids consumption and reported pain at 1, 2, 24, and 48 hours postoperatively. PONV in the QLB group was lower than in the placebo and control groups. CONCLUSION: Preoperative anterior QLB for laparoscopic cholecystectomy did not affect postoperative opioid requirements and pain. However, anterior QLB may decrease PONV.


Asunto(s)
Analgesia , Colecistectomía Laparoscópica , Bloqueo Nervioso , Anestésicos Locales , Colecistectomía Laparoscópica/efectos adversos , Humanos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control
2.
Rev Bras Ter Intensiva ; 33(1): 48-67, 2021.
Artículo en Español, Inglés | MEDLINE | ID: mdl-33886853

RESUMEN

OBJECTIVE: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. METHODS: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. RESULTS: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. DISCUSSION: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


Asunto(s)
Analgesia/normas , Consenso , Delirio/terapia , Manejo del Dolor/normas , /terapia , Analgesia/métodos , Analgésicos/administración & dosificación , Lista de Verificación , Delirio/diagnóstico , Ambulación Precoz , Familia , Humanos , Unidades de Cuidados Intensivos , Intubación Intratraqueal/métodos , Bloqueo Neuromuscular/métodos , Bloqueo Neuromuscular/normas , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Agitación Psicomotora/terapia
3.
Artículo en Inglés | MEDLINE | ID: mdl-33807296

RESUMEN

Erector spinae plane block was recently introduced as an alternative to postoperative analgesia in surgical procedures including thoracoscopies and mastectomies. There are no clinical trials regarding erector spinae plane block in percutaneous nephrolithotomy. The aim of our study was to test the efficacy and safety of erector spinae plane block after percutaneous nephrolithotomy. We analyzed 68 patients, 34 of whom received erector spinae plane block. The average visual analogue scale score 24 h postoperatively was the primary endpoint. The secondary endpoints were nalbuphine consumption and the need for rescue analgesia. Safety measures included the mean arterial pressure, Ramsey scale score, and rate of nausea and vomiting. The visual analogue scale, blood pressure, and Ramsey scale were assessed simultaneously at 1, 2, 4, 6, 12, and 24 h postoperatively. The average visual analogue scale was 2.9 and 3 (p = 0.65) in groups 1 (experimental) and 2 (control), respectively. The visual analogue scale after 1 h postoperatively was significantly lower in the erector spinae plane block group (2.3 vs. 3.3; p = 0.01). The average nalbuphine consumption was the same in both groups (46 mL vs. 47.2 mL, p = 0.69). The need for rescue analgesia was insignificantly different in both groups (group 1, 29.4; group 2, 26.4%; p = 1). The mean arterial pressure was similar in both groups postoperatively (91.8 vs. 92.5 mmHg; p = 0.63). The rate of nausea and vomiting was insignificantly different between the groups (group 1, 17.6%; group 2, 14.7%; p = 1). The median Ramsey scale in all the measurements was two. Erector spinae plane block is an effective pain treatment after percutaneous nephrolithotomy but only for a very short postoperative period.


Asunto(s)
Analgesia , Nefrolitotomía Percutánea , Bloqueo Nervioso , Humanos , Dolor Postoperatorio/prevención & control , Músculos Paraespinales
4.
5.
Georgian Med News ; (311): 36-40, 2021 Feb.
Artículo en Ruso | MEDLINE | ID: mdl-33814387

RESUMEN

Acute postoperative pain is still an urgent problem in surgery. Today there are many drugs for pain relief, but at the same time, the adequacy of postoperative analgesia for the subjective assessments of patients does not exceed 50%. Therefore, taking into account the pathophysiology of acute pain syndrome, it is necessary to inject an anesthetic directly near the operating field, which can be achieved by long-term conduction anesthesia. So, in the area of the head and neck, there are several techniques (G. Brown, J. Bershet, V. M. Uvarov, J. S. Vaisblat, V. A. Dubov and V. D. Dunaevsky, P. Yu. Stolyarenko), but all of them have a metric definition of the point at the near and do not take into account the individual anatomical characteristics of patients, as well as anastomoses of the nerves. Therefore, the goal of our work was to create an optimal complex of conductive postoperative pain relief taking into account the pathophysiology of acute pain and the characteristics of postoperative defects in patients with pathology of the maxillofacial region. We have proposed a combination of three blockades: central anesthesia at the foramen ovale, angular glossopharyngeal nerve block and superficial cervical plexus block with prolonged catheterization. This technique of anesthesia allows you to carry out dressings painlessly and in full. It also significantly improves the ability to swallow, even with a probe. It has a positive effect on the state of moisture in the oral cavity.


