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1.
Int Arch Allergy Immunol ; 181(1): 24-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31752003

RESUMO

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most prevalent causes of drug hypersensitivity reactions (DHRs), yet the underlying processes are far from clear. Despite the established role of histamine in allergic reactions, its precise implication in DHRs is elusive. OBJECTIVES: This study aimed to explore the connection of basal blood histamine levels to the reported NSAID hypersensitivity. METHODS: Sixteen patients reporting hypersensitivity reactions to a single or multiple NSAIDs and/or paracetamol and 18 healthy volunteers serving as the normal control group enrolled in the study. The medical history was recorded and histamine was quantified spectrophotofluorometrically in whole peripheral blood and plasma. RESULTS: Compared to the normal group, plasma but not whole blood histamine levels were significantly higher in patients (p < 0.001), mainly in the subgroup reporting hypersensitivity to a single agent (p < 0.001). Plasma histamine levels were significantly correlated with the culprit drug selectivity for cyclooxygenase (COX) isozymes (p < 0.001), with higher levels being obtained in patients reporting reactions to COX-1 than to COX-2 selective inhibitors (p < 0.05). CONCLUSIONS: The findings provide first evidence connecting basal blood histamine levels to the reported NSAID-triggered DHRs. Prospective studies are expected to decipher the contribution of histamine-associated parameters to the mechanisms underlying DHRs.


Assuntos
Acetaminofen/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Hipersensibilidade a Drogas/imunologia , Histamina/sangue , Acetaminofen/imunologia , Acetaminofen/uso terapêutico , Adulto , Idoso , Alérgenos/imunologia , Anti-Inflamatórios não Esteroides/imunologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Biomarcadores/sangue , Inibidores de Ciclo-Oxigenase 2/imunologia , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Adulto Jovem
2.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31801377

RESUMO

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Assuntos
Analgésicos/uso terapêutico , Anestesiologia , Anestésicos/uso terapêutico , Antieméticos/uso terapêutico , Pediatria , Padrões de Prática Médica , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Acetaminofen/uso terapêutico , Adenoidectomia , Extubação/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Fentanila/uso terapêutico , Humanos , Midazolam/uso terapêutico , Morfina/uso terapêutico , Óxido Nitroso/uso terapêutico , Ondansetron/uso terapêutico , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
3.
Vet Clin North Am Small Anim Pract ; 49(6): 993-1011, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31519356

RESUMO

This article reviews the mechanisms of action, clinical use, and recent scientific evidence for the use of nonsteroidal antiinflammatory drugs, grapiprant, acetaminophen (paracetamol), metamizole (dipyrone), and corticosteroids in pain management. The discussion is presented with an emphasis on the treatment of acute pain.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Manejo da Dor/veterinária , Dor/veterinária , Acetaminofen/uso terapêutico , Animais , Dipirona/uso terapêutico , Dor/tratamento farmacológico , Manejo da Dor/métodos
4.
Braz Oral Res ; 33: e076, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432927

RESUMO

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.


Assuntos
Analgésicos Opioides/uso terapêutico , Assistência Odontológica/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Brasil , Codeína/uso terapêutico , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Valores de Referência , Fatores Socioeconômicos , Estatísticas não Paramétricas , Tramadol/uso terapêutico
6.
J Trauma Acute Care Surg ; 87(1): 100-103, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31259870

