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1.
Ann Emerg Med ; 76(3S): S12-S20, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928457

RESUMO

STUDY OBJECTIVE: This was a prospective, pre-post, 13-year observational study documenting the multiyear implementation of an observation unit sickle cell pathway for patients with uncomplicated vaso-occlusive events. METHODS: The sickle cell pathway begins with rapid triage to identify patients with uncomplicated vaso-occlusive events for immediate transfer to the observation unit and initiation of patient-controlled analgesia followed by repeated evaluations of pain and identification of other complications. Data were abstracted from the electronic medical record or observation unit database. The sickle cell pathway was initiated in April 2006. Major revisions of it were carried out in June 2009 (physician evaluation occurs in sickle cell pathway and only patient-controlled analgesia administration of medications) and October 2010 (multidisciplinary management and individual dosing). RESULTS: Annual ED visits ranged between 287 and 528. The preimplementation hospital admission rate was 33% (123/368), 3-day return rate 16% (60/368), and 30-day return rate 67% (248/368). Refinements to the sickle cell pathway have resulted in a decrease in admission rate to 20% (258/1276); 3-day return rate, to 3.6% (46/1,276); and 30-day return rate, to 41% (525/1,276) for the past 3 years. CONCLUSION: The use of a sickle cell pathway for the treatment of uncomplicated vaso-occlusive events has been effective in providing rapid treatment and reducing hospital admissions. However, it was not only the intervention and its refinement that made the sickle cell pathway successful. With the Consolidated Framework for Implementation Research, it was discerned that outer setting factors of organizational commitment to the care of patients with SCD, inner setting factors of learning climate and leadership engagement, individuals, and process contributed to the success of the sickle cell pathway.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Anemia Falciforme/terapia , Unidades de Observação Clínica , Serviço Hospitalar de Emergência , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Adolescente , Adulto , Idoso , Anemia Falciforme/complicações , Estudos Controlados Antes e Depois , Procedimentos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Prospectivos , Triagem , Doenças Vasculares/etiologia , Adulto Jovem
2.
Anaesthesia ; 75(12): 1635-1642, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32530518

RESUMO

The programmed intermittent epidural bolus technique has shown superiority to continuous epidural infusion techniques, with or without patient-controlled epidural analgesia for pain relief, reduced motor block and patient satisfaction. Many institutions still use patient-controlled epidural analgesia without a background infusion, and a comparative study between programmed intermittent epidural bolus and patient-controlled epidural analgesia without a background infusion has not yet been performed. We performed a randomised, two-centre, double-blind, controlled trial of these two techniques. The primary outcome was the incidence of breakthrough pain requiring a top-up dose by an anaesthetist. Secondary outcomes included: motor block; pain scores; patient satisfaction; local anaesthetic consumption; and obstetric and neonatal outcomes. We recruited 130 nulliparous women who received initial spinal analgesia, and then epidural analgesia was initiated and maintained with either programmed intermittent epidural bolus or patient-controlled epidural analgesia using ropivacaine 0.12% with sufentanil 0.75 µg·ml-1 . The programmed intermittent epidural bolus group had a programmed bolus of 10 ml every hour, with on-demand patient-controlled epidural analgesia boluses of 5 ml with a 20 min lockout, and the patient-controlled epidural analgesia group had a 5 ml bolus with a 12 min lockout interval; the potential maximum volume per hour was the same in both groups. The patients in the programmed intermittent epidural bolus group had less frequent breakthrough pain compared with the patient-controlled epidural analgesia group, 7 (10.9%) vs. 38 (62.3%; p < 0.0001), respectively. There was a significant difference in motor block (modified Bromage score ≤ 4) frequency between groups, programmed intermittent epidural bolus group 1 (1.6%) vs. patient-controlled epidural analgesia group 8 (13.1%); p = 0.015. The programmed intermittent epidural bolus group had greater local anaesthetic consumption with fewer patient-controlled epidural analgesia boluses. Patient satisfaction scores and obstetric or neonatal outcomes were not different between groups. In conclusion, we found that a programmed intermittent epidural bolus technique using 10 ml programmed boluses and 5 ml patient-controlled epidural analgesia boluses was superior to a patient-controlled epidural analgesia technique using 5 ml boluses and no background infusion.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Gravidez
3.
Pain Res Manag ; 2020: 8517652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566063

