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1.
Eur J Anaesthesiol ; 38(7): 758-767, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34101639

RESUMO

BACKGROUND: Transversus abdominis plane (TAP) blocks have been shown to successfully reduce pain and opioid consumption after general and gynaecological surgery. OBJECTIVE: To evaluate whether TAP blocks alleviate pain and opioid consumption after urological procedures. DESIGN: A systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase and CENTRAL. ELIGIBILITY CRITERIA: Without language restriction, randomised controlled trials (RCTs) that compared the effects of TAP blocks with placebo or no treatment in urological surgery. MAIN OUTCOME MEASURES: Primary outcomes were pain intensities at rest and movement at 6, 12 and 24 h after surgery. Secondary outcomes were postoperative opioid consumption in the first 24 h after surgery and postoperative nausea and vomiting. We performed meta-analyses using random effects models. Effect sizes were expressed as mean differences for continuous variables. We used the Cochrane risk of bias tool (RoB 2.0) to assess risk of bias. RESULTS: We analysed 20 RCTs comprising a total of 1239 patients. The risk of bias of the studies was relatively high. TAP blocks significantly reduced postoperative pain at all time points compared with placebo or no treatment. Mean differences on an 11-point pain intensity scale were between 0.55 (95% CI: -0.90, to -0.21; P = 0.002; I2 = 94%) to 1.13 (95% CI: -1.62 to -0.65; P < 0.001; I2 = 95%) less at rest and 0.74 (95% CI: -1.25 to -0.23; P = 0.005; I2 = 79%) to 1.32 (95% CI: -1.83 to -0.81; P < 0.001; I2 = 68%) less on movements. TAP blocks also reduced opioid consumption in the first 24 h after surgery significantly by 12.25 mg (95% CI: -17.99 to -6.52 mg; P < 0.001; I2 = 99%) morphine equivalents. Possibly, this had no influence on postoperative nausea and vomiting (risk ratio: 0.98; 95% CI: 0.66 to 1.45; P = 0.91; I2 = 30%). CONCLUSION: TAP blocks seem to offer improved analgesia when used after urological surgery. However, due to the large heterogeneity between and the considerable risk of bias within the included studies results should be viewed with caution. SYSTEMIC REVIEW REGISTRATION: PROSPERO CRD42018112737.


Assuntos
Analgesia , Bloqueio Nervoso , Músculos Abdominais , Analgésicos Opioides , Humanos , Morfina , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia
2.
Medicine (Baltimore) ; 100(22): e25884, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087830

RESUMO

BACKGROUND: Currently, no meta-analysis exists elucidate the analgesic effect of adding IPACK block to our current multimodal analgesia regimen after total knee replacement (TKR). The purpose of this study is to systematically review the level I evidence in the literature to ascertain whether IPACK block can bring additional analgesic benefits to existing multimodal analgesia regimens. METHODS: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Only level I randomized controlled trials (RCTs) were included in our study. The primary outcome was the pain scores with rest and activity. Secondary outcomes included cumulative opioid consumption, cumulative distance ambulated, and length of stay (LOS). RESULTS: Five RCTs with a total of 467 patients were included. The most important finding in our study was that although IPACK block supplementation improved pain scores at 12 hours with rest or activity after surgery, no such benefit was observed at subsequent time points during the postoperative period. Interestingly, IPACK supplementation did not reduce opioid consumption, especially in the first 24 hours after surgery. Furthermore, other postoperative outcomes, including cumulative distance ambulated and LOS, were also not improved by the addition of an IPACK. CONCLUSIONS: The addition of an IPACK block to multimodal analgesia regiments does not reduce the postoperative opioid consumption nor improve functional performance. However, it may be an appropriate method to improve immediate analgesic effects after TKR.