RESUMO

BACKGROUND: Postoperative outpatient narcotic overprescription plays a significant role in the opioid epidemic. Outpatient opioid prescription ranges from 150 to 350 oral morphine equivalent (OME) for a laparoscopic cholecystectomy or appendectomy, with 75 OME (10 pills of 5 mg of oxycodone) being the lowest recommendation (National Institute on Drug Abuse, 2018). We hypothesized that the addition of nonopioid medications to the outpatient pain control regimen would decrease the need for narcotics. METHODS: In this prospective, observational pilot study, we prescribed a 3-day regimen of ibuprofen and acetaminophen to patients after uncomplicated laparoscopic cholecystectomies and appendectomies. An additional opioid prescription for 5 pills of 5 mg of oxycodone (37.5 OME) was written for breakthrough pain. During their postoperative visit, we evaluated patients' adherence to the pain control regime, their postdischarge opioid use, and the adequacy of their pain control. RESULTS: Sixty-five patients were included in the study (52% male). The majority (80%) of surgeries were performed urgently or emergently. The visual analog scale pain score at home was significantly better than upon discharge (3.7 vs. 5.5, p = 0.001). The average number of oxycodone pills taken postdischarge was 1.8 pills. Half (51%) of the patients did not take any opioids. All but four patients reported that their pain was adequately controlled. No patient required additional opioid prescriptions or visited the emergency department. CONCLUSION: This study demonstrated that opioids can be eliminated in at least half of the patients and that five pills of 5 mg of oxycodone (37.5 OME) is sufficient for outpatient pain control when a 3-day course of ibuprofen and acetaminophen is prescribed. LEVEL OF EVIDENCE: Therapeutic study, level V.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Ibuprofeno/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Analgésicos Opioides/uso terapêutico , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Projetos Piloto , Estudos Prospectivos
7.
Paediatr Drugs ; 21(3): 177-183, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155693

RESUMO

AIM: Studies in adults have reported frequent episodes of blood pressure drops following intravenous paracetamol administration. We aimed to investigate the hemodynamic effects of intravenous paracetamol in critically ill children. METHODS: The charts of 100 pediatric intensive care patients (age range 0.1-18 years) who were treated with intravenous paracetamol between March and September 2017 were retrospectively reviewed. A hemodynamic event was defined as a drop of > 15% in systolic or mean arterial blood pressure within 120 min after drug administration. Hypotension was defined as either a drop in systolic blood pressure (SBP) below the 5th percentile for age or a hemodynamic event associated with tachycardia, increased lactate level, or treatment with a fluid bolus or vasopressors. RESULTS: A hemodynamic event was observed in 39 patients (39%). In these patients, SBP was in the pre-hypertension or hypertension values in 36/39 patients before paracetamol administration, median (IQR) SBP decreased from the 99th (95-99) percentile for age before to the 50th (50-95) percentile after paracetamol (p < 0.001) and mean heart rate was 137 bpm before treatment and 115 bpm after (p = 0.002). SBP values did not drop below the 5th percentile in any patient. In 15 patients diagnosed with shock on admission, paracetamol treatment did not cause an increase in vasopressor treatment after drug administration. CONCLUSIONS: In the present study of critically ill pediatric patients, intravenous paracetamol administration was associated with a drop in SBP from high to normal values for age, possibly due to pain relief, with no evidence for a negative hemodynamic event.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Acetaminofen/farmacologia , Administração Intravenosa , Adolescente , Analgésicos não Entorpecentes/farmacologia , Criança , Pré-Escolar , Feminino , Hemodinâmica , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
8.
BMJ Case Rep ; 12(6)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31253660

RESUMO

Transient splenial lesion(TSL) is seen in a variety of conditions and is detectable only on MRI of the brain. Dengue fever (DF) is a common viral infection encountered in the tropics. The affected patients may face neurological complications like encephalopathy and intracranial haemorrhage, or even ischaemic stroke. Non-cirrhotic hyperammonaemia is a rare scenario; and its occurrence in DF is unknown. The patient being described had DF and developed dysarthria. His MRI brain showed splenial hyperintensity. Further evaluation revealed non-cirrhotic hyperammonaemia. To the best of our knowledge, TSL due to non-cirrhotic hyperammonaemia in DF is an unreported scenario.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/virologia , Dengue/complicações , Dengue/diagnóstico , Hiperamonemia/etiologia , Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Diagnóstico Diferencial , Ácido Fólico/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Humanos , Lactulose/uso terapêutico , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico
10.
Int J Pediatr Otorhinolaryngol ; 124: 173-178, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202034

