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1.
Ann R Coll Surg Engl ; 102(1): 28-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232611

RESUMO

INTRODUCTION: Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. MATERIALS AND METHODS: A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. RESULTS: A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. DISCUSSION: Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.


Assuntos
Analgesia/métodos , Doenças do Colo/cirurgia , Laparoscopia/métodos , Padrões de Prática Médica/estatística & dados numéricos , Doenças Retais/cirurgia , Idoso , Analgesia/estatística & dados numéricos , Analgesia Controlada pelo Paciente/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Conversão para Cirurgia Aberta/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Resultado do Tratamento
2.
Women Birth ; 32(2): e272-e278, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31007208

RESUMO

BACKGROUND: The increasing prevalence and adverse outcomes associated with opioid analgesia use in women of reproductive age have become a significant public health issue internationally, with use during pregnancy potentially affecting maternal and infant health outcomes. OBJECTIVE: This study aims to provide national estimates of chronic pain, pain severity and analgesia use in Australian women of reproductive age by pregnancy status. METHOD: Data were obtained from the Australian Bureau of Statistics 2011-12 National Health Survey (n=20,426). Weighting was applied to sample data to obtain population estimates. For this study data were analysed for pregnant (n=166, N=192,617) and non-pregnant women (n=4710, N=5,256,154) of reproductive age (15-49 years). RESULTS: Chronic or reoccurring pain was reported in 5.1% of pregnant women and 9.7% of non-pregnant women, and 0.7% and 2.6% of pregnant and non-pregnant women reported recent opioid analgesia use respectively. Moderate-to-very severe pain was more common in pregnant than non-pregnant women taking opioid analgesics, and no pain and very mild-to-mild pain in non-pregnant women. CONCLUSION: Approximately 1 in 20 pregnant Australian women have chronic or reoccurring pain. Opioid analgesia was used by around 1% of Australian pregnant women during a two-week period, with use associated with moderate-to-very severe pain. Given that the safety of many analgesic medications in pregnancy remains unknown, pregnant women and health professionals require accurate, up-to-date information on the risks and benefits of analgesic use during pregnancy. Further evidence on the decision-making processes of pregnant women with pain should assist health professionals maximise outcomes for mothers and infants.


Assuntos
Analgesia/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Dor Crônica/epidemiologia , Complicações na Gravidez/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Austrália/epidemiologia , Dor Crônica/tratamento farmacológico , Dor Crônica/patologia , Feminino , Humanos , Medição da Dor , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/patologia , Prevalência , Adulto Jovem
3.
Biomed Res Int ; 2019: 7596165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30895195

RESUMO

Aim: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. Results: From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). Conclusions: The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.


Assuntos
Analgesia/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Internacionalidade , Trabalho de Parto/fisiologia , Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Inquéritos e Questionários , Organização Mundial da Saúde , Adulto , Feminino , Humanos , Análise Multivariada , Gravidez , Resultado da Gravidez , Prevalência , Adulto Jovem
4.
West J Emerg Med ; 20(2): 232-236, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30881541

RESUMO

Introduction: Procedural sedation and analgesia (PSA) provides safe and effective relief for pain, anxiety and discomfort during procedures performed in the emergency department (ED). Our objective was to identify hospital-level factors associated with routine PSA capnography use in the ED. Methods: This study was a cross-sectional telephone survey of ED nurse managers and designees in a Midwestern state. Respondents identified information about hospital infrastructure, physician staffing, family practice (FP) physicians only, board-certified emergency physicians (EPs) only (or both), and critical intervention capabilities. Additional characteristics including ED volume and hospital designation (i.e., rural-urban classification) were obtained from the Centers for Medicare and Medicaid Services and the state hospital association database, respectively. The primary outcome was reported use of PSA capnography. We conducted univariate analyses (relative risks, 95% confidence interval [CI]) to identify associations between hospital-level characteristics and PSA capnography use. Results: We had an overall response rate of 98% (n=118 participating hospitals). The majority of EDs were in rural settings (78%), with a median of 5,057 visits per year (interquartile range 2,823-14,322). Nearly half of the EDs were staffed by FP physicians only, while 16% had board-certified EPs only. Nearly all hospitals (n=114, 97%), reported using continuous capnography for ventilated patients, and 74% reported use of capnography during PSA. Urban hospitals were more likely to use PSA capnography than critical access hospitals (relative risk 1.45; 95% CI, 1.22-1.73), and PSA capnography use increased with each ED volume quartile. Facilities with only EPs were 1.46 (95% CI, 1.15-1.87) times more likely to use PSA capnography than facilities with FP physicians only. Conclusion: Continuous capnography was available in nearly all EDs, independent of size, location or patient volume. The implementation of capnography during PSA was less penetrant. Smaller, rural departments were less likely than their larger, urban counterparts to implement these national guidelines. Rurality and hospital size may be potential institutional barriers to capnography implementation.


