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1.
J Surg Res ; 246: 19-25, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31550671

RESUMO

BACKGROUND: Some surgeons have adopted the use of video-assisted thoracoscopic surgery (VATS) or robotic surgery to perform resections for lung cancer. VATS is associated with less pain and a decrease in pulmonary complications compared with open thoracotomies. Long-acting liposomal bupivacaine (LB) intercostal nerve blocks are reported to provide superior pain relief compared with epidural catheters in the first 3 d after a thoracotomy. This study examined whether LB improves pain after VATS and if it provides effective analgesia after a thoracotomy. MATERIALS AND METHODS: A retrospective review was performed on 151 consecutive patients undergoing a VATS or thoracotomy who received paravertebral nerve blocks. VATS patients received paravertebral nerve blocks with LB (VATS-LB) or 0.25% bupivacaine with epinephrine (BE; VATS-BE). Thoracotomy patients received paravertebral nerve blocks via LB injections. Pain scores, narcotic utilization, complications, and hospital length of stay were examined. RESULTS: Fifty patients underwent a VATS-LB, 53 underwent a VATS-BE, and 32 underwent a thoracotomy. Thoracotomy and VATS-LB patients had pain scores lower than VATS-BE patients in the first 48 h after surgery (P < 0.004). Opioid use was not significantly different between the thoracotomy and VATS-LB patients throughout the first 2 wk postoperatively. CONCLUSIONS: LB paravertebral blocks significantly improve postoperative pain in comparison with 0.25% BE blocks in VATS patients. LB paravertebral blocks also provide effective analgesia in patients undergoing thoracotomies.


Assuntos
Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Idoso , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Nervos Espinhais/efeitos dos fármacos , Vértebras Torácicas/inervação , Resultado do Tratamento , Vasoconstritores/administração & dosagem
2.
Pharm Res ; 36(12): 179, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31705417

RESUMO

PURPOSE: It is unknown whether there are sex differences in response to free or encapsulated local anesthetics. METHODS: We examined nerve block duration and toxicity following peripheral nerve blockade in male and female rats. We studied the local anesthetic bupivacaine (free or encapsulated) as well as tetrodotoxin, which acts on a different site of the same voltage-gated channel. RESULTS: Sensory nerve blockade was 158.5 [139-190] minutes (median [interquartile range]) (males) compared to 173 [134-171] minutes (females) (p = 0.702) following bupivacaine injection, N = 8 male, 8 female. Motor nerve blockade was 157 [141-171] minutes (males) compared to 172 [146-320] minutes (females) (p = 0.2786). Micellar bupivacaine (N = 8 male, 8 female) resulted in sensory nerve blockade of 266 [227-320] minutes (males) compared to 285 [239-344] minutes (females) (p = 0.6427). Motor nerve blockade was 264 [251-264] minutes (males) compared to 287 [262-287] minutes (females) (p = 0.3823). Liposomal bupivacaine (N = 8 male, 8 female) resulted in sensory nerve blockade of 240 [207-277] minutes (males) compared to 289 [204-348] minutes (females) (p = 0.1654). Motor nerve blockade was 266 [237-372] minutes (males) compared to 317 [251-356] minutes (females) (p = 0.6671). Following tetrodotoxin injection (N = 12 male,12 female) sensory nerve blockade was 54.8 [5-117] minutes (males) compared to 54 [14-71] minutes (females) (p = 0.6422). Motor nerve blockade was 72 [40-112] minutes (males) compared to 64 [32-143] minutes (females) (p = 0.971). CONCLUSIONS: We found no statistically significant sex differences associated with the formulations tested. In both sexes, durations of nerve block were similar between micellar and liposomal bupivacaine formulations, despite the micellar formulation containing less drug.


Assuntos
Anestésicos Locais/farmacocinética , Bupivacaína/farmacocinética , Preparações de Ação Retardada/química , Bloqueio Nervoso/métodos , Tetrodotoxina/farmacocinética , Anestésicos Locais/administração & dosagem , Animais , Bupivacaína/administração & dosagem , Portadores de Fármacos/química , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Feminino , Injeções , Masculino , Micelas , Fosfatidiletanolaminas/química , Polietilenoglicóis/química , Ratos , Ratos Sprague-Dawley , Fatores Sexuais , Tetrodotoxina/administração & dosagem , Distribuição Tecidual
3.
Am Surg ; 85(9): 956-960, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638506