RESUMO

In recent years, with the continuous understanding of pain knowledge and the continuous improvement of quality of life requirements, patient-controlled analgesia (PCA) has been widely used in a variety of pain patients. In this study, text mining technology was used to analyze relevant literature, try to find out the main drugs of PCA, classify the drugs, and dig out the important drug combination rules. PCA studies were retrieved from PubMed database in recent 10 years, and the bibliographic information of the literatures was taken as mining sample. First, the names of the drugs in the sample were identified by MetaMap package; then, Bicomb software was used to extract high-frequency drugs for the word frequency analysis and to construct a drug-sentence matrix. Finally, "hclust" package and "arules" package of R were used for the cluster analysis and association analysis of drugs. 39 main PCA drugs were screened out. Morphine, dexmedetomidine, and fentanyl were the top three drugs. Through cluster analysis, these drugs were divided into two clusters, one containing 26 common drugs and the other containing 13 core drugs. The association analysis of these drugs was carried out, and 22 frequent itemsets and 6 association rules were obtained. The maximum frequent 1-itemset was {Morphine} and the maximum frequent 2-itemset was {Morphine, Ropivacaine}. The research results have certain guidance and reference value for clinicians and researchers. In addition, it provides a way to study the relationship between drugs from the perspective of text mining.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos/uso terapêutico , Mineração de Dados/métodos , Combinação de Medicamentos , Adulto , Análise por Conglomerados , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Pain Res Manag ; 2020: 3105874, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32377285

RESUMO

Objective: To compare the effects of continuous paravertebral block analgesia and patient-controlled intravenous analgesia after minimally invasive radical esophagectomy for esophageal cancer and their effects on postoperative recovery. Methods: A retrospective analysis was performed among 233 patients who underwent minimally invasive esophageal cancer radical operation and met the requirements, including 87 patients (group C) who were successfully placed with a continuous paravertebral block device under direct vision and 146 patients (group P) who used a patient-controlled intravenous analgesia device. Visual analogue pain score (VAS) at rest and in motion for 1, 3, 6, 12, 24, 36, and 48 hours after awakening, incidence of adverse reactions of the two analgesic methods, occurrence of pulmonary complications after operation, use of emergency analgesics, and hospital stay after operation was recorded. Results: The VAS scores of group C in resting and active state at 1, 3, 6, 12, 24, 36, and 48 hours after operation were significantly lower than those of group P (P < 0.001). The incidence of adverse reactions, pulmonary complications, and the use of emergency analgesics in group C were lower than those in group P (P < 0.05). The hospitalization time of group C was significantly shortened, and the satisfaction degree of group C was significantly higher than that of group P (P < 0.05). Conclusion: Paravertebral block is safe and effective for patients undergoing minimally invasive radical esophagectomy. The incidence of adverse reactions and complications is lower, and the satisfaction of postoperative analgesia is higher, which is beneficial to the rapid recovery of patients after operation.


Assuntos
Esofagectomia/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Analgesia Controlada pelo Paciente/métodos , Analgésicos/uso terapêutico , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos
6.
Can J Surg ; 63(3): E250-E253, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386476

RESUMO

Background: Postoperative opioid analgesia may cause respiratory depression. We assessed whether following total hip arthroplasty, placebo-adjusted reductions in morphine consumption at 48 hours with parecoxib (47.0%), propacetamol (35.1%) or parecoxib plus propacetamol (67.9%) translated into a reduction in hypoxemic events. Methods: This was a post hoc analysis of a randomized, placebo-controlled, noninferiority study. Patients were randomly assigned to receive intravenous parecoxib (40 mg twice daily), propacetamol (2 g 4 times daily), parecoxib plus propacetamol (40 mg twice daily + 2 g 4 times daily) or placebo. Dose, date and time of morphine administration via patient-controlled analgesia were monitored throughout the study. In patients not receiving supplemental oxygen, peripheral blood oxygenation was assessed continuously for 48 hours after surgery. Hypoxemia was defined as peripheral oxygen saturation less than 90%. The times and oximeter readings of hypoxemic events were recorded. Pearson correlation coefficient was used to assess for correlations between cumulative morphine consumption at 48 hours and mean number of hypoxemic events. Results: A significantly smaller proportion of patients who received the combined treatment with parecoxib and propacetamol had hypoxemia versus placebo (2.8% v. 13.2%, p < 0.05), and the mean number of hypoxemic events was significantly smaller for parecoxib (0.12), propacetamol (0.06) and parecoxib plus propacetamol (0.03) versus placebo (0.36; all p < 0.05). There was no correlation between the reduction in cumulative morphine consumption at 48 hours and the mean number of hypoxemic events in any treatment group (all p > 0.1). Conclusion: Following total hip arthroplasty, a greater than 70% reduction in morphine consumption may be necessary to translate into a corresponding reduction in hypoxemic events.


