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1.
Cochrane Database Syst Rev ; 10: CD004908, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33078388

RESUMO

BACKGROUND: Women may experience differing types of pain and discomfort following birth, including cramping pain (often called after-birth pain) associated with uterine involution, where the uterus contracts to reduce blood loss and return the uterus to its non-pregnant size. This is an update of a review first published in 2011. OBJECTIVES: To assess the effectiveness and safety of pharmacological and non-pharmacological pain relief/analgesia for the relief of after-birth pains following vaginal birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 October 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials comparing two different types of analgesia or analgesia versus placebo or analgesia versus no treatment, for the relief of after-birth pains following vaginal birth. Types of analgesia included pharmacological and non-pharmacological. Quasi-randomised trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, conducted 'Risk of bias' assessment, extracted data and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: In this update, we include 28 studies (involving 2749 women). The evidence identified in this review comes from middle- to high-income countries. Generally the trials were at low risk of selection bias, performance bias and attrition bias, but some trials were at high risk of bias due to selective reporting and lack of blinding. Our GRADE certainty of evidence assessments ranged from moderate to very low certainty, with downgrading decisions based on study limitations, imprecision, and (for one comparison) indirectness. Most studies reported our primary outcome of adequate pain relief as reported by the women. No studies reported data relating to neonatal adverse events, duration of hospital stay, or breastfeeding rates. Almost half of the included studies (11/28) excluded breastfeeding women from participating, making the evidence less generalisable to a broader group of women. Non-steroidal anti-inflammatory drugs (NSAIDs) compared to placebo NSAIDs are probably better than placebo for adequate pain relief as reported by the women (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.45 to 1.91; 11 studies, 946 women; moderate-certainty evidence). NSAIDs may reduce the need for additional pain relief compared to placebo (RR 0.15, 95% CI 0.07 to 0.33; 4 studies, 375 women; low-certainty evidence). There may be a similar risk of maternal adverse events (RR 1.05, 95% CI 0.78 to 1.41; 9 studies, 598 women; low-certainty evidence). NSAIDs compared to opioids NSAIDs are probably better than opioids for adequate pain relief as reported by the women (RR 1.33, 95% CI 1.13 to 1.57; 5 studies, 560 women; moderate-certainty evidence) and may reduce the risk of maternal adverse events (RR 0.62, 95% CI 0.43 to 0.89; 3 studies, 255 women; low-certainty evidence). NSAIDs may be better than opioids for the need for additional pain relief, but the wide CIs include the possibility that the two classes of drugs are similarly effective or that opioids are better (RR 0.37, 95% CI 0.12 to 1.12; 2 studies, 232 women; low-certainty evidence). Opioids compared to placebo Opioids may be better than placebo for adequate pain relief as reported by the women (RR 1.26, 95% CI 0.99 to 1.61; 5 studies, 299 women; low-certainty evidence). Opioids may reduce the need for additional pain relief compared to placebo (RR 0.48, 95% CI 0.28 to 0.82; 3 studies, 273 women; low-certainty evidence). Opioids may increase the risk of maternal adverse events compared with placebo, although the certainty of evidence is low (RR 1.59, 95% CI 0.99 to 2.55; 3 studies, 188 women; low-certainty evidence). Paracetamol compared to placebo Very low-certainty evidence means we are uncertain if paracetamol is better than placebo for adequate pain relief as reported by the women, the need for additional pain relief, or risk of maternal adverse events (2 studies, 123 women). Paracetamol compared to NSAIDs Very low-certainty evidence means we are uncertain if there are any differences between paracetamol and NSAIDs for adequate pain relief as reported by the women, or the risk of maternal adverse events. No data were reported about the need for additional pain relief comparing paracetamol and NSAIDs (2 studies, 112 women). NSAIDs compared to herbal analgesia We are uncertain if there are any differences between NSAIDs and herbal analgesia for adequate pain relief as reported by the women, the need for additional pain relief, or risk of maternal adverse events, because the certainty of evidence is very low (4 studies, 394 women). Transcutaneous nerve stimulation (TENS) compared to no TENS Very low-certainty evidence means we are uncertain if TENS is better than no TENS for adequate pain relief as reported by the women. No other data were reported comparing TENS with no TENS (1 study, 32 women). AUTHORS' CONCLUSIONS: NSAIDs may be better than placebo and are probably better than opioids at relieving pain from uterine cramping/involution following vaginal birth. NSAIDs and paracetamol may be as effective as each other, whereas opioids may be more effective than placebo. Due to low-certainty evidence, we are uncertain about the effectiveness of other forms of pain relief. Future trials should recruit adequate numbers of women and ensure greater generalisability by including breastfeeding women. In addition, further research is required, including a survey of postpartum women to describe appropriately their experience of uterine cramping and involution. We identified nine ongoing studies, which may help to increase the level of certainty of the evidence around pain relief due to uterine cramping in future updates of this review.