Assuntos
Analgesia/métodos , Artroplastia do Joelho/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Analgésicos Opioides/administração & dosagem , Índice de Massa Corporal , Terapia Combinada , Deambulação Precoce , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Jt Dis Relat Surg ; 32(2): 290-298, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145803

RESUMO

OBJECTIVES: The aim of this study was to analyze the postoperative effects of extended nerve blocks and local infiltration analgesia (LIA) on postoperative pain control, muscle weakness, and blood loss after total knee arthroplasty (TKA). PATIENTS AND METHODS: Between February 24th 2020 and July 10th 2020, a total of 161 patients (55 males, 106 females; median age: 69.0 years [IQR 63.0-75.0], range, 41 to 81 years) who underwent primary TKA were randomly allocated into three parallel groups according to their concomitant procedure in a double-blind fashion: (i) those to whom nerve blockade was performed after competition of surgery under the duration of spinal anesthesia (n=50); (ii) those to whom LIA was performed during surgery (n=52), and (iii) control group (n=59). The content of LIA was 10-10 mL of 20 mg lidocaine with 0.01 mg adrenalin and 100 mg ropivacaine, 1 mL (30 mg) ketorolac, and 5 mL (500 mg) tranexamic acid was diluted by 50 mL 0.9% NaCl under aseptic conditions. Outcome parameters were the evaluation of pain until the evening of first postoperative day (24 to 36 h), mobilization, and blood loss within the first three postoperative days. RESULTS: The pain was maximal between 4 and 8 h postoperatively, when the effect of the spinal anesthetic drugs disappeared. During this critical period, tolerable pain (Numerical Rating Scale, NRS ≤3) was observed in 52%, 42%, and 19% of nerve blockade in LIA and control groups, respectively. None of the patients complained of high-intensity pain (NRS >8) in the LIA group, which was a significant difference from the block and control groups (10% and 14%, p<0.008, respectively). There was no significant muscle weakness associated with the use of this extended block. The decrease in hemoglobin level was significantly lower in the LIA group than in the control and block groups (odds ratio [OR]: 0.379, 95% confidence interval [CI]: 0.165-0.874 for nerve blockade vs. LIA, OR: 1.189, 95% CI: 0.491-2.880 for nerve blockade vs. control, OR: 0.319, 95% CI: 0.140-0.727, respectively). The common language effect size for pain in each referred interval in each group and for decrease of hemoglobin between the first and third postoperative days fell between 0.507 and 0.680. CONCLUSION: This study demonstrates that LIA technique offers a fast and safe treatment option for pain relief after TKA. No clinically relevant muscle weakness was observed among groups according to field block applications. Significant advantages were also achieved in blood loss.


Assuntos
Analgesia/métodos , Anestesia Local/métodos , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Raquianestesia , Anestésicos Locais , Anti-Inflamatórios não Esteroides , Antifibrinolíticos/administração & dosagem , Método Duplo-Cego , Epinefrina/administração & dosagem , Feminino , Hemoglobinas/metabolismo , Humanos , Cetorolaco , Lidocaína , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ropivacaina , Ácido Tranexâmico/administração & dosagem , Vasoconstritores/administração & dosagem , Caminhada
4.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(6): 565-569, 2021 Jun 09.
Artigo em Chinês | MEDLINE | ID: mdl-34098672

RESUMO

Objective: To evaluate the effect of preventive use of etocoxib-induced preemptive analgesia on three types of pain (wound pain, swallowing pain, mouth opening pain) after extraction of impacted teeth. Methods: In this study, 60 patients (60 teeth) with impacted mandibular third molars in Department of Jinyintan Outpatient, School of Stomatology, Wuhan University from May to October 2020 were enrolled. The patients were numbered by SPSS 21.0 and randomly divided into two groups. The odd number was included in the etocoxib group, and the even number was included in the control group, with 30 cases in each group. Patients in the two groups were given etocoxib 60 mg or placebo vitamin C 100 mg 30 min before operation. Pain at 2, 4, 6, 8, 10, 12, and 24 hours after tooth extraction was recorded with numeric rating scale (NRS) score. The total dose of ibuprofen rescue intake was recorded. Kaplan-Meier curves and Log-Rank analyses were used to evaluate the proportion of patients without rescue analgesic. Results: The NRS scores of wound pain, swallowing pain and mouth opening pain in the etoricoxib group were lower than those in the control group within 24 hours after tooth extraction (P<0.05). The total dose of emergency analgesics in the etoricoxib group [(0.7±0.7) dose] was lower than that in the control group [(1.4±0.9) dose] (P<0.01). The mean time between first application of analgesics was 11.5 hours in etoricoxib group and 3.5 hours in the placebo group, respectively (P<0.05). Conclusions: This study revealed that etoricoxib has a substantial preemptive analgesic effect, resulting in the reduced use of analgesics after third molar removal.