RESUMO

Postoperative pain managed with opioids has contributed to the opioid crisis through overprescribing practices. We assessed opioid-prescribing habits and their use by patients undergoing surgery for cutaneous malignancies. An Institutional Review Board-approved retrospective analysis was conducted for patients who underwent skin cancer resection between January 2018 and June 2018. Data were collected from the electronic medical record, and opioid-related data were collected from patient interviews and state registries. There were 120 study participants (42 females and 78 males) with a median age of 67 years (range, 21-94 years). All received preincision local anesthetic: 64 had liposomal bupivacaine (LB) (53%) and 56 had non-LB bupivacaine (47%). Most participants (n = 88) used 0 opioids (73%), including 43 LB-anesthetic (67%) and 45 non-LB-anesthetic (80%). No significance was seen between those with a diagnosis of chronic pain, narcotic tolerance, an area of resection, and nodal sampling groups in opioid use. Four patients (3%) requested a refill. Of 105 prescriptions written for opioids, 99 had leftover opioids for an overprescribing rate of 94 per cent. This study suggests pain after skin cancer surgery is manageable with very limited opioid requirements. Our results support prescribing no more than five opioid tablets for postoperative pain control in patients undergoing resection for skin malignancies.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgésicos Opioides/uso terapêutico , Prescrição Inadequada/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Feminino , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos , Sudeste dos Estados Unidos , Adulto Jovem
4.
Am Surg ; 85(9): 1013-1016, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638516

RESUMO

Transversus abdominis plane (TAP) blocks are a safe and effective way to provide immediate postoperative pain relief in surgical patients, and have been shown to decrease narcotic requirements. Concerns about complications of narcotics, increase in hospital length of stay (LOS), and health-care costs make this of particular interest. We compared standard bupivacaine TAP blocks with those carried out using liposomal bupivacaine to evaluate postoperative outcomes. Fifty patients undergoing elective laparoscopic colectomy received laparoscopic liposomal bupivacaine TAP blocks using 80 cc of local anesthetic, and data were collected prospectively during hospitalization. Data collected included amount of narcotic medication used during hospitalization, number of days to ambulation, number of days to bowel function, and LOS. These patients were compared with the last 50 patients recruited to the control/bupivacaine TAP block arm of the study. The same data parameters were collected and all patients were on an enhanced recovery protocol, which included scheduled acetaminophen, ibuprofen, and gabapentin by mouth, as well as clear liquid diet starting on postoperative day zero. Statistical analysis was performed using Student's t test and Fisher's exact test; P < 0.05 was considered statistically significant. Patients treated with liposomal bupivacaine needed less narcotics (5.06 vs 18.75 mg, P = 0.0002), had earlier bowel function (1.7 vs 2.4 days, P = 0.0002), and shorter LOS (2.7 vs 3.4 days, P = 0.0146). Patients undergoing laparoscopic colon resections seem to require fewer narcotics and have better patient outcomes with liposomal bupivacaine TAP blocks. Based on our data, liposomal bupivacaine seems to be superior to bupivacaine for TAP blocks.


Assuntos
Músculos Abdominais/inervação , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Colectomia/efeitos adversos , Laparoscopia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Tempo de Internação , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos
5.
AANA J ; 87(1): 51-57, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31587744

RESUMO

Femoral nerve blocks (FNBs) and periarticular injections (PAIs) are often used for analgesia following bone and joint surgery. The purpose of this retrospective analysis was to investigate the association of analgesic technique with outcomes. All patients receiving total knee arthroplasty (TKA) at a regional medical center in 2014 were analyzed. Patients were grouped by whether they received an FNB or PAI of bupivacaine liposome injectable suspension (Exparel) for postoperative analgesia. Outcome variables of pain perception, morphine equivalents administered, length of stay, and total cost of care were compared using 2-tailed t tests. Readmission rate was examined using a 2-sample z test for proportions. One hundred forty-four patients were included in the study. This analysis demonstrated an association between receiving an FNB and less pain perception (P = .0497). Results also demonstrated a possible relationship between less opioid consumption in patients receiving a PAI of liposomal bupivacaine (P = .037). No statistical differences were found for the other variables. Receiving a FNB was preferable regarding patients' pain perception. Patients received less opioid analgesic when they received a PAI, possibly relating to the particular surgeon performing the primary TKA. Patients were 5 times likelier to require hospital readmission in the PAI group.