RESUMO

OBJECTIVE: To understand parent perceptions of post-operative narcotic use in the pediatric otolaryngology patient population. METHODS: This was a descriptive survey of caregivers on children being seen in a university pediatric otolaryngology clinic. Caregiver role, age of child, previous exposure to analgesics, choice of analgesics, comfort and concern with narcotic use in this child, knowledge of narcotic side effects, and knowledge about narcotic disposal were included. Comfort and concern questions were scored on a 10-point VAS where the higher numbers indicated more concern/discomfort. RESULTS: 301 caregivers participated, 84.5% were mothers, 11% were fathers and the rest were custodial grandparents. 45.2% knew someone addicted to narcotics. Respondents were uncomfortable with their child experiencing pain in a hypothetical postoperative situation, with 63.9% having at least some discomfort with it. First choice of medication to treat hypothetical post-tonsillectomy pain was ibuprofen (47.5%) followed by acetaminophen (38.9%). 29.9% were concerned about addiction, and 26.6% were concerned about drowsiness as a sequela of narcotic use. There were significant differences between respondents who knew a person addicted to narcotics and those who did not for comfort using narcotics in their child (VAS median 6.0 versus 5.0, p = 0.025), concern that their child would become addicted to narcotics (VAS median 5.0 versus 2.0, p = 0.001), concern about side effects (VAS median 7.0 versus 6.0, p = 0.007) and concern about having narcotics in the home (VAS median 3.0 versus 0.0, p < 0.001). CONCLUSIONS: The national opioid epidemic exposes more parents to narcotic addiction in the community, which affects their perceptions of pediatric post-operative narcotic use. These experiences may need to be considered when planning postoperative pain management strategies in children.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Entorpecentes/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Pais/psicologia , Tonsilectomia/efeitos adversos , Acetaminofen/uso terapêutico , Adolescente , Analgésicos não Entorpecentes/uso terapêutico , Cuidadores/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Ibuprofeno/uso terapêutico , Lactente , Masculino , Transtornos Relacionados ao Uso de Opioides , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Inquéritos e Questionários
11.
Rehabilitación (Madr., Ed. impr.) ; 53(2): 126-130, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185469

RESUMO

El edema óseo idiopático se considera una entidad de fisiopatología no aclarada y origen multifactorial que afecta a personas de mediana edad; se caracteriza por dolor e impotencia funcional en extremidades inferiores asociados a hallazgos característicos en resonancia magnética: imágenes hipointensas en T1 e hiperintensas en T2 en las articulaciones afectadas. Presentamos 3 casos clínicos de varones (edad: 45-64), 2 en rodillas y uno en cadera. Inicio con dolor intenso (EVA ≥ 5), sin desencadenante claro e impotencia funcional con imágenes características en resonancia magnética. Tratamiento: vitamina D (20.000 UI/semana vía oral) y dosis única subcutánea de denosumab (60mg) (indicación fuera de ficha técnica), descarga de articulación afectada y ejercicios autoasistidos de mantenimiento de recorrido articular. Evolución favorable con resolución clínica y del edema óseo, sin complicaciones reseñables. El denosumab se muestra como una opción de tratamiento para la resolución clínico-radiológica del edema óseo idiopático y parece acortar la evolución natural del proceso


