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1.
BMJ Open ; 11(8): e048803, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34426465

RESUMO

INTRODUCTION: Techniques using local anaesthetics provide high-quality analgesia, while the anti-inflammatory properties of these drugs may represent an additional advantage. Perioperative intravenous lidocaine has shown positive effects not only on postoperative pain but also on bowel function and duration of hospital stay, due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in patients undergoing resection with colorectal cancer. This research aims to determine the effect of perioperative intravenous lidocaine on postoperative outcomes in patients undergoing resection of colorectal cancer. METHODS AND ANALYSIS: PubMed, Embase, Web of Science, CNKI, SinoMed and WanFang Data databases were electronically retrieved to include the randomised controlled trials comparing perioperative intravenous lidocaine with placebo infusion in patients undergoing resection of colorectal cancer before August 2021. Registers of clinical trials, potential grey literature and abstracts from conferences will also be searched. Two reviewers will screen literature, extract data and assess risk of bias of studies included independently. The primary outcome variable will be long-term survival outcome, tumour recurrence and metastasis rate, and restoration of intestinal function. The secondary outcome variables will consist of the severity of postoperative pain at 4, 12, 24 and 48 hours after surgery, the incidence of postoperative nausea and vomiting, and the length of hospital stay. A meta-analysis will be performed using RevMan V.5.4 software provided by the Cochrane Collaboration and Stata V.12.0. subgroup and sensitivity analyses will be conducted. ETHICS AND DISSEMINATION: Because the data used for this systematic review will be exclusively extracted from published studies, ethical approval and informed consent of patients will not be required. The systematic review will be published in a peer-reviewed journal, presented at conferences and shared on social media platforms. PROSPERO REGISTRATION NUMBER: CRD42020216232.


Assuntos
Neoplasias Colorretais , Lidocaína , Anestésicos Locais/uso terapêutico , Neoplasias Colorretais/cirurgia , Humanos , Lidocaína/uso terapêutico , Metanálise como Assunto , Revisões Sistemáticas como Assunto
2.
Anesthesiology ; 135(2): 304-325, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34237128

RESUMO

BACKGROUND: Chronic postsurgical pain can severely impair patient health and quality of life. This systematic review update evaluated the effectiveness of systemic drugs to prevent chronic postsurgical pain. METHODS: The authors included double-blind, placebo-controlled, randomized controlled trials including adults that evaluated perioperative systemic drugs. Studies that evaluated same drug(s) administered similarly were pooled. The primary outcome was the proportion reporting any pain at 3 or more months postsurgery. RESULTS: The authors identified 70 new studies and 40 from 2013. Most evaluated ketamine, pregabalin, gabapentin, IV lidocaine, nonsteroidal anti-inflammatory drugs, and corticosteroids. Some meta-analyses showed statistically significant-but of unclear clinical relevance-reductions in chronic postsurgical pain prevalence after treatment with pregabalin, IV lidocaine, and nonsteroidal anti-inflammatory drugs. Meta-analyses with more than three studies and more than 500 participants showed no effect of ketamine on prevalence of any pain at 6 months when administered for 24 h or less (risk ratio, 0.62 [95% CI, 0.36 to 1.07]; prevalence, 0 to 88% ketamine; 0 to 94% placebo) or more than 24 h (risk ratio, 0.91 [95% CI, 0.74 to 1.12]; 6 to 71% ketamine; 5 to 78% placebo), no effect of pregabalin on prevalence of any pain at 3 months (risk ratio, 0.88 [95% CI, 0.70 to 1.10]; 4 to 88% pregabalin; 3 to 80% placebo) or 6 months (risk ratio, 0.78 [95% CI, 0.47 to 1.28]; 6 to 68% pregabalin; 4 to 69% placebo) when administered more than 24 h, and an effect of pregabalin on prevalence of moderate/severe pain at 3 months when administered more than 24 h (risk ratio, 0.47 [95% CI, 0.33 to 0.68]; 0 to 20% pregabalin; 4 to 34% placebo). However, the results should be interpreted with caution given small study sizes, variable surgical types, dosages, timing and method of outcome measurements in relation to the acute pain trajectory in question, and preoperative pain status. CONCLUSIONS: Despite agreement that chronic postsurgical pain is an important topic, extremely little progress has been made since 2013, likely due to study designs being insufficient to address the complexities of this multifactorial problem.