Asunto(s)
Analgesia , Neoplasias de Cabeza y Cuello , Bloqueo Nervioso , Anestésicos Locales , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Dolor Postoperatorio/tratamiento farmacológico
7.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(1): 136-143, 2021 Feb 28.
Artículo en Chino | MEDLINE | ID: mdl-33663675

RESUMEN

Video-assisted thoracoscopic surgery(VATS)has become the main method of lobectomy.Multimodal analgesia is one of the core contents of enhanced recovery after surgery(ERAS)management in VATS lobectomy,which aims to control perioperative pain,reduce stress response,and achieve rapid recovery after surgery.In recent years,multimodal analgesia has developed rapidly,emphasizing the comprehensive implementation of a variety of analgesic methods and the synergistic application of analgesics with different mechanisms.This article reviews the new progress in the implementation of multimodal analgesia in VATS lobectomy and addresses the current problems and challenges,aiming to help develop more effective and practical analgesic strategies of ERAS.


Asunto(s)
Analgesia , Recuperación Mejorada Después de la Cirugía , Analgésicos/uso terapéutico , Humanos , Dolor , Cirugía Torácica Asistida por Video
8.
Zhonghua Shao Shang Za Zhi ; 37(3): 201-206, 2021 Mar 20.
Artículo en Chino | MEDLINE | ID: mdl-33706434

RESUMEN

The writing group of Expert consensus on the application of nitrous oxide and oxygen mixed inhalation for sedation and analgesia technology in burn surgery (2021 version) formulated the consensus through three face-to-face national multi-disciplinary expert meetings, combining theoretical and practical experience, and drawing lessons from application of nitrous oxide and oxygen mixed inhalation for sedation and analgesia technology in other disciplines at home and abroad. The consensus provided detailed descriptions on the indications, contraindications, possible side effects and corresponding first aid measures, application process, operation conditions, and training of the technology in burn surgery, and formulated the relevant plans.


Asunto(s)
Analgesia , Quemaduras , Quemaduras/cirugía , Consenso , Humanos , Óxido Nitroso , Oxígeno , Tecnología
9.
Nat Commun ; 12(1): 1391, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33654105

RESUMEN

The brain systems underlying placebo analgesia are insufficiently understood. Here we performed a systematic, participant-level meta-analysis of experimental functional neuroimaging studies of evoked pain under stimulus-intensity-matched placebo and control conditions, encompassing 603 healthy participants from 20 (out of 28 eligible) studies. We find that placebo vs. control treatments induce small, widespread reductions in pain-related activity, particularly in regions belonging to ventral attention (including mid-insula) and somatomotor networks (including posterior insula). Behavioral placebo analgesia correlates with reduced pain-related activity in these networks and the thalamus, habenula, mid-cingulate, and supplementary motor area. Placebo-associated activity increases occur mainly in frontoparietal regions, with high between-study heterogeneity. We conclude that placebo treatments affect pain-related activity in multiple brain areas, which may reflect changes in nociception and/or other affective and decision-making processes surrounding pain. Between-study heterogeneity suggests that placebo analgesia is a multi-faceted phenomenon involving multiple cerebral mechanisms that differ across studies.