Assuntos
Acetaminofen/análogos & derivados , Analgesia Controlada pelo Paciente/métodos , Artroplastia de Quadril/efeitos adversos , Hipóxia/epidemiologia , Isoxazóis/administração & dosagem , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Acetaminofen/administração & dosagem , Adulto , Idoso , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Hipóxia/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Suíça/epidemiologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(17): e19896, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332664

RESUMO

BACKGROUND: Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy. METHODS: A total of 180 geriatric patients undergoing esophagectomy were randomly divided into 2 groups and treated with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP, IL-1ß, IL-6, and TNF-α levels were detected in all patients. Pain intensity was measured by a numerical rating scale. Delirium was assessed using the confusion assessment method. RESULTS: The incidence of postoperative delirium was significantly lower in the PVB group than in the PCA group. Patients in the PVB group had lower plasma CRP, IL-1ß, IL-6, and TNF-α levels and less pain when coughing after surgery. CONCLUSIONS: Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery.


Assuntos
Delírio/prevenção & controle , Esofagectomia/normas , Bloqueio Nervoso/métodos , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente/métodos , Analgesia Controlada pelo Paciente/normas , Delírio/tratamento farmacológico , Esofagectomia/métodos , Feminino , Geriatria/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/normas , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos
8.
Chin Med J (Engl) ; 133(5): 523-529, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32142492

RESUMO

BACKGROUND: Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients. METHODS: One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded. RESULTS: The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ±â€Š16 bolus, 129 ±â€Š25 mL) than those in group MN (15 ±â€Š10 bolus, 120 ±â€Š16 mL) (both P < 0.05) and group HN (13 ±â€Š9 bolus, 117 ±â€Š13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05). CONCLUSIONS: Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS. TRIAL REGISTRATION NUMBER: ChiCTR1800015014, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Hidromorfona/administração & dosagem , Nalbufina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Adulto , Cesárea , Feminino , Humanos , Hidromorfona/efeitos adversos , Nalbufina/efeitos adversos , Satisfação do Paciente , Gravidez , Escala Visual Analógica
9.
BMC Pregnancy Childbirth ; 20(1): 151, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164593

RESUMO

BACKGROUND: Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor. METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included. RESULTS: A total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (- 10.6 [13.87, - 7.44], P < 0.00001, I2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group. CONCLUSION: There is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.


Assuntos
Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Dor do Parto/tratamento farmacológico , Remifentanil/uso terapêutico , Analgesia Obstétrica/métodos , Índice de Apgar , Feminino , Febre/terapia , Humanos , Recém-Nascido , Trabalho de Parto , Complicações do Trabalho de Parto/terapia , Manejo da Dor/métodos , Medição da Dor , Satisfação do Paciente , Gravidez
10.
Ir J Med Sci ; 189(4): 1365-1369, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32157585

RESUMO

BACKGROUND: Judicious spending in healthcare is of paramount importance, particularly when introducing new devices or interventions. These products or interventions need to be economically efficient both directly and indirectly. An accepted method of cost estimation is micro-costing. Micro-costing involves direct enumeration and costing of every input consumed in the treatment of a particular patient when using new device, medicine or intervention. In our study, we investigated the cost of using a novel sublingual (SL) patient-controlled analgesia (PCA) device and compared it with our conventional intravenous (IV) PCA device. METHODS: A previous study performed in our institution produced a cost per use of IV PCA device at €97. This compared with a previous European study published in this journal in 2010 which showed a similar figure of €96 per use of IV PCA device. In our comparative study, we used a case record form (CRF) to incorporate a cost to all consumables used, staff time and equipment used to both the SL PCA and the IV PCA. RESULTS: A total of 60 patients of similar demographic were included in our study. The cost of an IV PCA episode was €97.89 and €182.32 for an SL PCA episode. Standl et al. (2010) showed that the average cost of an IV PCA episode was €96.40 with 78% of this being made up of staff time. SL PCA was more efficacious in certain patient groups and in certain surgical groups. CONCLUSION: After performance of a micro-costing study, the less costly IV PCA episode was statistically significant compared with a SL PCA episode. However, the associated staff costs were less with a SL PCA episode. We performed a micro-costing study on a novel sublingual PCA device and compared it with a conventional intravenous PCA device. All resources were included and compared.