Assuntos
Corticosteroides/uso terapêutico , Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adulto , Humanos
3.
Int J Clin Pharmacol Ther ; 59(9): 603-609, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34236302

RESUMO

OBJECTIVE: Lidocaine 5% patches are approved for the treatment of post-herpetic neuralgia in adults. Little information is available on the penetration of lidocaine into skin and skin-related soft tissue, which are thought to be closer to the site where lidocaine exerts its pharmacological action on neuronal structures. This pilot study investigated subcutaneous and systemic pharmacokinetics of lidocaine during topical application of two different lidocaine 5% patches. MATERIALS AND METHODS: This randomized two-way, two-period crossover study assessed lidocaine concentrations in subcutaneous tissue (by microdialysis) and plasma of n = 5 healthy subjects during 12-hour-long applications of a recently developed lidocaine 5% patch (Laboratorios Gebro Pharma, SA, Barcelona, Spain) and a marketed reference patch (Versatis 5% lidocaine patch, Grünenthal, Brunn am Gebirge, Austria), respectively. RESULTS: Lidocaine was detectable in subcutaneous tissue within 60 minutes from start of patch application, and in plasma only after a marked delay. The test formulation led to increased exposure to lidocaine in both subcutaneous tissue and plasma. CONCLUSION: This study has underscored the potential of microdialysis to comparatively assess the pharmacokinetics of two different drug formulations and encourages its further use in this area.


Assuntos
Anestésicos Locais , Lidocaína , Administração Cutânea , Adulto , Anestésicos Locais/uso terapêutico , Estudos Cross-Over , Humanos , Microdiálise , Projetos Piloto
4.
Clin J Pain ; 37(9): 657-663, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34265786

RESUMO

OBJECTIVES: The aim was to evaluate the safety of intravenous lidocaine for postoperative pain and the impact on opioid requirements and pain scores. MATERIALS AND METHODS: This was a single-center, retrospective, single-arm analysis of adult patients who received intravenous lidocaine for postoperative pain from January 2016 to December 2019. Patients were excluded if they received lidocaine for any indication other than pain or if lidocaine was only given intraoperatively. The primary outcome of this analysis was to determine the incidence of adverse effects (AEs) and the reason for discontinuation of lidocaine. Secondary outcomes included median daily pain scores (visual analog scale and Critical-Care Pain Observation Tool) and opioid consumption (daily morphine milligram equivalents) 24 hours before infusion and during day 1. RESULTS: A total of 452 patients were evaluated of which 298 (65.9%) patients met inclusion criteria. Of the 154 patients excluded, 153 did not receive lidocaine postoperatively. The median duration of infusion was 34 [20:48] hours with a median initial and maintenance rate of 1 mg/kg/h dosed on ideal body weight. In our analysis, 174 (58.4%) patients had a documented AE during infusion and 38 (12.8%) had lidocaine discontinued because of an AE. The most common AE was nausea in 62 (20.8%) patients and the most common reason for discontinuation was confusion in 8 (2.7%) patients. Daily morphine milligram equivalents (P<0.001) and visual analog scale (P<0.001) significantly decreased when comparing 24 hours before infusion and day 1. CONCLUSION: Although a majority of patients receiving lidocaine for postoperative pain experienced an AE, this did not result in discontinuation in most patients.


Assuntos
Lidocaína , Dor Pós-Operatória , Adulto , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/uso terapêutico , Método Duplo-Cego , Humanos , Infusões Intravenosas , Lidocaína/efeitos adversos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos
5.
J Cardiothorac Surg ; 16(1): 157, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059093

RESUMO

OBJECTIVE: Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery. METHODS: A comprehensive database search was conducted by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. RESULTS: Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally. Key findings included [1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl; and [2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics. Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery. No significant associations were observed between lidocaine and overall mortality, hospital length of stay or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias. CONCLUSIONS: Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.


