Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.928
Filtrar
1.
Phys Med Rehabil Clin N Am ; 34(1): 291-309, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410889

RESUMO

Peripheral nerve blocks (PNB) can lessen procedural pain and eliminate the known detrimental effects of our local anesthetics on our orthobiologic target tissues. Local nerve damage and local anesthetic systemic toxicity are risks of PNBs that can be minimized with meticulous injection technique and an understanding of why these complications can occur. Herein, several PNB techniques are described in an effort to enhance procedural safety, efficacy, and comfort.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Doenças do Sistema Nervoso Periférico , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Anestesia por Condução/métodos , Anestésicos Locais , Nervos Periféricos
2.
Reg Anesth Pain Med ; 48(1): 7-13, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36167477

RESUMO

BACKGROUND AND AIMS: An opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery. METHODS: In this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events. RESULTS: The total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences. CONCLUSION: The administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery. Trial registration number NCT03570541.


Assuntos
Neoplasias do Colo , Laparoscopia , Bloqueio Nervoso , Humanos , Analgésicos Opioides , Ropivacaina/uso terapêutico , Anestésicos Locais , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Colectomia/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Método Duplo-Cego , Analgésicos/uso terapêutico , Neoplasias do Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/tratamento farmacológico
3.
Reg Anesth Pain Med ; 48(1): 47-48, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36261263
4.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(10): 1526-1531, 2022 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-36329587

RESUMO

OBJECTIVE: To explore the effect of thoracic paravertebral anesthesia (TPVB) on prognosis of patients undergoing resection of lung cancer. METHODS: This study was conducted among the patients undergoing surgical resection of primary lung cancer under general anesthesia or TPVB combined with general anesthesia (TPVB+GA) between January, 2017 and May, 2018.The patients were enrolled in TPVB+GA group and GA group (control group) using a propensity score matching (PSM) method at the ratio of 1:2 based on their baseline characteristics.The clinical parameters, 5-year overall survival (OS), progression-free survival (PFS) and intraoperative dosage of opioids were compared between the two groups to assess the impact of TPVB on prognosis of the patients. RESULTS: Forty-seven patients were enrolled in TPVB+GA group and 94 in the control group.Kaplan-Meier survival analysis showed a significantly prolonged PFS in the patients with TPVB+GA (log-rank P=0.034), with an odds ratio (OR) of 0.45(95%CI: 0.33-0.89).Consistently, univariate and multivariate Cox regression analyses identified TPVB as an independent protective prognostic factor for patients with lung cancer resection (P=0.002, OR=0.33, 95%CI: 0.16-0.66).Cox regression analyses indicated that a lower intraoperative dose of remifentanil was significantly correlated with a longer PFS of the patients following lung cancer resection (P=0.017, OR=0.47, 95%CI: 0.25-0.87).Chi-square test confirmed that TPVB, but not general anesthesia, significantly reduced intraoperative dose of remifentanil, indicating a possible synergistic effect of TPVB with opioids to affect the survival of the patients. CONCLUSION: TPVB can prolong the survival time and improve the prognosis of the patients undergoing surgical resection of lung cancer.


Assuntos
Neoplasias Pulmonares , Bloqueio Nervoso , Humanos , Remifentanil , Dor Pós-Operatória , Bloqueio Nervoso/métodos , Analgésicos Opioides , Prognóstico , Neoplasias Pulmonares/cirurgia
8.
Turk J Med Sci ; 52(3): 631-640, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36326308