Assuntos
Analgesia , Dente Impactado , Método Duplo-Cego , Etoricoxib , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Extração Dentária , Dente Impactado/cirurgia
5.
Zhonghua Yi Xue Za Zhi ; 101(21): 1592-1597, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34098686

RESUMO

Objective: To report a method of visualized saphenous nerve block (VSNB) through minimally invasive far medial-subvastus approach distal to the adductor canal in total knee arthroplasty (TKA), and investigate the effect of VSNB in this way on postoperative pain relief. Methods: A total of 100 patients with knee osteoarthritis were prospectively included from June 2018 to October 2019, 29 males and 71 females, aged 50-87(70±8) years. All patients undergoing TKA through minimally invasive far medial-subvastus approach were randomized to visualized saphenous nerve block combined with periarticular infiltration analgesia group (Group VSNB+PIA) or only periarticular infiltration analgesia group (Group PIA),50 cases in each group. The visual analogue scale (VAS) was used to evaluate the pain degree of patients. Furthermore, the scores of VAS in resting and active state at 4, 8, 12, 24, 48, 72 hours after operation and the proportion of patients receiving parecoxib within 72 hours after operation were compared between the two groups. Results: There was statistically significant difference between the two groups in terms of VAS scores in resting state after surgery(F=15.295,P<0.05).The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at resting state were 1.3±0.8, 1.4±0.7, 1.7±0.8, 3.1±0.8 respectively, which were all significantly lower than those of Group PIA (1.6±0.9, 1.8±0.8, 2.3±0.9, 3.6±0.8) (P<0.05). The overall difference in terms of VAS scores at active state after surgery was statistically significant between the two groups(F=18.532, P<0.05). The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at active state were 2.0±0.8, 2.2±0.7, 2.7±0.6, 3.7±0.7 respectively, which were all significantly lower than those of Group PIA (2.3±0.8, 2.7±0.7, 3.3±0.8, 4.4±0.7)(P<0.05). Fourteen percent of patients (7/50) in VSNB+PIA group accepted parecoxib within 72 hours after surgery, which was significantly lower than that in PIA group (34%, 17/50) (P<0.05). Conclusions: It is easy to expose the saphenous nerve beyond the adductor canal through minimally invasive far medial-subvastus approach. The Combination therapy of VSNB+PIA is more effective than the simple per-articular infiltration analgesia in providing pain relief after total knee arthroplasty.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Anestésicos Locais , Feminino , Humanos , Masculino , Manejo da Dor , Dor Pós-Operatória
7.
Stomatologiia (Mosk) ; 100(3): 30-34, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34180622

RESUMO

THE AIM OF THE STUDY: Was the assessment of the efficacy of using non-steroidal anti-inflammatory drug Ketorol Express as a preventive analgesia in the treatment of acute pulpitis in molars. MATERIALS AND METHODS: The study comprised 128 individuals, 76 (59.4%) women and 52 (40.6%) men. The mean age was 37.4 years. Two different visual-analog scales were used to evaluate the effectiveness of pain relief and the general well-being of the patient and the doctor. THE RESULTS: Of the study proved that the preventive analgesia with Ketorol Express at a dosage of 20 mg 15 minutes before local anesthesia with 4% articaine with epinephrine 1:200 000 in patients diagnosed with acute pulpitis of molars was effective since local anesthesia high effectiveness, absence of necessity for alternate anesthesia were registered by patients, which coincided with the dentist's opinion. CONCLUSION: Preventive analgesia with Ketorol Express improves the efficacy of local anesthesia in the treatment of acute pulpitis in molars.