Idiopathic bone marrow oedema is considered an unclarified pathophysiological entity of multifactorial origin affecting middle-aged persons; it is characterised by pain and functional limitation of the lower extremities. Characteristic findings on magnetic resonance imaging are hypointense T1 and hyperintense T2 images in the affected joints. We present 3clinical cases of BMO in men (age: 45-64 years), involving 2knees and one hip. Onset occurred with intense pain (VAS ≥ 5), with no clear cause and functional limitation with characteristic images on magnetic resonance imaging. Treatment consisted of vitamin D 20,000 IU/week orally and a single subcutaneous dose of denosumab 60mg (off label use). The patients avoided weight bearing on affected joints and conducted self-assisted exercises to maintain range of movement. Outcome was favourable with clinical and bone oedema resolution, with no notable complications. This report demonstrates that denosumab is a treatment option for the clinical/radiological resolution of bone marrow oedema and seems to shorten the clinical course of the process


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Edema/diagnóstico , Osteíte/tratamento farmacológico , Denosumab/uso terapêutico , Modalidades de Fisioterapia , Osteíte/reabilitação , Tramadol/uso terapêutico , Acetaminofen/uso terapêutico
12.
Pediatr. aten. prim ; 21(82): e67-e70, abr.-jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184588

RESUMO

La infección por el virus de Epstein-Barr (VEB) es habitual y generalmente ocurre en la infancia o en la adultez temprana. El VEB es la etiología de la mononucleosis infecciosa, generalmente asociada con fiebre, dolor de garganta, inflamación de los ganglios linfáticos en el cuello y en ocasiones esplenomegalia. El síndrome de Alicia en el País de las Maravillas (SAPM) o síndrome de Todd es una afección rara, que principalmente afecta la integración visual y somatoestética. El SAPM sigue siendo un síndrome poco conocido y probablemente mal diagnosticado, puede ocurrir a cualquier edad, pero sobre todo en los niños en los que se asocia principalmente con la migraña y la infección por VEB. Presentamos a una paciente de diez años que acudió al servicio de urgencias con distorsión visual de la forma corporal y comportamiento extraño, sospechado inicialmente como una patología psiquiátrica pero posteriormente diagnosticado con mononucleosis infecciosa e infección por VEB confirmada serológicamente. Este caso refleja la importancia de reconocer este síndrome por parte de los médicos de urgencias y evitar derivaciones inadecuadas al servicio psiquiátrico


Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood. EBV is the cause of infectious mononucleosis, usually associated with fever, sore throat, swollen lymph nodes in the neck, and sometimes an enlarged spleen. Alice in Wonderland Syndrome (AIWS), also called Todd's syndrome, is a rare condition, principally involving visual and somesthetic integration. AIWS remains a poorly known and probably misdiagnosed syndrome, can occur at any age but mostly in children is mostly associated with migraine and EBV infection. We present a 10-year-old patient who went to the emergency department with visual distortion of corporal form and bizarre behaviour, initially suspected as a psychiatric pathology but subsequently diagnosed with infectious mononucleosis and serologically confirmed Epstein-Barr virus (EBV) infection. This case reflects the importance of recognizing this syndrome by emergency physicians in order to avoid inadequate referrals to the psychiatric service


Assuntos
Humanos , Gravidez , Criança , Síndrome de Alice no País das Maravilhas/diagnóstico , Mononucleose Infecciosa/diagnóstico , Infecções por Vírus Epstein-Barr/diagnóstico , Síndrome de Alice no País das Maravilhas/complicações , Mononucleose Infecciosa/complicações , Herpesvirus Humano 4/patogenicidade , Infecções por Vírus Epstein-Barr/complicações , Acetaminofen/uso terapêutico , Ibuprofeno/uso terapêutico
13.
Drugs Aging ; 36(Suppl 1): 7-14, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31073920