Assuntos
Dióxido de Carbono/análise , Hospitais Comunitários/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Analgesia/estatística & dados numéricos , Capnografia/estatística & dados numéricos , Certificação , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Inquéritos Epidemiológicos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Manejo da Dor , Saúde da População Rural , Inquéritos e Questionários , Estados Unidos , Saúde da População Urbana/estatística & dados numéricos
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(1): 108-111, 2019 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-30707879

RESUMO

OBJECTIVE: To investigate the current state of sedation, analgesia and blood glucose management in intensive care units (ICUs) of county hospitals in Guizhou Province of China, and to provide the evidences for improving quality control in critical care medicine. METHODS: In March 2018, 3-4 ICUs of hospitals in every prefecture (one hospital per county) in Guizhou Province were visited to do the field survey. The patients' nursing records within 24 hours after ICU admission were reviewed, and the information such as gender, age, major diagnosis at the ICU admission, the time of admission, were collected. Moreover, the conditions about sedation and analgesia drug use and monitoring, blood pressure, blood glucose as well as and the usage of insulin and ventilator were recorded. Because not all the needed information of every ICU or patient was obtained, only the numbers of the ICUs and patients whose required information had been obtained were analyzed. RESULTS: Twenty-eight county hospitals in nine prefectures of Guizhou Province and 152 ICU patients were surveyed. There was a median of 5 (4, 7) patients stayed in every ICU on the day of survey. A total of 152 patients were enrolled, with 102 male (67.1%) and 50 female (32.9%); the median age was 65.0 (51.5, 74.8) years old; the major diagnosis at ICU admission was mainly cerebral diseases which accounted for 50.0% (76/152), and the second place was digestive system diseases which accounted for 13.8% (21/152); 53.8% (78/145) of patients were admitted to ICUs during 08:00-18:00. The percentages of ICUs which had patients received sedation and analgesia were 92.6% (25/27) and 88.9% (24/27) respectively, while only 44.4% (12/27) and 18.5% (5/27) of them were evaluated the depth of sedation and the level of pain respectively. There was 49.0% (71/145) of patients received sedation, and 33.8% (24/71) of them was evaluated by sedation scores; 49.7% (72/145) of patients received analgesia, and 13.9% (10/72) of them were evaluated by pain scores. The proportions of invasive mechanical ventilation in the patients with sedation or analgesia were both higher than those in the patients without sedation or analgesia [sedation compared with non-sedation: 85.9% (61/71) vs. 21.6% (16/74), analgesia compared with non-analgesia: 87.5% (63/72) vs. 19.2% (14/73), both P < 0.01]. The incidence of hypotension was similar between the sedated patients and the non-sedated patients [55.9% (38/68) vs. 40.3% (29/72), P > 0.05], while the incidence of hypotension was higher in the patients with analgesia as compared with that in the patients without analgesia with significant difference [56.9% (41/72) vs. 38.2% (26/68), P < 0.05]. Within 24 hours after ICU admission, there were 40.7% (59/145) and 5.5% (8/145) of patients had hyperglycemia (random blood glucose level ≥ 11.1 mmol/L) or hypoglycemia (random blood glucose level ≤ 3.9 mmol/L) respectively. No insulin was used to control the blood glucose level in the patients who had hypoglycemia or did not have hyperglycemia. However, only 23.7% (14/59) of patients with hyperglycemia were treated with insulin, the initiation of insulin therapy was triggered when median blood glucose level was 19.8 (16.8, 24.5) mmol/L. CONCLUSIONS: The evaluation of analgesia and sedation in the ICUs of county hospitals in Guizhou Province was seriously inadequate and needed to be strengthened urgently. Moreover, the strategy of blood glucose management was also needed to be improved.