Asunto(s)
Analgesia , Imagen por Resonancia Magnética , Sistema Nervioso/diagnóstico por imagen , Sistema Nervioso/fisiopatología , Adulto , Conducta , Encéfalo/fisiopatología , Femenino , Humanos , Aumento de la Imagen , Masculino , Dolor/fisiopatología , Placebos
10.
J Opioid Manag ; 17(1): 69-78, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33735429

RESUMEN

OBJECTIVE: Remifentanil, a rapid onset rapid offset synthetic opioid and potent analgesic, is often used for procedural conscious sedation in spontaneous ventilation, especially when delivered in target controlled infusion (TCI), which allows precise titration. We assessed efficacy, tolerance, and adverse events related with the use of remifentanil TCI during various procedures. DESIGN: Prospective, observational. SETTING: Two teaching hospitals. PATIENTS: We enrolled 434 patients undergoing procedures suitable for conscious sedation. INTERVENTIONS: The following procedures considered suitable were included: interventional radiology, gastrointestinal (GI) endoscopy, interventional cardiology, and peripheral dermatology. Sedation options were determined during the preoperative anesthesia assessment. MAIN OUTCOME MEASURES: Demographics were recorded as well as success rate, remifentanil dosage, pain scores, respiratory or cardiovascular events, and patient and operator satisfaction. RESULTS: The procedure was successful in 429 patients (99 percent), canceled in four patients because of agitation, apnea, desaturation, and converted to general anesthesia in two for major pain. The maximal remifentanil target was around 2-3 ng/ml for most procedures, but it was 3-5 ng/ml for GI endoscopy and urology. A total of 172 patients (40 percent) had bradypnea < 8 min-1, but only 26 (6 percent) had hypoxemia < 90 percent. Eighteen patients (4 percent) required mandibular luxation, and twelve needed face mask ventilation. There were no major cardiovascular adverse events. CONCLUSIONS: Remifentanil TCI is a suitable protocol for procedural sedation, but respiratory depression is a permanent concern. This risk requires equipped environment and competent medical personnel on hand to adjust the target before hypoxemia occurs. Respiratory rate monitoring, based on capnography or thoracic impedance is of a great help in anticipating this threat.


Asunto(s)
Analgesia , Antígeno Prostático Específico , Analgésicos Opioides/efectos adversos , Humanos , Infusiones Intravenosas , Masculino , Dolor/tratamiento farmacológico , Piperidinas/efectos adversos , Estudios Prospectivos , Remifentanilo
11.
AAPS PharmSciTech ; 22(3): 104, 2021 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-33718986

RESUMEN

Pain is a phenomenon present in the majority of the population, affecting, among others, the elderly, overweight people, and especially recently operated patients, analgesia being necessary. In the specific case of relief of postoperative pain, different kinds of anesthetics are being used, among them bupivacaine, a widely used drug which promotes long-lasting analgesic effects. However, cardiotoxicity and neurotoxicity are related to its repetitive use. To overcome these shortcomings, Novabupi® (a racemic mixture) was developed and is marketed as an injectable solution. This formulation contains an enantiomeric excess of the levogyre isomer, which has reduced toxicity effects. Seeking to rationalize its use by extending the duration of effect and reducing the number of applications, the objectives of this work were to develop and evaluate liposomes containing Novabupi (LBPV), followed by incorporation into thermogel. Liposomes were prepared using the lipid hydration method, followed by size reduction using sonication, and the developed formulations were characterized by hydrodynamic diameter, polydispersity index (PDI), surface zeta potential, and encapsulation efficiency. The selected optimal liposomal formulation was successfully incorporated into a thermogel without loss of thermoresponsive properties, being suitable for administration as a subcutaneous injection. In the ex vivo permeation studies with fresh rodent skin, the thermogel with liposomes loaded with 0.5% LBPV (T-gel formulation 3) showed higher permeation rates compared to the starting formulation, thermogel with 0.5% LBPV (T-Gel 1), which will probably translate into better therapeutic benefits for treatment of postoperative analgesia, especially with regard to the number of doses applied.