RESUMO

BACKGROUND: Although laparoscopic inguinal herniorrhaphy is associated with faster return to daily activity, inadequate postoperative pain control can cause prolonged hospital stays and patient discomfort. Erector spinae plane block (ESP) can be administered for postoperative pain management in abdominal and thoracic surgery. We investigated the effects of unilateral ESP block application in laparoscopic hernia surgery. METHODS: A total of 60 patients who were scheduled for laparoscopic inguinal hernia surgery were included. ESP block was performed in group E (n = 30) after induction of anesthesia. There was no intervention in Group C (n = 30). Postoperative pain was assessed by the patient using the numeric rating scale (NRS) at postanesthetic care unit (PACU),1, 4, 6, 12, and 24 h after surgery. The quality of postoperative functional recovery was evaluated using the quality of recovery-40 questionnaire. RESULTS: NRS scores were lower in Group E (n = 30) than in Group C (n = 30) at PACU, 1th, 4th, 6th hours in both rest and movement. Total tramadol consumption was reduced at postoperative 24 h by the ESP block [median(IQR), 60(40) versus 85(30)]. Quality of recovery score of the patients after operation was better in the ESP group than in the control group [mean(SD), 177.9(6.5) in group E and 173.2(7.09) in group C with mean differences: 4.633 and CI: 95% (1.11 to 8.15) respectively]. DISCUSSION: Unilateral ESP blocks in laparoscopic inguinal hernia surgery reduce both postoperative pain levels and analgesic consumption. In addition, the ESP block could be used safely in pain management of this type of surgery and improve the quality of recovery.


Assuntos
Hérnia Inguinal , Laparoscopia , Bloqueio Nervoso , Humanos , Hérnia Inguinal/cirurgia , Analgésicos Opioides , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Analgésicos , Ultrassonografia de Intervenção/efeitos adversos , Laparoscopia/efeitos adversos
9.
Turk J Med Sci ; 52(4): 1408-1410, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36326408

RESUMO

Patients with various aetiology of pain who underwent erector spinae plane block at different levels were evaluated at the tertiary Algology clinic. Visual analog scale (VAS) values were recorded before the block; 30 min, two weeks, and two months after the block. Medical records of fifteen patients have been obtained. The average VAS decreased from 7 ± 1 to 5 ± 3 in the second month when compared to the values before block (p < 0.01). ESP block can be an option for chronic pain in postsurgical pain syndrome and myofascial pain management.


Assuntos
Dor Crônica , Bloqueio Nervoso , Humanos , Dor Crônica/terapia , Dor Crônica/complicações , Estudos Retrospectivos , Músculos Paraespinais , Dor Pós-Operatória/tratamento farmacológico
10.
Anesthesiol Clin ; 40(4): 751-773, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36328627

RESUMO

Patients undergoing vascular surgery tend to have significant systemic comorbidities. Vascular surgery itself is also associated with greater cardiac morbidity and overall mortality than other types of noncardiac surgery. Regional anesthesia is amenable as the primary anesthetic technique for vascular surgery or as an adjunct to general anesthesia. When used as the primary anesthetic, regional anesthesia techniques avoid complications associated with general anesthesia in this challenging patient population. In this article, the authors describe regional anesthetic techniques for carotid endarterectomy, arteriovenous fistula creation, lower extremity bypass surgery, and amputation.


Assuntos
Anestesia por Condução , Endarterectomia das Carótidas , Bloqueio Nervoso , Humanos , Bloqueio Nervoso/métodos , Manejo da Dor , Anestesia por Condução/métodos , Endarterectomia das Carótidas/métodos , Anestesia Geral , Procedimentos Cirúrgicos Vasculares
11.
Artigo em Inglês | MEDLINE | ID: mdl-36361237

RESUMO

BACKGROUND: Chest surgery is associated with significant pain, and potent opioid medications are the primary medications used for pain relief. Opioid-free anaesthesia (OFA) combined with regional anaesthesia is promoted as an alternative in patients with an opioid contraindication. METHODS: Objective: To assess the efficacy of OFA combined with a paravertebral block in pain treatment during video-assisted thoracic surgery. DESIGN: A randomized, open-label study. SETTING: A single university hospital between December 2015 and March 2018. PARTICIPANTS: Sixty-six patients scheduled for elective video-assisted thoracic surgery were randomized into two groups. Of these, 16 were subsequently excluded from the analysis. INTERVENTIONS: OFA combined with a paravertebral block with 0.5% bupivacaine in the OFA group; typical general anaesthesia with opioids in the control group. MAIN OUTCOME MEASURES: Intraoperative nociceptive intensity measured with a skin conductance algesimeter (SCA) and traditional intraoperative monitoring. RESULTS: Higher mean blood pressure was observed in the control group before induction and during intubation (p = 0.0189 and p = 0.0095). During chest opening and pleural drainage, higher SCA indications were obtained in the control group (p = 0.0036 and p = 0.0253), while in the OFA group, the SCA values were higher during intubation (p = 0.0325). SCA during surgery showed more stable values in the OFA group. Pearson analysis revealed a positive correlation between the SCA indications and mean blood pressure in both groups. CONCLUSIONS: OFA combined with a paravertebral block provides effective nociception control during video-assisted thoracic surgery and can be an alternative for general anaesthesia with opioids. OFA provides a stable nociception response during general anaesthesia, as measured by SCA.


