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1.
Medicine (Baltimore) ; 99(5): e18939, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000411

RESUMO

RATIONALE: Diagnosing and treating refractory cancer pain have become standardized and effective procedures with guidance from the Expert Consensus on Refractory Cancer Pain released in 2017 by the Committee of Rehabilitation and Palliative Care of China. Doxorubicin has been used for perineural injection in the treatment of chronic non-cancer pain owing to its retrograde sensory ganglion resection effect. Our study reports a new fourth-ladder treatment for cancer pain: CT-guided paravertebral doxorubicin injection for patients with refractory cancer pain caused by paraspinal metastasis. PATIENT CONCERNS: A 48-year-old female and a 47-year-old male patients suffered from refractory cancer pain over the past months. They had both undergone surgical tumor resection, chemotherapy, and precision radiotherapy but result in limited analgesic effect. The daily oral morphine dosage was around 60 to 100 mg and rescue analgesic methods had been used at the time. DIAGNOSES: Refractory cancer pain in 2 patients with renal cancer and hepatobiliary adenocarcinoma. INTERVENTIONS: The patients both received computed tomography (CT)-guided 1 mL of 0.5% doxorubicin paravertebral injection at each affected nerve root segments. OUTCOMES: The Visual Analog Scale and Douleur Neuropathique four Questions were used for 6-month follow-up, and the analgesic requirement was also recorded. The patients enjoyed satisfactory analgesia for up to 6 months without adverse reaction. In addition, the oral opioid analgesic doses were significantly reduced after the neurolytic block. LESSONS: The CT-guided paravertebral doxorubicin injection was an effective fourth-step analgesic interventional technology that allowed our 2 patients with refractory cancer pain to maintain satisfactory analgesia. This analgesia method taken at an appropriate stage, according to the latest analgesic concept, results in good analgesia and opioid use reduction. Also, with the imaging guidance, only a small amount of neurolytic agent is needed to achieve analgesia in a precise and safe way.


Assuntos
Analgésicos/administração & dosagem , Dor do Câncer/tratamento farmacológico , Doxorrubicina/administração & dosagem , Dor Intratável/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Tomografia Computadorizada por Raios X , Dor do Câncer/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Intratável/diagnóstico por imagem , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico
2.
Mymensingh Med J ; 29(1): 136-141, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915349

RESUMO

This study was designed to observe the haemodynamic changes, recovery status and cost effectiveness during anaesthesia in laparoscopic cholecystectomy with medical air in comparison to anaesthesia with nitrous oxide associated with maintain of adequate analgesia and was conducted in the department of Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2017. Nitrous oxide is popularly using as an analgesic in current balanced general anesthesia in addition carrier agent for anesthetic. Intraoperative pain intensity depends on many variables including, type of surgery, surgical stimulation and surgical incision. It is difficult to measure intraoperative pain properly under general anesthesia therefore anesthetist depends on the surrogate marker of inadequate analgesia like raised heart rate, blood pressure, sweating and lacrimation. However, unfortunately, these parameters may changes in same direction with light plane of anesthesia, hypercarbia and ongoing procedural status of the patient.


Assuntos
Analgésicos/administração & dosagem , Anestesia/métodos , Colecistectomia Laparoscópica/métodos , Óxido Nitroso/administração & dosagem , Analgésicos/economia , Período de Recuperação da Anestesia , Anestesia Geral/economia , Bangladesh , Colelitíase/cirurgia , Análise Custo-Benefício , Hemodinâmica/efeitos dos fármacos , Humanos , Monitorização Intraoperatória , Óxido Nitroso/economia , Período Pós-Operatório
3.
Postgrad Med ; 132(1): 28-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31900074

RESUMO

Interest in and use of topical analgesics has been increasing, presumably due to their potential utility for relief of acute and chronic pain. Topically applied agents with analgesic properties can target peripheral nociceptive pathways while minimizing absorption into the plasma that leads to potential systemic adverse effects.Clinical trials have found 5% lidocaine patches to be effective and well tolerated for the treatment of post-herpetic neuralgia (PHN) with a minimal risk of toxicity or drug-drug interactions. With this patch formulation, the penetration of lidocaine into the skin produces an analgesic effect without producing a complete sensory block. Use of topical lidocaine is supported by clinical practice guidelines, including first-line treatment by the American Academy of Neurology (guidelines retired 2018), the European Federation of Neurological Societies and second-line by the Canadian Pain Society.FDA approved 5% lidocaine patches in 1999, and a 1.8% topical lidocaine system in 2018 - both indicated for the treatment of pain secondary to PHN. The 1.8% system offers a more efficient delivery of lidocaine that is bioequivalent to 5% lidocaine patches, but with a 19-fold decrease in drug load (i.e., 36 mg versus 700 mg) as well as superior adhesion that allows the patch to maintain contact with the skin during the 12-h administration period.Although topical lidocaine formulations have advanced over time and play an important role in the treatment of PHN, a variety of other conditions that respond to topical lidocaine have been reported in the literature including PHN, lower back pain, carpal tunnel syndrome, diabetic peripheral neuropathy, and osteoarthritis joint pain. Other neuropathic or nociceptive pain syndromes may respond to topical lidocaine in select cases and warrant further study. Clinicians should consider local anesthetics and other topical agents as part of their multimodal treatments of acute and chronic pain.


