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1.
Medicine (Baltimore) ; 99(3): e18825, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011494

RESUMO

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) has been suggested as an effective method of pain relief. There are several randomized controlled trials (RCTs) of dexmedetomidine (DEX) combined with tramadol for PCIA in Chinese surgical patients. The purpose of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of DEX combined with tramadol for PCIA in Chinese surgical patients from current data. METHODS: The RCTs of DEX combined with tramadol for PCIA were gathered from the PubMed, Excerpta Medica Database, Cochrane Library, Cochrane Library, China National Knowledge Infrastructure database, and VIP databases. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was employed for the meta-analysis of visual analog scale (VAS) scores, Ramsay sedation scores, effective pressure times for PCIA, tramadol consumption, and safety. RESULTS: Fourteen RCTs were included. Compared with tramadol alone, postoperative intravenous tramadol-DEX combination PCA led to lower VAS scores (weighted mean differences [WMD]12h = 0.14, 95% confidence interval [CI] v1.50 to 1.79; WMD24h = 0.78, 95% CI -0.92 to -0.62; WMD48h = 0.51, 95% CI -0.66 to -0.38; all P < .05), lower Ramsay sedation scores (WMD24h = 0.08, 95% CI -0.14 to -0.02; WMD48h = 0.09, 95% CI -0.11 to -0.07; all P < .05), and less postoperative tramadol consumption (WMD0-24h = -102.59 mg, 95% CI -149.68 to -55.49; WMD0-48h = -152.91 mg, 95% CI -259.93 to -45.89; all P < .05). With regard to safety, there was a significant difference between DEX-tramadol and tramadol for PCIA in terms of the incidence of postoperative nausea and vomiting, dizziness, chills, and restlessness (all P < .05). CONCLUSION: According to the domestic evidence, this systematic review and meta-analysis suggests that DEX-tramadol PCIA is superior to tramadol in terms of analgesic efficacy and safety for Chinese surgical patients. However, because of some clear limitations (sample size and heterogeneity), these results should be interpreted with caution. Further large-scale and well-designed studies are needed to summarize and analyze the data to draw a more convincing conclusion.


Assuntos
Analgesia Controlada pelo Paciente , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Tramadol/administração & dosagem , Administração Intravenosa , China , Combinação de Medicamentos , Humanos
2.
AAPS PharmSciTech ; 21(2): 37, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31897804

RESUMO

Patients who suffer from dysphagia have difficulty in swallowing hard tablets and capsules; hence, gelatin-based soft-chew dosages are used as an alternative and novel drug delivery approach to overcome this problem. However, the conventional method of producing gelatin-based soft-chew dosages has many potential issues. The objective of this study was to use glycerol and the hot-melt extrusion technique to address potential issues and optimize the formulation. Gelatin, acetaminophen, saccharin, xylitol, and sodium chloride and six different ratios of water and glycerol were used in the seven formulations. Extrusion process temperature of formulations 1-6 and formulation 7 were 90°C and 140°C, respectively. Near-infrared spectra were collected during extrusion to monitor quality consistency. Scanning electron microscopic images of the cross-section of the soft-chew dosages were recorded. Differential scanning calorimetry (DSC) was used to characterize the crystal states of each formulation. Texture profile analysis was used to evaluate the physical properties of the tablets. In vitro drug release characteristics were studied. A 45-day stability study was carried out to evaluate the stability of each formulation. Near-infrared spectra showed that formulations 1-6 were uniform while formulation 7 was not. From the DSC results, formulations 1 and 2 showed crystallinity of acetaminophen. Formulation 5 displayed the desired physical and chemical stability in texture profile analysis and in the in vitro drug release studies. By using glycerol and hot-melt extrusion, the potential issues of conventional methods were successfully addressed.