Assuntos
Analgesia/estatística & dados numéricos , Glicemia/metabolismo , Hipnóticos e Sedativos/uso terapêutico , Unidades de Terapia Intensiva , Idoso , China , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais de Condado , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial
6.
Injury ; 50(1): 119-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30442372

RESUMO

INTRODUCTION: Multiple rib fractures have been shown to reduce quality of life both in the short and long term. Treatment of rib fractures with operative fixation reduces ventilator requirements, intensive care unit stay, and pulmonary complications in flail chest patients but has not been shown to improve quality of life in comparative studies to date. We therefore wanted to analyse a large cohort of multiple fractured rib trauma patients to see if rib fixation improved their quality of life. METHODS: Retrospective review (January 2012 - April 2015) of prospectively collected data on 1482 consecutive major trauma patients admitted to The Alfred Hospital with rib fractures. The main outcome measures were Quality of Life over 24 months post injury assessed using the Glasgow Outcome Scale Extended (GOSErate) and Short Form (SF12) health assessment forms and a pain questionnaire. RESULTS: 67 (4.5%) patients underwent rib fixation and were older, with a higher incidence of flail chest injury, and higher AIS and ISS scores than the remainder of the cohort. Rib fixation provided no benefit in pain, SF-12 or GOSErate scores over 24 months post injury. CONCLUSIONS: This study has not been able to demonstrate any quality of life benefit of rib fixation over 24 months post injury in patients with major trauma.


Assuntos
Tórax Fundido/psicologia , Tempo de Internação/estatística & dados numéricos , Dor/psicologia , Qualidade de Vida/psicologia , Fraturas das Costelas/psicologia , Traumatismos Torácicos/psicologia , Adulto , Idoso , Analgesia/estatística & dados numéricos , Austrália , Feminino , Tórax Fundido/fisiopatologia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas , Consolidação da Fratura/fisiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/fisiopatologia , Fraturas das Costelas/cirurgia , Inquéritos e Questionários , Traumatismos Torácicos/complicações , Traumatismos Torácicos/fisiopatologia , Traumatismos Torácicos/cirurgia , Fatores de Tempo , Adulto Jovem
7.
Emerg Med J ; 36(1): 12-17, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30377161

RESUMO

OBJECTIVE: Pain management in the ED is often suboptimal, with many patients not receiving analgesia. We aimed to determine why some patients refuse it, why others do not receive it, and whether these variables impact on patient satisfaction with their pain management. METHODS: We undertook a prospective, observational study in a large, Australian, tertiary referral ED (February-May 2017). A convenience sample of consecutive adult patients with a triage pain score of ≥4 were examined. Data were collected from the medical record and the treating nurses. At follow-up at least 48 hours postdischarge, patients were asked if they received analgesia in the ED (if not, then why not) and how satisfied they were with their pain management (very dissatisfied/dissatisfied/slightly dissatisfied/slightly satisfied/satisfied/very satisfied). The primary outcome was why patients refuse analgesia. RESULTS: Of the 651 enrolled patients, 171 (26.3%) did not receive analgesia; for 30 (17.5%), patients and their nurses agreed that analgesia was refused. Patients mainly refused analgesia because their pain was not bad enough, they had recent analgesia intake, and concerns about side effects and interactions. Patients who received analgesia were more likely to be 'very satisfied' with their pain management (difference in proportions 10.8%, 95% CI 2.1 to 19.4). The satisfaction of patients who refused analgesia and those who did not receive analgesia for other reasons did not differ. CONCLUSION: Patient refusal is the most common reason for patients not receiving analgesia. Analgesia receipt is associated with greater patient satisfaction. However, a patient's knowledge of their analgesia receipt status may be incorrect. Disregard of the reasons for patients not receiving analgesia may underestimate the number offered analgesia.


Assuntos
Analgesia/métodos , Manejo da Dor/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia/estatística & dados numéricos , Austrália , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/enfermagem , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Satisfação do Paciente , Estudos Prospectivos , Inquéritos e Questionários
8.
Am J Emerg Med ; 37(6): 1025-1032, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30121157