Assuntos
Analgésicos/administração & dosagem , Lidocaína/administração & dosagem , Administração Cutânea , Analgésicos/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Neuralgia/tratamento farmacológico , Adesivo Transdérmico
4.
J Zoo Wildl Med ; 50(4): 868-873, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926517

RESUMO

Blue poison dart frogs (Dendrobates tinctorius azureus) are commonly maintained in zoological institutions and are becoming popular in the pet trade industry. Sedation or light anesthesia is required for safe and effective handling of this species. In this study, the sedative effects of subcutaneously administered alfaxalone-midazolam-dexmedetomidine (AMD) (20, 40, 5 mg/kg, respectively) and ketamine-midazolam-dexmedetomidine (KMD) (100, 40, 5 mg/kg, respectively) were compared in a prospective, randomized, blinded, crossover study in juvenile blue poison dart frogs (n = 10). Both protocols were partially reversed 45 min after administration of either protocol with subcutaneously administered flumazenil (0.05 mg/kg) and atipamezole (50 mg/kg). Heart rate, pulmonic respiratory rate, various reflexes, and behavioral parameters were monitored after drug administration. Both protocols resulted in rapid loss of righting reflex [median (range): AMD, 5 min (5-5 min); KMD, 5 min (5-10 min)]. Time to complete recovery was similar with both protocols (mean ± SD: AMD, 97.5 ± 11.4 min; KMD, 96.5 ± 25.4 min). The AMD protocol resulted in pulmonic respiratory depression, whereas no significant difference in heart rate was found between the two protocols. All frogs were observed eating within 24 hr of chemical restraint. Gastric prolapses occurred in four frogs (AMD 3, KMD 1) that were easily reduced with a cotton-tip application. No other adverse reactions were observed. The results of this study provide two different subcutaneous chemical restraint protocols in juvenile blue poison dart frogs.


Assuntos
Dexmedetomidina/farmacologia , Midazolam/farmacologia , Pregnanodionas/farmacologia , Antagonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Envelhecimento , Analgésicos/administração & dosagem , Analgésicos/farmacologia , Anestésicos/administração & dosagem , Anestésicos/farmacologia , Animais , Antídotos/administração & dosagem , Antídotos/farmacologia , Anuros , Sedação Consciente , Estudos Cross-Over , Dexmedetomidina/administração & dosagem , Quimioterapia Combinada , Flumazenil/administração & dosagem , Flumazenil/farmacologia , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Imidazóis/administração & dosagem , Imidazóis/farmacologia , Ketamina/administração & dosagem , Ketamina/farmacologia , Midazolam/administração & dosagem , Pregnanodionas/administração & dosagem
5.
J Zoo Wildl Med ; 50(4): 993-996, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926534

RESUMO

Seven anesthesia events were performed over 6 wk on a 1.5-yr-old female okapi (Okapia johnstoni) being managed for a fetlock injury. A combination of butorphanol (B) (median; range) (0.045; 0.031-0.046 mg/kg), medetomidine (M) (0.037; 0.031-0.037 mg/kg), ketamine (K) (0.553; 0.536-1.071 mg/kg), and thiafentanil (T) (0.0045; 0.0040-0.0046 mg/kg) was administered in a padded stall. One dart containing all drugs was used for the first two anesthesias. Subsequently, BM was administered 10 min prior to KT using two darts. Time (median; range) from initial injection to first effects (6; 3-7 min) and recumbency (14; 4-20 min) were recorded. Induction quality with the one-dart protocol was poor or fair and was good or excellent with the two-dart protocol. Following recumbency, the okapi was intubated and ventilated, and physiological parameters were recorded. Anesthesia was consistently achieved with BMKT, but induction was smoother with the staged two-dart approach. Neither resedation nor renarcotization was observed post-reversal.


Assuntos
Antílopes/fisiologia , Butorfanol/farmacologia , Fentanila/análogos & derivados , Ketamina/farmacologia , Medetomidina/farmacologia , Analgésicos/administração & dosagem , Analgésicos/farmacologia , Anestesia/veterinária , Animais , Butorfanol/administração & dosagem , Esquema de Medicação , Espécies em Perigo de Extinção , Feminino , Fentanila/administração & dosagem , Fentanila/farmacologia , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Ketamina/administração & dosagem , Medetomidina/administração & dosagem
6.
Gastroenterology ; 158(1): 123-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470006