Assuntos
Bloqueio Nervoso , Cirurgia Torácica , Humanos , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Medição da Dor , Cirurgia Torácica Vídeoassistida
12.
Acta Clin Croat ; 61(1): 3-10, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36398073

RESUMO

Transversus abdominis plane (TAP) block is used to provide analgesia after lower abdominal surgery operations. TAP block has been shown to reduce postoperative pain scores and side effects of opioids after cesarean section. Generally, TAP block was introduced after cesarean section. It is assumed that delivery affects sonographic characteristics of the abdominal wall. For this reason, ultrasonographic measurement of the anatomy of the region defined for TAP block was performed before and after cesarean section. It was aimed to determine the estimated TAP block distance in the population undergoing cesarean section. Fifty patients who underwent cesarean section in the operating room were included in the study. The inclusion criteria were ASA score I-II, age 18-45 years, gestational age ≥32 weeks, and cesarean section performed by Pfannenstiel incision. Data on patient age, weight, height, body mass index, gravidity, parity, gestational age (weeks), concomitant disease and allergy were recorded. According to the results obtained in the study, ultrasound should be performed if TAP block is accessible. Before cesarean section, the external oblique muscle and internal oblique muscle are closer to surface than after cesarean section since the TAP distance after pregnancy will be deeper. Systematic data on ultrasonographic anatomy of the abdominal wall in pregnant women have not yet been published. The obstetric anesthesiologist should be aware of these changes when planning a TAP block in the context of cesarean section. There is a need for larger prospective studies.


Assuntos
Cesárea , Bloqueio Nervoso , Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Lactente , Cesárea/métodos , Estudos Prospectivos , Músculos Abdominais/diagnóstico por imagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/etiologia
14.
RMD Open ; 8(2)2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36418088

RESUMO

OBJECTIVE: Adhesive capsulitis is a common painful shoulder condition. Treatment for the condition remains unsatisfactory. Suprascapular nerve block (SSNB) shows promise as a treatment option for adhesive capsulitis but there are no randomised controlled trials that examine its effect on pain or duration of the condition. The objective of this study was to examine the efficacy of SSNB for the management of adhesive capsulitis. METHODS: A randomised double-blind placebo-controlled trial of SSNB and standard therapy versus placebo and standard therapy was performed. In total, 54 patients were enrolled in the study. 27 patients received a glenohumeral joint (GHJ) injection and physiotherapy plus a 3-month SSNB, and 27 patients received a GHJ injection and physiotherapy plus a 3-month placebo injection. Patients were followed to resolution of their symptoms as measured by a combination of range of movement, pain scores, Shoulder Pain and Disability Index (SPADI) scores and perceived recovery scores. The primary outcome measure was time to resolution of symptoms. RESULTS: Participants who received the SSNB reduced the duration of their symptoms of adhesive capsulitis by an average of 6 months (mean time to resolution 5.4 (95% CI 4.4 to 6.3) months vs 11.2 (95% CI 9.3 to 13) months) in the placebo group. They also had reduced pain scores, improved range of movement and lower SPADI scores compared with the placebo group across all time points. CONCLUSION: SSNB reduced the duration of adhesive capsulitis and resulted in improved pain and disability experience for patients. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANCTRN 12615001378516).


