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1.
Contrast Media Mol Imaging ; 2022: 4199868, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35909584

RESUMO

Colorectal cancer is a common malignant tumor of the digestive system. In order to study the clinical efficacy of ultrasound-guided QLB and TAPB in the treatment and postoperative analgesia of patients undergoing laparoscopic colorectal surgery. A total of 96 patients undergoing laparoscopic colorectal surgery from January 2021 to January 2022 are selected as the study subjects. The results show that ultrasound-guided QLB and TAPB therapy have good analgesic effects in patients undergoing laparoscopic colorectal surgery, and QLB treatment and postoperative analgesic effect are better than TAPB.


Assuntos
Analgesia , Cirurgia Colorretal , Laparoscopia , Bloqueio Nervoso , Músculos Abdominais/diagnóstico por imagem , Analgesia/métodos , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anestésicos Locais/farmacologia , Anestésicos Locais/uso terapêutico , Benzamidinas , Humanos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ultrassonografia de Intervenção/métodos
2.
Int J Nanomedicine ; 17: 3177-3189, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35909815

RESUMO

Introduction: The restricted duration is a fundamental drawback of traditional local anesthetics during postoperative pain from a single injection. Therefore, an injectable local anesthetic that produces repeatable on-demand nerve blocks would be ideal. Methods: We offer ultrasound-triggered on-demand analgesia consisting of dendritic mesoporous silica nanoparticles (DMSN) carried with ultrasound-sensitive perfluoropentane (PFP) and levobupivacaine (DMSN-bupi-PFP) to achieve repeatable and customizable on-demand local anesthetics. Results: The vaporization of liquid PFP was triggered by ultrasound irradiation to produce a gas environment. Subsequently, the enhanced cavitation effect could improve the release of levobupivacaine to achieve pain relief under a moderate-intensity ultrasound irradiation. DMSN-bupi-PFP demonstrated a controlled-release pattern and showed a reinforced ultrasonic sensitivity compared to levobupivacaine loaded DMSN (DMSN-bupi). The sustained release of levobupivacaine produced continuous analgesia of more than 9 hours in a model of incision pain, approximately 3 times longer than a single free levobupivacaine injection (3 hours). The external ultrasound irradiation can trigger the release of levobupivacaine repeatedly, resulting in on-demand analgesia. In addition, DMSN-bupi-PFP nanoplatforms for ultrasound-enabled analgesia showed low neurotoxicity and good biocompatibility in vitro and in vivo. Conclusion: This DMSN-bupi-PFP nanoplatform can be used in pain management by providing long-lasting and on-demand pain alleviation with the help of moderate-intensity ultrasound.


Assuntos
Analgesia , Anestésicos Locais , Analgesia/métodos , Bupivacaína , Humanos , Levobupivacaína , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
3.
Comput Math Methods Med ; 2022: 2651062, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35924112

RESUMO

Objective: To explore the clinical advantages of grid body surface locator combined with preemptive analgesia in the treatment of osteoporotic lumbar fractures in daytime vertebroplasty. Methods: A retrospective study was conducted on 120 patients who underwent lumbar vertebroplasty in the Department of Orthopedics of General Hospital of Northern Theater Command from January 2017 to January 2020. According to the preoperative planning and analgesic mode of treatment, they were divided into the daily operation experimental group and the traditional mode control group. Prone positioning of a patient under anesthetic is safe of ensuring optimum surgical access for many procedures, providing that the risks are fully understood. The general baseline data, intraoperative fluoroscopy times and operation time, bone cement injection volume, bone cement permeability, VAS score before operation, 1 day, and 3 months after operation, and the recovery of anterior vertebral height before and after operation were analyzed. Results: There was no statistically significant difference in the preoperative general data between the two groups. One day after operation, the VAS score of the experimental group was lower than that of the control group, but there was no difference after 3 months. The permeability of bone cement in the experimental group was lower than that in the control group, the height of anterior edge of injured vertebra was better than that in the control group, and the operation time was less than that in the control group. Conclusion: The daytime operation experimental group can significantly alleviate postoperative pain, increase the amount of bone cement injection, and reduce the permeability of bone cement through preoperative planning of puncture path and key puncture points, combined with advanced labor pain, but there is no significant difference in long-term pain relief.