Assuntos
Analgesia Obstétrica/métodos , Cãibra Muscular/complicações , Dor/tratamento farmacológico , Contração Uterina/fisiologia , Doenças Uterinas/tratamento farmacológico , Acetaminofen/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Viés , Feminino , Humanos , Miométrio , Placebos/uso terapêutico , Período Pós-Parto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Elétrica Nervosa Transcutânea , Útero/fisiologia
2.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194187

RESUMO

Low back pain (LBP) is a common and costly condition and a leading cause of disabilities across the globe. In Australia and other countries, there has been changes in LBP management guidelines and evidence in recent years, including the use of pharmacotherapy. Inadequately treated LBP is a burden with significant health and economic impacts. Although there is some variability, non-steroidal anti-inflammatory drugs (NSAIDs) have largely replaced paracetamol as the first-choice analgesic for non-specific LBP in many international clinical guidelines, including the current Australian Therapeutic Guidelines. More recent clinical evidence also supports that targeting LBP with the use of NSAIDs can provide superior and more effective relief of LBP symptoms compared with paracetamol. Community pharmacists are one of the most accessible and frequently visited health professionals that offer vital primary healthcare services aimed to provide enhanced clinical outcomes for patients. The position of a community pharmacist is pivotal in LBP assessment and management, from both a pharmacological and non-pharmacological standpoint, including the use of clinical guidelines, yet their roles are often not fully utilized in LBP therapy. Studies investigating the community pharmacist's views, practices, knowledge, and roles, specifically in LBP management in Australia are variable and limited. This narrative review will briefly cover the impacts of LBP, and to provide a summary on recent evidence, updates and a comparison of the Australian and international low back pain management guidelines on paracetamol vs NSAIDs in LBP, as well as pharmacists' roles and interventions in a primary healthcare setting in this context


No disponible


Assuntos
Humanos , Papel Profissional , Farmacêuticos , Dor nas Costas/diagnóstico , Dor nas Costas/tratamento farmacológico , Acetaminofen/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Guias de Prática Clínica como Assunto
4.
Am Surg ; 86(8): 926-932, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32749863

RESUMO

BACKGROUND: Rib fractures are common injuries among traumatically injured patients, and elderly patients with rib fractures are at increased risk for adverse events and death. The purpose of this study was to determine if oral Per os (PO) acetaminophen is as effective as intravenous (IV) acetaminophen in treating the pain associated with rib fractures. METHODS: We performed a single-center, randomized, placebo-controlled, double-blinded study. Trauma patients who were ≥65 years old and had ≥1 rib fracture were included in this study. Patients were randomized into IV acetaminophen and oral placebo (n = 63) or IV placebo and oral solution acetaminophen (n = 75) groups. The primary outcome was a mean reduction in pain score at 24 hours, and secondary outcomes included opioid use, intensive care unit (ICU) length of stay (LOS), hospital LOS, hospital mortality, the difference in incentive spirometry, and development of pneumonia. RESULTS: Among the 138 patients included, there was no statistically significant difference between the 2 study groups in a mean reduction in pain score at 24 hours after injury (PO: 3.24, IV: 2.49; P = .230). Opioid pain medication use was equivalent between groups (P = .212), and there was no significant difference in hospital mortality rate between groups (P = .827). There was no statistically significant difference in ICU LOS, hospital LOS, or development of pneumonia. DISCUSSION: In elderly trauma patients (age ≥65 years) with 1 or more rib fractures, PO acetaminophen is equivalent to IV acetaminophen for pain control, with no difference in morbidity or mortality. Oral acetaminophen should be preferentially used over IV acetaminophen when treating the elderly trauma patient with rib fractures.