Assuntos
Acetaminofen/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Acetaminofen/análise , Acetaminofen/química , Administração Oral , Analgésicos não Entorpecentes/análise , Analgésicos não Entorpecentes/química , Varredura Diferencial de Calorimetria , Composição de Medicamentos , Liberação Controlada de Fármacos , Excipientes , Gelatina , Glicerol , Solubilidade , Espectroscopia de Luz Próxima ao Infravermelho
3.
Medicine (Baltimore) ; 98(51): e18188, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860965

RESUMO

AIM: We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing. METHODS: In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6). RESULTS: The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%). CONCLUSION: N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Ansiolíticos/uso terapêutico , Queimaduras/terapia , Óxido Nitroso/uso terapêutico , Administração por Inalação , Adolescente , Adulto , Idoso , Analgésicos não Entorpecentes/administração & dosagem , Ansiolíticos/administração & dosagem , Ansiedade/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/administração & dosagem , Manejo da Dor , Método Simples-Cego , Adulto Jovem
4.
Medicine (Baltimore) ; 98(51): e18473, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861028

RESUMO

BACKGROUND: The aim of this study is to determine the efficacy of preemptive analgesia with paracetamol and ibuprofen to reduce the intensity and incidence of headache and myalgia after electroconvulsive therapy (ECT). METHODS: Sixty patients with major depression who were treated with ECT were randomized to receive ECT 3 times a week. The first 3 sessions were included in the study. The patients were divided into 3 groups; Group C (Control, Saline, n = 20), Group P (Paracetamol, n = 20), and Group I (Ibuprofen, n = 20). Demographics, duration of seizure, visual analog scale (VAS) for headache and myalgia and nausea, vomiting and pruritus were evaluated at postoperative 24 hours period. RESULTS: Duration of seizure after ECT was similar in all groups (P = .148). In the study, heart rate and mean arterial pressure were found to be some changes in some of the sessions. There were no significant differences in any comparison for all groups in all sessions regarding VAS scores for headache and myalgia. Incidence of headache and myalgia in Group I was lower than the other groups (P = .233, P = .011, respectively). But, there was no significant difference between the other groups. There was no significant difference in vomiting, intergroups, and intragroup. CONCLUSIONS: The findings of our study indicate that pain intensity of headache and myalgia did not show a significant change between groups and within groups. While pain intensity of myalgia between the groups reached no statistical significance, ibuprofen was significantly lowered the incidence of myalgia at postoperative 24 hours period.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Eletroconvulsoterapia/efeitos adversos , Cefaleia/prevenção & controle , Mialgia/prevenção & controle , Acetaminofen/administração & dosagem , Adulto , Transtorno Depressivo Maior/terapia , Método Duplo-Cego , Feminino , Cefaleia/etiologia , Humanos , Ibuprofeno/administração & dosagem , Masculino , Pessoa de Meia-Idade , Mialgia/etiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 98(48): e17983, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770207

RESUMO

BACKGROUND: The anesthetic-sparing effect of dexmedetomidine has led to its use as a general adjuvant. The present study aimed to determine intravenous infusion of dexmedetomidine to epidural analgesia after open thoracotomy. METHODS: Forty-four patients scheduled for admission to the intensive care unit after open thoracotomy were divided into 2 groups. An epidural catheter was placed at T4 to T7. Thirty minutes before the end of thoracotomy, group D was injected with 0.3 µg/kg/h of dexmedetomidine and group C received an equal dose of normal saline. For patient-controlled epidural analgesia (PCEA), 150 mL of levobupivacaine 300 mg was infused at a rate of 1 mL/h, plus a bolus dose of 3 mL with a lockout time of 30 minutes. The primary outcome evaluated was analgesic efficacy using a visual analog scale (VAS) 48 hours postoperatively. Other outcomes included additional analgesic use, total consumed local analgesia via PCEA, sedation score, blood pressure, heart rate, arterial blood gases, patient satisfaction, and adverse effects. RESULTS: The VAS scores in group D were significantly lower than that in group C immediately, 1, 4, 12, 36, and 48 hours after admission to the intensive care unit (P = .016, .009, .015, .002, .001, and .042, respectively). The total dose of additional analgesic was also significantly lower in group D (P = .011). Patient satisfaction was higher in group D (P < .05). There were no significant differences in the other outcomes between groups. CONCLUSION: Intravenous infusion of dexmedetomidine amplifies thoracic epidural analgesic effect after open thoracotomy.