Asunto(s)
Analgesia/métodos , Levobupivacaína/administración & dosificación , Levobupivacaína/farmacocinética , Dolor/tratamiento farmacológico , Dolor/metabolismo , Animales , Bovinos , Pollos , Membrana Corioalantoides/efectos de los fármacos , Membrana Corioalantoides/metabolismo , Geles , Humanos , Liposomas , Masculino , Ratones , Células 3T3 NIH , Técnicas de Cultivo de Órganos , Ratas , Ratas Wistar , Piel/efectos de los fármacos , Piel/metabolismo , Absorción Cutánea/efectos de los fármacos , Absorción Cutánea/fisiología
13.
Zhonghua Shao Shang Za Zhi ; 37(2): 126-130, 2021 Feb 20.
Artículo en Chino | MEDLINE | ID: mdl-33550769

RESUMEN

Severe burns trigger the stress response, cause different degrees of damage to the body, and participate in the occurrence and development of immune dysfunction and hypermetabolism after burn. Rational application of analgesic and sedative drugs is the major method of inhibiting the severe burn-induced stress response, which can alleviate the organ damages and reduce the incidence of burn sepsis. Furthermore, integrated approaches including wound management, infection control, nutritional support, and gastrointestinal tract protection, as well as sleep management, etc., collectively contribute to the alleviation of stress response after burn injury. To further improve the success rate of severe burn treatment, it is essential to study the changes of various stresses, endocrine hormones and immune patterns in patients with severe burn, to explore the mechanism and regulation of burn-induced hypermetabolism, and to reach a consensus on sedation and analgesia strategy, the management of stress response and hypermetabolism after severe burns.


Asunto(s)
Analgesia , Quemaduras , Analgésicos , Quemaduras/tratamiento farmacológico , Humanos , Apoyo Nutricional , Dolor/tratamiento farmacológico
14.
Vet J ; 269: 105607, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33593491

RESUMEN

Regional hypothermia has shown promise as analgesic in horses when used to manage painful conditions of the distal limb such as laminitis. In this prospective study, the analgesic effects of regional hypothermia were assessed using mechanical nociceptive thresholds during distal limb cooling. The study population consisted of eight healthy adult Standardbred horses, selected from a teaching herd. A distal forelimb of each horse was cooled using water immersion at the following sequential target water temperatures: 34 °C, 20 °C, 10 °C, 5 °C, 1 °C, 5 °C, 10 °C, 20 °C. Limb surface temperature was measured after 30 min at each target water temperature and the mechanical force required to elicit a response (mechanical nociceptive threshold) was determined using a pneumatic actuator. Both forelimbs of each horse were tested one week apart. At skin surface temperatures above 7 °C, there was little association between skin surface temperature and the mechanical force required to elicit a response. As the skin surface temperature decreased below 7 °C, there was a rapid increase in the force required to elicit a response (P = 0.036). Skin surface temperatures of <7 °C required water temperatures below 2 °C. The results of this study suggest that hypothermia has potential to provide distal limb analgesia in horses at skin surface temperatures below 7 °C. Further evaluation of the technique is warranted.


Asunto(s)
Analgesia/veterinaria , Miembro Anterior , Caballos/fisiología , Hipotermia Inducida/veterinaria , Nocicepción/fisiología , Umbral del Dolor/fisiología , Analgesia/métodos , Animales , Fenómenos Biomecánicos/fisiología , Femenino , Enfermedades de los Caballos/terapia , Masculino , Estudios Prospectivos
15.
Nat Rev Neurosci ; 22(3): 133, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33547450
16.
Cochrane Database Syst Rev ; 2: CD012968, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33629404