RESUMO

OBJECTIVE: This study attempted to evaluate the efficacy of ultra-low-dose intravenous (IV) naloxone combined with IV morphine, as compared to IV morphine alone, in terms of reducing pain and morphine-induced side effects in patients with renal colic. METHODS: In this double-blind clinical trial, 150 patients aged 34 to 60 years old who presented to the emergency department (ED) with renal colic were randomly allocated to either an intervention group that received ultra-low-dose IV naloxone combined with IV morphine or to a control group that received morphine plus a placebo. The severity of pain, sedation, and nausea were assessed and recorded for all patients at entrance to the ED (T1), then at 20 (T2), 40 (T3), 60 (T4), 120 (T5), and 180 (T6) minutes after starting treatment. The Numeric Rating Scale (NRS) was used for the assessment of pain and nausea intensities, and the Ramsay Sedation Scale (RSS) was used to assess sedation. RESULTS: A GEE model revealed that patients in the naloxone group had non-significantly reduced pain scores compared to those in the morphine group (coefficient = -0.68; 95% CI: -1.24 to -0.11, Wald X2 (1) = 5.41, p = 0.02). The sedation outcome demonstrated no statistically significant differences at T1 to T4 among patients with renal colic compared to the ones who only received morphine. At T5 and T6, 1.5% vs. 20% and 1.5% vs. 16.9% of subjects from the naloxone group versus the morphine group obtained RSS scores equal to 3, respectively (p = 0.001 and p = 0.004, respectively). CONCLUSIONS: Compared to patients who only received IV morphine, co-treatment of ultra-low-dose naloxone with morphine could not provide better analgesia and sedation/agitation states in renal colic patients.


Assuntos
Analgesia/normas , Morfina/administração & dosagem , Naloxona/administração & dosagem , Manejo da Dor/normas , Cólica Renal/complicações , Adulto , Analgesia/métodos , Analgesia/estatística & dados numéricos , Análise de Variância , Método Duplo-Cego , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Quimioterapia Combinada/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Morfina/normas , Morfina/uso terapêutico , Naloxona/normas , Naloxona/uso terapêutico , Dor/tratamento farmacológico , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Cólica Renal/tratamento farmacológico , Estatísticas não Paramétricas
9.
Medicine (Baltimore) ; 97(46): e13215, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431597

RESUMO

To investigate the predictive factors of pain intensity during the first 48 hours after spinal correction and fusion operations for idiopathic scoliosis patients.A total of 290 scoliosis patients who underwent posterior spinal instrumentation and fusion operations were enrolled in this study. A standard surgical and analgesic method was implemented for all participants and pain intensity was evaluated at fixed times within 48 hours after the operation. Variables including demographics (age, sex, body mass index [BMI], patient sources), surgical variables (procedure, duration of operation), intraoperative variables (total transfusion, autologous transfusion, heterogeneous transfusion, fluid intake, use of preventive analgesia) were investigated.On univariate analysis, BMI, transfusion type and not implementing preventive analgesia were associated with more serious pain after a scoliosis correction operation. Multivariate analysis indicated that receiving heterogeneous transfusion and not implementing preventive analgesia were significant predictive factors for moderate and severe pain after the spinal correction operation.Our research indicated that the type of transfusion and preventive analgesia were significantly associated with the severity of pain. Body mass and patient sources should be considered before surgery. For patients under high risk of moderate and severe pain, the type of transfusion must be taken into consideration. This study explored the influencing factors of postoperative pain from a novel perspective, but some limitations existed in this present study, and future studies are needed.


Assuntos
Dor Pós-Operatória/etiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Analgesia/métodos , Analgesia/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Masculino , Medição da Dor/métodos , Fatores de Risco , Coluna Vertebral/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
Vet J ; 239: 1-6, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30197103

RESUMO

Altered body lean has been subjectively observed during lungeing in lame horses. The objectives were to quantify the influence of lameness on body lean in trot on the lunge and to investigate the influence of improvement in lameness on the differences in body lean between reins. Thirteen lame horses were trotted in straight lines and lunged on a 10m-diameter circle on both reins before and after lameness was subjectively substantially improved by diagnostic analgesia. A global position system-aided inertial measurement unit attached to the tubera sacrale quantified body lean. Differences between reins in body lean before and after diagnostic analgesia were calculated and means were determined. Five and eight horses had unilateral and bilateral hindlimb lameness, respectively. Two of five horses with unilateral and three of eight horses with bilateral lameness leaned more on the rein with the lame or lamer hindlimb on the inside of the circle (difference between reins 5-8°). Two of five horses with unilateral and two of eight horses with bilateral lameness leaned more on the rein with the lame or lamer hindlimb on the outside of the circle (4-10°). Four horses, one with unilateral and three with bilateral lameness, had only 1° difference in body lean angle between left and right reins. When lameness was improved by diagnostic analgesia, the body lean changed significantly towards similar leaning on left and right reins (mean angle changed from 8.8° to 10.0° (P=0.03) on one rein and 13.4° to 10.8° (P=0.002) on the other rein). It was concluded that body lean becomes more symmetrical between reins after improvement in lameness using diagnostic analgesia.