Assuntos
Acetaminofen/administração & dosagem , Dor Aguda/tratamento farmacológico , Analgésicos não Entorpecentes/administração & dosagem , Dor Musculoesquelética/tratamento farmacológico , Fraturas das Costelas/complicações , Acetaminofen/uso terapêutico , Dor Aguda/etiologia , Administração Intravenosa , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Entorpecentes/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Dor Musculoesquelética/etiologia , Estudos Prospectivos , Resultado do Tratamento
5.
J Neurovirol ; 26(5): 800-801, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32779108

RESUMO

A woman in her forties with asthma and COPD was admitted to a general medical floor with respiratory symptoms, body aches, and anosmia. Reverse transcription polymerase chain reaction detected severe acute respiratory syndrome coronavirus-2. Admission labs, including biomarkers of the systemic immunological dysfunction seen in many cases of coronavirus disease 2019 (COVID-19), were within normal ranges. On the second day of admission, she developed neck and back pain that was constant, burning in quality, and exacerbated by light touch and heat. Wearing clothing caused pain and interfered with her sleep. The area was tender to light finger stroke. The patient was given acetaminophen, NSAIDs, and opioids with no relief of pain. However, gabapentin was effective. At follow-up 1 month later, her symptoms were improved and still relieved by gabapentin. Neuropathic pain was seen in over 2% of COVID-19 patients in one observational study. The pain seen in our case was bilateral, involved an area innervated by multiple levels of spinal nerves, and was limited to the back. While it is rare, a significant number of COVID-19 patients are afflicted by neuropathic pain, and our case illustrates that gabapentin may be effective.


Assuntos
Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/complicações , Dor nas Costas/complicações , Infecções por Coronavirus/complicações , Cervicalgia/complicações , Transtornos do Olfato/complicações , Dor/complicações , Pneumonia Viral/complicações , Acetaminofen/uso terapêutico , Analgésicos/uso terapêutico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/tratamento farmacológico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/patologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/virologia , Dor nas Costas/tratamento farmacológico , Dor nas Costas/patologia , Dor nas Costas/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Gabapentina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Cervicalgia/patologia , Cervicalgia/virologia , Transtornos do Olfato/tratamento farmacológico , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Dor/tratamento farmacológico , Dor/patologia , Dor/virologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Resultado do Tratamento
6.
Am J Trop Med Hyg ; 103(4): 1635-1639, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32828135

RESUMO

The COVID-19 pandemic is showing an exponential growth, mandating an urgent need to develop an effective treatment. Indeed, to date, a well-established therapy is still lacking. We aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) added to standard care in patients with COVID-19. This was a multicenter, randomized controlled trial conducted at three major university hospitals in Egypt. One hundred ninety-four patients with confirmed diagnosis of COVID-19 were included in the study after signing informed consent. They were equally randomized into two arms: 97 patients administrated HCQ plus standard care (HCQ group) and 97 patients administered only standard care as a control arm (control group). The primary endpoints were recovery within 28 days, need for mechanical ventilation, or death. The two groups were matched for age and gender. There was no significant difference between them regarding any of the baseline characteristics or laboratory parameters. Four patients (4.1%) in the HCQ group and 5 (5.2%) patients in the control group needed mechanical ventilation (P = 0.75). The overall mortality did not differ between the two groups, as six patients (6.2%) died in the HCQ group and 5 (5.2%) died in the control group (P = 0.77). Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Acetaminofen/uso terapêutico , Adulto , Cefalosporinas/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Esquema de Medicação , Reposicionamento de Medicamentos , Egito , Feminino , Humanos , Hidrocortisona/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
8.
Am J Vet Res ; 81(8): 627-634, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32701001

RESUMO

OBJECTIVE: To compare the ability of acetaminophen-codeine (AC; 15.5 to 18.5 mg/kg and 1.6 to 2.0 mg/kg, respectively) or carprofen (4.2 to 4.5 mg/kg) administered PO to attenuate experimentally induced lameness in dogs. ANIMALS: 7 purpose-bred dogs. PROCEDURES: A blinded crossover study was performed. Dogs were randomly assigned to receive AC or carprofen treatment first and then the alternate treatment a minimum of 21 days later. Synovitis was induced in 1 stifle joint during each treatment by intra-articular injection of sodium urate (SU). Ground reaction forces were assessed, and clinical lameness was scored at baseline (before lameness induction) and 3, 6, 9, 12, 24, 36, and 48 hours after SU injection. Plasma concentrations of acetaminophen, carprofen, codeine, and morphine were measured at various points. Data were compared between and within treatments by repeated-measures ANOVA. RESULTS: During AC treatment, dogs had significantly higher lameness scores than during carprofen treatment at 3, 6, and 9 hours after SU injection. Peak vertical force and vertical impulse during AC treatment were significantly lower than values during carprofen treatment at 3, 6, and 9 hours. Plasma concentrations of carprofen (R)- and (S)-enantiomers ranged from 2.5 to 19.2 µg/mL and 4.6 to 25.0 µg/mL, respectively, over a 24-hour period. Plasma acetaminophen concentrations ranged from 0.14 to 4.6 µg/mL and codeine concentrations from 7.0 to 26.8 ng/mL, whereas plasma morphine concentrations ranged from 4.0 to 58.6 ng/mL. CONCLUSIONS AND CLINICAL RELEVANCE: Carprofen as administered was more effective than AC at attenuating SU-induced lameness in dogs.