Assuntos
Artroplastia do Joelho , Dor Pós-Operatória/prevenção & controle , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Feminino , Nervo Femoral , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Enfermeiras Anestesistas , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/enfermagem , Estudos Retrospectivos , Resultado do Tratamento
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 222-227, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183875

RESUMO

Introducción: Existen diferentes técnicas para reconstrucción del músculo temporal (MT) en el abordaje pterional (AP) con el objetivo de evitar y disminuir la atrofia, hasta el momento ninguna ha logrado evitarla en su totalidad. La administración de bupivacaína genera regeneración de fibras musculares. Aún no existe en la literatura médica estudios que evalúen el tiempo de manipulación del MT y que den uso a la bupivacaína para el tratamiento de la atrofia después de un abordaje pterional, el presente estudio pretende describir los efectos de estas variables. Pacientes y métodos: Estudio longitudinal, incluyendo pacientes de 18-80 años y sometidos a abordaje pterional en los años 2016-2017. Evaluamos los efectos de la manipulación del MT y la administración de bupivacaína al 0,5% sobre el trofismo y la función del MT. Resultados: Veintinueve pacientes fueron sometidos a AP; 16(55,17%) contaron con criterios para infiltración con bupivacina al 0,5%. Se encontró una correlación negativa entre los tiempos de manipulación y el trofismo, no estadísticamente significativo (p>0,05). Se evalúo los índices de disfunción de Helkimo y Fonseca prequirúrgicos y posquirúrgicos encontrándose un incremento estadísticamente significativo en la disfunción (p<0,05). En pacientes infiltrados con bupivacaína al 0,5% se observó una diferencia media del espesor de MT de 0,275±1,18mm, en contraste con los no infiltrados de 2,39±1,30mm (t[27] = -5,118, p=0,0001). Conclusiones: La manipulación del MT durante el abordaje pterional, condiciona un impacto sobre la calidad de vida de acuerdo con los índices de disfunción, debido a la atrofia. Esta investigación presenta que la administración de bupivacaína al 0,5% durante la cirugía ofrece una disminución en la atrofia del MT


Introduction: There are different techniques for the reconstruction of the temporal muscle (TM) in the pterional approach (PA) in order to avoid and reduce atrophy, it has not been able to avoid it in its entirety. The administration of bupivacaine generates regeneration of muscle fibres. There are no studies in the medical literature that evaluate the time of TM manipulation and the use of bupivacaine for the treatment of atrophy after pterional approach, the present investigation aim is to describe the effects of these variables. Patient and methods: Longitudinal study, including patients from 18-80 years old with pterional approach at 2016-2017. We evaluated the effects of the TM manipulation times and the administration of 0.5% bupivacaine on the trophism and function of TM. Results: Twenty-nine patients underwent a PA; 16(55.17%) count with criteria for 0.5% bupivacain infiltration. We found a negative correlation between manipulation times and trophism, with no statistically significance (p>.05). We evaluated presurgical and postsurgical index of Helkimo and Fonseca's index, finding an increase of disfunction with statistically significance (p<.05). In patients who were infiltrated with 0.5% bupivacaine we observed a mean difference in the TM's trophism of 0.275±1.18mm, in contrast with no infiltrated which was 2.39±1.30mm (t[27] = -5.118, p=.0001). Conclusions: The manipulation of the TM during a pterional approach conditioned an impact on the quality of life according to the disfunction indexes, due to atrophy. This investigation exhibits that de administration of 0.5% bupivacaine during surgery offers a decrease in the TM atrophy


Assuntos
Humanos , Músculo Temporal/cirurgia , Atrofia/prevenção & controle , Atrofia/cirurgia , Bupivacaína/administração & dosagem , Craniotomia/métodos , Músculo Temporal/efeitos dos fármacos , Fibras Musculares Esqueléticas , Estudos Longitudinais , Retalhos Cirúrgicos
7.
AANA J ; 85(2): 91-97, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31554561

RESUMO

Poorly managed postoperative pain decreases patient satisfaction, impedes early patient mobilization, lengthens inpatient hospital stay, and increases healthcare costs. Multimodal analgesia with local anesthetics is considered most effective for postoperative pain management. This study compared patients undergoing lumbar fusion who received plain bupivacaine from May 2011 until August 2012 with those who received liposomal bupivacaine from September 2012 until May 2013. The aim was to determine which preparation reduced postoperative opioid use the most. All lumbar spinal fusion surgeries in the periods indicated were included in the study. Ninety-three patient charts were reviewed: 47 for the plain bupivacaine group and 46 for the liposomal bupivacaine group. The study found no statistical difference between liposomal and plain bupivacaine in providing postoperative pain control from lumbar fusion surgery. Liposomal bupivacaine is as effective as plain bupivacaine for postoperative pain control after lumbar fusion. However, a continuous infusion system carries substantial inherent drawbacks: need for training and setup, pump cost, risk of infection at the insertion site, or catheter migration. Therefore, liposomal bupivacaine becomes the logical and attractive choice to manage postoperative pain following lumbar fusion.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Fusão Vertebral , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Distribuição Aleatória , Estudos Retrospectivos , Resultado do Tratamento
8.
Niger J Clin Pract ; 22(9): 1301-1303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489871