RESUMEN

BACKGROUND: Breast cancer is one of the most common cancers among women. Surgical removal of the cancer is the mainstay of treatment; however, tumour handling during surgery can cause microscopic dissemination of tumour cells and disease recurrence. The body's hormonal response to surgery (stress response) and general anaesthesia may suppress immunity, promoting tumour dissemination. Paravertebral anaesthesia numbs the site of surgery, provides good analgesia, and blunts the stress response, minimising the need for general anaesthesia. OBJECTIVES: To assess the effects of paravertebral anaesthesia with or without sedation compared to general anaesthesia in women undergoing breast cancer surgery, with important outcomes of quality of recovery, postoperative pain at rest, and mortality. SEARCH METHODS: On 6 April 2020, we searched the Specialised Register of the Cochrane Breast Cancer Group (CBCG); CENTRAL (latest issue), in the Cochrane Library; MEDLINE (via OvidSP); Embase (via OvidSP); the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal; and ClinicalTrials.gov for all prospectively registered and ongoing trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs) conducted in adult women undergoing breast cancer surgery in which paravertebral anaesthesia with or without sedation was compared to general anaesthesia. We did not include studies in which paravertebral anaesthesia was given as an adjunct to general anaesthesia and then this was compared to use of general anaesthesia. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted details of trial methods and outcome data from eligible trials. When data could be pooled, analyses were performed on an intention-to-treat basis, and the random-effects model was used if there was heterogeneity. When data could not be pooled, the synthesis without meta-analysis (SWiM) approach was applied. The GRADE approach was used to assess the certainty of evidence for each outcome. MAIN RESULTS: Nine studies (614 participants) were included in the review. All were RCTs of parallel design, wherein female patients aged > 18 years underwent breast cancer surgery under paravertebral anaesthesia or general anaesthesia. None of the studies assessed quality of recovery in the first three postoperative days using a validated questionnaire; most assessed factors affecting quality of recovery such as postoperative analgesic use, postoperative nausea and vomiting (PONV), hospital stay, ambulation, and patient satisfaction. Paravertebral anaesthesia may reduce the 24-hour postoperative analgesic requirement (odds ratio (OR) 0.07, 95% confidence interval (CI) 0.01 to 0.34; 5 studies, 305 participants; low-certainty evidence) compared to general anaesthesia. Heterogeneity (I² = 70%) was attributed to the fixed dose of opioids and non-steroidal analgesics administered postoperatively in one study (70 participants), masking a difference in analgesic requirements between groups. Paravertebral anaesthesia probably reduces the incidence of PONV (OR 0.16, 95% CI 0.08 to 0.30; 6 studies, 324 participants; moderate-certainty evidence), probably results in a shorter hospital stay (mean difference (MD) -79.39 minutes, 95% CI -107.38 to -51.40; 3 studies, 174 participants; moderate-certainty evidence), and probably reduces time to ambulation compared to general anaesthesia (SWiM analysis): percentages indicate vote counting based on direction of effect (100%, 95% CI 51.01% to 100%; P = 0.125; 4 studies, 375 participants; moderate-certainty evidence). Paravertebral anaesthesia probably results in higher patient satisfaction (MD 5.52 points, 95% CI 1.30 to 9.75; 3 studies, 129 participants; moderate-certainty evidence) on a 0 to 100 scale 24 hours postoperatively compared to general anaesthesia. Postoperative pain at rest and on movement was assessed at 2, 6, and 24 postoperative hours on a 0 to 10 visual analogue scale (VAS). Four studies (224 participants) found that paravertebral anaesthesia as compared to general anaesthesia probably reduced pain at 2 postoperative hours (MD -2.95, 95% CI -3.37 to -2.54; moderate-certainty evidence). Five studies (324 participants) found that paravertebral anaesthesia may reduce pain at rest at 6 hours postoperatively (MD -1.54, 95% CI -3.20 to 0.11; low-certainty evidence). Five studies (278 participants) found that paravertebral anaesthesia may reduce pain at rest at 24 hours postoperatively (MD -1.19, 95% CI -2.27 to -0.10; low-certainty evidence). Differences in the methods of two studies (119 participants) and addition of clonidine to the local anaesthetic in two studies (109 participants), respectively, contributed to the heterogeneity (I² = 96%) observed for these two outcomes. Two studies (130 participants) found that paravertebral anaesthesia may reduce pain on movement at 6 hours (MD-2.57, 95% CI -3.97 to -1.17) and at 24 hours (MD -2.12, 95% CI -4.80 to 0.55; low-certainty evidence). Heterogeneity (I² = 96%) was observed for both outcomes and could be due to methodological differences between studies. None of the studies reported mortality related to the anaesthetic technique. Eight studies (574 participants) evaluated adverse outcomes with paravertebral anaesthesia: epidural spread (0.7%), minor bleeding (1.4%), pleural puncture not associated with pneumothorax (0.3%), and Horner's syndrome (7.1%). These complications were self-limiting and resolved without treatment. No data are available on disease-free survival, chronic pain, and quality of life. Blinding of personnel or participants was not possible in any study, as a regional anaesthetic technique was compared to general anaesthesia. Risk of bias was judged to be serious, as seven studies had concerns of selection bias and three of detection bias. AUTHORS' CONCLUSIONS: Moderate-certainty evidence shows that paravertebral anaesthesia probably reduces PONV, hospital stay, postoperative pain (at 2 hours), and time to ambulation and results in greater patient satisfaction on the first postoperative day compared to general anaesthesia. Paravertebral anaesthesia may also reduce postoperative analgesic use and postoperative pain at 6 and 24 hours at rest and on movement based on low-certainty evidence. However, RCTs using validated questionnaires are needed to confirm these results. Adverse events observed with paravertebral anaesthesia are rare.