Assuntos
Analgesia , Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/uso terapêutico , Humanos , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos
4.
BMJ Open Qual ; 11(3)2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35914816

RESUMO

INTRODUCTION: Pain management after elective, unilateral total hip and knee arthroplasty (THA and TKA) should use a multimodal approach. At discharge, challenges include ensuring correct prescribing practices to optimise analgesia and rationalise opioid use as well as ensuring patients are adequately educated to take these medications safely and effectively in the community. This audit cycle reports on a prescriber and patient education intervention using printed guidelines, educational outreach and prescription standardisation along with a patient information sheet to address the high unplanned readmission rate following THA and TKA at our institution. METHODS: Two cohorts of patients were identified before (2016) and after (2019) the introduction of the educational package. The primary outcome was the unplanned hospital readmission rate in the 42 days following discharge. Secondary outcomes were the compliance with the set prescribing standards and the prescription of strong opioid medications (morphine or oxycodone) on discharge. RESULTS: There was a reduction in the readmission rate from 20.4% to 10.0% (p=0.004). Readmission rates for pain and constipation were also reduced. The prescribing of tramadol (p<0.001) and non-steroidal anti-inflammatory drugs (p<0.001) both increased while the number of patients who received a strong opioid at discharge decreased (p<0.001) as did the number of patients who received a sustained release strong opioid (p<0.001). CONCLUSION: We have observed significant improvement in discharge prescribing which coincided with a reduction in unplanned readmissions after elective TKA and THA. Our approach used prescriber guidelines, education and standardisation with printed information for patients to enhance understanding and recall.


Assuntos
Analgesia , Artroplastia de Quadril , Artroplastia do Joelho , Analgésicos Opioides/uso terapêutico , Humanos , Dor/induzido quimicamente , Manejo da Dor , Alta do Paciente , Readmissão do Paciente
5.
Comput Math Methods Med ; 2022: 9447649, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35912159

RESUMO

This research was aimed at analyzing the role of ultrasound-guided nerve block based on intelligent three-dimensional (3D) reconstruction algorithm in intraoperative anesthesia and postoperative analgesia of orthopedic surgery. 68 elderly patients were undergoing orthopedic surgery on the lower extremities, and they were randomly rolled into two groups with 34 patients in each group. The patients in control group received sciatic nerve block anesthesia (SNBA), and the patients in the experimental group received ultrasound-guided SNBA (UG-SNBA) under 3D reconstruction algorithm to analyze and compare the anesthesia effect and the postoperative analgesia effect. The results showed that compared with other algorithms, the evaluation index of ultrasound images processed by the 3D reconstruction algorithm was better. In terms of anesthesia effect, there was no significant difference in systolic blood pressure, diastolic blood pressure, and heart rate between the two groups before surgery (P > 0.05). Intraoperative and postoperative indicators of the experimental group were significantly better than those of the control group; the drug dosage (61 mg) was less than that of the control group (78 mg). In addition, the onset time of anesthesia, the time of pain blockade, and the postoperative awake time (5 minutes, 8 minutes, and 8 minutes, respectively) were shorter than those in the control group (13 minutes, 15 minutes, and 15 minutes, respectively). The visual analogue scale (VAS) scores of the experimental group were better than those of the control group on the day after surgery, one day after surgery, two days after surgery, and three days after surgery, with significant differences (P < 0.05). In summary, 3D reconstruction algorithm-based ultrasound image effect was clearer, the effect of UG-SNBA was more stable, and the postoperative analgesic effect was better. This work provided a higher reference for the selection of safe and effective anesthesia options in orthopedic surgery.


Assuntos
Analgesia , Bloqueio Nervoso , Procedimentos Ortopédicos , Idoso , Algoritmos , Humanos , Imageamento Tridimensional , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção
6.
J Cardiothorac Surg ; 17(1): 170, 2022 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794614

RESUMO

BACKGROUND: Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences. METHODS: This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined. RESULTS: The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block. CONCLUSION: Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures. Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.