Assuntos
Analgesia Epidural/métodos , Analgésicos não Entorpecentes/administração & dosagem , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Toracotomia/efeitos adversos , Idoso , Analgesia Controlada pelo Paciente/métodos , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Levobupivacaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Vértebras Torácicas , Toracotomia/métodos , Resultado do Tratamento
6.
Am Surg ; 85(10): 1155-1158, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657314

RESUMO

The utility of opioid-sparing multimodal analgesia protocols (OSMMAPs) in opioid-tolerant (OT) patients is unknown. We sought to determine the impact of a standardized OSMMAP in OT versus opioid-naïve (ON) patients after major colorectal surgery. Consecutive patients undergoing surgery before (January 2015-March 2017) and after OSMMAP implementation (April 2017-March 2018) were identified from a single-institution prospective colorectal surgery registry. OT was defined by the presence of an opioid on the preadmission medication record. Opioid use (measured in oral morphine equivalents (OMEs)) and surgical outcomes were compared between OT and ON patients pre- and post-OSMMAP. The study cohort of 201 patients included 59 OT patients (25 pre- and 34 post-OSMMAP) and 142 ON controls (34 pre- and 108 post-OSMMAP). The median age was 47.5 years (IQR 32), and 50% were male. 185 patients (92%) had a laparoscopic/robotic resection and 16 (8%) open. There were statistically significant reductions in OME required post-OSMMAP on each postoperative day (days 1 to 4) and cumulative OME for both OT and ON patients. The reduction in opioid requirements was significantly larger in OT than ON patients. We present the first study highlighting a larger opioid usage reduction in OT than in ON patients after OSMMAP implementation.


Assuntos
Analgésicos Opioides/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Tolerância a Medicamentos , Morfina/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/administração & dosagem , Estudos de Casos e Controles , Protocolos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Medicação Pré-Anestésica/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do Tratamento
7.
Gynecol Oncol ; 155(3): 468-472, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31601494

RESUMO

OBJECTIVE: To determine which non-narcotic analgesic, acetaminophen (Ofirmev®) or ketorolac (Toradol®), provides better post-operative pain control when combined with an opioid patient-controlled analgesia (PCA) pump. Secondary objectives include comparisons of the rates of ileus, post-operative bleeding, transfusions, and length-of-hospitalization (LOH). METHODS: A prospective, randomized trial of acetaminophen (A) 1-g intravenous (IV) every 6-h or ketorolac (K) 15-mg IV every 6-h from post-operative day 1-3 in addition to an opioid PCA for patients undergoing benign or malignant gynecologic laparotomy procedures was performed. Abstracted data included pain levels via visual analogue pain scales (VAS), amount of narcotic used, hepatic enzyme levels, hemoglobin, urine output, blood transfusions, time to return of flatus and LOH. RESULTS: One-hundred patients were accrued and underwent 55 benign gynecologic laparotomies and 45 cancer-related laparotomies. VAS pain levels (3.3 K, 3.5 A) and morphine PCA use (79.1 oral morphine equivalents [OME] K vs. 84.5 A) were not different, however dilaudid PCA usage was less by K patients (84.4 OME K and 136.8 OME A, p < 0.001). There was a significant hemoglobin change between the two groups (2.6 g K vs. 2 g A, p = 0.015), however blood transfusions were equal (28% K, 22% A, p > 0.05). Return of flatus was 2.7-days for K vs. 3.4-days for A (p = 0.011) and LOH was not different (4.4-days K vs. 5.1-days A, p = 0.094). CONCLUSIONS: Both intravenous ketorolac and acetaminophen provide similar post-operative analgesia through VAS pain scales and total usage of morphine via PCA pumps. Use of ketorolac with dilaudid PCA was associated with less dependence on dilaudid and a quicker return of bowel function than acetaminophen, however length of stay and transfusion rates were not different.