Assuntos
Anestésicos Locais/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Lidocaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Administração Tópica , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/mortalidade , Fentanila/uso terapêutico , Humanos , Lidocaína/administração & dosagem , Medição da Dor , Dor Pós-Operatória/etiologia , Mecânica Respiratória
6.
Aging (Albany NY) ; 13(12): 16341-16352, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34126594

RESUMO

Breast cancer is a prevalent malignancy with high mortality and poor prognosis. Ropivacaine is a widely used local anesthetic and presents potential anti-tumor activity. Nevertheless, the function of ropivacaine in breast cancer development remains elusive. Here, we tried to investigate the impact of ropivacaine on breast cancer progression and the underlying mechanism. Significantly, we revealed that ropivacaine was able to reduce the proliferation and induce the apoptosis of breast cancer cells. Ropivacaine could attenuate the invasion and migration in the cells. Mechanically, ropivacaine could enhance the miR-27b-3p expression and miR-27b-3p inhibited breast cancer progression in breast cancer cells. MiR-27b-3p targeted YAP in the breast cancer cells. Ropivacaine decreased the breast cancer progression by modulating miR-27b-3p/YAP axis in vitro. Ropivacaine could inhibit tumor growth in vivo. In conclusion, we discovered that the local anesthetic ropivacaine inhibits the progression of breast cancer via the miR-27b-3p/YAP axis. Our finding presents novel insights into the mechanism of ropivacaine inhibiting the development of breast cancer. Ropivacaine may potentially serve as an anti-tumor candidate in the therapeutic strategy of breast cancer.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Anestésicos Locais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Progressão da Doença , Regulação Neoplásica da Expressão Gênica , MicroRNAs/genética , Ropivacaina/uso terapêutico , Fatores de Transcrição/genética , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Anestésicos Locais/farmacologia , Apoptose/efeitos dos fármacos , Apoptose/genética , Sequência de Bases , Neoplasias da Mama/patologia , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Movimento Celular/genética , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/genética , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , MicroRNAs/metabolismo , Invasividade Neoplásica , Ropivacaina/farmacologia , Fatores de Transcrição/metabolismo
8.
Pain Res Manag ; 2021: 6668738, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34055121

RESUMO

The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft-Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.


Assuntos
Anestésicos Locais/uso terapêutico , Carticaína/uso terapêutico , Lidocaína/uso terapêutico , Dente Molar/efeitos dos fármacos , Adulto , Feminino , Humanos , Injeções , Ligamentos , Masculino , Mandíbula , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Pulpite/etiologia , Adulto Jovem
9.
Orthopedics ; 44(3): e343-e346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039195

RESUMO

Spinal anesthesia has grown in popularity for total hip arthroplasty (THA) due to its documented low complications. However, the use of a local anesthetic agent dictates the recovery of neuraxial blockade. Bupivacaine has emerged as the most popular choice, but its relatively long-acting effect limits its use with rapid recovery. Although not well studied, ropivacaine may offer a viable alternative with shorter-acting properties. Primary unilateral THA patients who received either ropivacaine or bupivacaine spinal anesthesia were retrospectively reviewed. These groups were compared for common demographics, such as age, sex, and body mass index. The primary outcomes included postoperative ambulation time and distance, post-anesthesia care unit transition time, and selective complications. Five hundred three patients were included. Of these, 227 received ropivacaine and 276 received bupivacaine. The ropivacaine group showed superior ambulation time and distance, quicker post-anesthesia care unit transition, and equivalent complications compared with the bupivacaine group. Ropivacaine shows a clear advantage over bupivacaine for spinal anesthesia during THA when considering rapid recovery. Its use should be strongly considered, especially in the ambulatory setting. [Orthopedics. 2021;44(3):e343-e346.].