Assuntos
Analgesia , Anestesia por Condução , Bloqueio Nervoso , Analgesia/métodos , Analgésicos Opioides , Anestesia por Condução/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Humanos , Bloqueio Nervoso/métodos , Dor/etiologia , Estudos Retrospectivos
7.
Comput Math Methods Med ; 2022: 9833591, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35799642

RESUMO

Objective: To investigate the association between CYP3A4∗1G and OPRM1A118G gene polymorphisms and postoperative analgesia with sufentanil in women of Zhuang ethnicity from western Guangxi, China. Methods: Forty-eight Chinese Zhuang women who underwent elective myomectomy under general anesthesia in our hospital from January 2019 to December 2020 were selected, and another 47 Chinese Han patients in the same period were selected as the control subjects. CYP3A4∗1G and OPRM1 A118G gene polymorphisms as well as sedation and pain scores at different time points after surgery were compared between the two groups of patients to analyze the relationship between the degree of pain and dosage of sufentanil and to analyze the effect of gene polymorphisms on the occurrence of adverse reactions. Results: The frequencies of ∗1/∗1G and ∗1G/∗1G genotypes, allele 1∗G of CYP3A4∗1G and genotypes AA, and allele A of OPRM1 A118G in Zhuang patients were lower than those in Han patients, while the frequencies of ∗1/∗1, allele ∗1 of CYP3A4∗1G and genotypes AG, genotypes GG, and allele G of OPRM1 A118G were higher in Zhuang women. There was no significant difference in the Ramsay and VAS scores between the two groups at different time points after surgery, but the sufentanil use in Zhuang patients was higher than in Han patients at different time points after surgery. In addition, sufentanil use was highest in Zhuang patients with the ∗1/∗1 genotype of the CYP3A4∗1G gene. No significant difference was found in the incidence of adverse reactions during analgesia between the two groups. Conclusion: CYP3A4∗1G could be associated with postoperative sufentanil analgesia in Zhuang patients in western Guangxi and should be considered when developing personalized analgesia regimens.


Assuntos
Analgesia , Citocromo P-450 CYP3A , Receptores Opioides mu , Sufentanil , Analgésicos Opioides/administração & dosagem , China , Citocromo P-450 CYP3A/genética , Etnicidade/genética , Feminino , Genótipo , Humanos , Dor/induzido quimicamente , Polimorfismo de Nucleotídeo Único , Receptores Opioides mu/genética , Sufentanil/administração & dosagem
8.
Int J Clin Pract ; 2022: 6924489, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35832798

RESUMO

Background: Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS). Methods: We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0-12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group (P < 0.001), and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups (P=0.813). At 12-24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group (P < 0.001), and no great diversity in sufentanil consumption was found between the RIB and ESP groups (P=0.589). No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24-48 hours (P=0.192). At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group ((P < 0.05) for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients ((P < 0.05) for all contrasts). At 24 hours after surgery, a significant difference in IL-1ß and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block ((P < 0.05) for all contrasts). However, no great diversities were observed in IL-1ß, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively ((P < 0.05) for all comparisons). Conclusion: The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.


Assuntos
Analgesia , Bloqueio Nervoso , Analgesia/métodos , Analgésicos Opioides , Humanos , Interleucina-6 , Bloqueio Nervoso/métodos , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Sufentanil , Cirurgia Torácica Vídeoassistida , Ultrassonografia de Intervenção/métodos
10.
JSLS ; 26(2)2022.
Artigo em Inglês | MEDLINE | ID: mdl-35815323

RESUMO

Objective: To evaluate the efficacy of intracervical injection of liposomal bupivacaine for postoperative pain control among women undergoing minimally invasive supracervical hysterectomy. Methods: A randomized double-blinded placebo-controlled trial of intracervical injection of combination liposomal bupivacaine and bupivacaine for postoperative pain among patients undergoing laparoscopic and robotic supracervical hysterectomy. Patients were enrolled between October 1, 2018 and April 30, 2019. The primary outcome was pain at 12 hours postoperatively using a numeric rating scale from zero to 10. Pain scores were also recorded pre-operatively, immediately postoperatively, at 12, 24, and 48 hours postoperatively. The secondary outcome was the number of patients who required opioid analgesic medications up to 48 hours postoperatively. Results: Sixty participants were randomized into the control (n = 30) and intervention (n = 30) groups. Pain scores were 1 and 1.75 (p = 0.89) immediately postoperatively, 3 and 3.5 (p = 0.85) at 12 hours, 3.5 and 5 (p = 0.22) at 24 hours, and 2.75 and 4 (p = 0.18) at 48 hours for the control and intervention groups, respectively. Within the first 24 hours, 10 patients in the control and 14 patients in the intervention group used narcotics (p = 0.37). From the 24 to 48 hours window, 6 and 8 patients in the control and intervention groups used narcotics (p = 0.74), respectively. Conclusion: There was no statistically significant difference in pain scores between patients receiving combination liposomal bupivacaine and bupivacaine intracervical block and those receiving placebo in the first 48 hours after surgery. There was no difference in analgesic use between the two study groups.