Assuntos
Analgesia/veterinária , Doenças dos Cavalos/diagnóstico , Coxeadura Animal/diagnóstico , Manejo da Dor/veterinária , Medição da Dor/veterinária , Postura , Analgesia/estatística & dados numéricos , Animais , Inglaterra , Feminino , Membro Anterior/fisiopatologia , Membro Posterior/fisiopatologia , Doenças dos Cavalos/fisiopatologia , Cavalos , Masculino , Estudos Prospectivos
11.
Eur Urol Focus ; 4(5): 662-664, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30194030

RESUMO

The use of robot-assisted surgery (RAS) by paediatric urologists is increasing. This mini review looks at the current status of RAS in paediatric urology. The challenges involved in RAS use in children are reviewed, as well as the indications for and feasibility of procedures performed and, where possible, outcomes with RAS. PATIENT SUMMARY: The current status of robot-assisted surgery (RAS) in paediatric urology, together with the challenges in using RAS for children is outlined in this mini review. Innovative adaptation has pushed the boundaries as regards the feasibility of RAS procedures in children with good outcomes.


Assuntos
Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Urológicos/instrumentação , Urologia/instrumentação , Analgesia/estatística & dados numéricos , Criança , Humanos , Laparoscopia/métodos , Tempo de Internação , Metanálise como Assunto , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/estatística & dados numéricos
12.
Vet J ; 236: 62-67, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29871752

RESUMO

There has been considerable interest in the area of acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is ever increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The second part of this review will consider the non-traditional analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.


Assuntos
Analgesia/veterinária , Analgésicos/administração & dosagem , Gatos/fisiologia , Cães/fisiologia , Manejo da Dor/veterinária , Dor Aguda , Analgesia/estatística & dados numéricos , Animais , Dor/prevenção & controle , Dor/veterinária , Manejo da Dor/métodos , Medição da Dor
13.
J Surg Res ; 228: 160-169, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29907207

RESUMO

BACKGROUND: Although evidence-based guidelines recommend a multimodal approach to pain management, limited information exists on adherence to these guidelines and its association with outcomes in a generalized population. We sought to assess the association between discharge multimodal analgesia and postoperative pain outcomes in two diverse health care settings. METHODS: We evaluated patients undergoing four common surgeries associated with high pain in electronic health records from an academic hospital (AH) and Veterans Health Administration (VHA). Multimodal analgesia at discharge was characterized as opioids in combination with acetaminophen (O + A) and nonsteroidal antiinflammatory (O + A + N) drugs. Hierarchical models estimated associations of analgesia with 45-d follow-up pain scores and 30-d readmissions. RESULTS: We identified 7893 patients at AH and 34,581 at VHA. In both settings, most patients were discharged with O + A (60.6% and 54.8%, respectively), yet a significant proportion received opioids alone (AH: 24.3% and VHA: 18.8%). Combining acetaminophen with opioids was associated with decreased follow-up pain in VHA (Odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.79, 0.93) and readmissions (AH OR: 0.74, CI: 0.60, 0.90; VHA OR: 0.89, CI: 0.82, 0.96). Further addition of nonsteroidal antiinflammatory drugs was associated with further decreased follow-up pain (AH OR: 0.71, CI: 0.53, 0.96; VHA OR: 0.77, CI: 0.69, 0.86) and readmissions (AH OR: 0.46, CI: 0.31, 0.69; VHA OR: 0.84, CI: 0.76, 0.93). In both systems, patients receiving multimodal analgesia received 10%-40% less opioids per day compared to opioids only. CONCLUSIONS: A majority of surgical patients receive a multimodal pain approach at discharge yet many receive only opioids. Multimodal regimen at discharge was associated with better follow-up pain and all-cause readmissions compared to the opioid-only regimen.


Assuntos
Analgesia/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Analgesia/normas , Analgesia/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento
14.
Vet J ; 238: 76-82, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29907456

RESUMO

There has been considerable interest in acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The first part of this review will consider the opioid and anti-inflammatory analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.