Assuntos
Doenças do Cão/tratamento farmacológico , Sinovite/veterinária , Acetaminofen/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Carbazóis/uso terapêutico , Codeína/uso terapêutico , Estudos Cross-Over , Cães , Coxeadura Animal/tratamento farmacológico
9.
Lancet ; 396(10249): 467-478, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32702298

RESUMO

BACKGROUND: The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be curtailed by vaccination. We assessed the safety, reactogenicity, and immunogenicity of a viral vectored coronavirus vaccine that expresses the spike protein of SARS-CoV-2. METHODS: We did a phase 1/2, single-blind, randomised controlled trial in five trial sites in the UK of a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) expressing the SARS-CoV-2 spike protein compared with a meningococcal conjugate vaccine (MenACWY) as control. Healthy adults aged 18-55 years with no history of laboratory confirmed SARS-CoV-2 infection or of COVID-19-like symptoms were randomly assigned (1:1) to receive ChAdOx1 nCoV-19 at a dose of 5 × 1010 viral particles or MenACWY as a single intramuscular injection. A protocol amendment in two of the five sites allowed prophylactic paracetamol to be administered before vaccination. Ten participants assigned to a non-randomised, unblinded ChAdOx1 nCoV-19 prime-boost group received a two-dose schedule, with the booster vaccine administered 28 days after the first dose. Humoral responses at baseline and following vaccination were assessed using a standardised total IgG ELISA against trimeric SARS-CoV-2 spike protein, a muliplexed immunoassay, three live SARS-CoV-2 neutralisation assays (a 50% plaque reduction neutralisation assay [PRNT50]; a microneutralisation assay [MNA50, MNA80, and MNA90]; and Marburg VN), and a pseudovirus neutralisation assay. Cellular responses were assessed using an ex-vivo interferon-γ enzyme-linked immunospot assay. The co-primary outcomes are to assess efficacy, as measured by cases of symptomatic virologically confirmed COVID-19, and safety, as measured by the occurrence of serious adverse events. Analyses were done by group allocation in participants who received the vaccine. Safety was assessed over 28 days after vaccination. Here, we report the preliminary findings on safety, reactogenicity, and cellular and humoral immune responses. The study is ongoing, and was registered at ISRCTN, 15281137, and ClinicalTrials.gov, NCT04324606. FINDINGS: Between April 23 and May 21, 2020, 1077 participants were enrolled and assigned to receive either ChAdOx1 nCoV-19 (n=543) or MenACWY (n=534), ten of whom were enrolled in the non-randomised ChAdOx1 nCoV-19 prime-boost group. Local and systemic reactions were more common in the ChAdOx1 nCoV-19 group and many were reduced by use of prophylactic paracetamol, including pain, feeling feverish, chills, muscle ache, headache, and malaise (all p<0·05). There were no serious adverse events related to ChAdOx1 nCoV-19. In the ChAdOx1 nCoV-19 group, spike-specific T-cell responses peaked on day 14 (median 856 spot-forming cells per million peripheral blood mononuclear cells, IQR 493-1802; n=43). Anti-spike IgG responses rose by day 28 (median 157 ELISA units [EU], 96-317; n=127), and were boosted following a second dose (639 EU, 360-792; n=10). Neutralising antibody responses against SARS-CoV-2 were detected in 32 (91%) of 35 participants after a single dose when measured in MNA80 and in 35 (100%) participants when measured in PRNT50. After a booster dose, all participants had neutralising activity (nine of nine in MNA80 at day 42 and ten of ten in Marburg VN on day 56). Neutralising antibody responses correlated strongly with antibody levels measured by ELISA (R2=0·67 by Marburg VN; p<0·001). INTERPRETATION: ChAdOx1 nCoV-19 showed an acceptable safety profile, and homologous boosting increased antibody responses. These results, together with the induction of both humoral and cellular immune responses, support large-scale evaluation of this candidate vaccine in an ongoing phase 3 programme. FUNDING: UK Research and Innovation, Coalition for Epidemic Preparedness Innovations, National Institute for Health Research (NIHR), NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and the German Center for Infection Research (DZIF), Partner site Gießen-Marburg-Langen.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vacinas Virais/efeitos adversos , Vacinas Virais/imunologia , Acetaminofen/uso terapêutico , Adenovirus dos Símios/genética , Adulto , Analgésicos não Entorpecentes/uso terapêutico , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Feminino , Vetores Genéticos/administração & dosagem , Humanos , Imunização Secundária , Imunoglobulina G/sangue , Masculino , Pneumonia Viral/tratamento farmacológico , Método Simples-Cego , Glicoproteína da Espícula de Coronavírus/imunologia , Linfócitos T/imunologia , Reino Unido , Vacinas Virais/administração & dosagem
10.
J Endod ; 46(10): 1387-1402.e4, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32668310