Assuntos
Administração Intravenosa/economia , Analgesia Controlada pelo Paciente/economia , Administração Intravenosa/métodos , Administração Sublingual , Analgesia Controlada pelo Paciente/métodos , Feminino , Humanos , Masculino
11.
Pain Physician ; 23(2): 175-201, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214301

RESUMO

BACKGROUND: Meperidine, a synthetic opioid, has a rapid onset and short duration of action. Mounting evidence has challenged meperidine's analgesic benefits, and concerns have been raised about its safety profile. Despite recommendations to restrict the prescription of meperidine, the drug remains frequently used. OBJECTIVES: The aim of this study was to evaluate the evidence regarding the efficacy and safety of meperidine for acute postoperative and labor pain. STUDY DESIGN: This was a narrative review of the analgesic efficacy and side effects of meperidine compared to other analgesic drugs for acute postoperative and labor pain in adults. SETTING: Randomized controlled trials that compared the analgesic efficacy and side effect profile of meperidine versus another analgesic drug in adult patients were evaluated. METHODS: A systemized search of randomized controlled trials studying meperidine for acute postoperative or labor pain in the adult patient population from PubMed, Medline, and EMBASE was performed. Included studies reported on different routes of meperidine administration including intramuscular, intravenous, and patient-controlled analgesia in various surgical procedures such as abdominal surgery, Cesarean section, gynecological surgery, orthopedic surgery, cardiothoracic surgery, as well as for labor analgesia. Meperidine's analgesic efficacy and safety profile were compared to other opioids (morphine, tramadol, fentanyl, buprenorphine, nalbuphine, and pentazocine), nonsteroidal anti-inflammatory drugs (ketorolac, diclofenac, and indomethacin), dipyrone, ketamine, and bupivacaine. RESULTS: A total of 62 randomized controlled trials published between 1972 and 2018 were reviewed. Meperidine had a similar or inferior analgesic efficacy compared to other analgesics for acute postoperative or labor pain. Meperidine was associated with more sedation and respiratory depression. LIMITATIONS: The sample sizes of many clinical studies were small, and therefore probably insufficiently powered to detect differences in uncommon side effects, such as central nervous system toxicity. In addition, some of the included clinical studies were old. CONCLUSION: Considering the availability of other effective analgesics with potentially fewer side effects, the use of meperidine for acute postoperative or labor pain should not be recommended. KEY WORDS: Acute postoperative pain, adverse effects, labor analgesia, meperidine, pethidine.


Assuntos
Dor do Parto/tratamento farmacológico , Meperidina/administração & dosagem , Meperidina/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Adulto , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Cesárea/efeitos adversos , Feminino , Humanos , Dor do Parto/diagnóstico , Morfina/uso terapêutico , Dor Pós-Operatória/diagnóstico , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Náusea e Vômito Pós-Operatórios/diagnóstico , Gravidez , Resultado do Tratamento
12.
Pain Physician ; 23(2): E185-E193, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214297

RESUMO

BACKGROUND: Opioid-based postoperative analgesia provides adequate analgesia with much adverse effects and immunosuppression. Dexmedetomidine and ketorolac have properties of opioid-sparing, antiinflammation, and immune protection. OBJECTIVES: To investigate the efficacy and safety of whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia and its effect on inflammatory response and immune function in thoracoscopic surgery of lung cancer. STUDY DESIGN: Double-blind, randomized control trial. SETTING: The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China. METHODS: Sixty patients scheduled for thoracoscopic surgery were enrolled and randomly divided into 2 groups to receive a combination of intraoperative usage of dexmedetomidine and postoperative patient-controlled intravenous analgesia of dexmedetomidine 0.1 µg/kg/h and ketorolac 3 mg/kg (DEX group) or only postoperative patient-controlled intravenous analgesia of sufentanil 1.5 µg/kg and ketorolac 3 mg/kg (SUF group) for 48 hours. Vital signs, postoperative Visual Analog Scale (VAS) score, Ramsay sedation score, patient-controlled analgesia pressing times, consumption of sufentanil and rescue drug, and complications were compared between the 2 groups. The levels of inflammatory factors and immune function were also compared. RESULTS: A significant reduction in median blood pressures and heart rates within 48 hours after surgery and perioperative consumption of sufentanil were observed in the DEX group compared with the SUF group (P < 0.05). No statistically significant difference was found in VAS scores, patient-controlled analgesia pressing times, and rescue drug consumption between the 2 groups (P > 0.05). The incidence of nausea was significantly lower in the DEX group compared with the SUF group (P < 0.05). A significant decrease of interleukin (IL)-1 beta, IL-6, tumor necrosis factor (TNF)-alpha, and increased CD4+ and CD4+/CD8+ were observed in the DEX group compared with the SUF group at 24 and 48 hours after surgery (P < 0.05). There was no difference in the levels of CD8+ and natural killer cells between the 2 groups (P > 0.05). LIMITATIONS: This study was limited by its sample size. CONCLUSIONS: Whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia provided adequate and safe postoperative analgesia, reduced sufentanil consumption, analgesia-related complications, alleviated inflammatory response, and immunosuppression compared with sufentanil-based analgesia in thoracoscopic surgery. KEY WORDS: Dexmedetomidine, ketorolac, sufentanil, thoracoscopic surgery, postoperative analgesic, patient-controlled analgesia, inflammatory response, immune function.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Dexmedetomidina/administração & dosagem , Cetorolaco/administração & dosagem , Neoplasias Pulmonares/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Toracoscopia/métodos , Adulto , Analgesia Controlada pelo Paciente/métodos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Toracoscopia/efeitos adversos
13.
PLoS One ; 15(2): e0229320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092098