Asunto(s)
Analgesia/métodos , Anestesia General/métodos , Anestesia Raquidea/métodos , Neoplasias de la Mama/cirugía , Estrés Fisiológico/efectos de los fármacos , Adulto , Periodo de Recuperación de la Anestesia , Anestesia Raquidea/efectos adversos , Sesgo , Neoplasias de la Mama/inmunología , Ambulación Precoz , Femenino , Síndrome de Horner/epidemiología , Humanos , Incidencia , Análisis de Intención de Tratar , Tiempo de Internación , Bloqueo Nervioso/métodos , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto
17.
Eur J Pain ; 25(5): 1150-1161, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33533139

RESUMEN

BACKGROUND: Offset analgesia (OA) is characterized by a disproportionately large decrease in pain perception after a slight decrease in noxious stimulation. In patients with ongoing pain, this response is reduced. The effect is pronounced in painful body areas. The influence of acute pain has not been sufficiently investigated. The aim of this study was to investigate the influence of two experimental acute pain models, measured within the area of acute pain and on the non-affected opposite side, thereby considering the possible somatotopic nature of OA. METHODS: Healthy, pain-free volunteers (n = 75) were randomly assigned to one of three groups (cold water, exercise and control group). The 'cold water group' immersed one hand into cold water for 3 min (Cold Pressor Task), while the 'exercise group' performed an isometric grip exercise for 3 min. There was no manipulation in the control group. Each experimental pain stimulus was performed at both (dominant, non-dominant) forearms. The individualized OA paradigm consisted of offset and constant temperature trials. Offset analgesia was measured immediately before, during and after the experimental pain stimuli. RESULTS: A significant difference in OA was shown during experimental pain when compared to the control condition (exercise vs. control: p < 0.001, cold vs. control: p = 0.001), with no difference between the experimental conditions (p > 0.05). Immediately following the pain stimulation, results were marginally non-significant (p = 0.05). CONCLUSIONS: Experimental painful stimulation reduced OA. This result should be interpreted with caution due to potential influences of conditioned pain modulation or exercise-induced hypoalgesia as well as possible floor effects. SIGNIFICANCE: Temporal contrast of pain perception is inhibited in acute pain states. This study showed that reduced offset analgesia is observed when pain is experimentally induced using noxious cold and exercise stimuli.


Asunto(s)
Dolor Agudo , Analgesia , Frío , Humanos , Manejo del Dolor , Dimensión del Dolor , Percepción del Dolor
18.
Br J Surg ; 108(1): 58-65, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33640920

RESUMEN

BACKGROUND: Thoracic epidural analgesia (TEA) has been regarded as the standard of care after oesophagectomy for pain control, but has several side-effects. Multimodal (intrathecal diamorphine, paravertebral and rectus sheath catheters) analgesia (MA) may facilitate postoperative mobilization by reducing hypotensive episodes and the need for vasopressors, but uncertainty exists about whether it provides comparable analgesia. This study aimed to determine whether MA provides comparable analgesia to TEA following transthoracic oesophagectomy. METHODS: Consecutive patients undergoing oesophagectomy for cancer between January 2015 and December 2018 were grouped according to postoperative analgesia regimen. Propensity score matching (PSM) was used to account for treatment selection bias. Pain scores at rest and on movement, graded from 0 to 10, were used. The incidence of hypotensive episodes and the requirement for vasopressors were evaluated. RESULTS: The study included 293 patients; 142 (48.5 per cent) received TEA and 151 (51.5 per cent) MA. After PSM, 100 patients remained in each group. Mean pain scores were significantly higher at rest in the MA group (day 1: 1.5 versus 0.8 in the TEA group, P = 0.017; day 2: 1.7 versus 0.9 respectively, P = 0.014; day 3: 1.2 versus 0.6, P = 0.047). Fewer patients receiving MA had a hypotensive episode (25 per cent versus 45 per cent in the TEA group; P = 0.003) and fewer required vasopressors (36 versus 53 per cent respectively; P = 0.016). There was no significant difference in the overall complication rate (71.0 versus 61.0 per cent; P = 0.136). CONCLUSION: MA is less effective than TEA at controlling pain, but this difference may not be clinically significant. However, fewer patients experienced hypotension or required vasopressor support with MA; this may be beneficial within an enhanced recovery programme.