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the efficacy and safety of postoperative medications in decreasing pain after nonsurgical endodontic treatment using a network meta-analytic approach. METHODS: MEDLINE, Embase, CENTRAL, CINAHL, and Scopus were searched (until July 31, 2019). Two reviewers selected eligible randomized controlled trials and extracted and meta-analyzed data to estimate the treatment effects of pain assessed on a 0-100 scale (mean difference [MD]); 95% credible interval [CrI], and surface under the cumulative ranking curve [SUCRA]) at 6-8, 12, 24, and 48 hours postoperatively after the administration of various interventions. The Cochrane risk of bias tool was applied to eligible trials. The overall quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach obtained from the CINeMA Web application (University of Bern, Bern, Switzerland). RESULTS: Eight interventions among 11 studies were identified: nonsteroidal anti-inflammatory drugs (NSAIDs), NSAIDs + acetaminophen, NSAIDs + benzodiazepines, NSAIDs + opioids, corticosteroids, opioids, acetaminophen, and placebo. Compared with placebo, nonsurgical endodontic treatment pain 6-8 hours postoperatively improved with NSAIDs + acetaminophen (MD = -22; 95% CrI, -38 to -7.2; SUCRA = 73%; moderate confidence) and NSAIDs (MD = -21; 95% CrI, -34 to -7.6; SUCRA = 68%; very low confidence). At 12 and 24 hours, only NSAIDs were effective in decreasing postoperative pain. At 48 hours, no treatment resulted in significant pain reduction. Corticosteroids and opioids did not significantly decrease pain. No major safety concerns were reported. CONCLUSIONS: Very low- to moderate-quality evidence suggests that NSAIDs or NSAIDs + acetaminophen administered after nonsurgical endodontic treatment lead to a clinically relevant decrease in postoperative pain for patients with irreversible pulpitis or pulpal necrosis and are the most effective treatments available. Postoperative corticosteroids or opioids did not significantly decrease postoperative pain.


Assuntos
Acetaminofen/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Analgésicos Opioides/uso terapêutico , Endodontia , Humanos , Metanálise em Rede , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
11.
Clin Immunol ; 217: 108490, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32492478
12.
Medicine (Baltimore) ; 99(24): e20405, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541462

RESUMO

BACKGROUND: The efficacy and safety of buprenorphine transdermal patch (BTP) has been well established in chronic pain, but data regarding acute postoperative pain relief is still very limited. Therefore, we design a prospective, randomized, controlled study to evaluate the effectiveness and safety of the BTP for postoperative analgesia in total hip arthroplasty. METHODS: This study is designed as a single-center, prospective, double-blind, randomized controlled trial. Group A receives a 10 mg patch of buprenorphine at the conclusion of surgery which is continued for 14 days. Group B receives a conventional analgesic regimen, that is, IV paracetamol 1 mg every 8 hours alternating with parenteral tramadol 50 mg every 8 hours for the first 2 postoperative days followed by oral administration of the same drug still the end of 2 weeks. A total of 160 patients are needed with an allowance for 10% drop-out. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. The secondary outcomes included numerical rating scale scores at rest, postoperative complications, length of hospital stay, and patient satisfaction. RESULTS: This trial is expected to be the largest randomized trial assessing the efficacy of BTP after primary total hip arthroplasty and powered to detect a potential difference in the primary outcome. TRIAL REGISTRATION NUMBER: This study protocol was registered in Research Registry (researchregistry5524).