Assuntos
Analgesia , Bupivacaína , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Feminino , Humanos , Histerectomia , Lipossomos/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
11.
Artigo em Inglês | MEDLINE | ID: mdl-35843915

RESUMO

Background: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the need for opioids during surgery and the suffering of postoperative pain. Multimodal analgesia can be achieved by providing non-opioid drugs (lidocaine, ketamine, and magnesium sulfate), three different types of drugs. Each of these drugs as different analgesic effects and they belong to three different pharmacological groups. The aim of this study is to develop a better understanding of the effects of each drug (lidocaine, ketamine, and magnesium sulfate) on postoperative analgesia, the needs for rescue analgesics, and analyze the total amount of fentanyl during the intraoperative period in patients undergoing laparoscopic cholecystectomy. Methods: 120 patients were enrolled in this randomized controlled study. They were classified as ASA 1 and 2 and were scheduled for laparoscopic cholecystectomy. They were further divided into 3 groups. Group 1, or the lidocaine group, had received lidocaine at 1 mg/kg and a continuous intravenous infusion with lidocaine at 2 mg/kg/h. Group 2, or the ketamine group, received ketamine at 0.5 mg/kg. Group 3, or the magnesium sulfate group, received a continuous intravenous infusion of magnesium sulfate at 1.5 gr/kg. The intensity of postoperative pain was assessed using a VAS score at rest and when coughing, with evaluation at 1, 4, 8, 12, and 24 hours, postoperatively. Also, the needs for rescue analgesics and the total amount of fentanyl during the intraoperative period in all groups was also followed. Results: The patients from the lidocaine group had the highest scores of pain in the postoperative period at rest and when coughing, and the ketamine group had the lowest pain scores. Rescue analgesia was given the most to lidocaine group, and less so in the magnesium group. The magnesium group received the highest dose of fentanyl during surgery and the lowest dose was received by patients from the lidocaine group. Conclusion: Multimodal analgesia can lower the need for opioids in the intra- and postoperative period after laparoscopic cholecystectomy.


Assuntos
Analgesia , Colecistectomia Laparoscópica , Ketamina , Analgésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Método Duplo-Cego , Fentanila/efeitos adversos , Humanos , Ketamina/efeitos adversos , Lidocaína/efeitos adversos , Magnésio/uso terapêutico , Sulfato de Magnésio/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia
12.
Cell Mol Biol (Noisy-le-grand) ; 68(2): 103-108, 2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35869732

RESUMO

The study aimed to investigate the effects of different anesthesia methods on the analgesia, inflammation and oxidative stress levels and cognitive function in elderly patients undergoing hip replacement. 100 elderly patients requiring hip replacement and admitted to Tianjin Hospital from March 2017 to March 2019 were enrolled and divided into group A (n=35, general anesthesia with endotracheal intubation), group B (n=35, epidural anesthesia) and group C (n=30, general anesthesia with endotracheal intubation + epidural anesthesia). The basic vital signs, inflammatory factors, stress response indicators and cognitive function changes were compared among three groups. Additionally, the effects of three different anesthesia methods were analyzed based on the differences in postoperative analgesic effect, extubation time and recovery time. The vital signs [systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)] were lower in group C than those in group A and group B after surgery (p<0.05). The VAS score at 12 h and 24 h after surgery was lower than that at 3 h after surgery (p<0.05). Group A and B had increased levels of these inflammatory factors after surgery compared with those before surgery. Postoperative extubation time, eye-opening time upon calling and recovery time were significantly shorter in group C than those in groups A and B (p<0.05). The oxidative stress indexes in group C were remarkably lower than those in groups A and B (p<0.05). The MMSE score was decreased in groups A and B after surgery compared with that before surgery (p<0.05). General anesthesia combined with epidural anesthesia applied in elderly patients undergoing hip replacement achieves a good anesthetic effect and is able to stabilize the vital signs and stress levels of patients and improve postoperative analgesic effect and cognitive function, which is worthy of popularization in clinical practice.