Assuntos
Analgésicos/uso terapêutico , Gatos/fisiologia , Cães/fisiologia , Manejo da Dor/veterinária , Dor/veterinária , Analgesia/estatística & dados numéricos , Analgesia/veterinária , Analgésicos Opioides/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor/prevenção & controle , Manejo da Dor/métodos , Medição da Dor
15.
BMC Anesthesiol ; 18(1): 74, 2018 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-29935528

RESUMO

BACKGROUND: Studies have shown that dexmedetomidine (Dex) can prolong the duration of analgesia when added to local anaesthetic as an adjuvant in a central or peripheral nerve block. We hypothesized that intrathecal Dex can reduce the ED95 of spinal hyperbaric bupivacaine. Therefore, we conducted this prospective, double-blinded, randomized study to verify our hypothesis. METHODS: Ninety patients were allocated into the Dexmedetomidine group (received bupivacaine + 5 mcg dexmedetomidine) and the Control group (received bupivacaine + the same volume of saline) using a double-blinded and randomized method. The first patient in each group received 5 mg of IT hyperbaric bupivacaine, and the next dose for the following patient was determined by the probability of successful anaesthesia of the previous neighbouring dose. An improved up-down sequence allocated method combined with probit analysis was used to determine the ED95 of intrathecal hyperbaric bupivacaine for the two groups. RESULTS: The ED95 and 95% confidence intervals (95% CI) of IT hyperbaric bupivacaine of the Dex group and Control group were 8.4 mg (95% CI, 6.5~ 13.8 mg) and 12.1 mg (95% CI, 8.3~ 312.8 mg), respectively. The duration of sensory block was longer in the Dex group than in the Control group (110.3 ± 35.3 vs 67.5 ± 26.2). The duration of analgesia was also longer in the Dex group than in the Control group (224.9 ± 45.4 vs 155.1 ± 31.6). The consumption of postoperative rescued sufentanil was significantly higher in the Control group than in the Dex group. CONCLUSION: Intrathecal 5 mcg dexmedetomidine potentiated hyperbaric bupivacaine antinociception by 31% in spinal anaesthesia for patients undergoing caesarean section. TRIAL REGISTRATION: We registered this study in a Chinese Clinical Trial Registry (ChiCTR) centre on Nov 1st 2016 and received the registration number: ChiCTR-IPR-16009699 .


Assuntos
Pressão do Ar , Bupivacaína/administração & dosagem , Cesárea/métodos , Dexmedetomidina/uso terapêutico , Adulto , Analgesia/estatística & dados numéricos , Anestesia Obstétrica/métodos , Raquianestesia , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Sinergismo Farmacológico , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/uso terapêutico , Injeções Espinhais , Gravidez , Sufentanil/uso terapêutico , Fatores de Tempo , Adulto Jovem
16.
Anaesth Intensive Care ; 46(3): 326-331, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29716492

RESUMO

There is a growing body of evidence in favour of continuous adductor canal block (CACB) for total knee arthroplasty. However, there are no studies describing the optimal duration of the infusion. At our institution the usual practice was to stop the infusion on day three. Our hypothesis was that extending the infusion to five days would improve analgesia and quality of recovery. A prospective, non-blinded, randomised trial was undertaken. Patients received a continuous infusion of 0.2% ropivacaine via an adductor canal catheter for either three or five days. Primary outcome was pain while walking during the 24-hour period up to day five (numeric rating scale from 0 to 10). The minimum clinically important difference was set at 1.5 on the numeric rating scale. Secondary outcome measures included quality of recovery, mobility, pain while walking on postoperative day six, Oxford Knee Scores, and complications. Eighty-six patients were recruited with 43 randomised to each group. Seventy-eight were analysed. Median pain scores reported on day five were significantly better in the intervention group (1 versus 3, P=0.003). Furthermore, quality of recovery (QOR-15) scores were significantly better in the intervention group (133.6 versus 123.4, P=0.017). No statistically significant difference between groups was identified for other secondary outcome measures. CACB prolonged to five days provides superior analgesia and a higher quality of recovery on postoperative days four and five compared to a three-day infusion. This benefit did not extend beyond the period of infusion.