RESUMO

Osteoarthritis (OA) is a major cause of pain and physical disability in adults, and an increasingly common disease given its associations with aging and a growing obese/overweight population. Paracetamol is widely recommended for analgesia at an early stage in the management of OA, and, although frequently prescribed, evidence suggests the efficacy of paracetamol for OA pain is low. Furthermore, there have been recent concerns over the safety profile of paracetamol, with reports of gastrointestinal, cardiovascular, hepatic and renal adverse events. This narrative review summarizes recent literature on the benefits and harms of paracetamol for OA pain. Data on long-term paracetamol safety are derived largely from observational evidence, and are difficult to interpret given the potential biases of such data. Nonetheless, a considerable degree of toxicity is associated with paracetamol use among the general population, especially at the upper end of standard analgesic doses. Paracetamol is linked to liver function abnormalities and there is evidence for liver failure associated with non-intentional paracetamol overdose. Safety data for paracetamol use in the older population (aged >65 years) are sparse; however, there is some evidence that frail elderly people may have impaired paracetamol clearance. Given that the analgesic benefit of paracetamol in OA joint pain is uncertain and potential safety issues have been raised, more careful consideration of its use is required.


Assuntos
Acetaminofen/efeitos adversos , Analgésicos não Entorpecentes/efeitos adversos , Artralgia/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Idoso , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Relação Dose-Resposta a Droga , Humanos , Manejo da Dor/métodos
14.
Dermatol Clin ; 37(3): 341-348, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084728

RESUMO

Given the opposing pressures placed on dermatologists and dermatologic surgeons by the need for adequate postoperative analgesia and the current US opioid epidemic, a systematic review was performed to analyze postoperative pain management in outpatient dermatologic surgery. Dermatologic procedures are generally associated with minor postoperative pain of short duration. Anxiety reduction may lead to less postoperative pain. Studies vary on which anatomic locations and repair types are more or less associated with pain. Evidence supports the use of acetaminophen and ibuprofen for first-line postoperative analgesia in dermatologic surgery. Opioids, if given, should only be prescribed in small quantities.


Assuntos
Analgésicos/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Acetaminofen/uso terapêutico , Analgésicos Opioides/uso terapêutico , Humanos , Ibuprofeno/uso terapêutico , Cirurgia de Mohs/efeitos adversos , Dor Pós-Operatória/etiologia
16.
Ear Nose Throat J ; 98(6): 356-361, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31072190

RESUMO

The aim of this study was to examine how ibuprofen and paracetamol prevent pain after cold-steel extracapsular tonsillectomy in children. Also, we examined the relation between age, gender, nausea, postoperative bleeding, antibiotic use, type of diet, and postoperative pain intensity and the type of administered analgesic. A prospective study was conducted on 147 children (95 males and 52 females, aged 7-17 years) who underwent tonsillectomy in the Clinical-Hospital Center "Dragisa Misovic" from January 1 to June 30, 2016. The degree of pain was measured using a visual analog scale (VAS). We did not observe any significant differences in postoperative nausea, hospitalization rate postoperative bleeding, and antibiotic use between the paracetamol and ibuprofen groups. A test of within-patient effects showed that VAS scores changed significantly during the postoperative follow-up period (P = .00), but there were no significant differences between the groups (P = .778). After 12 hours, 29.3% of the patients on paracetamol and 21.8% on ibuprofen were transferred to a soft diet; after 24 hours, 84.8% of the paracetamol group and 85.5% of the ibuprofen group were on a soft diet (χ2 test, P < .05). There was a statistically significant correlation between VAS scores measured 4 hours after the surgery and the time of transference to the soft diet (Spearman ρ test, P < .001). The transfer to soft and normal diets was not significantly different between the 2 groups as assessed by the VAS scores (Pearson χ2 test, P = .565).There is still no consensus on the most effective postoperative pain-control regiment after tonsillectomy. This study showed that satisfactory pain management was achieved equally with both paracetamol and ibuprofen.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Ibuprofeno/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Tonsilectomia , Tonsilite/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Criança , Feminino , Humanos , Masculino , Manejo da Dor , Medição da Dor , Readmissão do Paciente , Hemorragia Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Recidiva , Sérvia
17.
Med Sci Monit ; 25: 3668-3675, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31100058