Assuntos
Acetaminofen/administração & dosagem , Analgesia Controlada pelo Paciente , Neoplasias dos Genitais Femininos/cirurgia , Hidromorfona/administração & dosagem , Cetorolaco/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Injeções Intravenosas , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
8.
Br J Anaesth ; 123(5): 627-636, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563269

RESUMO

BACKGROUND: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. METHODS: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews. RESULTS: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia. CONCLUSIONS: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Humanos , Manejo da Dor/métodos , Cuidados Pós-Operatórios/métodos
10.
Eur Arch Otorhinolaryngol ; 276(11): 3231-3238, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377901

RESUMO

PURPOSE: Our previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain. METHODS: A double-blinded RCT including 79 children, aged 2-6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered. RESULTS: 63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group. CONCLUSIONS: The results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain. TRIAL REGISTRATION: This study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).


Assuntos
Acetaminofen/administração & dosagem , Adenoidectomia , Dor Pós-Operatória , Hemorragia Pós-Operatória , Tonsilectomia , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Analgésicos não Entorpecentes/administração & dosagem , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Apneia Obstrutiva do Sono/fisiopatologia , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Resultado do Tratamento
11.
Life Sci ; 233: 116752, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31415770

RESUMO

AIMS: Few studies have compared the interaction of single and repeated administration of amitriptyline (amit) with the nitrergic system and glutamatergic system in the experimental model of neuropathic pain. We aimed to evaluate the antinociceptive effect of single and repeated administration of amit and to assess whether glutamate preceded inducible nitric oxide synthase (iNOS) inhibition as a mechanism of the analgesic effect of amit in the neuropathic model of pain. MATERIALS AND METHODS: Male Wistar rats were subjected to left sciatic nerve ligation. The effect of single (25 mg kg-1) and repeated (10 mg kg-1 daily for 3 weeks) administration of amit intraperitoneally (i.p.) alone or in combination with aminoguanidine (AG i.p., 100 mg kg-1 for 3 days, a selective iNOS inhibitor) and MK-801 (0.05 mg kg-1 i.p., NMDA antagonist) on resting paw posture and mechanical hyperalgesia were studied. Glutamate level and iNOS protein expression in hippocampus were detected. KEY FINDINGS: Single and repeated administration of amit alone or in combination with AG or MK-801 demonstrated a significant decrease in resting pain score and increase in the pain threshold. Both glutamate and nitrite levels decreased in the hippocampi of single and repeated amit + MK-801 groups. Immunohistochemistry showed a marked decrease in iNOS immunoreactivity in rats treated with single and repeated amit + MK-801. SIGNIFICANCE: Our results suggest that glutamate-dependent mechanisms are involved in the analgesic responses to amit administration. Importantly, glutamatergic system and its upstream nitrergic system play an important role in the antinociceptive action of amit.


Assuntos
Amitriptilina/farmacologia , Analgésicos não Entorpecentes/farmacologia , Ácido Glutâmico/metabolismo , Neuralgia/tratamento farmacológico , Nitrogênio/metabolismo , Amitriptilina/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Animais , Modelos Animais de Doenças , Masculino , Neuralgia/metabolismo , Neuralgia/patologia , Óxido Nítrico Sintase Tipo II/antagonistas & inibidores , Limiar da Dor , Ratos , Ratos Wistar
12.
Medicine (Baltimore) ; 98(34): e16810, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441852