Assuntos
Analgesia , Anestesia Dentária , Bloqueio Nervoso , Pulpite , Adulto , Anestesia Local , Anestésicos Locais , Carticaína , Método Duplo-Cego , Feminino , Humanos , Masculino , Dente Molar , Dor , Pulpite/tratamento farmacológico
8.
Curr Opin Anaesthesiol ; 34(4): 544-552, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34184643

RESUMO

PURPOSE OF REVIEW: This review aims to provide an overview of selective periarticular blocks for postoperative pain after hip and knee arthroplasty and the current evidence for their use. RECENT FINDINGS: Most interventional analgesia techniques for hip and knee arthroplasty result in a motor block and muscle weakness. Therefore, these are not well suited for fast-track protocols. In contrast, selective pericapsular infiltration techniques provide selective joint sensory block without an associated motor block. This facilitates postoperative pain management and avoids impairing ambulation and early rehabilitation. SUMMARY: The pericapsular blocks of the hip (pericapsular nerve group block, iliopsoas plane block, hip block), genicular nerves block, and infiltration between the popliteal artery and the capsule of the knee play an increasingly important role in providing postoperative analgesia after hip and knee arthroplasty without impeding fast-track protocols.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Anestésicos Locais , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
9.
J Clin Anesth ; 73: 110372, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34098394

RESUMO

STUDY OBJECTIVE: This study aimed to evaluate the efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. DESIGN: This was a prospective, randomized controlled trial. SETTING: We collected data in the preoperative area, operating room, and bed ward. PATIENTS: A total of 80 patients with American Society of Anesthesiology functional status scores of II-III were included and assigned to two groups, and all 80 patients were included in the final analysis. INTERVENTIONS: All included patients were randomly assigned to the nerve block (group N) or the control group (group C). Patients in the group N received transmuscular QLB combined with LIA, while patients in the group C received only LIA. MEASUREMENTS: The primary outcome was postoperative pain during the first active motion: it was measured at six hours after surgery and assessed using a visual analog scale (VAS). Secondary outcomes were the resting VAS scores in the post-anesthesia care unit (PACU) and at 2, 6, 12, 24, 48, and 72 h after surgery; VAS scores during motion at 12, 24, 48, and 72 h after surgery; intraoperative consumption of opioids; postoperative consumption of morphine hydrochloride; frequency of sleep interruption due to pain on the night of surgery; time until the first "walk out of the bed" after surgery; muscle strength of the quadriceps femoris; and postoperative adverse effects. MAIN RESULTS: Compared to the group C, patients in the group N had significantly lower VAS scores during motion at 6, 12, and 24 h after surgery, as well as lower resting VAS scores in the PACU and at 2, 6, 12, and 24 h after surgery. Patients in the group N also consumed significantly smaller amounts of intraoperative opioids and morphine after surgery. Patients in the group N reported significantly fewer interruptions in sleep due to pain on the night of surgery and were able to "walk out of the bed" significantly earlier than those in the group C. There was no significant difference between the two groups in muscle strength of the quadriceps femoris or incidence of postoperative adverse effects. CONCLUSIONS: Compared to treatment with LIA alone, ultrasound-guided transmuscular QLB combined with LIA can provide better postoperative pain relief and enhance the recovery of THA patients, since it does not cause quadriceps femoris muscle weakness and is associated with significantly lower need for intraoperative opioids.


Assuntos
Analgesia , Artroplastia de Quadril , Bloqueio Nervoso , Anestésicos Locais , Artroplastia de Quadril/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , Manejo da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ultrassonografia de Intervenção
11.
J Cardiothorac Surg ; 16(1): 118, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933112

RESUMO

OBJECTIVE: To study the effect of an early childhood education machine on sedation and analgesia in children after cardiothoracic surgery. METHODS: A prospective randomized controlled study was conducted in a provincial hospital in China. Fifty-two patients (aged from 1 to 5 years) underwent cardiothoracic surgery (including: ventricular septal defect, patent ductus arteriosus, atrial septal defect, pulmonary stenosis, pulmonary sequestration and congenital cystic adenomatoid lung malformation) were divided into the study group (n = 26) and the control group (n = 26). The patients in the study group underwent intervention with an early childhood education machine (uniform type) in addition to routine standard treatment and nursing, while the patients in the control group only received routine standard treatment and nursing. Richmond agitation sedation score (RASS) and face, legs, activity, cry, consolability (FLACC) score of all of the patients were evaluated, and the negative emotions (self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) score) of the parents of the two groups were compared. RESULTS: There was no significant difference in the general clinical data between the two groups. The RASS and FLACC scores in the study group were significantly lower than those in the control group, and the SAS and SDS scores of the parents in the study group were significantly lower than those in the control group. CONCLUSION: The application of an early childhood education machine for children after cardiothoracic surgery can effectively reduce postoperative agitation, improve sedation and analgesia of the patients, and ease the pessimistic mood of the patients' parents.


