The Effectiveness of Periarticular Anesthetic Infiltration in Postoperative Analgesia of Total Hip Arthroplasty.

Objective The present study aims to evaluate the effectiveness of the periarticular hip infiltration technique in the postoperative period of total hip arthroplasty. Methods This is a randomized double-blind controlled clinical trial in patients with femoral neck fractures or hip osteoarthritis submitted to a total hip arthroplasty at our institution. The periarticular infiltration technique consisted of the administration of an anesthetic (levobupivacaine) and a steroid (dexamethasone) agent in the nociceptor-rich tissues of the hip after orthopedic implants placement. The control group received an injection of 0.9% saline into the same tissues. Pain, range of motion, and use of opioid analgesic agents after 24 and 48 hours of the procedure were evaluated, as well as the presence of adverse effects, time to resume walking, and total hospitalization time. Results The study evaluated 34 patients. The experimental group required fewer opioid agents between 24 and 48 hours. The reduction in pain scores was greater in the placebo group. Conclusion Periarticular anesthetic infiltration as a method of postoperative analgesia for total hip arthroplasty reduced the rates of opioid intake between 24 and 48 hours. It provided no benefits regarding pain, mobility, length of stay, or complications.

The Effectiveness of Periarticular Anesthetic Infiltration in Postoperative Analgesia of Total Hip Arthroplasty / A eficácia da infiltração periarticular anestésica na analgesia pós-operatória de artroplastia total do quadril

Abstract Objective The present study aims to evaluate the effectiveness of the periarticular hip infiltration technique in the postoperative period of total hip arthroplasty. Methods This is a randomized double-blind controlled clinical trial in patients with femoral neck fractures or hip osteoarthritis submitted to a total hip arthroplasty at our institution. The periarticular infiltration technique consisted of the administration of an anesthetic (levobupivacaine) and a steroid (dexamethasone) agent in the nociceptor-rich tissues of the hip after orthopedic implants placement. The control group received an injection of 0.9% saline into the same tissues. Pain, range of motion, and use of opioid analgesic agents after 24 and 48hours of the procedure were evaluated, as well as the presence of adverse effects, time to resume walking, and total hospitalization time. Results The study evaluated 34 patients. The experimental group required fewer opioid agents between 24 and 48 hours. The reduction in pain scores was greater in the placebo group. Conclusion Periarticular anesthetic infiltration as a method of postoperative analgesia for total hip arthroplasty reduced the rates of opioid intake between 24 and 48hours. It provided no benefits regarding pain, mobility, length of stay, or complications.

Resumo Objetivo Este estudo tem como objetivo avaliar a eficácia da técnica de infiltração periarticular do quadril no pós-operatório de artroplastia total do quadril. Métodos Estudo clínico randomizado duplo-cego controlado. O estudo foi realizado nos pacientes com fratura de colo femoral ou osteoartrose de quadril, submetidos ao procedimento cirúrgico de artroplastia total do quadril em nossa instituição. A técnica de infiltração periarticular consistiu na aplicação da combinação de um anestésico (levobupivacaína) com um corticosteroide (dexametasona) nos tecidos ricos em nociceptores do quadril, após a colocação dos implantes ortopédicos. No grupo controle, foi realizada infiltração de soro fisiológico 0,9% nos mesmos tecidos. Após 24 e 48 horas do procedimento, foram avaliados os quesitos de dor, amplitude de movimentos, uso de analgésicos opióides, presença de efeitos adversos, período do início da deambulação e o tempo total de hospitalização. Resultados Trinta e quatro pacientes foram estatisticamente avaliados no estudo. Foi observada uma redução no consumo de opioides entre 24 e 48 h no grupo experimental. Uma redução maior da pontuação de dor foi observada no grupo placebo. Conclusão A infiltração periarticular anestésica como método de analgesia pós-operatória de artroplastia total do quadril, neste estudo, reduziu as taxas deconsumo de opioides

Perfil pedagógico da preceptoria na residência médica em anestesiologia da cidade de Manaus / Pedagogical profile of preceptorship in anesthesiology medical residency in the city of Manaus

Resumo: Introdução: A residência médica é identificada como o melhor programa de formação de médicos em especialidades, sendo desenvolvida em cenário de treinamento em serviço, de duração extensa, entendida como um espaço de educação e ensino constantes. Nela, o médico em formação desenvolve não unicamente habilidades técnicas, mas também práticas de conduta responsável. Objetivo: Este estudo teve como objetivos conhecer o perfil de formação profissional dos preceptores do Programa de Residência Médica em Anestesiologia, verificar a percepção deles sobre a sua prática educativa desenvolvida no programa e identificar os modelos pedagógicos utilizados no mesmo ambiente. Método: Trata-se de um estudo transversal, do tipo descritivo exploratório, com abordagem quantitativa e componente analítico, realizado no período de janeiro de 2017 a janeiro de 2018, em três instituições públicas de ensino que oferecem o Programa de Residência Médica em Anestesiologia na cidade de Manaus, no Amazonas. Os dados foram coletados por meio de um instrumento contendo informações sociodemográficas, um questionário validado (com foco na percepção acerca da preceptoria), acrescido de uma questão sobre o modelo pedagógico adotado. Resultado: A amostra do estudo foi composta majoritariamente por preceptores do sexo feminino (60%) e com maior titulação na residência médica (96,6%). Um percentual expressivo (80%) informou não possuir formação pedagógica para desenvolver a preceptoria. O modelo pedagógico tradicional foi o mais adotado na prática docente dos preceptores. Conclusão: Mostra-se a importância do diagnóstico situacional da preceptoria na residência médica em Anestesiologia, apontando a necessidade de formação docente para o desenvolvimento da atividade do preceptor, bem como sua valorização adequada, objetivando a melhor formação médica.

