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J Clin Med ; 8(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295896


Osteoarthritis (OA) is considered to be one of the most disabling diseases. The intra-articular opioid injection has been widely studied for its simplicity, safety, and efficacy in OA. In this study, however, we suggest a novel method of buprenorphine transdermal patch (BTDP) to painful knee joints of OA patients, instead of intra-articular opioid injection, and subsequently compared the knee application with conventional chest application. We retrospectively enrolled 213 patients with knee OA who did not respond to conventional therapy. The Numeric Rating Scale (NRS), adverse effects, and compliance were recorded before and after the application of the BTDP. All parameters were compared between the knee applied group and the chest applied group. After the BTDP application, the NRS score in the knee applied group was lower than that of the chest applied group (p = 0.007). NRS scores after buprenorphine patch decreased to 2.21 ± 0.77, and 2.55 ± 0.71 in the chest applied group and the knee applied group, respectively. The adverse effects were 19.32% in the knee applied group, and 64.00% in the chest applied group. The compliances were 82.95% and 37.60% in the knee applied group and chest applied group, respectively. This novel application of BTDP directly to the painful knee joint of knee OA patients led to a decrease in the NRS score, adverse effects, and an increase in compliance compared with the chest application method.

Clin Interv Aging ; 12: 1835-1842, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29138544


Purpose: Postoperative delirium is a risk factor for worse outcome after hip fracture surgery in elderly patients. Postoperative delirium is associated with anesthesia, postoperative pain, and patient factors. We investigated the incidence, predictors, and prognostic implications of post-operative delirium after hemiarthroplasty (HA) in elderly patients with femoral neck fracture. Patients and methods: A total of 356 consecutive patients aged >70 years who underwent HA for femoral neck fracture were enrolled. Diagnosis of delirium was made by a psychiatrist based on patient status and an objective scoring system. The patients were divided into 2 categories according to the HA onset time (immediate [≤24 h after surgery] vs delayed delirium [>24 h after surgery]) and its incidence, predictors and mortality were evaluated. Results: Postoperative delirium was diagnosed in 110 patients (30.9%) during hospitalization. Immediate and delayed delirium occurred in 59 (53.6%), and 51 (46.4%) patients, respectively. The independent predictors of immediate delirium included age (odds ratio [OR] 1.47, 95% CI 0.98-2.23, p=0.066), and general anesthesia (OR 2.25, 95% CI 1.17-4.43, p=0.015). The independent predictors of delayed delirium were parkinsonism (OR 5.75, 95% CI 1.66-19.96, p=0.006), intensive care unit stay (OR 1.85, 95% CI 0.97-3.56, p=0.064), and higher American Society of Anesthesiologists grade (OR 2.33, 95% CI 0.90-6.07, p=0.083). On Kaplan-Meier survival analysis, the 2-year survival rate was significantly lower in the immediate delirium group than those in the delayed and control groups (71.0% vs 83.6% vs 87.8%, respectively; p=0.031). Conclusion: Immediate and delayed delirium after HA for femoral neck fracture had different predictors and immediate delirium was associated with worse prognosis.

Delírio/epidemiologia , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Razão de Chances , Prognóstico , Fatores de Risco
Saudi J Anaesth ; 11(1): 83-85, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28217060


Although the major mechanism of complex regional pain syndrome (CRPS) involves dysfunctional central or sympathetic nervous system activation, the peripheral nervous system also contributes significantly to its clinical manifestations. Pulsed radiofrequency (PRF) is a recently developed treatment option for neuropathic pain syndromes. Here, we report a case of CRPS Type II after a femur fracture and sciatic nerve injury, in which the pain was treated successfully with ultrasonography-guided selective sciatic nerve PRF application.

BMC Anesthesiol ; 16(1): 50, 2016 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-27484339


BACKGROUND: Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia. METHODS: Children (aged 3-9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 µg/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 µg/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed. RESULTS: The incidence of EA was significantly lower in groups R (32 %, 11/34; P = 0.01) and RA (31 %, 11/35; P = 0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2 ± 2.3 min; P = 0.004 and P = 0.016) compared with groups S (9.2 ± 2.3 min) andR (9.5 ± 2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P < 0.001). CONCLUSIONS: The administration of remifentanil to children undergoing ophthalmic surgery undersevoflurane anesthesia reduced the incidence of EA without clinically significant hemodynamic changes. However, the addition of alfentanil(5 µg/kg)10 min before the end of surgery provided no additional benefit compared withremifentanil alone. CLINICAL TRIAL NUMBER: NCT02486926 , June.29.2015.

Alfentanil/administração & dosagem , Delírio do Despertar/epidemiologia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Piperidinas/administração & dosagem , Extubação , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Incidência , Masculino , Éteres Metílicos/administração & dosagem , Remifentanil , Sevoflurano , Fatores de Tempo
Pain Physician ; 16(2): 155-64, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23511682


BACKGROUND: Cervical interlaminar epidural injection (CIEI) is widely used in the management of acute or chronic neck and upper extremity pain. There is no consensus regarding the optimal volume of solution to be used for CIEI. STUDY DESIGN: Randomized, double blind controlled trial. OBJECTIVE: The purpose of this study was to evaluate how many spinal segments would be covered with different volumes of contrast medium, given by fluoroscopically guided CIEI, in efforts to establish the optimal volume of medication with consideration of clinical pathologic lesions. METHODS: One hundred and twenty-six CIEI were performed at C7-T1 in 133 patients. All patients were divided into 3 groups (A, B, and C) according to the amount of contrast medium used: 2.5 mL for group A, 5 mL for group B, and 10 mL for group C. The extent of contrast medium spread was determined by anteroposterior and lateral view under fluoroscopy. LIMITATION: We did not evaluate the clinical outcomes with pain measurements during the study period. RESULTS: The total number of vertebral segments of contrast media spread and spreading range of caudad or cephalad were significantly different among the 3 groups (P < 0.001). However, groups B and C in cephalad spreading and groups A and B in caudad spreading did not show any significant difference. A proportion of the patients with a cephalad spread of up to C4 and C2 in group A (59.5% and 31%) was significantly different from that in the other 2 groups (92.9% and 69.1% in group B and 97.6% and 73.8% in group C) (P < 0.001). CONCLUSION: Five mL for CIEI at C7-T1 could be an optimal volume for distribution to the lower cervical spine for degenerative cervical spinal diseases, as well as to the upper cervical spine for head and facial pain.

Vértebras Cervicais/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Espaço Epidural/diagnóstico por imagem , Injeções Epidurais/métodos , Bloqueio Nervoso/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
Korean J Anesthesiol ; 60(5): 365-8, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21716567


A 22-year-old man underwent an operation for posterolateral fusion of the lumbar spine at L3-5. He was ventilated via a tracheostomy site in a prone position for 210 minutes. Ventilator function and eyeballs were checked periodically. After changing his position to supine for the wake-up test, it was noticed that his tongue was self-inflicted and looked to be cut unless immediate decompression was applied. After several manual attempts to open the mouth failed, anesthesia depth was deepened with thiopental sodium and neuromuscular blocker to decompress and reposition the tongue into the intraoral cavity. Minimal teeth marks and scarring remained after seven months without any complications.