RESUMO

BACKGROUD: The aim of this study was to compare the analgesic and adverse effects of oxycodone with 3 different infusion modes on postoperative pain after laparoscopic radical surgery of cervical cancer. METHODS: Ninety patients undergoing laparoscopic radical surgery of cervical cancer were randomly divided into 3 groups: Group A (continuous infusion with 0.01 mg/kg/h and a bolus dose with 0.03 mg/kg), Group B (a bolus dose with 0.03 mg/kg) and Group C (PCA was administered as a time-scheduled decremental continuous infusion based on lean body mass). A blinded observer recorded Visual Analogue Scale (VAS), Ramsay sedation score (RSS), infused cumulative dose of oxycodone and side effects at 1, 6, 12, 24, and 48 hours postoperatively, and satisfaction during the postoperative 48 hours. RESULTS: There were significant differences in the VAS pain score when resting or coughing among 3 groups at 1, 6 and 48 hours postoperatively (P <.05). VAS was significantly higher in Group B than in Group A and C until postoperative 1, 6, and 48 hours (P <.05). There were significant differences in cumulative PCA dose among the 3 groups at 1 and 48 hours postoperatively (P <.05). Group C showed significantly less amount of cumulative PCA dose compared to other 2 groups at 1 hour, whereas cumulative PCA dose of Group A at 48 hours was significantly more than other 2 groups (P <.05). There were no significant differences in postoperative nausea and vomiting, FAS, muscle chilling score and RSS among 3 groups at 1, 6, 12, 24 and 48 hours postoperatively. In addition, there was no difference in overall satisfaction during 48 hours postoperatively among 3 groups. CONCLUSIONS: Oxycodone provides significant analgesic effect in 3 different infusion modes over 48 hours after laparoscopic radical surgery of cervical cancer, and a time-scheduled decremental continuous infusion of oxycodone can become a better choice for patients after surgery of cervical cancer.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Neoplasias do Colo do Útero/cirurgia , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Laparoscopia , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Oxicodona/efeitos adversos , Medição da Dor , Estudos Prospectivos
13.
Crit Care Resusc ; 21(3): 188-199, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462206

RESUMO

OBJECTIVE: Acute liver failure (ALF) leads to severe illness and usually requires admission to the intensive care unit (ICU). Despite its importance, little is known about patients with ALF in Australia and New Zealand. DESIGN: Binational observational study to evaluate the aetiology, baseline characteristics, patterns of illness, management, and outcomes for patients with ALF admitted to Australian and New Zealand ICUs. SETTING: All six Australian and New Zealand ICUs in liver transplant centres submitted de-identified data for ten or more consecutive patients with ALF. Data were obtained from the clinical record and included baseline characteristics, aetiology, mode of presentation, illness severity, markers of liver failure, critical care interventions, utilisation of transplantation, and hospital outcome. RESULTS: We studied 62 patients with ALF. Paracetamol overdose (POD) was the underlying cause of ALF in 53% of patients (33/62), with staggered ingestion in 42% of patients (14/33). Among patients with POD, 70% (23/33) were young women, most had psychiatric diagnoses, and most presented relatively early with overt liver failure. This group were transplanted in only 6% of cases (2/33) and had an overall mortality of 24% (8/33). The remaining patients with ALF had less common conditions, such as hepatitis B and non-paracetamol drug-induced ALF. These patients presented later and exhibited less extreme evidence of acute hepatic necrosis. Transplantation was performed in 38% of patients (11/29) in this subgroup. The mortality of nontransplanted non-POD patients was 56% (10/18). Illness severity at ICU admission, initial requirement for organ support therapies and length of hospital stay were similar between patients with POD and non-POD ALF. CONCLUSION: POD is the major cause of ALF in Australian and New Zealand liver transplant centres and is a unique and separate form of ALF. It has a much lower associated mortality and treatment with liver transplantation than non-POD ALF. Non-POD patients have a poor prognosis in the absence of transplantation.


Assuntos
Acetaminofen/administração & dosagem , Acetaminofen/toxicidade , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/toxicidade , Overdose de Drogas/epidemiologia , Falência Hepática Aguda/induzido quimicamente , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Falência Hepática Aguda/epidemiologia , Falência Hepática Aguda/etiologia , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Nova Zelândia/epidemiologia , Resultado do Tratamento , Adulto Jovem
14.
World J Surg Oncol ; 17(1): 118, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288822