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Buprenorfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adesivo Transdérmico/efeitos adversos , Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Administração Intravenosa , Administração Oral , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Estudos de Casos e Controles , Método Duplo-Cego , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Medição da Dor/estatística & dados numéricos , Medição da Dor/tendências , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Tramadol/administração & dosagem , Tramadol/uso terapêutico
13.
Ann Afr Med ; 19(2): 131-136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499470

RESUMO

Background: Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients (≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients' case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients (259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Codeína , Estudos Transversais , Diclofenaco/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Retrospectivos , Tramadol/uso terapêutico
14.
Am J Emerg Med ; 38(7): 1470-1474, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32349890

RESUMO

INTRODUCTION: The choice of intravenous paracetamol or morphine for the pain control of renal colic remains controversial. We conduct a systematic review and meta-analysis to compare the analgesic efficacy and safety of intravenous paracetamol with morphine for renal colic pain. METHODS: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2019 for randomized controlled trials (RCTs) assessing the analgesic efficacy and safety of intravenous paracetamol versus morphine for renal colic pain. This meta-analysis is performed using the random-effect model. RESULTS: Five RCTs are included in the meta-analysis. Intravenous paracetamol can lead to significantly lower pain scores at 30 min (standard mean difference (Std. MD) = -0.40; 95% confidence interval (CI) = -0.68 to -0.12; P = 0.005) and incidence of dizziness (risk ratio (RR) = 0.06; 95% CI = 0.01 to 0.48; P = 0.007) than morphine for renal colic pain. There is no statistical difference of pain scores at 15 min (Std. MD = -0.80; 95% CI = -1.84 to 0.24; P = 0.13), analgesic rescue (RR = 0.73; 95% CI = 0.45 to 1.19; P = 0.21), the incidence of adverse events (RR = 0.60; 95% CI = 0.35 to 1.03; P = 0.06), nausea or vomiting (RR = 0.61; 95% CI = 0.20 to 1.87; P = 0.38) between two groups. CONCLUSIONS: Intravenous paracetamol may result in lower pain scores at 30 min than morphine for renal colic pain, and more studies should be conducted to compare their analgesic efficacy.


Assuntos
Acetaminofen/uso terapêutico , Morfina/uso terapêutico , Cólica Renal/tratamento farmacológico , Administração Intravenosa , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Tontura/induzido quimicamente , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
J Cardiothorac Surg ; 15(1): 80, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393370

RESUMO

INTRODUCTION: Pain management after coronary artery bypass graft (CABG) surgery remains challenging. OBJECTIVE: This study aimed to compare the effects of Ketorolac and Paracetamol on postoperative CABG pain relief. METHOD: This double-blind randomized clinical trial study was conducted in Ahvaz, Iran, from September 2018-December 2019. Two consecutive groups of 60 patients undergoing elective on-pump coronary artery bypass graft surgery. INTERVENTION: The patients were divided into 0.5 mg/kg of ketorolac mg/dl and 10 mg/kg of Paracetamol after surgery for pain management. Primary outcomes were: visual analog pain scale (VAS) at the time point immediately after extubation (baseline) and at 6, 12, 24 and 48 h and the total dose of morphine consumption. Secondary outcomes included the hemodynamic variables, weaning time, chest tube derange, in-hospital mortality and myocardial infarction. STATISTICAL ANALYSIS: The data were analyzed using SPSS version 22(SPSS, Chicago, IL). The Mann-Whitney U-test was used to compare demographic data, VAS scores, vital signs, and side effects. Repeated measurements were tested within groups using Friedman's ANOVA and the Wilcoxon rank-sum test. Values were expressed as means ± standard deviations. Statistical significance was defined as a p-value < 0.05. RESULTS: Compared with baseline scores, there were significant declines in VAS scores in both groups throughout the time sequence (P< 0.05). The statistical VAS score was slightly higher in the Paracetamol group at most time points, except for the time of 6 h. However, at 24 and 48 h, the VAS score in group Paracetamol was significantly higher than in group Ketorolac. There were no significant differences between groups about hemodynamic variables. CONCLUSION: The efficacy of ketorolac is comparable to that of Paracetamol in postoperative CABG pain relief. TRIAL REGISTRY: IRCT20150216021098N5. Registered at 2019-09-12.


Assuntos
Acetaminofen/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Cetorolaco/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Analgésicos/uso terapêutico , Analgésicos Opioides , Ponte de Artéria Coronária/mortalidade , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Morfina , Infarto do Miocárdio , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Fatores de Tempo , Escala Visual Analógica
16.
BMC Public Health ; 20(1): 714, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429936

RESUMO

BACKGROUND: Self-medication (SM) is the practice of consuming medication without the consultation of physician. The drugs most commonly self-medicated are paracetamol, analgesics, ranitidine, oral rehydration solution and antibiotics. The objective of the study was to assess the SM status and its causes in Pokhara valley of Nepal. METHOD: The study was conducted among the people residing in Pokhara metropolitan city. The study duration was of 4 months from April to July, 2018. The study population were patients attending health general and oral health screening programs at Baidam, Birauta, Hemja and Pame areas of Pokhara. Structured questionnaire was used to collect demographics of the patients and the details of the usage of self-medication. RESULT: Out of 201 patients, 38.2% patients were found to be self-medicating. The most common illness sought for SM was ache (headache, body ache) in 50% subjects followed by cough and cold in 31% and gastritis in 23%. Paracetamol was the drug consumed by 16 subjects followed by nimesulide by 11. Lack of knowledge about the disadvantages of SM led to self-medication in 65% of respondents. The personnel most commonly consulted for medication were pharmacists (60%). CONCLUSION: The trend of SM is high in Pokhara valley. The comedics were consulted most often for SM due to lack of knowledge of consultation to physicians. The public should be made aware about SM.