RESUMO

BACKGROUND: Immersive virtual reality (IVR) is a form of distraction therapy that has shown potential as an analgesia and sedation sparing agent. This study assessed the effect of IVR on the self-administered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center. METHODS AND FINDINGS: This study was a single-center, randomized control trial at St Vincent's Hospital in Melbourne, Australia. Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone. The primary outcome measure was intra-operative propofol use. Secondary outcomes included pattern of propofol use over time, use of adjunct analgesia, unmet propofol demand, and patient satisfaction survey scores. Of 50 total patients, 25 received IVR in conjunction with PCS, and 25 received PCS alone. All patients received adjunct analgesia from the treating Anesthesiologist. Median propofol use/hour over the entire procedure in the control group was 40 (11.1, 93.9) mg/hour compared with 45 (0, 94.7) mg/hour in the IVR group (p = 0.90). There were no differences in patterns of propofol use over the course of each procedure. Adjusting for various baseline characteristics did not change the results. Postoperative satisfaction scores were equivalent in both groups. The VR intervention was well tolerated by all patients, with no report of major side effects. Key limitations were relatively small sample size, the non-blinded nature of the study, and use of adjunct analgesia. CONCLUSIONS: In patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Anestesia por Condução/métodos , Anestésicos Intravenosos , Artroplastia de Substituição/métodos , Propofol/administração & dosagem , Terapia de Exposição à Realidade Virtual , Idoso , Artroplastia de Quadril , Artroplastia do Joelho , Austrália , Sedação Consciente/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Medição da Dor , Dor Pós-Operatória/etiologia
14.
Int J Med Sci ; 17(2): 207-213, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038104

RESUMO

Background: The incidence of postoperative nausea and vomiting (PONV) remains high. The effects of sufentanil for PONV is not firmly confirmed. The aim of this study was to compare the effect of sufentanil- and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) on the incidence of PONV after laparoscopic nephrectomy. Methods: Eighty-six patients were randomly allocated to receive either the sufentanil (n =43) or fentanyl (n =43). IV-PCA was prepared using either sufentanil 3 µg/kg or fentanyl 20 µg/kg, ramosetron 0.3 mg, and ketorolac 120 mg. The primary outcome of was the incidence of PONV during 24 h after post anesthesia care unit (PACU) discharge. The secondary outcomes were the modified Rhodes index and patient satisfaction scores at 24 h after PACU discharge, need for rescue antiemetics, pain score, need for additional analgesics, and cumulative consumption of IV-PCA Results: The incidence of PONV was comparable between the sufentanil and fentanyl groups (64.3% vs. 65%, p = 0.946; respectively). The number of patients who required antiemetics (p = 0.946) and the modified Rhodes index at 24 h after post-anesthesia care unit discharge (p = 0.668) were also comparable in both groups. No significant differences were found in the secondary outcomes, including the analgesic profiles and adverse events between the groups. Conclusions: In conclusion, sufentanil- and fentanyl-based IV-PCA showed similar incidence of PONV with comparable analgesic effects after laparoscopic nephrectomy. Based on these results, we suggest that sufentanil and fentanyl may provide comparable effects for IV-PCA after laparoscopic nephrectomy.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Fentanila/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Sufentanil/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Estudos Prospectivos , Adulto Jovem
15.
Rev. Soc. Esp. Dolor ; 27(1): 24-36, ene.-feb. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193930