RESUMO

CONTEXT: Brainstem tumour surgery is difficult, and accidents can easily occur. OBJECTIVE: To explore the effect of dexmedetomidine hydrochloride on brainstem tumour surgery. DESIGN, SETTING AND PARTICIPANTS: A total of 60 patients with brainstem tumours successfully operated on by our hospital from March 2016 to March 2018 were selected as subjects. INTERVENTIONS: These patients were randomised into two groups: the research group (n = 30) and control group (n = 30). Patients in the control group were given propofol together with a placebo (0.9% sodium chloride solution) to maintain anaesthesia after general anaesthesia, while patients in the research group were supplemented with dexmedetomidine hydrochloride. MAIN OUTCOME MEASURE: Awakening time, overall stability of various indicators in the operation and adverse reactions during the awakening period were observed. RESULTS: The results revealed that patients in the research group had a longer awakening time, higher mean stability rate, higher effective rate and less incidence of adverse reactions during the awakening period than the control group; the differences were all statistically significant (P < 0.05). CONCLUSION: Dexmedetomidine hydrochloride has a good analgesic effect in intraoperative anaesthesia during brainstem tumour surgery, which significantly reduces the incidence of adverse reactions. Therefore, it can be used to assist anaesthesia during brainstem tumour operations and is worthy of clinical popularisation and application.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Período de Recuperação da Anestesia , Neoplasias do Tronco Encefálico/cirurgia , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adulto , Idoso , Estudos de Casos e Controles , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
15.
Trials ; 20(1): 399, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272502

RESUMO

BACKGROUND: The morbidity of knee arthritis is increasing among aged people and total knee arthroplasty has been its mainstream treatment to date. Postoperative rehabilitation is an important part of the procedure. However, the intense pain during the functional exercise involved has always been a challenge for both patients and health care professionals. The aim of this study is to test the analgesic effect of a mixture of nitrous oxide/oxygeb (1:1) inhalation for patients who are doing functional exercise 1 month after total knee arthroplasty. METHODS/DESIGN: This double-blind, randomized, placebo-controlled study will be implemented in the Rehabilitation Department in the General Hospital of Ningxia Medical University. Patients aged between 50 and 75 years who underwent a primary unilateral total knee arthroplasty are eligible for inclusion. The key exclusion criteria include: epilepsy, pulmonary embolism, intestinal obstruction, aerothorax. The treatment group (A) will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesics), and the control group (B) will receive oxygen plus conventional treatment (no analgesics). Patients, physicians, therapists, and data collectors are all blind to the experiment. Assessments will be taken immediately after functional exercise begins (T0), 5 min (T1) after functional exercise begins, and 5 min after functional exercise has finished (T2). Patients will be randomly allocated between a treatment group (A) and a control group (B) in a ratio of 1:1. Primary outcome, including pain severity in the procedure, will be taken for each group. Secondary outcomes include blood pressure, heart rate, oxygen saturation, side effects, knee joint range of motion, Knee Society Score (KSS), rescue analgesia need, and satisfaction from both therapists and patients. DISCUSSION: This study will focus on exploring a fast and efficient analgesic for patients who are doing functional exercise after total knee arthroplasty. Our previous studies suggested that the prefixed nitrous oxide/oxygen mixture was an efficacious analgesic for the management of burn-dressing pain and breakthrough cancer pain. The results of this study should provide a more in-depth insight into the effects of this analgesic method. If this treatment proves successful, it could be implemented widely for patients doing functional exercise in the rehabilitation department. TRIAL REGISTRATION: ChiCTR-INR-17012891 . Registered on 6 October 2017.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Artralgia/prevenção & controle , Artrite/cirurgia , Artroplastia do Joelho/reabilitação , Terapia por Exercício , Articulação do Joelho/cirurgia , Óxido Nitroso/administração & dosagem , Oxigenoterapia , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Artrite/diagnóstico , Artrite/fisiopatologia , Artroplastia do Joelho/efeitos adversos , China , Método Duplo-Cego , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Oxigenoterapia/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
16.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(3): 373-378, 2019 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-31282332