Assuntos
Raquianestesia/métodos , Anestésicos Locais/uso terapêutico , Artroplastia de Quadril/métodos , Deambulação Precoce , Ropivacaina/uso terapêutico , Idoso , Anestesia Local , Bupivacaína/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
10.
Int J Pharm ; 602: 120675, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33961954

RESUMO

Lipid nanocapsules (LNC) are special drug delivery system (DDS) carriers obtained by the phase-inversion temperature method (PIT). This study describes the encapsulation of the local anesthetics (LA) prilocaine (PLC) and lidocaine (LDC) in lipid nanocapsules (LNCPLC+LDC) optimized by 23 factorial design, characterized through DLS, NTA, CRYO-EM and release kinetics and incorporated in carbopol gel (GelLNC PLC+LDC) prior to in vivo anesthetic effect (in mice) evaluation. A very homogeneous population of small (50 nm; polydispersity index = 0.05) spherical nanocapsules with negative zeta potentials (-21 mV) and ca. 2.3 × 1015 particles/mL was obtained. The encapsulation efficiency was high (81% and 89% for prilocaine and lidocaine, respectively). The release rate profile was free PLC = free LDC > LNCPLC+LDC > GelLNC PLC+LDC. The hybrid system increased (4x) the anesthesia time in comparison to an equipotent gel formulation prepared without LNC. No tissue damage was detected on the tail skin of mice that received the formulations. This study shows that lipid nanocapsules are suitable carriers for PLC and LDC, promoting longer and safer topical anesthesia. GelLNC PLC+LDC is mucoadhesive and suitable for application in the mouth, where it could be used as a pre-anesthetic, to reduce pain of needle stick (infiltrative anesthesia).


Assuntos
Nanocápsulas , Prilocaína , Anestésicos Locais/uso terapêutico , Animais , Lidocaína , Lipídeos , Camundongos
11.
BMC Neurol ; 21(1): 184, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941100

RESUMO

BACKGROUND: A patient with a history of cluster headaches, now in remission, presented with confirmed hemicrania continua that resolved with a local anaesthetic injection into the Sternocleidomastoid (SCM) muscle. To the best of our knowledge, this is the first reported case of a trigeminal autonomic cephalalgia arising from a soft tissue source in the neck. CASE PRESENTATION: A 66-year-old man with a history of cluster headaches presented with a six-month history of a new constant right-sided headache. The new headaches were associated with tearing and redness of the right eye and responded to indomethacin, thus meeting the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for hemicrania continua. The history and physical examination suggested a cervical source of the headache arising from the ipsilateral SCM muscle. Injection of the muscle with 1% lidocaine resulted in the elimination of the pain for 1 month without indomethacin. CONCLUSIONS: Due to the convergence of trigeminal, cervical and autonomic nerve fibres, various combinations of headache syndromes can result. This case report demonstrates how a meticulous examination is a crucial component of headache evaluation. Treatment directed to this muscle spared this patient further daily indomethacin and associated side effects.


Assuntos
Músculos do Pescoço , Dor Referida/etiologia , Cefalalgias Autonômicas do Trigêmeo/etiologia , Idoso , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Bupivacaína/uso terapêutico , Humanos , Indometacina/uso terapêutico , Lidocaína/uso terapêutico , Masculino , Músculos do Pescoço/inervação , Dor Referida/tratamento farmacológico
12.
Revista Digital de Postgrado ; 10(1): 262, abr. 2021. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1147578

RESUMO

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)


The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Próstata/patologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Bloqueio Nervoso/métodos , Placebos/uso terapêutico , Próstata/diagnóstico por imagem , Administração Retal , Estudos Prospectivos , Manejo da Dor/métodos , Biópsia Guiada por Imagem , Anestesia Local
13.
London; National Institute for Health and Care Excellence; Apr. 7, 2021. 36 p.
Monografia em Inglês | BIGG - guias GRADE | ID: biblio-1179029

RESUMO

This guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease. This guideline should be used alongside NICE guidelines for other chronic pain conditions, including the NICE guidelines on headaches, low back pain and sciatica, rheumatoid arthritis, osteoarthritis, spondyloarthritis, endometriosis, neuropathic pain and irritable bowel syndrome.