Assuntos
Analgesia/métodos , Sequestro Broncopulmonar/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Permeabilidade do Canal Arterial/cirurgia , Comunicação Interatrial/cirurgia , Comunicação Interventricular/cirurgia , Estenose da Valva Pulmonar/cirurgia , Anestesia , Pré-Escolar , China , Feminino , Hemodinâmica , Humanos , Lactente , Masculino , Dor , Manejo da Dor , Período Pós-Operatório , Estudos Prospectivos , Índice de Gravidade de Doença
12.
Chirurg ; 92(7): 647-663, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34037807

RESUMO

BACKGROUND: Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. METHODS: An expert panel representing the German national societies of pain, anaesthesiology and intensive care medicine and surgery developed recommendations for the perioperative use of nonopioid analgesics within a formal, structured consensus process. RESULTS: The panel agreed that nonopioid analgesics shall be part of a multimodal analgesia concept and that patients have to be informed preoperatively about possible complications and alternative treatment options. Patients' history of pain and analgesic intake shall be evaluated. Patients at risk of severe postoperative pain and possible chronification of postsurgical pain shall be identified. Depending on the duration of surgery, nonopioid analgesics can already be administered preoperatively or intraoperatively so that plasma concentrations are sufficient after emergence from anesthesia. Nonopioid analgesics or combinations of analgesics shall be administered for a limited time only. An interdisciplinary written standard of care, comprising the nonopioid analgesic of choice, possible alternatives, adequate dosing and timing of administration as well as surgery-specific policies, have to be agreed upon by all departments involved. At discharge, the patient's physician shall be informed of analgesics given and those necessary after discharge. Patients shall be informed of possible side effects and symptoms and timely discontinuation of analgesic drugs. CONCLUSION: The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.


Assuntos
Analgesia , Analgésicos não Narcóticos , Anestesiologia , Consenso , Cuidados Críticos , Humanos
13.
J Card Surg ; 36(8): 2818-2823, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34047403

RESUMO

BACKGROUND: The mid-sternum is the main source of pain after open cardiac surgery. The aim of this study was to investigate the effect of bilateral transversus thoracis muscle plane (TTMP) blocks on open cardiac surgery. METHODS: Sixty patients were randomly divided into two groups: bilateral TTMP blocks (TP group) or no nerve block (CO group). The primary endpoint was perioperative sufentanil consumption. The secondary outcome measures included postoperative pain, flurbiprofen axetil administration, quality of sleep after extubation, time to extubation, time to the return of gastrointestinal function, time to drain removal, the Intensive Care Unit (ICU) stay time, and hospital stay. RESULTS: The TP group reported significantly less sufentanil and flurbiprofen axetil consumption than the CO group. The CO group had higher Numerical Rating Scale (NRS) pain scores at 1, 2, 6, 12, and 24 h after extubation both at rest and during movement than the TP groups. Compared with the CO group,time to extubation, time to the first bowel movement, ICU stay time, and hospital stay were significantly decreased in the TP group. The TP group was rated as better in the quality of the two nights of sleep after extubation. CONCLUSION: Bilateral TTMP blocks can provide good perioperative analgesia for patients undergoing open cardiac surgery and promote postoperative recovery.


Assuntos
Analgesia , Procedimentos Cirúrgicos Cardíacos , Analgésicos Opioides , Humanos , Músculos , Dor Pós-Operatória/prevenção & controle
15.
Neuron ; 109(9): 1413-1416, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33957067

RESUMO

How genetic loss of the sodium channel NaV1.7 results in painlessness is puzzling. MacDonald et al. (2021) demonstrate that instead of impairing peripheral excitability, NaV1.7 channels at central terminals of pain-sensing afferents play a pivotal role in the balance between pain and analgesia.