RESUMO

Objective To investigate the 50% effective dose(ED50)and 95% effective dose(ED95)of dexmedetomidine(DEX)combined with 0.032 µg/(kg·h)sufentanil as well as its analgesic effect for patient-controlled intravenous analgesia(PCIA)after video-assisted thoracoscopic surgery(VATS).Methods Totally 25 patients undergoing elective VATS were enrolled. DEX and 0.032 µg/(kg·h)sufentanil were used for postoperative PCIA. The loading dose of DEX was 0.048 µg/(kg·h),and the dose difference between two adjacent patients was 0.008 µg/(kg·h). The DEX dose of a current patient was determined by whether the previous patient was satisfied with postoperative analgesic effect. If the previous patient was satisfied with postoperative analgesic effect,the DEX dose of the current patient was decreased by 0.008 µg/(kg·h);and if the previous analgestic effect was not satisfactory,DEX dose of the current patient was increased by 0.008 µg/(kg·h). The study endpoint was dexmedetomidine dose was<0.008 µg/(kg· h) within 7 upper and lower cycles in 7 consecutive cases. Finally,the probability unit regression was used to estimate the ED50 and ED95 of DEX and their 95% CI.Results When DEX combined with 0.032 µg/(kg·h) sufentanil was used for postoperative PCIA in young patients undergoing VATS,the ED50 and ED95of DEX were 0.0346 µg/(kg· h)[95%CI:0.0283-0.0408 µg/(kg·h)] and 0.0459 µg/(kg·h)[95%CI:0.0400-0.0880 µg/(kg·h)],respectively. No adverse reaction such as vomiting,respiratory depression,or bradycardia occurred. The average Visual Analogue Scale(VAS)scores at rest(Z=-5.128,P=0.000)and cough(Z=-6.642,P=0.000)and the Ramsay sedation score(Z=-2.335,P=0.020)within 6 hours after surgery were higher than those after 6 hour.Conclusion DEX combined with 0.032 µg/(kg·h) sufentanil are effective for postoperative PCIA in patients undergoing VATS when the ED50 and ED95 are 0.0346 µg/(kg·h)and 0.0459 µg/(kg·h),respectively.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Dexmedetomidina/uso terapêutico , Sufentanil/uso terapêutico , Cirurgia Torácica Vídeoassistida , Analgesia Controlada pelo Paciente , Analgésicos não Entorpecentes/administração & dosagem , Dexmedetomidina/administração & dosagem , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Humanos , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/administração & dosagem
17.
Curr Opin Anaesthesiol ; 32(5): 674-682, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356362

RESUMO

PURPOSE OF REVIEW: Anesthesia for cardiac surgery has traditionally utilized high-dose opioids to blunt the sympathetic response to surgery. However, recent data suggest that opioids prolong postoperative intubation, leading to increased morbidity. Given the increased risk of opioid dependency after in-hospital exposure to opioids, coupled with an increase in morbidity, regional techniques offer an adjunct for perioperative analgesia. The aim of this review is to describe conventional and emerging regional techniques for cardiac surgery. RECENT FINDINGS: Well-studied techniques such as thoracic epidurals and paravertebral blocks are relatively low risk despite lack of widespread adoption. Benefits include reduced opioid exposure after paravertebral blocks and reduced risk of perioperative myocardial infarction after epidurals. To further lower the risk of epidural hematoma and pneumothorax, new regional techniques have been studied, including parasternal, pectoral, and erector spinae plane blocks. Because these are superficial compared with paravertebral and epidural blocks, they may have even lower risks of hematoma formation, whereas patients are anticoagulated on cardiopulmonary bypass. Efficacy data have been promising, although large and generalizable studies are lacking. SUMMARY: New regional techniques for cardiac surgery may be potent perioperative analgesic adjuncts, but well-designed studies are needed to quantify the effectiveness and safety of these blocks.


Assuntos
Analgesia/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Assistência Perioperatória/métodos , Analgesia/efeitos adversos , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , /prevenção & controle , Dor Pós-Operatória/etiologia , Assistência Perioperatória/efeitos adversos , Resultado do Tratamento
18.
Eur J Clin Pharmacol ; 75(10): 1393-1404, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31312867