Assuntos
Analgesia , Anestesia Geral , Idoso , Analgésicos , Cognição , Humanos , Inflamação , Estresse Oxidativo
13.
Curr Opin Anaesthesiol ; 35(4): 436-441, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35787588

RESUMO

PURPOSE OF REVIEW: A family of neuronal voltage-gated calcium channels (VGCCs) have received only recently a significant consideration regarding the mechanisms of anesthesia because VGCC inhibition may be important in anesthetic action by decreasing neuronal excitability and presynaptic excitatory transmission. The T-type VGCCs channels (T-channels), although rarely involved in synaptic neurotransmitter release, play an important role in controlling neuronal excitability and in generating spontaneous oscillatory bursting of groups of neurons in the thalamus thought to be involved in regulating the state of arousal and sleep. Furthermore, these channels are important regulators of neuronal excitability in pain pathway. This review will provide an overview of historic perspective and the recent literature on the role of VGCCs and T-channel inhibition in particular in the mechanisms of action of anesthetics and analgesics. RECENT FINDINGS: Recent research in the field of novel mechanisms of hypnotic action of anesthetics revealed significant contribution of the Ca V 3.1 isoform of T-channels expressed in the thalamus. Furthermore, perioperative analgesia can be achieved by targeting Ca V 3.2 isoform of these channels that is abundantly expressed in pain pathways. SUMMARY: The review summarizes current knowledge regarding the contribution of T-channels in hypnosis and analgesia. Further preclinical and clinical studies are needed to validate their potential for developing novel anesthetics and new perioperative pain therapies.


Assuntos
Analgesia , Anestesia , Canais de Cálcio/metabolismo , Canais de Cálcio/uso terapêutico , Humanos , Dor/tratamento farmacológico , Dor/etiologia , Dor/metabolismo , Isoformas de Proteínas/metabolismo , Isoformas de Proteínas/uso terapêutico
14.
PLoS One ; 17(7): e0270701, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35877689

RESUMO

INTRODUCTION: Simply inspecting one's own body can reduce clinical pain and magnification of body parts can increase analgesia. Thus, body perceptions seem to play an important role for analgesia. Conversely, pain may also affect bodily perceptions. Therefore, we evaluated the effects of clinical and/or experimental pain on perceived hand size in fibromyalgia patients (FM) and healthy controls (HC). METHODS: To investigate the effects of chronic and/or acute pain on size perception we compared hand size estimates of 35 HC and 32 FM patients at baseline and during tonic mechanical pain stimuli applied to one ear lobe. Mechanical stimuli were adjusted for each individual pain sensitivity to achieve a rating of 4 ± 1 VAS (0-10) units. Photographs of each subject's hands were digitally manipulated to produce a monotonic series of 5 images larger and 6 smaller than actual size which were then presented to the participants in ascending and descending order (total number of images: 12). RESULTS: FM and HC participants' clinical pain ratings at baseline were 3.3 (3.1) and .3 (.8) VAS units, respectively. At baseline, FM participants selected significantly smaller hand images than HC as representative of their actual size (p < .02). During application of tonic experimental pain, the image size chosen to represent their actual hand size decreased significantly in FM participants and HC (p < .001) but this decrease was not different between groups (p > .05). Hand size estimates of FM participants correlated negatively with their clinical pain ratings (p < .04). CONCLUSION: The decreased hand size perception of FM patients and HC was associated with their clinical and/or experimental pain, supporting the hypothesis that pain can result in visual body distortions.