Assuntos
Bursite , Bloqueio Nervoso , Humanos , Resultado do Tratamento , Austrália , Bursite/terapia , Bursite/etiologia , Dor de Ombro/terapia , Dor de Ombro/tratamento farmacológico , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos
15.
West J Emerg Med ; 23(6): 878-885, 2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36409943

RESUMO

INTRODUCTION: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research. METHODS: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends. RESULTS: In total, 133 eligible publications were included. We found that overall 23 techniques have been described and results published in the EM literature. Articles related to RA increased from one article in 1982 to 18 in 2021, and the rate of publication has increased more rapidly since 2016. Reports of lower extremity blocks (60.90%) were published most frequently in ranked-first aggregated citations. The use of thoracic nerve blocks, such as the erector spinae plane block, has increased exponentially in the past three years. The United States (41.35%) has published the most RA-related articles. Regional anesthesia administered by emergency physicians (52.63%) comprised the leading field in published articles related to RA. Most publications discussed single-shot (88.72%) and ultrasound-guided methods (55.64%). CONCLUSION: This study highlights that the number of published articles related to regional anesthesia in EM has increased. Although RA research has primarily focused on lower extremity blocks, clinical researchers continue to broaden the field of study to encompass a wide spectrum of techniques and indications.


Assuntos
Anestesia por Condução , Medicina de Emergência , Bloqueio Nervoso , Humanos , Estados Unidos , Bibliometria , Manejo da Dor
17.
Ann Plast Surg ; 89(6): 656-659, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416694

RESUMO

ABSTRACT: The analgesic efficacy of bilateral low thoracic erector spinae blocks for combined major breast and abdominal surgery has not been reported. The aim of this case series was to assess the feasibility and efficacy of T8 thoracic preincisional erector spinae blocks in patients undergoing total radical mastectomies with axillary lymph node dissections in addition to reconstruction with abdominal deep inferior epigastric flaps. The aim was to supply dermatomal coverage to provide analgesia for T2-L1 that formed the basis for an opioid-sparing multimodal technique in the context of our early recovery after breast surgery with deep inferior epigastric flap program.


Assuntos
Neoplasias da Mama , Bloqueio Nervoso , Retalho Perfurante , Humanos , Feminino , Mastectomia Simples , Mastectomia , Neoplasias da Mama/cirurgia , Estudos de Viabilidade , Mastectomia Radical , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção
18.
Rev. esp. anestesiol. reanim ; 69(9): 556-566, Nov. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-211678

RESUMO

La cirugía sobre la articulación coxofemoral es muy frecuente. Mejorar el manejo del dolor ha sido y es uno de los pilares fundamentales para optimizar la recuperación funcional de los pacientes. Para ello debemos diseñar un plan anestésico-analgésico multimodal que abarque todo el periodo perioperatorio.Los bloqueos nerviosos periféricos y los bloqueos fasciales son un componente importante de las estrategias analgésicas multimodales. Los bloqueos tradicionales tienen una eficacia moderada, afectación motora prolongada y aumento de riesgo de caídas. Como alternativa, recientemente se describieron los bloqueos capsulares (bloqueo del plano del ileopsoas o «ileopsoas plane block» [IPB] y bloqueo del grupo nervioso pericapsular o «PENG block»), que pretenden evitar la afectación motora manteniendo una óptima eficacia analgésica.El objetivo de esta revisión es la descripción de los nuevos bloqueos capsulares y analizar si permiten mejorar la analgesia postoperatoria y favorecer la recuperación funcional con menos complicaciones, con base en la inervación de la cadera. Para realizarlo se ha llevado a cabo una revisión bibliográfica en las bases de datos de PubMed, Embase y Cochrane Library desde enero 2018 hasta junio de 2020.(AU)


Surgery on the hip joint is very common. Improving pain management has been and is one of the fundamental pillars to optimize the functional recovery of patients. To do this, we must design a multimodal anesthetic-analgesic plan that covers the entire perioperative period.Peripheral nerve blocks and fascial blocks are an important component of multimodal analgesic strategies. Traditional blocks have moderate efficacy, prolonged motor impairment, and increased risk of falls. As an alternative, capsular blocks («ileopsoas plane block» or «IPB» and pericapsular nerve group block or «PENG block») have recently been described that aim to avoid motor impairment while maintaining optimal analgesic efficacy.The objective of this review is to describe the new capsular blocks and to analyze whether they allow to improve postoperative analgesia and promote functional recovery with fewer complications, based on the innervation of the hip. To do this, a bibliographic review was carried out in the PubMed, Embase and Cochrane Library databases from January 2018 to June 2020.(AU)