RESUMO

PURPOSE: There is a need for alternative analgosedatives such as dexmedetomidine in neonates. Given the ethical and practical difficulties, protocol design for clinical trials in neonates should be carefully considered before implementation. Our objective was to identify a protocol design suitable for subsequent evaluation of the dosing requirements for dexmedetomidine in mechanically ventilated neonates. METHODS: A published paediatric pharmacokinetic model was used to derive the dosing regimen for dexmedetomidine in a first-in-neonate study. Optimality criteria were applied to optimise the blood sampling schedule. The impact of sampling schedule optimisation on model parameter estimation was assessed by simulation and re-estimation procedures for different simulation scenarios. The optimised schedule was then implemented in a neonatal pilot study. RESULTS: Parameter estimates were more precise and similarly accurate in the optimised scenarios, as compared to empirical sampling (normalised root mean square error: 1673.1% vs. 13,229.4% and relative error: 46.4% vs. 9.1%). Most importantly, protocol deviations from the optimal design still allowed reasonable parameter estimation. Data analysis from the pilot group (n = 6) confirmed the adequacy of the optimised trial protocol. Dexmedetomidine pharmacokinetics in term neonates was scaled using allometry and maturation, but results showed a 20% higher clearance in this population compared to initial estimates obtained by extrapolation from a slightly older paediatric population. Clearance for a typical neonate, with a post-menstrual age (PMA) of 40 weeks and weight 3.4 kg, was 2.92 L/h. Extension of the study with 11 additional subjects showed a further increased clearance in pre-term subjects with lower PMA. CONCLUSIONS: The use of optimal design in conjunction with simulation scenarios improved the accuracy and precision of the estimates of the parameters of interest, taking into account protocol deviations, which are often unavoidable in this event-prone population.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/farmacocinética , Dexmedetomidina/administração & dosagem , Dexmedetomidina/farmacocinética , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacocinética , Modelos Biológicos , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Respiração Artificial
19.
Rev Bras Anestesiol ; 69(4): 417-419, 2019.
Artigo em Português | MEDLINE | ID: mdl-31326113

RESUMO

Erector spinae plane block is gaining popularity both for its ease of application and as its comparable effect on postoperative analgesia with central regional techniques like paravertebral block or epidural anesthesia. Its use for many indications has been reported in the literature for pediatric patients. We would like to share our experiences in a 2.5-month infant scheduled for thoracotomy for a giant congenital cyst. Single shot erector spinae plane block was done at T4 level before the start of the surgery for both surgical and postoperative analgesia. No complication was seen during both surgery and follow up period. Erector spinae plane block with the combination of paracetamol was adequate for pain relief.


Assuntos
Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Toracotomia/métodos , Acetaminofen/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Cistos/congênito , Cistos/cirurgia , Seguimentos , Humanos , Lactente
20.
Expert Opin Drug Metab Toxicol ; 15(8): 659-669, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31293190

RESUMO

Introduction: Although the hepatotoxicity of acetaminophen is a well-known problem, the search for reliable biomarker of toxicity is still a current issue as clinical tools are missing to assess patients intoxicated following chronic use, sequential ingestion, use of modified release formulations or in case of delayed arrival to hospital. The need for new specific and robust biomarkers for acetaminophen toxicity has prompted many studies exploring the use of blood levels of acetaminophen derivatives, mitochondrial damage markers, liver cell apoptosis and/or necrosis markers and circulating microRNAs. Areas covered: In this review, we present a concise overview of the most promising biomarkers currently under evaluation including descriptions of their properties with respect to exposure type, APAP specificity, and potential clinical application. In addition, we illustrate the power of new technologies for biomarker research and describe their current application to the field of acetaminophen-induced hepatotoxicity. Expert opinion: Recently the use of extracellular vesicles isolation in combination with omics techniques has opened a new perspective to the field of biomarker research. However, the potential of those new technologies for the prediction and monitoring of hepatic diseases and acetaminophen toxicity has not yet been fully taken into consideration.


Assuntos
Acetaminofen/efeitos adversos , Analgésicos não Entorpecentes/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Acetaminofen/administração & dosagem , Acetaminofen/farmacocinética , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/farmacocinética , Animais , Apoptose/efeitos dos fármacos , Biomarcadores/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/fisiopatologia , Humanos , MicroRNAs/metabolismo , Mitocôndrias/patologia , Projetos de Pesquisa
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