Assuntos
Humanos , Adolescente , Dor Crônica/classificação , Dor Crônica/prevenção & controle , Dor Crônica/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Terapia por Acupuntura , Corticosteroides/uso terapêutico , Maconha Medicinal/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico
14.
World Neurosurg ; 150: e585-e590, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33753319

RESUMO

BACKGROUND: Postoperative pain in spine surgery is an issue. Erector spinae plane block (ESPB) may reduce such postoperative pain, but its usefulness has never been evaluated in the specific context of trauma surgery. We thus studied the effect of bilateral ultrasound-guided ESPB on postoperative pain and opioid requirement after percutaneous lumbar arthrodesis for trauma. METHODS: All patients who underwent percutaneous lumbar arthrodesis for spine trauma between December 2019 and March 2020 were retrospectively studied. Some patients received preoperative bilateral ESPB (30 mL of 0.375% ropivacaine on each side; ESPB group), others received the standard of care (i.e., postoperative muscular infiltration with 30 mL of 0.75% of ropivacaine; control group), according to the preference of the anesthesiologist in charge of the patient. The rest of the management was identical in all patients. The primary outcome was the cumulative morphine consumption at 24 hours postoperatively. Secondary outcomes included pain score at various time points until 24 hours. RESULTS: Fifty-five patients were included, of whom 24 received an EPSB and 31 received the standard of care. The cumulative morphine consumption (mean [standard deviation]) at 24 hours was 13 (12) mg in the ESPB group, and 35 (17) mg in the control group (P < 0.001). Pain scores were significantly lower in the ESPB group compared with the control group up to 9 hours after surgery (P < 0.01). CONCLUSIONS: In this pilot study, compared with standard analgesia, ESPB reduced opioid requirement and postoperative pain after percutaneous lumbar arthrodesis for trauma. A randomized controlled trial is required to prove this effectiveness.


Assuntos
Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Fusão Vertebral/efeitos adversos , Ultrassonografia de Intervenção/métodos , Adulto , Anestésicos Locais/uso terapêutico , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Músculos Paraespinais/efeitos dos fármacos , Projetos Piloto , Estudos Retrospectivos , Ropivacaina/uso terapêutico
16.
Anesthesiology ; 134(5): 722-733, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33740816

RESUMO

BACKGROUND: Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty. METHODS: This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events. RESULTS: There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (ß = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events. CONCLUSIONS: After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen.


Assuntos
Anestésicos Locais/uso terapêutico , Artroplastia de Quadril/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/uso terapêutico , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Estudos Prospectivos , Solução Salina , Resultado do Tratamento
18.
Can J Anaesth ; 68(6): 825-834, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33564993

RESUMO

PURPOSE: There is some evidence for the use of intrathecal morphine as a means to provide prolonged analgesia in selective cardiac surgical patients; however, the hemodynamic effects of intrathecal morphine are not well defined. This study was designed to study the effect of intrathecal morphine on hemodynamic parameters in cardiac surgery patients. METHODS: In a prospective, double-blind study, 100 adult cardiac surgical patients were randomized to receive either intrathecal 40 mg of 0.5% hyperbaric bupivacaine alone (intrathecal bupivacaine [ITB] group, n = 50) or intrathecal 250 µg of morphine added to 40 mg of 0.5% bupivacaine (intrathecal bupivacaine and morphine [ITBM] group, n = 50). Hemodynamic data, pain scores, rescue analgesic use, spirometry, and vasopressor use were recorded every four hours after surgery for 48 hr. The primary outcome was the incidence of vasoplegia in each group, which was defined as a cardiac index > 2.2 L·min-1·m-2 with the requirement of vasopressors to maintain the mean arterial pressure > 60 mmHg with the hemodynamic episode lasting > four hours. RESULTS: Eighty-seven patients were analyzed (ITB group, n = 42, and ITBM group, n =45). The incidence of vasoplegia was higher in the ITBM group than in the ITB group [14 (31%) vs 5 (12%), respectively; relative risk, 2.6; 95% confidence interval [CI], 1.0 to 6.6; P = 0.04]. The mean (standard deviation [SD]) duration of vasoplegia was significantly longer in the ITBM group than in the ITB group [8.9 (3.0) hr vs 4.3 (0.4) hr, respectively; difference in means, 4.6; 95% CI, 3.7 to 5.5; P < 0.001]. CONCLUSION: Intrathecal morphine added to bupivacaine for high spinal anesthesia increases the incidence and duration of vasoplegia in cardiac surgery patients. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02825056); registered 19 June 2016.