Assuntos
Assistência Farmacêutica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Acetaminofen/uso terapêutico , Adulto , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Resfriado Comum/tratamento farmacológico , Resfriado Comum/epidemiologia , Tosse/tratamento farmacológico , Tosse/epidemiologia , Estudos Transversais , Feminino , Hidratação/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Dor/tratamento farmacológico , Dor/epidemiologia , Ranitidina/uso terapêutico , Inquéritos e Questionários
17.
Am J Obstet Gynecol ; 223(2): 262.e1-262.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413429

RESUMO

BACKGROUND: Postoperative opioid prescription patterns play a key role in driving the opioid epidemic. A comprehensive system toward pain management in surgical patients is necessary to minimize overall opioid consumption. OBJECTIVE: This study aimed to evaluate the efficacy of a pain management model in patients undergoing pelvic reconstructive surgery by measuring postdischarge narcotic use in morphine milligram equivalents. STUDY DESIGN: This is a prospective clinical practice study that included women undergoing inpatient pelvic reconstructive surgery from December 2018 to June 2019 with overnight stay after surgery. As a routine protocol, all the patients followed an enhanced recovery after surgery protocol that included a preoperative multimodal pain regimen. Brief Pain Inventory surveys were collected preoperatively and on postoperative day 1. Brief pain inventory and activities assessment scale scores were collected at postoperative week 1 and postoperative weeks 4-6 after surgery. Patients were discharged with 15 tablets of an oral narcotic using an electronic prescription for controlled substances software platform, which is mandated in the state of Connecticut for all controlled substances, prescriptions, and refills. Patients were called at postoperative week 1 and postoperative weeks 4-6 to answer questions regarding their pain, the number of remaining narcotic tablets, and patient satisfaction regarding pain management. Patient electronic medical records and the Connecticut Prescription Monitoring and Reporting System were reviewed to determine whether patients received narcotic refills. Primary outcome was postdischarge narcotic use measured in morphine milligram equivalents. Secondary outcomes evaluated refill rate, brief pain inventory and activities assessment scale scores, and patient satisfaction with pain management. Descriptive statistics were described as mean and standard deviation and median and interquartile range. Bivariate comparisons used Spearman's rho (ρ) with α=0.05. RESULTS: A total 113 patients were enrolled; the median (interquartile range) morphine milligram equivalent prescribed (including refills) was 112.5 (112.5-112.5). The median postdischarge narcotic use was 24.0 (0-82.5) morphine milligram equivalent, which is equivalent to fewer than 4 oxycodone (5 mg) tablets. About 75% of our participants required fewer than 11 oxycodone tablets. The median unused morphine milligram equivalent was 90.0 (45-112.5). 81.4% (92/113), and 83.2% (94/113) of patients at postoperative week 1 and postoperative weeks 4-6, respectively, reported being satisfied or extremely satisfied with their postdischarge pain control. About 88.5% (100/113) of patients felt that the number of opioids they were discharged with was sufficient for their pain needs at the postoperative 1 and postoperative weeks 4-6 time points. At postoperative weeks 4-6, 19.5% of patients said that they filled the narcotic prescription but did not use any of the pills. The overall refill rate was 10.6% (12/113). All patients who needed a refill described the refill process as easy. In-hospital narcotic use was not predictive of postdischarge narcotic use (ρ0.065, P=.495). Patients reported median brief pain inventory scores for "average pain" of 0 (no pain) at postoperative week 1 and postoperative weeks 4-6; however, the scores did not clinically correlate with postdischarge narcotic use. Activities assessment scale scores were not correlated with postdischarge narcotic use. CONCLUSION: Most patients after pelvic reconstructive surgery used fewer than 11 oxycodone (5 mg) tablets, averaging less than 4 tablets, with a third of patients not requiring any opioids. Pain and activities scores did not correlate with narcotic use. A minimal number of opioids can be prescribed because the secure electronic prescribing system allows for convenient electronic refill if required. Our practical and comprehensive pre- and postoperative protocol for pain management minimizes opioid consumption in addition to maximizing patient satisfaction.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia , Dor Pós-Operatória/tratamento farmacológico , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Acetaminofen/uso terapêutico , Idoso , Celecoxib/uso terapêutico , Recuperação Pós-Cirúrgica Melhorada , Feminino , Gabapentina/uso terapêutico , Humanos , Ibuprofeno/uso terapêutico , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Assistência Perioperatória , Estudos Prospectivos
18.
Ann Otol Rhinol Laryngol ; 129(10): 949-963, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436727