Assuntos
Analgesia , Gânglios Espinais , Animais , Humanos , Camundongos , Canal de Sódio Disparado por Voltagem NAV1.7/genética , Canal de Sódio Disparado por Voltagem NAV1.8 , Dor/genética , Células Receptoras Sensoriais
16.
Croat Med J ; 62(2): 137-145, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33938653

RESUMO

AIM: To explore the effects of an anterior quadratus lumborum block (QLB) on opioid consumption, pain, nausea, and vomiting (PONV) after ambulatory laparoscopic cholecystectomy. METHODS: This randomized controlled study recruited 70 patients scheduled for ambulatory laparoscopic cholecystectomy from January 2018 to March 2019. The participants were randomly allocated to one of the following groups: 1) anterior QLB (n=25) with preoperative ropivacaine 3.75 mg/mL, 20 mL bilaterally; 2) placebo QLB (n=22) with preoperative isotonic saline, 20 mL bilaterally; and 3) controls (n=23) given only standard intravenous and oral analgesia. The primary endpoint was opioid analgesic consumption. The secondary endpoints were pain (numeric rating scale 0-10) and PONV (scale 0-3, where 0=no PONV and 3=severe PONV). Assessments were made up to 48 hours postoperatively. RESULTS: The groups did not significantly differ in opioids consumption and reported pain at 1, 2, 24, and 48 hours postoperatively. PONV in the QLB group was lower than in the placebo and control groups. CONCLUSION: Preoperative anterior QLB for laparoscopic cholecystectomy did not affect postoperative opioid requirements and pain. However, anterior QLB may decrease PONV.


Assuntos
Analgesia , Colecistectomia Laparoscópica , Bloqueio Nervoso , Anestésicos Locais , Colecistectomia Laparoscópica/efeitos adversos , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle
17.
Biomed Res Int ; 2021: 6693221, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33954198

RESUMO

Background: Although video-assisted thoracoscopy has a smaller incision than traditional surgery, the postoperative pain is still severe. Ultrasound-guided pectoral nerve block (PECS) II is a new technique that can reduce pain in patients, and it had not been reported in the analgesia after thoracoscopic lobectomy. Methods: 40 patients scheduled for thoracoscopic lobectomy were randomly divided into two groups. Patients in the PECS II group received 0.5% ropivacaine 25 ml before the general anesthesia, while patients in the placebo group received 0.9% saline. Thirty minutes after the block was performed, a pin-prick test was used to analyze the sense of pain of T2-T6 segments. The primary endpoint was the total consumption of fentanyl. Data were collected in the postanesthesia care unit (PACU) and in the ward within 24 hours after operation. Results: The total consumption of fentanyl and the consumption of fentanyl in the intravenous analgesia pump within 24 hours after the operation were significantly lower in the PECS II group compared to the placebo group (p < 0.05). The implementation rate of rescue analgesia during operation and in PACU in the PECS II group was significantly lower than that in the placebo group (p < 0.05). The numerical rating scale (NRS) in 1 and 4 h after operation was lower in the PECS II group (p < 0.05). Mean arterial pressure (MAP) and heart rate (HR) of the PECS II group at chest entering (T1) were significantly lower than those in the placebo group (p < 0.05). Conclusion: Preconditioning of PECS II can stabilize the intraoperative circulation and significantly reduce pain and the consumption of opioids after operation.


Assuntos
Pulmão/cirurgia , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Nervos Torácicos/cirurgia , Toracoscopia/efeitos adversos , Analgesia , Pressão Arterial , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Placebos
18.
Artigo em Inglês | MEDLINE | ID: mdl-34019749

RESUMO

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.


