Multicentre evaluation of postoperative pain control after 24hours in three hospitals of Colombia. / Evaluación multicéntrica de control del dolor postoperatorio a las 24 horas en tres hospitales de Colombia.

OBJECTIVE: To determine the intensity of pain in operated patients using a visual analogue scale and identify variables associated with lack of pain control in three cities in Colombia. METHOD: A cross-sectional study in patients over the age of 18 years, between January 1st and September 30th 2014, in 3 clinics in Colombia. The intensity of postoperative pain using a visual analogue scale at 24hours after surgery was recorded. Socio-demographic, clinical and pharmacological variables were taken into account. SPSS 22.0 was used for the analysis. RESULTS: 460 patients were evaluated, mean age 47.6±17.4 years, and 63.3% were female. The mean pain level was 23.8±17.4mm, with 91 (19.8% of patients) with moderate or greater pain (i.e., lack of pain control). Tramadol was the most used analgesic, followed by dipyrone and diclofenac. 53.0% were treated with monotherapy. Compliance with the dosing regimen of the first analgesic (OR: 0.53; 95% CI: 0.294 to .988; p=.046) was statistically significantly associated with a decreased risk of poorly controlled pain. CONCLUSIONS: Pain intensity and the proportion of patients with uncontrolled pain at 24hours after surgery show better results than other studies previously published in the country. There must be insistence on the administration of analgesia within a suitable interval in order to improve pain control.

Estudio multicéntrico sobre efectividad de control del dolor postquirúrgico en pacientes de Colombia / Multicenter study on effectiveness of controlling postoperative pain in Colombian patients

Introduction: Postoperative pain can cause complications, prolonged hospital stays and has often been poorly assessed. Objectives: To determine the intensity of pain in patients operated on using a visual analog scale (VAS) and to identify variables associated with a lack of control in seven cities in Colombia. Materials and methods: Cross-sectional study in patients older than 18 years between 1st January and 30th September, 2014 in eight clinics across Colombia. The intensity of postoperative pain was assessed with a VAS 4h after the procedure. Socio-demographic, clinical and pharmacological variables were considered. Multivariate analysis was done using SPSS 22.0. Results: A total of 1015 patients were evaluated. The mean age was 42.5 ± 17.1 years, and 63.8% were female. The mean pain level was 38.8 ± 19.4 mm, with a total of 600 (59.1% of patients) without pain control. Dipyrone was the most used analgesic, followed by morphine and tramadol. Being treated at Nuestra Señora del Rosario Clinic in Ibagué (OR: 1.65; 95%CI: 1.096-2.479; p = 0.016), coming from urban areas (OR: 1.71; 95%CI: 1.186-2.463; p = 0.005), being subjected to major surgery (OR: 2.02; 95%CI: 1.316-3.109; p = 0.001), emergency surgery (OR: 1.46; 95%CI: 1.065-2.013; p = 0.019), and suffering nausea (OR: 2.05; 95%CI: 1.341-3.118; p = 0.001) were statistically associated with no pain control. Conclusion: None of the clinics had acceptable percentages of patients with pain controlled 4 h after surgery. Clinical practice guides should be incorporated, institutional policies should be defined, health personnel should be trained, and the outcomes of the interventions should be evaluated.

Introducción: El dolor postoperatorio puede causar complicaciones, prolongar la estancia hospitalaria y frecuentemente es mal valorado. Objetivos: Determinar la intensidad del dolor en pacientes intervenidos quirúrgicamente mediante una escala visual analógica (EVA) y determinar las variables asociadas a la falta de control en siete ciudades de Colombia. Materiales y métodos: Estudio de corte transversal en pacientes mayores de 18 años entre el 1 de enero y 30 de septiembre del año 2014 en 8 clínicas de Colombia. Se valoró la intensidad del dolor postoperatorio mediante EVA a las 4 horas del procedimiento. Se consideraron variables sociodemográficas, clínicas y farmacológicas. Se hizo análisis multivariado con SPSS 22.0. Resultados: Se evaluó un total de 1015 pacientes, con edad promedio 42,5±17,1 años, y 63,8% eran mujeres. La media del nivel de dolor fue 38,8±19,4 mm, con un total de 600 (59,1% de pacientes) sin control del dolor. Dipirona fue el analgésico más empleado, seguido de tramadol y morfina. Ser tratado en la clínica Nuestra Señora del Rosario de Ibagué (OR:1,65; IC95%:1,096-2,479; p = 0,016), provenir de área urbana (OR:1,71; IC95%:1,186-2,463; p = 0,005), ser sometido a cirugía mayor (OR:2,02; IC95%:1,316-3,109; p = 0,001), de urgencia (OR:1,46; IC95%:1,065-2,013; p = 0,019), y sufrir náuseas (OR:2,05; IC95%:1,341-3,118; p = 0,001) se asociaron estadísticamente con no controlar el dolor. Conclusión: En ninguna de las clínicas había porcentajes aceptables de pacientes con dolor controlado a las 4 horas después de la cirugía. Se deben incorporar guías de práctica clínica, definir políticas institucionales, capacitar al personal sanitario y evaluar resultados de las intervenciones.

Temporomandibular joint meniscopexy with Mitek mini anchors.

PURPOSE: The purpose of this study is to show long-term results with the use of Mitek mini anchors (DePuy Mitek, Raynham, MA) in the surgical treatment (meniscopexy or discoplasty) of internal derangements that lead to a dysfunctional temporomandibular joint (TMJ). PATIENTS AND METHODS: We evaluated 50 patients, 32 women and 18 men, ranging in age from 19 to 53 years, with a mean age of 33.5 years. All patients included in the study were diagnosed with anterior disc displacement without reduction. Each patient underwent surgical meniscopexy and placement of Mitek mini anchors with No. 2-0 nylon monofilament sutures. The variables taken into account in this study include range of mouth opening, painful symptoms (evaluated with the visual analog verbal scale), and the presence of any clicks in the TMJ. RESULTS: Preoperative analysis showed painful symptoms in 100% of evaluated patients, the presence of clicks of the TMJ in 76%, and a mean mouth opening range of 23.5 mm. Postoperative analysis showed that 92% of the patients had no painful symptoms, 90% did not have any associated clicks in the TMJ, and the mean mouth opening range on postoperative evaluation was 38.3 mm, with a mean increase of 14.8 mm. CONCLUSIONS: We conclude that surgical placement of Mitek mini anchors represents an alternative that can be considered a tool of great utility for discoplasty procedures, showing evident clinical improvement.