Assuntos
Amidas/uso terapêutico , Analgesia/estatística & dados numéricos , Anestésicos Locais/uso terapêutico , Artroplastia do Joelho/reabilitação , Manejo da Dor/métodos , Caminhada , Administração Intravenosa , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ropivacaina , Fatores de Tempo , Resultado do Tratamento , Caminhada/estatística & dados numéricos , Austrália Ocidental
17.
Arch. argent. pediatr ; 116(2): 196-203, abr. 2018. tab, graf
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-887460

RESUMO

Introducción. Los niños en unidades de cuidados intensivos pediátricos (UCIP) están expuestos a padecer dolor, estrés y ansiedad debido a su enfermedad, el tratamiento o el ambiente. La adecuada sedación y analgesia son fundamentales para su cuidado, especialmente, en aquellos que requieren asistencia ventilatoria mecánica (AVM). Objetivo. Determinar la práctica habitual en la sedación y analgesia de los pacientes que requieren ARM en UCIP de Argentina. Material y métodos. Estudio descriptivo, transversal, multicéntrico, realizado a través de encuestas enviadas por correo electrónico. Resultados. Se encuestaron y respondieron 45 UCIP. El 18% (N= 8) utiliza un protocolo de sedoanalgesia de seguimiento estricto, mientras que el 58% (N= 26) siguen un protocolo "tácito" producto de la automatización en la práctica. Las drogas más utilizadas son el midazolam para sedación y fentanilo para analgesia. El 31% (N= 14) de las UCIP monitorizan la sedación con escalas de evaluación (Ramsay modificada y/o Comfort). El 4% (N= 2) realizan la interrupción diaria de la sedación en forma programada. En pacientes de difícil sedación, la dexmedetomidina es la droga más utilizada como coadyuvante. El 73% (N= 33) de las unidades utilizan bloqueantes neuromusculares ante indicaciones precisas, y un monitoreo clínico. El 20% (N= 9) de las UCIP tienen un protocolo de destete para la sedoanalgesia, la morfina y lorazepam son las drogas más frecuentemente utilizadas. Conclusión. Existe un bajo porcentaje de protocolización en la práctica habitual del manejo de la sedoanalgesia en pacientes con AVM en las UCIP encuestadas.


Introduction. Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV). Objective. To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina. Material and methods. Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys. Results. A total of 45 PICUs were surveyed, 18% (N= 8) of which follow a sedation and analgesia protocol strictly, while 58% (N= 26) follow an "implied" protocol based on routine practice. The most commonly used drugs were midazolam, for sedation, and fentanyl, for analgesia. In 31% (N= 14) of the PICUs, sedation was monitored through assessment scales (modified Ramsay and/or Comfort scales). In 4% (N= 2) of units, daily, scheduled interruptions of sedation was implemented. In patients who are difficult to sedate, dexmedetomidine was the most commonly used adjuvant. In 73% (N= 33) of the units, neuromuscular blocking agents were used in compliance with precise guidelines and under clinical monitoring. In 20% (N= 9) of the PICUs there was a sedation and analgesia weaning protocol in place, and morphine and lorazepam are the most commonly used drugs. Conclusion. Only a low percentage of surveyed PICUs had a protocol in place for the routine management of sedation and analgesia in patients on MV.


Assuntos
Humanos , Criança , Unidades de Terapia Intensiva Pediátrica/normas , Sedação Consciente/estatística & dados numéricos , Sedação Profunda/estatística & dados numéricos , /estatística & dados numéricos , Analgesia/estatística & dados numéricos , Respiração Artificial , Estudos Transversais , Pesquisas sobre Serviços de Saúde
18.
Arch Argent Pediatr ; 116(2): e196-e203, 2018 Apr 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29557601

RESUMO

INTRODUCTION: Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV). OBJECTIVE: To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina. MATERIAL AND METHODS: Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys. RESULTS: A total of 45 PICUs were surveyed, 18% (N= 8) of which follow a sedation and analgesia protocol strictly, while 58% (N= 26) follow an "implied" protocol based on routine practice. The most commonly used drugs were midazolam, for sedation, and fentanyl, for analgesia. In 31% (N= 14) of the PICUs, sedation was monitored through assessment scales (modified Ramsay and/or Comfort scales). In 4% (N= 2) of units, daily, scheduled interruptions of sedation was implemented. In patients who are difficult to sedate, dexmedetomidine was the most commonly used adjuvant. In 73% (N= 33) of the units, neuromuscular blocking agents were used in compliance with precise guidelines and under clinical monitoring. In 20% (N= 9) of the PICUs there was a sedation and analgesia weaning protocol in place, and morphine and lorazepam are the most commonly used drugs. CONCLUSION: Only a low percentage of surveyed PICUs had a protocol in place for the routine management of sedation and analgesia in patients on MV.