RESUMO

INTRODUCCIÓN: La intensidad del dolor postoperatorio moderado-intenso después de una cirugía cardiaca (CC) varía, según los estudios, de un 45 a un 85 %. No existe evidencia sobre cuál es la pauta analgésica óptima en el postoperatorio de estos pacientes. El objetivo de este estudio es evaluar la efectividad de la aplicación de un protocolo analgésico multimodal, basado en la analgesia controlada por el paciente (PCA) con morfina, en pacientes sometidos a CC con circulación extracorpórea (CEC). PACIENTES Y MÉTODOS: Estudio prospectivo de todos los pacientes sometidos a CC con CEC, durante los primeros 3 días del postoperatorio (DPO). Se incluyeron 102 pacientes en dos periodos, noviembre de 2016, con analgesia convencional (AC) y enero-febrero de 2017 con PCA. RESULTADOS: El dolor en reposo se mantuvo controlado (mediana escala numérica < 3). Se registró un 27 % de pacientes con dolor moderado e intenso. No hubo diferencias en la intensidad del dolor entre los pacientes con AC y los de PCA. El grupo de PCA precisó menos analgesia de rescate (63 vs. 44 %, p = 0,0487). La incidencia de dolor crónico postquirúrgico fue de un 39 % a los tres meses y un 3 % al año. El dolor y la ansiedad preoperatorios se correlacionaron con la intensidad del dolor dinámico (r = 0,287, p = 0,03). CONCLUSIONES: La PCA con opioides a demanda y analgesia multimodal es una alternativa efectiva después de la CC. Se obtiene un buen control del dolor postoperatorio sin incrementar los efectos adversos y precisando menos analgesia de rescate administrada por enfermería


INTRODUCTION: The intensity of postoperative moderate/intense pain after cardiac surgery (CC), varies according to the different studies, from 45 % to 85 %. There is no evidence about which is the optimal analgesic regimen in the postoperative period. The main objective of this study is to evaluate the effectiveness of the application of a multimodal analgesic protocol, based on patient-controlled analgesia (PCA) with morphine, in patients undergoing cardiac surgery with extracorporeal circulation (ECC). PATIENTS AND METHODS: Prospective observational study of all patients undergoing CS with ECC, during the first 3 days postoperatively. There were included 102 patients in two periods, first, in November 2016 with conventional analgesia and second, in January - February 2017 with PCA. RESULTS: The pain at rest was controlled (median numerical scale <3). An average of 27 % of moderate and intense pain was recorded. There was no difference in pain intensity between patients with CA and those with PCA. The PCA group required less rescue analgesia in the first postoperative days (63 % vs. 44 % p = 0.0487). The incidence of Post-surgical Chronic Pain was 39 % at three months, and 3 % at one year. There was a correlation between preoperative pain and anxiety with the intensity of the dynamic pain (r = 0.287, p = 0.03). CONCLUSIONS: PCA with on-demand opioids and multimodal analgesia is an effective alternative after cardiac surgery. Good control of postoperative pain is obtained without increasing adverse effects, and requiring less rescue analgesia administered by the nursing staff


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Analgesia Controlada pelo Paciente/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Medição da Dor/métodos , Analgesia Controlada pelo Paciente/estatística & dados numéricos , Dor Aguda/tratamento farmacológico , Dor Crônica/tratamento farmacológico , Manejo da Dor/métodos , Estudos Prospectivos , Morfina/administração & dosagem , Terapia Combinada/métodos , Catastrofização/psicologia
16.
Orthop Nurs ; 39(1): 37-46, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977740

RESUMO

BACKGROUND: Multimodal pain management for surgery patients may include the use of a combination of scheduled oral pain medications with as-needed (PRN) oral opioids. Multiple concurrent time demands on nursing staff frequently cause delays in the delivery of oral PRN pain medication compromising pain management. PURPOSE: Postoperative pain control was compared using a wireless oral patient-controlled analgesia device for the delivery of oxycodone with a control group receiving PRN oxycodone from nursing staff. METHODS: Thirty patients were prospectively randomized into each of 2 groups after total hip arthroplasty. Patient demographics, pain scores, drug dose data, and physical therapy data were collected from chart reviews. Additional data were obtained from patient and nursing surveys. RESULTS: Device patients recorded statistically lower pain scores while taking lower doses of oxycodone on postoperative Day 1 as compared with the control group. Patient surveys indicated that those in the device group reported lower pain scores 24 hours prior to discharge, albeit not statistically different from the control group. Men in the device group reported statistically lower pain scores with physical therapy than men in the control group. Findings from the nursing survey indicate that nurses favored the device over nurse-administered PRN. CONCLUSION: Patients using the wireless patient-controlled analgesia (PCA) (oral) device had less pain at rest and with activity (men) while taking lower doses of oxycodone with each dose. Nursing surveys indicated that nursing staff in this orthopedic postoperative unit found the device easy to use, reliable, and efficient. They also recommended its adoption for those capable of using it.