RESUMO

BACKGROUND Neutrophil gelatinase-associated lipocalin plays an important role in renal dysfunctions. The objective of this study was to test the hypothesis that indomethacin used in treating patent ductus arteriosus protects infants from renal dysfunction. MATERIAL AND METHODS This prospective cohort study assessed data on urine prostaglandin metabolites, urinary neutrophil gelatinase-associated lipocalin, and the renal functions of preterm infants with confirmed patent ductus arteriosus who had been injected with indomethacin (n=144, ID group) or acetaminophen (n=144, AP group). RESULTS A reduction of neutrophil gelatinase-associated lipocalin in urine samples was found in the ID group (993±48 µG/L vs. 103±5 µG/L, p<0.0001). The reduction in prostaglandin (673±32 pg/mL vs. 139±7 pg/mL, p<0.0001) and the closure of ductus (2.64±0.89 mm vs. 2.31±0.81 mm, p=0.001) were found in the ID group after the first dose of indomethacin, but the closure of ductus (2.47±0.54 mm vs. 2.32±0.55 mm, p=0.02) and prostaglandin reduction (667±31 pg/mL vs. 129±7 pg/mL, p<0.0001) were found after the second dose of acetaminophen. Indomethacin had greater effect in reducing the risk of acute kidney injury than did acetaminophen (p=0.042). CONCLUSIONS Indomethacin treatment used in treating patent ductus arteriosus protects infants from renal dysfunction.


Assuntos
Lesão Renal Aguda/prevenção & controle , Permeabilidade do Canal Arterial/tratamento farmacológico , Indometacina/uso terapêutico , Acetaminofen/uso terapêutico , China , Estudos de Coortes , Feminino , Humanos , Indometacina/farmacologia , Recém-Nascido , Recém-Nascido Prematuro/metabolismo , Doenças do Prematuro/tratamento farmacológico , Lipocalina-2/análise , Lipocalina-2/urina , Masculino , Estudos Prospectivos , Prostaglandinas/análise , Prostaglandinas/urina , Resultado do Tratamento
18.
Eur Arch Otorhinolaryngol ; 276(7): 2081-2089, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31115688

RESUMO

OBJECTIVE: Post-tonsillectomy pain is one of the most frequent morbidities of tonsillectomy surgery. Currently, there is no standard protocol for post-tonsillectomy pain control. In our study, we aimed to compare the effects of perioperative peritonsillar dexamethasone-bupivacaine and bupivacaine-alone infiltration on pain control in pediatric patients. MATERIALS AND METHODS: This prospective, randomized, double-blind, controlled clinical trial was conducted between February 2018 and May 2018 in a single-center tertiary education and research hospital, otorhinolaryngology/head and neck surgery clinic, under general anesthesia, which included 120 pediatric patients between the ages of 2-12 (mean 5.7 ± 1.8), and who were with ASA (American Society of Anesthesiologists) I-II classification. Patients were randomly divided into three groups as 40 participants in each group. Group 1 consisted of patients who were injected with dexamethasone-bupivacaine into their peritonsillar region, group 2 consisted of patients who were injected with bupivacaine only, and group 3 consisted of patients who were injected with saline only as the control group. FLACC (face, legs, activity, cry, consolability) Scale and Wong-Baker FACES® Pain Rating Scale (WBS) were used for early and late period postoperative pain scoring. Patients with pain score ≥ 4 were treated with paracetamol rescue analgesia. Side effects such as nausea, vomiting and bleeding were recorded. Data of all groups were compared statistically and p ≤ 0.05 was considered statistically significant. RESULTS: There was no significant difference between the groups in terms of demographic data, duration of operation and duration of anesthesia. The pain scores of group 1 were significantly lower than those of the control group except for postoperative 45th min, 2nd day and 3rd day. The pain scores of the group 1 were significantly lower at all times except for the postoperative 12th and 24th hour, than those of group 2. The pain scores of the group 2 were lower than the control group only at postoperative 7th day, but no significant difference was found at other times. No statistically significant difference was found between the groups in terms of requirement rates for the first 60 min recovery analgesia (p = 0.686). No statistical difference was found between the groups in terms of side effects. CONCLUSION: In our study, preoperative local dexamethasone-bupivacaine infiltration in pediatric patients was shown to be more effective than bupivacaine-only and serum-only infiltration for early and late post-tonsillectomy pain control.