Assuntos
Analgesia , Fibromialgia , Fibromialgia/complicações , Humanos , Dor/complicações , Medição da Dor , Limiar da Dor
15.
Am J Vet Res ; 83(9)2022 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-35895764

RESUMO

OBJECTIVE: To evaluate the duration and analgesic quality of bupivacaine mixed with dexmedetomidine (BUP-DEX) or bupivacaine liposome suspension (BLS) administered as a transverse abdominis plane (TAP) block, compared with a negative control (no TAP block; CTRL) in dogs. ANIMALS: 26 mixed-breed shelter dogs undergoing elective ovariohysterectomy between January 28 and December 8, 2020. PROCEDURES: Each dog was randomly assigned to receive either an ultrasound-guided TAP block with either BUP-DEX or BLS or to receive no TAP block at time 0 after induction of general anesthesia. Superficial and abdominal wall pain scores were evaluated before time 0 and at 4, 6, 12, 24, 48, 72, and 96 hours later. Additionally, sedation scores and time to return of various behaviors, such as eating or drinking, were compared. RESULTS: The CTRL group had significantly greater pain scores than the BUP-DEX and BLS groups, but no differences were found between the BUP-DEX and BLS groups. Postoperatively, significantly more dogs needed rescue analgesia and the time to need it was shorter for the CTRL group, compared with the BUP-DEX or BLS groups. Additionally, the CTRL group had greater sedation scores than the other 2 groups. No significant differences were observed in any of the evaluated outcome variables such as eating or drinking. CLINICAL RELEVANCE: A TAP block appeared to provide adequate postoperative analgesia for abdominal surgery in the dogs of the present study undergoing elective ovariohysterectomy. The BLS TAP block did not appear to provide any extra benefit beyond what BUP-DEX TAP block added under these specific conditions.


Assuntos
Analgesia , Dexmedetomidina , Doenças do Cão , Bloqueio Nervoso , Músculos Abdominais , Analgesia/veterinária , Anestésicos Locais/uso terapêutico , Animais , Bupivacaína , Dexmedetomidina/uso terapêutico , Cães , Bloqueio Nervoso/veterinária , Medição da Dor/veterinária , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/veterinária
16.
Am J Vet Res ; 83(8)2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35895789

RESUMO

OBJECTIVE: To assess the pharmacokinetics, clinical efficacy, and adverse effects of injectable methadone with the pharmacokinetic enhancer fluconazole (methadone-fluconazole), compared with the standard formulation of injectable methadone, in dogs after ovariohysterectomy. We hypothesized that 2 doses of methadone-fluconazole would provide 24 hours of postoperative analgesia. ANIMALS: 3 purpose-bred dogs (pharmacokinetic preliminary study) and 42 female dogs from local shelters (clinical trial) were included. PROCEDURES: Pharmacokinetics were preliminarily determined. Clinical trial client-owned dogs were blocked by body weight into treatment groups: standard methadone group (methadone standard formulation, 0.5 mg/kg, SC, q 4 h; n = 20) or methadone-fluconazole group (0.5 mg/kg methadone with 2.5 mg/kg fluconazole, SC, repeated once at 6 h; n = 22). All dogs also received acepromazine, propofol, and isoflurane. Surgeries were performed by experienced surgeons, and dogs were monitored perioperatively using the Glasgow Composite Measure Pain Scale-Short Form (CMPS-SF) and sedation scales. Evaluators were masked to treatment. RESULTS: Findings from pharmacokinetic preliminary studies supported that 2 doses of methadone-fluconazole provide 24 hours of drug exposure. The clinical trial had no significant differences in treatment failures or postoperative CMPS-SF scores between treatments. One dog (methadone-fluconazole group) had CMPS-SF > 6 and received rescue analgesia. All dogs had moderate sedation or less by 1 hour (methadone-fluconazole group) or 4 hours (standard methadone group) postoperatively. Sedation was completely resolved in all dogs the day after surgery. CLINICAL RELEVANCE: Methadone-fluconazole with twice-daily administration was well tolerated and provided effective postoperative analgesia for dogs undergoing ovariohysterectomy. Clinical compliance and postoperative pain control may improve with an effective twice-daily formulation.


Assuntos
Analgesia , Doenças do Cão , Analgesia/veterinária , Analgésicos Opioides , Animais , Doenças do Cão/tratamento farmacológico , Doenças do Cão/cirurgia , Cães , Feminino , Fluconazol/efeitos adversos , Histerectomia/veterinária , Metadona/farmacologia , Metadona/uso terapêutico , Ovariectomia/efeitos adversos , Ovariectomia/veterinária , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/veterinária
17.
Zhonghua Shao Shang Za Zhi ; 38(7): 683-690, 2022 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-35899336