Assuntos
Raquianestesia , Procedimentos Cirúrgicos Cardíacos , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Bupivacaína , Método Duplo-Cego , Hemodinâmica , Humanos , Injeções Espinhais , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Estudos Prospectivos
19.
J Vet Intern Med ; 35(2): 980-986, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33538030

RESUMO

BACKGROUND: The effects of epidural anesthesia in dogs undergoing cystoscopy are unknown. OBJECTIVE: To investigate the effect of epidural analgesia on postcystoscopy pain in dogs. ANIMALS: Twenty-six dogs undergoing routine cystoscopy for lower urinary tract disease. METHODS: Prospective, randomized, blinded observational study. Dogs were assigned either to a treatment group that received epidural anesthesia (preservative free morphine sulfate, 0.09 mg/kg; 1% ropivacaine, 0.2 mg/kg; total volume delivered, 1 mL/4.5 kg of body weight to a maximum of 10 mL; n = 9) or to a nonepidural control group (n = 13). Vital signs were monitored for 24 hours, and sedation and pain scores, behavioral assessments, and presence or absence of complications was evaluated for 5 days postprocedure. RESULTS: All dogs tolerated the epidural without complications. Four dogs were removed from the study because of status unblinding, lack of patient cooperation, or incomplete follow-up. No significant differences were noted in postprocedural pain scores in dogs that received epidural analgesia. Significant differences in postprocedural pain scores were noted in the nonepidural control group. No significant differences were noted in vital signs, behavioral assessments, or the proportion of dogs with a 50% increase in pain scores between the epidural and nonepidural groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Epidural anesthesia was well-tolerated. Dogs not receiving the epidural had poor postprocedural pain control. A consistent benefit for the epidural vs nonepidural group could not be identified. Additional studies are required to better assess the impact and efficacy of epidural anesthesia for cystoscopic procedures.


Assuntos
Analgesia Epidural , Doenças do Cão , Analgesia Epidural/veterinária , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Animais , Cistoscopia/veterinária , Doenças do Cão/tratamento farmacológico , Cães , Manejo da Dor/veterinária , Dor Pós-Operatória/veterinária , Estudos Prospectivos
20.
Eur J Pain ; 25(6): 1274-1282, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33559245

RESUMO

BACKGROUND: Lower limb radicular pain resulting from a herniated intervertebral disc is a cause of functional disability and could lead to increased consumption of opioids. We evaluated the efficacy of epidural magnesium combined with a local anaesthetic and steroid in the management of this pain. METHODS: This was a prospective, case-control, randomized, double-blind study. Fifty patients each received 2 ml bupivacaine, 1 ml (40 mg) methylprednisolone and 1 ml saline (0.9%) (group C) or magnesium (200 mg) instead of saline (group M). The primary outcome measure was the improvement in the pain score (assessed using a visual analogue scale (VAS)), and the secondary outcome was the improvement in the functional ability (assessed using the Modified Oswestry Disability Questionnaire (MODQ)). The VAS and MODQ scores were assessed before and at 1 day, 1 week, 1 month and 3 months post-intervention. RESULTS: The VAS and MODQ scores were significantly better in group M compared to those in group C at all times post-injection (p-value < 0.001). Comparisons within the same group showed that the VAS and MODQ scores were significantly better at all post-injection time points compared to the pre-injection scores in both group C and group M (p-values < 0.0001). CONCLUSIONS: Adding magnesium to a local anaesthetic and steroid to be injected in the transforaminal epidural space could improve the pain and the quality of life in patients suffering from lower limb radicular pain due to lumbo-sacral disc herniation, and this improvement could last for up to 3 months. SIGNIFICANCE: Magnesium is efficient when added to local anaesthetics and steroids for management of lower limb radicular pain.


Assuntos
Deslocamento do Disco Intervertebral , Radiculopatia , Anestésicos Locais/uso terapêutico , Espaço Epidural , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Extremidade Inferior , Vértebras Lombares , Magnésio/uso terapêutico , Dor/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida , Radiculopatia/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do Tratamento
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