RESUMO

BACKGROUND & AIMS: Peppermint oil is frequently used to treat irritable bowel syndrome (IBS), despite a lack of evidence for efficacy from high-quality controlled trials. We studied the efficacy and safety of small-intestinal-release peppermint oil in patients with IBS and explored the effects of targeted ileocolonic-release peppermint oil. METHODS: We performed a double-blind trial of 190 patients with IBS (according to Rome IV criteria) at 4 hospitals in The Netherlands from August 2016 through March 2018; 189 patients were included in the intent-to-treat analysis (mean age, 34.0 years; 77.8% female; 57.7% in primary care), and 178 completed the study. Patients were randomly assigned to groups given 182 mg small-intestinal-release peppermint oil, 182 mg ileocolonic-release peppermint oil, or placebo for 8 weeks. The primary endpoint was abdominal pain response, as defined by the US Food and Drug Administration: at least a 30% decrease in the weekly average of worst daily abdominal pain compared with baseline in at least 4 weeks. The co-primary endpoint was overall relief of IBS symptoms, as defined by the European Medicines Agency. Secondary endpoints included abdominal pain, discomfort, symptom severity, and adverse events. RESULTS: Abdominal pain response did not differ significantly between the peppermint oil and placebo groups: 29 of 62 patients in the small-intestinal-release peppermint oil group had a response (46.8%, P = .170 vs placebo), 26 of 63 patients in the ileocolonic-release peppermint oil group had a response (41.3%, P = .385 vs placebo), and 22 of 64 patients in the placebo group had a response (34.4%). We did not find differences among the groups in overall relief (9.7%, P = .317 and 1.6%, P = .351 vs 4.7% for placebo). The small intestinal peppermint oil did, however, produce greater improvements than placebo in secondary outcomes of abdominal pain (P = .016), discomfort (P = .020), and IBS severity (P = .020). Adverse events, although mild, were more common in both peppermint oil groups (P < .005). CONCLUSIONS: In a randomized trial of patients with IBS, we found that neither small-intestinal-release nor ileocolonic-release peppermint oil (8 weeks) produced statistically significant reductions in abdominal pain response or overall symptom relief, when using US Food and Drug Administration/European Medicines Agency recommended endpoints. The small-intestinal-release peppermint oil did, however, significantly reduce abdominal pain, discomfort, and IBS severity. These findings do not support further development of ileocolonic-release peppermint oil for treatment of IBS. Clinicaltrials.gov, Number: NCT02716285.


Assuntos
Dor Abdominal/tratamento farmacológico , Analgésicos/administração & dosagem , Síndrome do Intestino Irritável/tratamento farmacológico , Óleos Vegetais/administração & dosagem , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Administração Oral , Adolescente , Adulto , Idoso , Analgésicos/efeitos adversos , Cápsulas , Método Duplo-Cego , Feminino , Humanos , Mucosa Intestinal/efeitos dos fármacos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Masculino , Pessoa de Meia-Idade , Países Baixos , Medição da Dor , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1159-1164, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874532