RESUMO

Objective: To investigate the effects of compound analgesia on ultra-pulsed fractional carbon dioxide laser (UFCL) treatment of post-burn hypertrophic s in children. Methods: A prospective randomized controlled study was conducted. From April 2018 to March 2020, 169 pediatric patients with post-burn hypertrophic s admitted to the First Affiliated Hospital of Air Force Medical University were randomly divided into general anesthesia alone group (39 cases, 19 males and 20 females, aged 35 (21, 48) months), general anesthesia+lidocaine group (41 cases, 23 males and 18 females, aged 42 (22, 68) months), general anesthesia+ibuprofen suppository group (41 cases, 25 males and 16 females, aged 38 (26, 52) months), and three-drug combination group with general anesthesia + lidocaine+ibuprofen suppository (48 cases, 25 males and 23 females, aged 42 (25, 60) months), and the pediatric patients in each group were treated with corresponding analgesic regimens when UFCL was used to treat s, and the pediatric patients were given comprehensive care throughout the treatment process. The pain degree of pediatric patients scar was evaluated by facial expression,legs,activity,cry,and consolability (FLACC) of children's pain behavior scale at 0 (immediately), 1, 2, and 4 h after awakening from the first anesthesia, respectively. At 4 h after awakening from the first anesthesia of postoperative pain assessment, the self-made analgesia satisfaction questionnaire was used to evaluate the satisfaction for the analgesic effect of the pediatric patients or their families, and the satisfaction rate was calculated. Within 2 h after the first operation, the occurrences of adverse reactions of the pediatric patients, such as nausea and vomiting, headache, dizziness, drowsiness, etc, were observed and recorded. Before the first treatment and 1 month after the last treatment, the Vancouver scar scale (VSS) was used to evaluate the pediatric patients scar, and the difference value between the two was calculated. Data were statistically analyzed with least significant difference test, Kruskal-Wallis H test, chi-square test and Fisher's exact probability test. Results: At 0 h after awakening from the first anesthesia, the FLACC scores of pediatric patients in general anesthesia+lidocaine group, general anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than those in general anesthesia alone group (P<0.01). The FLACC scores of the pediatric patients in anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than that in general anesthesia+lidocaine group (P<0.01), and the FLACC score of the pediatric patients in three-drug combination group was significantly lower than that in general anesthesia+ibuprofen suppository group (P<0.01). At 1 and 2 h after awakening from the first anesthesia, the FLACC scores of pediatric patients in general anesthesia+ibuprofen suppository group and three-drug combination group were both significantly lower than those in general anesthesia alone group and general anesthesia+lidocaine group (P<0.01), and the FLACC score of the pediatric patients in three-drug combination group was significantly lower than that in general anesthesia+ibuprofen suppository group (P<0.01). At 4 h after awakening from the first anesthesia, the FLACC scores of the pediatric patients in general anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than those in general anesthesia alone group and general anesthesia+lidocaine group (P<0.01). At 4 h after awakening from the first anesthesia, the satisfactions rate with the analgesic effect in the four groups of pediatric patients or their families were 79.49% (31/39), 85.37% (35/41), 87.80% (36/41), and 97.92% (47/48), respectively. The satisfaction rate of the pediatric patients in three-drug combination group was significantly higher than those in general anesthesia alone group, general anesthesia+lidocaine group, general anesthesia+ibuprofen suppository group. Within 2 h after the first operation, there was no significant difference in the overall comparison of adverse reactions such as nausea and vomiting, headache, dizziness, and drowsiness of pediatric patients among the 4 groups (P>0.05). The VSS scores of pediatric patients before the first treatment, 1 month after the last treatment, and and the difference value between the two in the 4 groups were not significantly different (P>0.05). Conclusions: Three-drug combination for analgesia has a good effect in the treatment of hypertrophic scars after burn in pediatric patients with UFCL. Pediatric patients or their families are highly satisfied with the effect, and the treatment effect and incidence of adverse reactions are similar to other analgesic regimens, so it is recommended to be promoted in clinical practice.