Assuntos
Humanos , Masculino , Feminino , Artroplastia de Quadril , Quadril , Bloqueio Nervoso , Analgesia , Quadril/cirurgia , Manejo da Dor , Período Perioperatório , Período de Recuperação da Anestesia , Reanimação Cardiopulmonar , Anestesiologia , Espanha
19.
Acta Chir Orthop Traumatol Cech ; 89(5): 339-343, 2022.
Artigo em Tcheco | MEDLINE | ID: mdl-36322033

RESUMO

PURPOSE OF THE STUDY Many physicians believe that loco-regional anaesthesia and analgesia improve the postoperative course of patients indicated for total hip arthroplasty compared to general anaesthesia. However, there are many patients who refuse subarachnoid or epidural anaesthesia, or have contraindications or conditions making the use of such techniques impossible. An alternative option is the combination of general anaesthesia and a peripheral nerve blockade. The aim of this prospective randomized open-label clinical trial was to compare the efficacy and quality of postoperative analgesia between fascia iliaca block combined with general anaesthesia (GA) and subarachnoid anaesthesia with morphine and bupivacaine (SAB). MATERIAL AND METHODS After having obtained the ethics committee approval and the patients consent, a prospective, open-label, randomized trial was conducted in patients referred for total hip arthroplasty (THR). The GA group was administered ultrasound-guided fascia iliaca block with 40 ml of 0.25% bupivacaine solution after the induction of general anaesthesia. In the SAB group, subarachnoid blockade was performed with a mixture of 3 ml of 0.5% bupivacaine with 0.150 mg morphine prepared in the hospital pharmacy. Right after surgery the patients were taken to the ICU for 24 hours, after which they were transferred to a general ward. In addition to vital signs monitoring, pain intensity using a 0-10 numeric rating scale (NRS), first morphine administration at NRS >4, total morphine consumption and potential adverse effects were observed over the period of 72 hours. RESULTS There was no statistical difference between the GA (14 persons) and the SAB (14 persons) group in demographic parameters, time to first morphine administration (10 hrs vs. 19 hrs, p=0.10), number of persons with no need for morphine after surgery (5 vs. 7), tingling sensation (1 vs. 0) or numbness of the limb (0 vs. 1). There was no difference in cardiorespiratory parameters or side effects of therapy. In neither case was there respiratory depression or delayed rehabilitation. No patient developed delirium after surgery, and no patient reported dissatisfaction with pain management. DISCUSSION The fascia iliaca block and subarachnoid anaesthesia using local anaesthetic with opioid addition have been repeatedly published for patients after total hip arthroplasty, but this study is unique by comparing the two methods. The study added a new piece of knowledge to the findings of several recent meta-analyses on the comparable outcomes of general and subarachnoid anaesthesia for hip replacement in the perioperative period. CONCLUSIONS If subarachnoid anaesthesia cannot be used in hip arthroplasty, general anaesthesia with fascia iliaca block provides comparable analgesia and quality of postoperative course. Key words: total hip arthroplasty, general anaesthesia, fascia iliaca block, subarachnoid anaesthesia, postoperative analgesia, postoperative course.


Assuntos
Artroplastia de Quadril , Bloqueio Nervoso , Humanos , Morfina/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Bupivacaína/uso terapêutico , Fáscia , Anestesia Geral
20.
Br J Hosp Med (Lond) ; 83(10): 1-10, 2022 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-36322433

RESUMO

Peripheral regional blockade is a type of regional anaesthesia involving depositing local anaesthetics around a specific nerve or bundle of nerves that help transmit nociceptive signals to higher centres, such as the thalamus and somatosensory cortex. It is not only a widely used technique that provides surgical anaesthesia, but also acts as an essential part of the armamentarium against postoperative pain and pain following major skeletal trauma. This article discusses the structure and function of peripheral nerves, the classification and pathophysiology of peripheral nerve injury and, finally, how practising anaesthetists are committed to maximising success and minimising harm when performing peripheral nerve blockade in the operating theatre.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Humanos , Bloqueio Nervoso/métodos , Anestesia por Condução/métodos , Anestésicos Locais/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Anestesia Local , Nervos Periféricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...