Assuntos
Bupivacaína/administração & dosagem , Dexametasona/administração & dosagem , Dor Pós-Operatória , Tonsilectomia/efeitos adversos , Acetaminofen/uso terapêutico , Anestésicos Locais/administração & dosagem , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Tonsilectomia/métodos , Resultado do Tratamento
19.
Br J Anaesth ; 123(2): e343-e349, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31130273

RESUMO

BACKGROUND: Both the adductor canal block (ACB) and local infiltration analgesia (LIA) are effective analgesic techniques after anterior cruciate ligament (ACL) reconstruction, but they have never been compared head-to-head. This randomised controlled triple-blinded trial tested the hypothesis that ACB provides superior analgesia to LIA after ACL reconstruction, with additional focus on postoperative functional outcomes. METHODS: Of 104 enrolled ACL reconstruction patients receiving general anaesthesia, 52 were randomly allocated to either ACB under ultrasound guidance or LIA. For each intervention, ropivacaine 0.5%, 20 ml was injected. Postoperative pain treatment followed a predefined protocol with i.v. patient-controlled morphine, paracetamol, and ibuprofen. The primary outcome was cumulative i.v. morphine consumption at 24 h after operation. Secondary pain-related outcomes included resting and dynamic pain scores (numeric rating scale out of 10) measured 2, 24, and 48 h after operation and cumulative i.v. morphine consumption 2 and 48 h after operation. Early function-related outcomes evaluated were quadriceps strength, walking distance, and range of motion, all measured 24 and 48 h after operation. Late function-related outcomes were concentric quadriceps strength, single-hop test, triple-hop test, cross-over test, and Y balance test, measured at 4 and 8 postoperative months. RESULTS: Cumulative i.v. morphine consumption at 24 h was similar between groups (ACB group: 17.1 mg [95% confidence interval, CI: 13.1, 21.2]; LIA group: 17.7 mg [95% CI: 13.2, 22.6], P=0.84). Similarly, no differences between groups were seen in the secondary pain- or function-related outcomes. CONCLUSIONS: ACB and LIA result in equivalent postoperative opioid consumption with similar impact on postoperative pain scores and functional outcomes. CLINICAL TRIAL REGISTRATION: NCT02524652.


Assuntos
Analgesia/métodos , Reconstrução do Ligamento Cruzado Anterior , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Acetaminofen/uso terapêutico , Adolescente , Adulto , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Ibuprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
20.
Clin Perinatol ; 46(2): 203-213, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010556

RESUMO

Many conditions that require frequent medication use are common during pregnancy. The purpose of this article is to list some of the most common of these disorders and to discuss the risk to the developing fetus of the medications used most frequently to treat them. Included are drugs used for the treatment of asthma, nausea and vomiting, hyperthyroidism, pain and fever, and depression during pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Anormalidades Congênitas/epidemiologia , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Acetaminofen/efeitos adversos , Acetaminofen/uso terapêutico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/uso terapêutico , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/uso terapêutico , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Antitireóideos/efeitos adversos , Antitireóideos/uso terapêutico , Asma/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Feminino , Humanos , Hipertireoidismo/tratamento farmacológico , Antagonistas de Leucotrienos/efeitos adversos , Antagonistas de Leucotrienos/uso terapêutico , Troca Materno-Fetal , Metimazol/uso terapêutico , Êmese Gravídica/tratamento farmacológico , Ondansetron/uso terapêutico , Gravidez , Propiltiouracila/uso terapêutico , Teratogênios
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