Assuntos
Administração Oral , Analgesia Controlada pelo Paciente/normas , Analgesia/normas , Idoso , Analgesia/métodos , Analgesia Controlada pelo Paciente/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Estudos Prospectivos
17.
Br J Surg ; 107(2): e133-e141, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903600

RESUMO

BACKGROUND: The optimal analgesia regimen after laparoscopic colorectal cancer surgery is unclear. The aim of the study was to characterize the beneficial effects of continuous transversus abdominis plane (TAP) blocks initiated before operation on outcomes following laparoscopic colorectal cancer surgery. METHODS: Patients undergoing surgery for colorectal cancer were divided randomly into three groups: combined general-TAP anaesthesia (TAP group), combined general-thoracic epidural anaesthesia (TEA group) and standard general anaesthesia (GA group). The primary endpoint was duration of hospital stay. Secondary endpoints included gastrointestinal motility, pain scores and plasma levels of cytokines. RESULTS: In total, 180 patients were randomized and 165 completed the trial. The intention-to-treat analysis showed that duration of hospital stay was significantly longer in the TEA group than in the TAP and GA groups (median 4·1 (95 per cent c.i. 3·8 to 4·3) versus 3·1 (3·0 to 3·3) and versus 3·3 (3·2 to 3·6) days respectively; both P < 0·001). Time to first flatus was earlier in the TAP group (P < 0·001). Visual analogue scale (VAS) scores during coughing were lower in the TAP and TEA groups than the GA group (P < 0·001). Raised plasma levels of vascular endothelial growth factor C, interleukin 6, adrenaline and cortisol were attenuated significantly by continuous TAP block. CONCLUSION: Continuous TAP analgesia not only improved gastrointestinal motility but also shortened duration of hospital stay. A decreased opioid requirement and attenuating surgical stress response may be potential mechanisms. Registration number: ChiCTR-TRC-1800015535 ( http://www.chictr.org.cn).


Assuntos
Músculos Abdominais/inervação , Analgesia Controlada pelo Paciente/métodos , Anestesia Epidural/métodos , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Anestesia Geral/métodos , Colectomia/métodos , Feminino , Motilidade Gastrointestinal , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor
18.
J Coll Physicians Surg Pak ; 29(12): 1138-1143, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31839083

RESUMO

OBJECTIVE: To compare the effects of preoperative ultrasound-guided erector spinae plane block (ESPB) and preoperative wound infiltration on perioperative opioid consumption and postoperative pain in thoracotomy. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from October 2018 to April 2019. METHODOLOGY: Sixty adult patients undergoing open esophagectomy were allocated randomly into two groups: experimental group (ultrasound-guided ESPB group, n = 30) and control group (wound infiltration group, n = 30). In ultrasound-guided ESPB group (group EB), ESPB with 20 ml of 0.5% ropivacaine was performed at the level of thoracic 5 transverse process. Whereas, in wound infiltration group (group WI), 20 ml of 0.5% ropivacaine was injected subcutaneously along the marked line of skin incision for surgery and chest tube placement. The perioperative opioid consumption, pain scores at rest and during coughing immediately after surgery, at postoperative day (POD) 1 and POD 2, consumption of rescue analgesic tramadol and postoperative opioid-related adverse events were all assessed. RESULTS: Compared with group WI, the intraoperative and postoperative opioid consumptions, postoperative tramadol consumption were significantly less in group EB (p <0.05). Moreover, the postoperative pain scores immediately after surgery, at POD 1 and POD 2, were all lower in group EB compared to group WI (p <0.05). Significantly, the postoperative incidence of nausea and vomiting was lower in group EB than that in group WI (p = 0.021). CONCLUSION: Compared to wound infiltration with local anesthetics, preoperative ultrasound-guided ESPB could significantly reduce perioperative opioid consumption, provide a better postoperative analgesia and reduce opioid-related adverse events in thoracotomy.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Terapia Assistida por Computador/métodos , Toracotomia/efeitos adversos , Ultrassonografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Medição da Dor , Dor Pós-Operatória/diagnóstico , Período Perioperatório , Vértebras Torácicas
19.
J Coll Physicians Surg Pak ; 29(12): 1169-1172, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31839089