RESUMO

Objective: To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer. Methods: A retrospective cohort study was carried out, which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (E2018026). Inclusion criteria were as follows: (1)age and gender were not limited; (2) all the gastrointestinal malignancies were confirmed histologically, and local recurrence or metastasis were confirmed by CT or MR; (3) numerical rating scale (NRS) ≥4 points, opioid analgesic drugs were required; (4) informed consents were signed by patients of their own. Exclusion criteria were as follows: (1) malignancies of early stage; (2) suspicious adverse mental states which might lead to poor administration compliance; (3) hypersensitivity or allergic reactions to opioids. Clinical data of patients with advanced gastrointestinal cancer receiving comprehensive treatment at the Medical Oncology Department of the Sixth Affiliated Hospital of Sun Yat-sen University from September 2016 to April 2017 were retrospectively collected. The patients were divided into the stoma group and the non-stoma group. The clinical findings of two groups were analyzed, including age, sex, ostomy status, pain location, presence or absence of intestinal obstruction, pain characteristics, selection of opioid analgesic agents, treatment of side effects of analgesics. Pain was assessed using brief pain inventory(BPI) table and NRS score. Strong opioids were prescribed for patients of NRS ≥4. Patients who were intolerant to opioids required opioid titration. The titration drugs included oral or IV morphine and oxycodone. After achievement of adequate pain control, long-acting opioids were administered, which included sustained-release morphine tablets, controlled release oxycodone and transdermal fentanyl. Criteria for pain relief included NRS≤3, breakthrough pain <3 times/day and duration of adequate pain control >3 days. The χ(2) test and the Wilcoxon signed rank sum test (nonparametric test) were used to analyze the clinical features of patients in the stoma and non-stomach groups. In order to find the factors associated with maintenance therapy and the use of laxatives, the variables were compared as well as in multivariate analysis with multiple regression models. For all the statistical tests, a value of P<0.05 in a two-tailed test was established as the alpha significance level. Result: A total of 123 patients were enrolled in this study, including 79 males (64.2%) and 44 females (35.8%) with a median age of 51 years. Fifty-two patients were in stoma group, including 30 (24.4%) of ileostomy and 22 (17.9%) of colostomy, and 71 patients were in non-stoma group. Pain of 40 (76.9%) patients in stoma group located in abdomenopelvic site while the pain of 44 (62.0%) patients in non-stoma group located in other sites. Compared with non-stoma group, cases in stoma group complained more abdominopelvic pain (73% vs. 62.0%, P<0.001).The median NRS pain score before treatment in the stoma group and the non-stoma group was 5.7 and 5.6, respectively, without statistically significant difference (P=0.741). After analgesic management, the above scores reduced to 2.1 and 2.3, respectively, without statistically significant difference as well (P=0.092). Analgesic treatment was effective in 111 cases (90.2%), including 49 cases (94.2%) in the stoma group, and 62 cases (87.3%) in the non-stoma group, and there was no statistically significant difference between the two groups (P=0.202). There was more application of fentanyl transdermal patch [34.6%(18/52) vs. 9.8%(7/71)] in the stoma group, while more application of lactulose laxative [78.9%(56/71) vs. 61.5%(32/52)](χ(2)=10.023, P=0.002) in the non-stoma group. Multivariate analysis revealed that ostomy (OR=0.290, 95%CI: 0.102-0.824, P=0.009) and pain site (OR=5.691, 95%CI:1.709-18.948, P=0.005) were independent factors affecting the choice of the first line opioid sustained release agent. Of the 123 patients with maintaining analgesia, 98 had available data of laxative use, of whom 46 used laxatives to prevent or treat constipation, and the proportion of laxatives in stoma group (21.2%, 11/52) was significantly lower than that in non-stoma group (49.3%, 35/71) (χ(2)=6.957, P=0.008). Multivariate analysis of the application of laxative use showed that age (OR=0.281, 95% CI: 0.123-0.684, P=0.010) and ostomy (OR=2.621, 95% CI: 1.033-6.687, P=0.045) were independent factors affecting the use of lactulose laxatives. Conclusions: Enterostomy may affect the analgesic pattern in advanced digestive tract cancer. Patients with stoma are more likely to use fentanyl transdermal patches and younger patients with stoma do not need prophylactic use of laxatives.


Assuntos
Analgésicos/uso terapêutico , Enterostomia , Neoplasias Gastrointestinais/complicações , Dor/tratamento farmacológico , Analgésicos/administração & dosagem , Feminino , Neoplasias Gastrointestinais/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos
8.
J Opioid Manag ; 15(5): 389-405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849030

RESUMO

OBJECTIVE: Characterize changes in intraoperative opioid and non-opioid administration over time and to evaluate self-reported pain scores in the immediate postoperative period. DESIGN: Single-center retrospective longitudinal study. SETTING: Academic medical center. PATIENTS, PARTICIPANTS: All patients presenting for surgery between 2011 and 2017 in both an inpatient and outpatient setting. MAIN OUTCOME MEASURE(S): Determine total intraoperative opioid administration using intravenous oral morphine equivalents standardized to weight and intraoperative non-opioid use. Furthermore, postoperative self-reported pain scores within 2 hours of completion of surgery are reported. RESULTS: A total of 112,167 individual cases were identified from March 2011 to June 2017. There was a sustained and significant reduction in intraoperative mean and median opioid administration [2011: 0.16 ± 0.15 mg/kg and 0.13 (0-4.92) mg/kg vs 2017: 0.09 ± 0.09 mg/kg and 0.07 (0-4.17) mg/kg]. These effects are seen in emergent vs elective surgery, ambulatory vs inpatient, preoperative opioid use vs no preoperative opioid use, and those with and without intraoperative loco-regional procedures. Although median number of intraoperative non-opioid analgesic agents was unchanged over time, average difference in the number of intraoperative non-opioids increased over time. Finally, pain scores decreased over time [2011: mean (standard deviation) and median (range): 5.1 ± 2.62 and 5.4 (0-10) vs 2017: 3.29 ± 3.27 and 3 (0-10)]. CONCLUSION: This study confirms that intraoperative opioid use has decreased over time with increased utilization of non-opioid analgesic adjuncts and a commensurate decrease in immediate postoperative pain.


Assuntos
Analgésicos Opioides , Analgésicos , Dor Pós-Operatória , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Estudos Longitudinais , Masculino , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos
9.
Int J Pharm Compd ; 23(6): 496-503, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31751946