Assuntos
Analgesia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Ultrassonografia de Intervenção/métodos , Idoso , Anestésicos Locais/administração & dosagem , Músculos do Dorso/inervação , Terapia Combinada , Humanos , Masculino , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
19.
Psychopharmacology (Berl) ; 238(7): 1857-1866, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33988725

RESUMO

RATIONALE: Preclinical studies demonstrate that the NK1 receptor is involved in opioid reinforcement and withdrawal expression. Few studies have examined the impact of treatment with NK1 antagonists on opioid response in humans. OBJECTIVE: To explore the potential for a selective NK1 antagonist, tradipitant, to attenuate the abuse liability and reinforcing and analgesic effects of oxycodone in opioid-experienced individuals. METHODS: Participants with recreational opioid use, but without opioid physical dependence, were enrolled as inpatients for ~6 weeks (n = 8). A within-subject, double-blind, randomized, placebo-controlled, crossover design was employed. The pharmacodynamic response to intranasal oxycodone across a range of doses (0 to 30 mg) was examined during two counterbalanced maintenance periods (tradipitant 0 or 85 mg/bid). Oxycodone self-administration was assessed with a modified progressive ratio procedure, and analgesia was assessed with the cold pressor test. RESULTS: Oxycodone produced significant and dose-related increases on a broad array of prototypic opioid measures, including subjective ratings related to abuse liability (e.g., liking) and physiological outcomes (i.e., expired CO2). Oxycodone self-administration increased with increasing dose, as did analgesia. Tradipitant largely did not alter any of these effects of oxycodone, with the exception of producing a reduction in ratings of desire for opioids. CONCLUSIONS: Given that the vast majority of oxycodone effects were unchanged by tradipitant, these data do not provide support for the utility of NK1 antagonists as a potential treatment for opioid use disorder.


Assuntos
Analgésicos Opioides/administração & dosagem , Antagonistas dos Receptores de Neurocinina-1/farmacologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Oxicodona/administração & dosagem , Medição da Dor/efeitos dos fármacos , Receptores da Neurocinina-1 , Administração Intranasal , Adolescente , Adulto , Analgesia/métodos , Analgesia/psicologia , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/psicologia , Medição da Dor/métodos , Medição da Dor/psicologia , Reforço Psicológico , Autoadministração , Resultado do Tratamento , Adulto Jovem
20.
J Appl Physiol (1985) ; 130(5): 1583-1593, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33830812

RESUMO

Ketamine is the recommended analgesic on the battlefield for soldiers with hemorrhage, despite a lack of supportive evidence from laboratory or clinical studies. Hence, this study determined the effects of ketamine analgesia on cardiorespiratory responses and survival to moderate (37% blood volume; n = 8/group) or severe hemorrhage (50% blood volume; n = 10/group) after trauma in rats. We used a conscious hemorrhage model with extremity trauma (fibular fracture + soft tissue injury) while measuring mean arterial pressure (MAP), heart rate (HR), and body temperature (Tb) by telemetry, and respiration rate (RR), minute volume (MV), and tidal volume (TV) via whole body plethysmography. Male rats received saline (S) or 5.0 mg/kg ketamine (K) (100 µL/100 g body wt) intra-arterially after trauma and hemorrhage. All rats survived 37% hemorrhage. For 50% hemorrhage, neither survival times [180 min (SD 78) vs. 209 min (SD 66)] nor percent survival (60% vs. 80%) differed between S- and K-treated rats. After 37% hemorrhage, K (compared with S) increased MAP and decreased Tb and MV. After 50% hemorrhage, K (compared with S) increased MAP but decreased HR and MV. K effects on cardiorespiratory function were time dependent, significant but modest, and transient at the analgesic dose given. K effects on Tb were also significant but modest and more prolonged. With the use of this rat model, our data support the use of K as an analgesic in injured, hypovolemic patients.NEW & NOTEWORTHY Ketamine administration at a dose shown to alleviate pain in nonhemorrhaged rats with extremity trauma had only modest and transient effects on multiple aspects of cardiorespiratory function after both moderate (37%) and severe (50%) traumatic hemorrhages. Such effects did not alter survival.


Assuntos
Analgesia , Ketamina , Animais , Hemorragia/tratamento farmacológico , Humanos , Ketamina/farmacologia , Masculino , Dor , Manejo da Dor , Ratos
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