Abstract: Introduction: Medical Residency is identified as the best program for training physicians in specialties, developed in an in-service training setting for an extensive period, and understood as a space for constant education and teaching. The trainee doctor develops not only technical skills but also practices of responsible conduct. Objectives: To understand the professional training profile of preceptors of the Medical Residency Program in Anesthesiology, to verify the preceptors' view of their educational practice developed in the Program, and to identify the pedagogical models used in the same environment. Methods: This is a cross-sectional, exploratory descriptive study, with a quantitative approach and analytical component, carried out from January 2017 to January 2018, in three public educational institutions that offer the Medical Residency Program in Anesthesiology in the city of Manaus - AM. Data were collected using an instrument containing sociodemographic information; a validated questionnaire (focusing on perception regarding preceptorship); plus a question about the adopted pedagogical model. Results: The study sample consisted mostly of female preceptors (60%) with medical residency as the highest level of their qualification (96.6%). A significant percentage (80%) reported not having pedagogical training to develop preceptorship. The traditional pedagogical model was the most commonly adopted in the teaching practice of preceptors. Conclusions: The importance of the situational diagnosis of preceptorship in the Medical Residency in Anesthesiology is shown, pointing out the need for teacher training for the development of the preceptor role, as well as it being given its due value, with the aim of achieving the best medical training.

Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction.

Objective To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions. Methods The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n = 12) - 20 mL of saline solution (control); Group II (n = 12) - 20 mL of 0.5% bupivacaine; Group III (n = 12) - 20 mL of 0.5% bupivacaine + 0.1 mg of epinephrine; and Group IV (n = 12) - 20 mL of saline solution + 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure. Results The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain ( p = 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions. Conclusion Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II ( p = 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects ( p > 0.05).

Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction / Avaliação da adição da epinefrina à bupivacaína intra-articular no controle da dor aguda em pacientes submetidos a reconstrução do ligamento cruzado anterior

Abstract Objective To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions. Methods The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n » 12) - 20 mL of saline solution (control); Group II (n » 12) - 20 mL of 0.5% bupivacaine; Group III (n » 12) - 20 mL of 0.5% bupivacaine þ 0.1 mg of epinephrine; and Group IV (n » 12) - 20 mL of saline solution þ 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure. Results The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain (p » 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions. Conclusion Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II (p » 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects (p > 0.05).

Resumo Objetivo Avaliar primariamente a dor pós-operatória, por meio da escala visual analógica (EVA), nos pacientes submetidos a reconstrução do ligamento cruzado anterior (RLCA) que receberam soluções anestésicas intra-articulares (IAs). Métodos Ensaio clínico randomizado com uma amostra de 48 pacientes, divididos em 4 grupos: Grupo I (n » 12) - 20 ml de solução fisiológica (controle); Grupo II (n » 12) - 20 ml de bupivacaína a 0,5%; Grupo III (n » 12) - 20 ml de bupivacaína a 0,5% þ 0,1 mg de epinefrina; e Grupo IV (n » 12) - 20 ml de solução fisiológica þ 0,1 mg de epinefrina, injetados no joelho ao término da cirurgia. A dor foi avaliada pela EVA imediatamente e 6, 12, 24 e 48 horas após o procedimento. Resultados Observou-se grande variabilidade nos resultados da EVA entre os pacientes avaliados em cada grupo. Verificou-se, pela análise de variância (analysis of variance, ANOVA) de Kruskal-Wallis, considerando um nível de 5% de significância, que as soluções anestésicas IAs de cada grupo influenciaram na avaliação da dor desses pacientes (p » 0,003), sendo os do Grupo III os que apresentaram menor dor pósoperatória. Não se evidenciou um maior ou menor consumo de drogas analgésicas suplementares, ou efeitos adversos das decorrentes das soluções empregadas. Conclusão A solução combinada de bupivacaína e epinefrina foi a mais eficaz no controle da dor nos pacientes submetidos a RLCA, mas sem diferenças estatisticamente significativas com relação ao grupo II (p » 0,547). Não se observou diminuição ou aumento no consumo de analgésicos suplementares, ou o aparecimento de efeitos sistêmicos adversos (p > 0,05).

Comparison between intravenous and intrathecal clonidine for postoperative analgesia of patients submitted to laparoscopic cholecystectomy: randomized clinical trial.

INTRODUCTION AND OBJECTIVES: Alpha2 adrenergic agonists, such as clonidine, are used as adjuvants during anesthesia due to their analgesic, sedative, and cardiovascular effects. The objective of the present study was to compare the effect of clonidine administered intravenously and intrathecally on the postoperative pain score of patients undergoing laparoscopic cholecystectomy, according to the route of administration and postoperative opioid consumption. METHODS: This randomized clinical trial, blind to patients and evaluator, assessed 60 patients, candidates for elective laparoscopic cholecystectomy under standardized general anesthesia techniques. Patients were randomly allocated into three groups (20 in each group): Control Group (CG), Intrathecal Clonidine Group (ITCG), and Intravenous Clonidine Group (IVCG). The primary outcome was the comparison of pain, Blood Pressure (BP) and Heart Rate (HR) scores among groups. The secondary outcome was report of adverse effects such as bradycardia, hypotension and sedation, and the need for rescue medication. RESULTS: The mean age was 37.2 ± 8.2 years, and the mean body mass was 28.3 ± 3.6 kg.m-2. Regarding HR (p = 0.003) and pain (p = 0.027), patients in ITCG and CG showed a different profile over time, with CG showing higher consumption of morphine as rescue medication (p = 0.005). CONCLUSION: The administration of intrathecal and intravenous clonidine in low doses can reduce hemodynamic parameters and decrease postoperative requirement of analgesics. Further studies should investigate the ideal dose and method.