RESUMO

The objective of this study was to investigate the effect of Lipoderm Cream, VersaBase Gel, and Emollient Cream on the release and permeation of gabapentin formulated for neuropathic pain. Gabapentin of different strengths (1%, 5%, and 10%) was compounded with the bases, diffusion of the drug from thebases, and permeation through artificial skin model studied with Franz diffusionsystem. Steady-state flux, cumulative permeation, and lag times were calculated,and release mechanisms modelled with first order, second-order, Higuchi, Korsmeyer-Peppas, and Hixon-Crowell kinetic models. Gabapentin recovery from VersaBase Gel, Lipoderm Cream, and Emollient Cream was 100.8 ± 2.7%, 101.3 ± 1.2%, and 104.9 ± 3.3%, respectively. Gabapentin completely diffused out of the three bases within 6 hours of application according to the Higuchi model. Flux of the drug appeared to be concentration-dependent with no permeation occurring at 1% strength. Whereas, 5% and 10% strengths in Lipoderm Cream permeated the skin rapidly, the same concentrations in Emollient Cream and VersaBase Gel required 60-minutes and 120-minutes lag times, respectively. For the three bases, a strong correlation was observed between lag times and flux. The overall permeation in VersaBase Gel and Lipoderm Base was not significantly different (P>0.05). However, Emollient Cream resulted in a significantly lower total permeation compared to other bases (P<0.05). As the formulations are for pain management, products with no lag times and higher flux are preferable. Although VersaBase Gel and Emollient Cream displayed some gabapentin permeability, it is important to consider gabapentin stability in these bases prior to use.


Assuntos
Analgésicos , Gabapentina , Neuralgia , Analgésicos/administração & dosagem , Analgésicos/farmacologia , Composição de Medicamentos , Gabapentina/administração & dosagem , Gabapentina/farmacologia , Humanos , Manejo da Dor , Pele , Absorção Cutânea
10.
Pan Afr Med J ; 33: 223, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692853

RESUMO

Ano-rectale malformations (ARM) are a spectrum of heterogeneous abnormalities in the development of the rectal canal. Its incidence is usually low and it is a little higher in some developing countries. Boys are more affected than girls and rectobulbar fistula associated with atresia of the anal canal is the most frequent disorder among them. We report the case of a 10-months old infant of male sex, whose mother lived in a mining area and had been complaining of fecaluria since the birth of her child. Physical examination showed fingerprint 1 cm below the intersection of the median raphe and the bi-ischiatic line. Paraclinical examinations showed no other associated malformation. Patient's management was based on anorectoplasty through abdominal and perineal approach with lower abdominoperineal reconstruction. In the post-operative period, the patient received antibiotic treatment and intravenous analgesia as well as dilations, which continued after discharge 2 weeks after surgery. No complications were observed and outcome was favorable.


Assuntos
Malformações Anorretais/cirurgia , Fístula Retal/cirurgia , Fístula Urinária/cirurgia , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Humanos , Lactente , Masculino , Fatores de Tempo
11.
Expert Opin Drug Metab Toxicol ; 15(12): 1033-1041, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31693437

RESUMO

Introduction: Chronic neuropathic pain (NP) is an incapacitating illness caused by a lesion of the somatosensory nervous system and is associated with several diseases or syndromes. Since current treatment options lack adequate efficacy in the majority of patients, ketamine is often administered to treat refractory NP.Areas covered: This review gives an overview of new ketamine pharmacokinetic data including data on intranasal and inhaled ketamine. The outcome of seven systematic reviews and meta-analyses, published since 2012, on ketamine efficacy in NP is discussed. The reader will additionally get an understanding of ketamine's complex metabolism with emphasis on the metabolite hydroxynorketamine.Expert opinion: Proof of sustained, large effects of ketamine in the treatment of NP from randomized controlled clinical trials is lacking, although we cannot exclude selective ketamine efficacy in patients with central sensitization, opioid-induced hyperalgesia or opioid tolerance. Interestingly, data from observational trials and case series do suggest the efficacy of ketamine in producing effective pain relief in NP with positive patient-related outcome measures. Additional randomized trials in often ill-defined groups of chronic pain patients are not useful and we suggest to conduct future studies in NP patients with central sensitization and/or with opioid refractory severe NP.


Assuntos
Antagonistas de Aminoácidos Excitatórios/administração & dosagem , Ketamina/administração & dosagem , Neuralgia/tratamento farmacológico , Analgésicos/administração & dosagem , Analgésicos/farmacocinética , Analgésicos/farmacologia , Animais , Dor Crônica/tratamento farmacológico , Dor Crônica/fisiopatologia , Antagonistas de Aminoácidos Excitatórios/farmacocinética , Antagonistas de Aminoácidos Excitatórios/farmacologia , Humanos , Ketamina/farmacocinética , Ketamina/farmacologia , Neuralgia/fisiopatologia
12.
JAMA ; 322(19): 1887-1898, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742631