RESUMO

OBJECTIVE: To compare post-TKA (total knee arthroplasty) analgesic effect of periarticular injection of different analgesics during surgery. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Tianjin People's Hospital, from December 2016 to July 2018. METHODOLOGY: Patients undergoing unilateral TKA were randomly divided into Group A and Group B, with 67 patients in each group. In Group A, compound analgesics of ropivacaine, ketorolac, adrenaline, morphine and normal saline were injected periarticularly during surgery. While in Group B, compound analgesics of bupivacaine, methylprednisolone, adrenalin, morphine and normal saline were injected periarticularly during surgery. Visual analogue scale (VAS), range of motion (ROM) of knee joint, and rehabilitation of knee joint of both groups were compared. RESULTS: VAS scores of Group A at 6-hour, 24-hour, 48-hour and 72-hour after surgery was lower than those of Group B (p=0.046, p<0.001, p<0.001 and p<0.001, respectively). ROM of knee joint of Group A on the 3rd, 7th, 10th and 14th day after surgery was superior to that of Group B (all p<0.001). On the 14th day after surgery, excellent and good rate of rehabilitation of knee joint of Group A was higher than that of Group B (p=0.032). CONCLUSION: Compared with periarticular injection of compound analgesics of bupivacaine, methylprednisolone, adrenaline, morphine and normal saline during surgery, periarticular injection of compound analgesics of ropivacaine, ketorolac, adrenaline, morphine and normal saline during surgery can alleviate post-TKA pain more effectively, improve early ROM of joint knee after surgery, increase rehabilitation effect of knee joint.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos/administração & dosagem , Artroplastia do Joelho/reabilitação , Dor Pós-Operatória/tratamento farmacológico , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intra-Articulares , Período Intraoperatório , Cetorolaco/administração & dosagem , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Morfina/administração & dosagem , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Vasoconstritores/administração & dosagem
20.
BMJ Open ; 9(12): e032203, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874879

RESUMO

OBJECTIVES: To explore women's experiences of remifentanil or pethidine for labour pain and infant feeding behaviours at 6weeks post partum. DESIGN: Qualitative postnatal sub-study to the randomised controlled trial of remifentanil intravenous patient controlled analgesia (PCA) versus intramuscular pethidine for pain relief in labour (RESPITE). Semistructured telephone interviews were conducted at 6 weeks post partum, and thematic analysis was undertaken. SETTING: Women recruited to the RESPITE trial from seven UK hospitals. PARTICIPANTS: Eighty women consented and 49 (30 remifentanil group and 19 pethidine group) completed the interview. RESULTS: Eight themes emerged which encompassed women's antenatal plans for pain management (Birth Expectations) through to their future preferences for pain relief (Reflections for Future Choices). Many women who used remifentanil felt it provided effective pain relief (Effectiveness of Pain Relief), whereas women in the pethidine group expressed more mixed views. Both groups described side effects, with women using pethidine frequently reporting nausea (Negative Physiological Responses) and women using remifentanil describing more cognitive effects (Cognitive Effects). Some women who used remifentanil reported restricted movements due to technical aspects of drug administration and fear of analgesia running out (Issues with Drug Administration). Women described how remifentanil enabled them to maintain their ability to stay focused during the birth (Enabling a Sense of Control). There was little difference in reported breastfeeding initiation and continuation between pethidine and remifentanil groups (Impact on Infant Behaviour and Breastfeeding). CONCLUSIONS: Qualitative insights from a follow-up study to a trial which explored experiences of intravenous remifentanil PCA with intramuscular pethidine injection found that remifentanil appeared to provide effective pain relief while allowing women to remain alert and focused during labour, although as with pethidine, some side effects were noted. Overall, there was little difference in reported breastfeeding initiation and duration between the two groups. TRIAL REGISTRATION NUMBER: ISRCTN29654603.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor do Parto/tratamento farmacológico , Meperidina/administração & dosagem , Remifentanil/administração & dosagem , Adulto , Analgesia Controlada pelo Paciente/métodos , Aleitamento Materno/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Meperidina/efeitos adversos , Gravidez , Pesquisa Qualitativa , Remifentanil/efeitos adversos
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