Assuntos
Analgesia/estatística & dados numéricos , Sedação Consciente/estatística & dados numéricos , Sedação Profunda/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Respiração Artificial , Argentina , Criança , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos
19.
Wilderness Environ Med ; 29(2): 211-214, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29576403

RESUMO

INTRODUCTION: In 2014, the Wilderness Medical Society (WMS) published guidelines for the treatment of acute pain in remote settings. We surveyed wilderness medicine providers on self-reported analgesia prescribing practices. METHODS: We conducted a prospective, anonymous survey. Respondents were recruited from the WMS annual symposium in 2016. All willing attendees were included. RESULTS: During the symposium, we collected a total of 124 surveys (68% response rate). Respondent age was 42±12 (24-79) years (mean±SD with range), 58% were male, and 69% reported physician-level training. All respondents had medical training of varying levels. Of the physicians reporting a specialty, emergency medicine (59%, n=51), family medicine (13%, n=11), and internal medicine (8%, n=7) were reported most frequently. Eighty-one (65%) respondents indicated they prefer a standardized pain assessment tool, with the 10-point numerical rating scale being the most common (54%, n=67). Most participants reported preferring oral acetaminophen (81%, n=101) or nonsteroidal anti-inflammatory drugs (NSAID) (91%, n=113). Of those preferring NSAID, most reported administering acetaminophen as an adjunct (82%, n=101). Ibuprofen was the most frequently cited NSAID (71%, n=88). Of respondents who preferred opioids, the most frequently preferred opioid was oxycodone (26%, n=32); a lower proportion of respondents reported preferring oral transmucosal fentanyl citrate (9%, n=11). Twenty-five (20%, n=25) respondents preferred ketamine. CONCLUSIONS: Wilderness medicine practitioners prefer analgesic agents recommended by the WMS for the treatment of acute pain. Respondents most frequently preferred acetaminophen and NSAIDs.


Assuntos
Analgesia/métodos , Manejo da Dor/métodos , Medicina Selvagem/métodos , Adulto , Idoso , Analgesia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos , Autorrelato , Medicina Selvagem/estatística & dados numéricos
20.
J Arthroplasty ; 33(6): 1693-1698, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29433962

RESUMO

BACKGROUND: Intrathecal morphine (ITM) combined with bupivacaine spinal anesthesia can improve postoperative pain, but has potential side effects of postoperative nausea/vomiting (PONV) and pruritus. With the use of multimodal analgesia and regional anesthetic techniques, postoperative pain control has improved significantly to a point where ITM may be avoided in total joint arthroplasty (TJA). METHODS: We performed a retrospective study of primary TJA patients who underwent a standardized multimodal recovery pathway and received bupivacaine neuraxial anesthesia with ITM vs bupivacaine neuraxial anesthesia alone (control). RESULTS: In total, 598 patients were identified (131 controls, 467 ITMs) with similar demographics. On postoperative day 0 (POD 0), ITM patients had significantly lower mean visual analog scale scores (1.5 ± 1.6 vs 2.5 ± 1.9, P < .001) and consumed less oral morphine equivalents (10.5 ± 25.4 vs 16.8 ± 27.2, P = .013). ITM patients walked further compared to controls by POD 1 (133.6 ± 159.6 vs 97.3 ± 141 m, P = .028) and were less likely to develop PONV during their entire hospital stay (38.5% vs 48.6%, P = .043). No significant differences were seen for total morphine equivalents consumption, rate of discharge to care facility, length of stay, and 90-day readmission rates. CONCLUSION: ITM was associated with improved POD 0 pain scores and less initial oral/intravenous opioid consumption, which likely contributes to the subsequent improved mobilization and lower rates of PONV. In the setting of a modern regional anesthesia and multimodal analgesia recovery plan for TJA, ITM can still be considered for its benefits.


Assuntos
Analgesia/estatística & dados numéricos , Analgésicos Opioides/administração & dosagem , Raquianestesia/estatística & dados numéricos , Morfina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Idoso , Analgesia/métodos , Analgésicos Opioides/efeitos adversos , Raquianestesia/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Bupivacaína/administração & dosagem , Feminino , Humanos , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Morfina/efeitos adversos , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/etiologia , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Prurido/induzido quimicamente , Estudos Retrospectivos
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