RESUMO

Importance: Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist under investigation for acute treatment of migraine. Objective: To evaluate the efficacy and tolerability of ubrogepant compared with placebo for acute treatment of a single migraine attack. Design, Setting, and Participants: Phase 3, multicenter, randomized, double-blind, placebo-controlled, single-attack, clinical trial (ACHIEVE II) conducted in the United States (99 primary care and research clinics; August 26, 2016-February 26, 2018). Participants were adults with migraine with or without aura experiencing 2 to 8 migraine attacks per month. Interventions: Ubrogepant 50 mg (n = 562), ubrogepant 25 mg (n = 561), or placebo (n = 563) for a migraine attack of moderate or severe pain intensity. Main Outcomes and Measures: Co-primary efficacy outcomes were pain freedom and absence of the participant-designated most bothersome migraine-associated symptom (among photophobia, phonophobia, and nausea) at 2 hours after taking the medication. Results: Among 1686 randomized participants, 1465 received study treatment (safety population; mean age, 41.5 years; 90% female); 1355 of 1465 (92.5%) were evaluable for efficacy. Pain freedom at 2 hours was reported by 101 of 464 participants (21.8%) in the ubrogepant 50-mg group, 90 of 435 (20.7%) in the ubrogepant 25-mg group, and 65 of 456 (14.3%) in the placebo group (absolute difference for 50 mg vs placebo, 7.5%; 95% CI, 2.6%-12.5%; P = .01; 25 mg vs placebo, 6.4%; 95% CI, 1.5%-11.5%; P = .03). Absence of the most bothersome associated symptom at 2 hours was reported by 180 of 463 participants (38.9%) in the ubrogepant 50-mg group, 148 of 434 (34.1%) in the ubrogepant 25-mg group, and 125 of 456 (27.4%) in the placebo group (absolute difference for 50 mg vs placebo, 11.5%; 95% CI, 5.4%-17.5%; P = .01; 25 mg vs placebo, 6.7%; 95% CI, 0.6%-12.7%; P = .07). The most common adverse events within 48 hours of any dose were nausea (50 mg, 10 of 488 [2.0%]; 25 mg, 12 of 478 [2.5%]; and placebo, 10 of 499 [2.0%]) and dizziness (50 mg, 7 of 488 [1.4%]; 25 mg, 10 of 478 [2.1%]; placebo, 8 of 499 [1.6%]). Conclusions and Relevance: Among adults with migraine, acute treatment with ubrogepant compared with placebo led to significantly greater rates of pain freedom at 2 hours with 50-mg and 25-mg doses, and absence of the most bothersome migraine-associated symptom at 2 hours only with the 50-mg dose. Further research is needed to assess the effectiveness of ubrogepant against other acute treatments for migraine and to evaluate the long-term safety of ubrogepant among unselected patient populations. Trial Registration: ClinicalTrials.gov Identifier: NCT02867709.


Assuntos
Analgésicos/administração & dosagem , Transtornos de Enxaqueca/tratamento farmacológico , Dor/tratamento farmacológico , Piridinas/administração & dosagem , Pirróis/administração & dosagem , Adulto , Idoso , Analgésicos/efeitos adversos , Tontura/induzido quimicamente , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Manejo da Dor , Piridinas/efeitos adversos , Pirróis/efeitos adversos , Adulto Jovem
13.
Vet Clin North Am Equine Pract ; 35(3): 515-527, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587973

RESUMO

The number of donkeys in the world may not be increasing but awareness of their use and concern for welfare and pain recognition and treatment are receiving increasing veterinary interest. Therefore, accurate information about anesthesia and analgesia in donkeys and mules is important to more equine practitioners. This review highlights the current knowledge on various anesthetic and analgesic approaches in donkey and mules. The authors emphasize that there is still much information that is not available about donkeys and mules; in many circumstances, the clinician must use available equine information to treat the patient, while monitoring for differences in response.


Assuntos
Anestesia/veterinária , Equidae , Doenças dos Cavalos/terapia , Manejo da Dor/veterinária , Analgésicos/administração & dosagem , Anestésicos/administração & dosagem , Animais , Doenças dos Cavalos/fisiopatologia , Cavalos , Hipnóticos e Sedativos/administração & dosagem
14.
Einstein (Sao Paulo) ; 17(4): eAO4905, 2019 Sep 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31508661

RESUMO

OBJECTIVE: To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. METHODS: The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. RESULTS: For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. CONCLUSION: Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III.


Assuntos
Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Artroplastia de Quadril , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Anestesia Geral , Raquianestesia , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Relação Dose-Resposta a Droga , Bloqueio Nervoso/métodos , Manejo da Dor , Dor Pós-Operatória/etiologia , Período Perioperatório/métodos , Estudos Retrospectivos , Fatores de Tempo
15.
Niger J Clin Pract ; 22(9): 1301-1303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489871

RESUMO

Neuropathic pain responds poorly to common analgesics that effectively control nociceptive pain because its pathophysiology is different and it is usually associated with co-morbidities such as sleep disturbance, depression and anxiety. Patients with this chronic pain are sometimes left with neurolysis as the last resort. A 65-year-old male multiply-injured retiree presented with disabling pain following traumatic brachial plexus injury sustained from road traffic accident 5 years earlier. Other injuries resolved with therapy except the chronic severe burning and electrifying pain (VAS score 9) in the paralyzed left upper limb associated with allodynia and insomnia which was unresponsive to conventional analgesics. PainDETECT score was 29. A test supraclavicular block with 0.25% Bupivacaine was done, followed by chemical neurolysis one month later. He was placed on oral Gabapentin. The pain score a week post injection was 3 and has remained same 18 months post injection. Patient's level of satisfaction on 5 point Likert scale was 5. Chronic neuropathic pain following traumatic brachial plexus injury could be successfully managed by chemical neurolysis and oral gabapentin.