Asunto(s)
Analgesia Epidural/métodos , Analgesia/métodos , Esofagectomía , Dolor Postoperatorio/terapia , Anciano , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Puntaje de Propensión , Vértebras Torácicas
19.
Medicine (Baltimore) ; 100(7): e24512, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607780

RESUMEN

BACKGROUND: The postoperative pain associated with total knee arthroplasty (TKA) is severe for most patients. The analgesic efficacy and safety of preoperative use of selective cyclooxygenase-2 (COX-2) inhibitors for patients undergoing TKA are unclear. OBJECTIVES: We conducted a systematic review and meta-analysis to assess whether the use of selective COX-2 inhibitors before TKA decreases the postoperative pain intensity. METHODS: Data sources: The PubMed, Embase, EBSCO, Web of Science, and Cochrane Controlled Register of Trials databases from inception to January 2020. STUDY ELIGIBILITY CRITERIA: All randomized controlled trials (RCTs) in which the intervention treatment was preoperative selective COX-2 vs placebo in patients undergoing TKA and that had at least one of the quantitative outcomes mentioned in the following section of this paper were included. Letters, review articles, case reports, editorials, animal experimental studies, and retrospective studies were excluded. INTERVENTIONS: All RCTs in which the intervention treatment was preoperative selective COX-2 vs placebo in patients undergoing TKA. STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of the RCTs was quantified using the Newcastle-Ottawa quality assessment scale. RevMan 5.3 software was used for the meta-analysis. RESULTS: Six RCTs that had enrolled a total of 574 patients were included in the meta-analysis. The visual analog scale pain score at rest was significantly different between the experimental group and control group at 24 hours (P < .05) and 72 hours (P < .05) postoperatively. The experimental group exhibited a significant visual analog scale pain score during flexion at 24 hours postoperatively (P < .05), and it was not different at 72 hours postoperatively (P = .08). There was a significant difference in opioid consumption (P < .05), but there was no difference in the operation time (P = .24) or postoperative nausea/vomiting (P = .64) between the groups. CONCLUSION: The efficacy of preoperative administration of selective COX-2 inhibitors to reduce postoperative pain and opioid consumption after TKA is validated. SYSTEMATIC REVIEW REGISTRATION NUMBER: INPLASY202090101.


Asunto(s)
Analgesia/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Dolor Postoperatorio/prevención & control , Cuidados Preoperatorios/métodos , Anciano , Analgésicos Opioides/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
Vet Clin North Am Food Anim Pract ; 37(1): 17-31, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33541697

RESUMEN

Small ruminants are increasing in popularity as production and companion animals in the United States, and among sheep, goats, and camelids there are many disease processes and management techniques that have the potential to result in painful or noxious stimuli. In these species, many medications and therapeutic techniques can be used to reduce or eliminate the long-term consequences of pain. In this second portion of the review, we focus on the application of pain management in these species. These strategies include mono- and multimodal and the use of precision pain management, such as epidural drug administration, regional perfusions, and transdermal applications.


Asunto(s)
Camélidos del Nuevo Mundo , Enfermedades de las Cabras/tratamiento farmacológico , Manejo del Dolor/veterinaria , Dolor/veterinaria , Enfermedades de las Ovejas/tratamiento farmacológico , Analgesia/métodos , Analgesia/veterinaria , Animales , Cabras , Dolor/tratamiento farmacológico , Manejo del Dolor/métodos , Rumiantes , Ovinos , Estados Unidos
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