Assuntos
Analgesia , Cicatriz Hipertrófica , Lasers de Gás , Analgésicos , Criança , Cicatriz Hipertrófica/patologia , Tontura/tratamento farmacológico , Feminino , Cefaleia/tratamento farmacológico , Humanos , Ibuprofeno/uso terapêutico , Lasers de Gás/uso terapêutico , Lidocaína , Masculino , Náusea/tratamento farmacológico , Dor/tratamento farmacológico , Estudos Prospectivos , Resultado do Tratamento , Vômito/tratamento farmacológico
18.
Sensors (Basel) ; 22(15)2022 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-35897999

RESUMO

There are many surgical operations performed daily in operation rooms worldwide. Adequate anesthesia is needed during an operation. Besides hypnosis, adequate analgesia is critical to prevent autonomic reactions. Clinical experience and vital signs are usually used to adjust the dosage of analgesics. Analgesia nociception index (ANI), which ranges from 0 to 100, is derived from heart rate variability (HRV) via electrocardiogram (ECG) signals, for pain evaluation in a non-invasive manner. It represents parasympathetic activity. In this study, we compared the performance of multilayer perceptron (MLP) and long short-term memory (LSTM) algorithms in predicting expert assessment of pain score (EAPS) based on patient's HRV during surgery. The objective of this study was to analyze how deep learning models differed from the medical doctors' predictions of EAPS. As the input and output features of the deep learning models, the opposites of ANI and EAPS were used. This study included 80 patients who underwent operations at National Taiwan University Hospital. Using MLP and LSTM, a holdout method was first applied to 60 training patients, 10 validation patients, and 10 testing patients. As compared to the LSTM model, which had a testing mean absolute error (MAE) of 2.633 ± 0.542, the MLP model had a testing MAE of 2.490 ± 0.522, with a more appropriate shape of its prediction curves. The model based on MLP was selected as the best. Using MLP, a seven-fold cross validation method was then applied. The first fold had the lowest testing MAE of 2.460 ± 0.634, while the overall MAE for the seven-fold cross validation method was 2.848 ± 0.308. In conclusion, HRV analysis using MLP algorithm had a good correlation with EAPS; therefore, it can play role as a continuous monitor to predict intraoperative pain levels, to assist physicians in adjusting analgesic agent dosage. Further studies may consider obtaining more input features, such as photoplethysmography (PPG) and other kinds of continuous variable, to improve the prediction performance.


Assuntos
Analgesia , Aprendizado Profundo , Algoritmos , Analgesia/métodos , Humanos , Nociceptividade/fisiologia , Dor
19.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(7): 748-752, 2022 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-35894188

RESUMO

OBJECTIVES: To investigate the effect of sequential sedative and analgesic drugs in preventing delirium and withdrawal symptoms in children after ventilator weaning. METHODS: A retrospective analysis was performed on 61 children who were admitted and received mechanical ventilation support for ≥5 days in the Pediatric Intensive Care Unit of Dongguan Children's Hospital Affiliated to Guangdong Medical University from December 2019 to September 2021. The children were divided into a control group (30 children with no maintenance of analgesic and sedative drugs after ventilator weaning) and an observation group (31 children with sequential sedative and analgesic drugs maintained for 48 hours after ventilator weaning). The two groups were compared in terms of the Sophia Observation Withdrawal Symptoms Scale (SOS) score, the Pediatric Delirium Scale (PD) score, the Richmond Agitation-Sedation Scale (RASS) score, and the incidence rates of delirium or withdrawal symptoms at 24 and 72 hours after ventilator weaning. RESULTS: There was no significant difference in the incidence rate of delirium at 24 hours and 72 hours after ventilator weaning between the two groups (P>0.05). Compared with the control group, the observation group had significantly lower incidence rate of withdrawal symptoms and scores of SOS, PD, and RASS scales at 24 hours and 72 hours after ventilator weaning (P<0.01). CONCLUSIONS: Sequential sedation and analgesia after ventilator weaning can reduce the incidence of withdrawal symptoms within 72 hours after ventilator weaning, but it cannot reduce the incidence rate of delirium.


Assuntos
Analgesia , Delírio , Síndrome de Abstinência a Substâncias , Analgésicos/uso terapêutico , Criança , Delírio/diagnóstico , Delírio/etiologia , Delírio/prevenção & controle , Humanos , Hipnóticos e Sedativos/uso terapêutico , Unidades de Terapia Intensiva Pediátrica , Dor , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Síndrome de Abstinência a Substâncias/prevenção & controle , Desmame do Respirador
20.
Anesth Analg ; 135(2S Suppl 1): S1-S4, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35839825
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