RESUMO

OBJECTIVE: To perform an evidence-based systematic review evaluating perioperative analgesia, including opioid alternatives, used for patients undergoing thyroidectomy and parathyroidectomy. METHODS: A comprehensive literature search from 1997 to January 2018 of Pubmed, Cochrane, and EmBase libraries was performed for studies reporting analgesic administration following thyroid or parathyroid surgery. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were evaluated for level of evidence and given a Jadad score to assess for risk of bias. Outcomes gathered included postoperative pain scores, time to rescue analgesia, rescue analgesic consumption, and adverse events. RESULTS: Thirty-eight randomized controlled trials met inclusion criteria. The GRADE criteria determined the overall evidence to be moderate-high. Studies utilizing NSAIDs reported reduced requirements for rescue analgesics. Acetaminophen studies presented with conflicting data on effectiveness. Gabapentinoid studies demonstrated lower pain scores and an increased time to rescue analgesic. Local anesthetics were effective at decreasing Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) pain scores while also reducing rescue analgesic consumption. Ketamine was shown to increased postoperative nausea and vomiting. NSAIDs and local anesthetic studies had an aggregate grade of evidence A, while all others had grade B evidence. CONCLUSION: There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens. LEVEL OF EVIDENCE: NA.


Assuntos
Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Paratireoidectomia , Tireoidectomia , Acetaminofen/uso terapêutico , Medicina Baseada em Evidências , Gabapentina/uso terapêutico , Humanos , Ketamina/uso terapêutico , Manejo da Dor , Assistência Perioperatória , Náusea e Vômito Pós-Operatórios/epidemiologia , Pregabalina/uso terapêutico
20.
PLoS One ; 15(4): e0231869, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32339169

RESUMO

OBJECTIVE: To evaluate the reduction of perineal pain after vaginal deliveries by capacitive resistive radiofrequency therapy (RF). METHODS: We conducted a double-blind randomized study in University Hospital Centre in France. We included women presenting either perineal tears or an episiotomy after vaginal delivery (instrumental assisted or not). The participants were randomly assigned to RF or not at day 1 and day 2 postpartum. The primary outcome was pain evaluated as visual analog scale (VAS) score >4 at rest on day 2 after the treatment. Secondary outcomes included discomfort and pain while walking and seating two days after treatment, type of pain two days after treatment and analgesics intake two days after treatment, sexual intercourse retake and painful of intercourse were also assessed by phone call 30 days after delivery. We performed univariate analysis and multivariable regressions adjusting on the value of the outcome at baseline to improve precision of the estimated intervention effect. RESULTS: Between June 1, 2017 and October 8, 2017, the RF group included 29 women compared with 31 women in the group without RF. There was no significant difference on VAS >4 between the two groups (13.8% vs. 9.7% p = 0.69; difference = 4.1%, 95%CI -12.2%- 20.4%); consumption of paracetamol was lower in the RF group (978.3 mg (sd = 804.5) vs 1703.7 mg (sd = 1381.6), p = 0.035; difference = -725.3 mg, 95%CI -1359.6 - -91.3). Multivariate analysis showed no association between RF and pain. Nevertheless, we found an association between RF and discomfort while walking (adjusted OR 0.24, 95% CI 0.07-0.90; p = 0.03). CONCLUSION: VAS>4 at day 2 was not different in the experimental and the control groups but RF was associated with less perineal discomfort while walking and lower consumption of paracetamol after delivery. CLINICAL TRIAL REGISTRATIONS: The study was registered in the Clinical Government trial (https://clinicaltrials.gov/ct2/show/NCT03172286?term=bretelle&rank=2) under the number NCT03172286.


Assuntos
Dor Pélvica/terapia , Terapia por Radiofrequência , Acetaminofen/uso terapêutico , Adulto , Parto Obstétrico , Método Duplo-Cego , Feminino , França , Humanos , Dor Pélvica/tratamento farmacológico , Período Pós-Parto , Gravidez
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