Assuntos
Analgésicos/administração & dosagem , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/tratamento farmacológico , Plexo Braquial/lesões , Gabapentina/administração & dosagem , Bloqueio Nervoso/métodos , Neuralgia/tratamento farmacológico , Extremidade Superior/lesões , Adulto , Idoso , Analgésicos/uso terapêutico , Neuropatias do Plexo Braquial/fisiopatologia , Bupivacaína/administração & dosagem , Gabapentina/uso terapêutico , Humanos , Hiperalgesia/etiologia , Masculino , Bloqueio Nervoso/efeitos adversos , Neuralgia/etiologia , Medição da Dor , Sono/efeitos dos fármacos , Distúrbios do Início e da Manutenção do Sono/etiologia , Resultado do Tratamento
16.
Tidsskr Nor Laegeforen ; 139(12)2019 Sep 10.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31502800

RESUMO

BACKGROUND: In July 2013, the Department of Paediatric and Adolescent Medicine at Østfold Hospital Trust introduced nitrous oxide as an option for procedural sedation of children and adolescents. MATERIAL AND METHOD: During the period 13 July 2013-25 August 2017, 311 procedures were performed with nitrous oxide in 238 patients aged 4-17 years. Age, sex, type and duration of procedure, any supplementary medications, complications and whether the procedure would previously have required general anaesthesia, were recorded in a form. The child rated the effectiveness of nitrous oxide using a graded age-appropriate 10-point pain scale, and the nurse rated it as good, moderate or none. RESULTS: The children reported a median pain score of 2/10 (interquartile range 0-4), and nurses rated effectiveness as good in 247 of 304 (81 %) cases. For 43 % of procedures, the nurse felt that general anaesthesia would have been necessary had the department not had access to nitrous oxide. Adverse effects, most often dizziness, were reported in 110 of 311 procedures (35 %). In 7 of 311 procedures (2 %), the patient experienced adverse effects that resulted in stoppage of the procedure. The procedure was completed in 286 (92 %) children. INTERPRETATION: Nitrous oxide is a useful option for children who require procedural sedation, and means that more procedures can be performed without general anaesthesia.


Assuntos
Anestésicos Inalatórios , Óxido Nitroso , Utilização de Procedimentos e Técnicas , Adolescente , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Anestesia Geral/estatística & dados numéricos , Anestesia Local , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Criança , Pré-Escolar , Contraindicações de Medicamentos , Feminino , Humanos , Masculino , Óxido Nitroso/administração & dosagem , Óxido Nitroso/efeitos adversos , Óxido Nitroso/farmacologia , Noruega , Enfermeiras e Enfermeiros , Medição da Dor , Utilização de Procedimentos e Técnicas/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Resultado do Tratamento
17.
BMC Complement Altern Med ; 19(1): 214, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412852

RESUMO

BACKGROUND: The present study evaluated the antinociceptive effect of the bark of Artocarpus lacucha, which is used for the treatment of stomachache, headache and boils in the traditional system of medicine. METHODS: The antinociceptive activity was investigated by the tail immersion, hot plate, acetic acid- & formalin-induced nociception and carrageenan-induced paw edema tests using a hydro-methanolic extract of A. lacucha bark. The plant extract was found to contain a substantial amount of phenolic compounds according to the total phenolic and flavonoid content assay. A phenolic metabolite, (+)-catechin, has been isolated using different chromatographic techniques. The compound was characterized with 1D and 2D NMR spectroscopic data. (+)-catechin, isolated from A. lacucha was assessed for antinociceptive effects swiss albino mice. Furthermore, the possible involvement of opioid receptors and ATP-sensitive K+ channel for the effect of the plant extract and (+)-catechin has been justified using naloxone and glibenclamide, respectively. RESULTS: Oral administration (p.o) of the plant extract (50-200 mg/Kg b.w.) resulted in significant thermal pain protection in the hot plate and tail immersion tests. The action of the plant extract was significantly antagonized by naloxone, a non-selective opioid antagonist, in the hot plate and tail immersion tests, which supports the involvement of opioid receptors. Both the plant extract and (+)-catechin, (50-200 mg/Kg b.w., p.o.) significantly diminished the acetic acid- & formalin-induced nociception, and carrageenan-induced paw edema. Glibenclamide, an ATP-sensitive K+ channel blocker, significantly reversed their effect in the acetic acid-induced writhing test which indicates the participation of ATP-sensitive K+ channel system. CONCLUSIONS: The investigation revealed potential central and peripheral antinociceptive effects of A. lacucha bark supports its applications in the traditional system of medicine.


Assuntos
Analgésicos/administração & dosagem , Artocarpus/química , Catequina/administração & dosagem , Edema/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Analgésicos/química , Analgésicos/isolamento & purificação , Animais , Carragenina/efeitos adversos , Catequina/análise , Catequina/isolamento & purificação , Edema/induzido quimicamente , Humanos , Masculino , Camundongos , Nociceptividade/efeitos dos fármacos , Dor/tratamento farmacológico , Extratos Vegetais/química
18.
Neurology ; 93(11): 500-509, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31413170

RESUMO

OBJECTIVE: To provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population. METHODS: The authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended. RESULTS: Fifteen Class I-III studies on migraine prevention in children and adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency. Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency. Children with migraine receiving amitriptyline plus cognitive behavioral therapy are more likely than those receiving amitriptyline plus headache education to have a reduction in headache frequency. RECOMMENDATIONS: The majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo. Recommendations for the prevention of migraine in children include counseling on lifestyle and behavioral factors that influence headache frequency and assessment and management of comorbid disorders associated with headache persistence. Clinicians should engage in shared decision-making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments.


Assuntos
Academias e Institutos/normas , Transtornos de Enxaqueca/tratamento farmacológico , Neurologia/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Adolescente , Analgésicos/administração & dosagem , Anticonvulsivantes/administração & dosagem , Criança , Cefaleia/tratamento farmacológico , Cefaleia/epidemiologia , Cefaleia/prevenção & controle , Humanos , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/prevenção & controle , Relatório de Pesquisa/normas , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Complement Ther Clin Pract ; 36: 34-38, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383440

RESUMO

BACKGROUND: Dysmenorrhea is the most common gynecologic complaint among adolescent and adult females. Some dysmenorrheic females do not respond to treatment with NSAIDs or oral contraceptives and exhibit contraindications to such medications. Therefore, alternative medication gained importance in management of dysmenorrhea. METHODS: A comparative clinical trial was conducted on thirty-one dysmenorrheic subjects, who were randomly assigned to three groups. The dosage was 1gr/day, 3gr/day and 3gr/day for Ginger, Dill seeds, and Cumin, respectively. The girls in respective group consumed the spice for three days during each cycle for three consecutive cycles. RESULTS: Dill seed was effective in reducing pain, followed by ginger wherein Cumin did not exhibit any effect. Cumin exhibited significant reduction in systemic responses like cold sweats, backache, fatigue and cramps. CONCLUSION: Dill seeds were more effective in reducing pain. It was obvious from our study that reducing symptoms is also important in the overall management of dysmenorrhea.


Assuntos
Analgésicos/uso terapêutico , Dismenorreia/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Especiarias , Analgésicos/administração & dosagem , Dismenorreia/fisiopatologia , Feminino , Humanos , Extratos Vegetais/administração & dosagem
20.
J Clin Nurs ; 28(23-24): 4207-4224, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410922

RESUMO

INTRODUCTION: Patients undergoing minimally invasive procedures under a light conscious sedation perceive pain and anxiety. Hypnosis used together with analgesics has been investigated in numerous studies. AIMS AND METHODS: To assess the effectiveness of hypnotic analgesia in management of pain, anxiety, analgesic consumption, procedure length and adverse events in adults undergoing minimally invasive procedures. Clinical controlled trials in which hypnosis was used together with pharmacological analgesia compared to pharmacological analgesia alone during invasive procedures were included. Seven databases were searched. The methodological quality of the studies was assessed by two reviewers using a standardised instrument for critical appraisal from Joanna Briggs Institute, 'Meta-Analysis of statistics assessment and review Instrument'. Meta-analyses using the review manager version 5.3 software were conducted on procedure length and adverse events. Results for pain, anxiety and analgesics were synthesised in narrative summaries. Conduction of the review adheres to the PRISMA checklist. RESULTS: Ten studies comprising 1,365 participants were included. A reduction in the consumption of pain medication was found between 21%-86% without aggravating pain intensity and anxiety. In few studies, significant reduction in pain intensity and anxiety was found. Meta-analysis including seven studies revealed a small beneficial effect on reducing procedure length. A meta-analysis on adverse events showed no significant reduction. Statistical heterogeneity was found among the studies included. CONCLUSION: For patients undergoing invasive procedures, hypnotic analgesia was effective in reducing consumption of analgesics. Only a slight effect was, however, found on experienced anxiety and pain intensity. It did not prolong the procedure and was safe to provide. RELEVANCE TO CLINICAL PRACTICE: Hypnosis is recommended as pain management for adults during invasive procedures. A reduced consumption of pain medication potentially has a major impact on monitoring and observation of patients following the procedure, thus improving patient safety and reducing resource consumption.


Assuntos
Sedação Consciente/métodos , Hipnose , Dor Processual/terapia , Analgésicos/administração & dosagem , Ansiedade/etiologia , Humanos , Medição da Dor
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