RESUMO

Neuropathic pain responds poorly to common analgesics that effectively control nociceptive pain because its pathophysiology is different and it is usually associated with co-morbidities such as sleep disturbance, depression and anxiety. Patients with this chronic pain are sometimes left with neurolysis as the last resort. A 65-year-old male multiply-injured retiree presented with disabling pain following traumatic brachial plexus injury sustained from road traffic accident 5 years earlier. Other injuries resolved with therapy except the chronic severe burning and electrifying pain (VAS score 9) in the paralyzed left upper limb associated with allodynia and insomnia which was unresponsive to conventional analgesics. PainDETECT score was 29. A test supraclavicular block with 0.25% Bupivacaine was done, followed by chemical neurolysis one month later. He was placed on oral Gabapentin. The pain score a week post injection was 3 and has remained same 18 months post injection. Patient's level of satisfaction on 5 point Likert scale was 5. Chronic neuropathic pain following traumatic brachial plexus injury could be successfully managed by chemical neurolysis and oral gabapentin.


Assuntos
Analgésicos/administração & dosagem , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/tratamento farmacológico , Plexo Braquial/lesões , Gabapentina/administração & dosagem , Bloqueio Nervoso/métodos , Neuralgia/tratamento farmacológico , Extremidade Superior/lesões , Adulto , Idoso , Analgésicos/uso terapêutico , Neuropatias do Plexo Braquial/fisiopatologia , Bupivacaína/administração & dosagem , Gabapentina/uso terapêutico , Humanos , Hiperalgesia/etiologia , Masculino , Bloqueio Nervoso/efeitos adversos , Neuralgia/etiologia , Medição da Dor , Sono/efeitos dos fármacos , Distúrbios do Início e da Manutenção do Sono/etiologia , Resultado do Tratamento
9.
Rev Bras Anestesiol ; 69(4): 369-376, 2019.
Artigo em Português | MEDLINE | ID: mdl-31362883

RESUMO

BACKGROUND AND OBJECTIVES: One of the disadvantages of unilateral spinal anesthesia is the short duration of post-operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery. METHODS: In this double-blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1mL bupivacaine 0.5% (5mg). In groups BD, BF and BS, 5µg of dexmedetomidine, 25µg of fentanyl and 0.5mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90min. RESULTS: The duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169min) and BD (92 and 166min) groups than the BS (84 and 157min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24h after surgery, than the BS (1.6) group. CONCLUSIONS: The addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine.


Assuntos
Raquianestesia/métodos , Bupivacaína/administração & dosagem , Dexmedetomidina/administração & dosagem , Fentanila/administração & dosagem , Adjuvantes Anestésicos/administração & dosagem , Adulto , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Adulto Jovem
10.
Prog Urol ; 29(8-9): 402-407, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31266700

RESUMO

INTRODUCTION: Spinal anesthesia in outpatient urology is controversial (longer hospital stay, risk of urinary retention). The main goal was to evaluate outpatient spinal anesthesia and to compare 2 local anesthetics secondarily. MATERIAL: Monocentric retrospective study including all patients undergoing surgery in urological ambulatory surgery under spinal anesthesia between December 2011 and May 2015, split into two groups according to the local anesthetic used: bupivacaine (BP) and chloroprocaine (CP). Quantitative variables were compared by Student's t-test, qualitative variables by χ2 test. RESULTS: Seventy-one (95%) out of the 75 patients included have been discharged the same day. Discharge was impossible in these cases: patient alone at home (1), bladder clot (1), JJ intolerance (1), delayed micturition (1). The mean duration of the procedure was 27±19min, the SSPI's was 55±31min, the stay's was 360±91min. A total of 45 patients (60%) received BP and 30 (40%) received CP. The mean residence time in SSPI was significantly reduced in the CP group (47±24min vs. 61±34min, P=0.04). One patient experienced urination delay in the BP group with no significant difference. No significant difference for the other criteria studied despite the mean age, which is higher in the CP group (P=0.02). CONCLUSION: Spinal anesthesia is adapted to ambulatory urology, and does not increase the risk of urinary retention, especially with CP that would decrease the length of stay in SSPI compared to BP. LEVEL OF EVIDENCE: 4.


Assuntos
Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Procaína/análogos & derivados , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Raquianestesia/efeitos adversos , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procaína/administração & dosagem , Procaína/efeitos adversos , Estudos Retrospectivos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia
11.
J Shoulder Elbow Surg ; 28(9): 1824-1834, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31324503

RESUMO

HYPOTHESIS: The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery. METHODS: A systematic literature review of randomized controlled clinical studies comparing the efficacy of LB with NLAs in shoulder surgery was conducted. Seven level I and II studies were included in the meta-analysis, and shoulder surgical procedures included arthroscopic rotator cuff repair and shoulder arthroplasty. Bias was assessed using The Cochrane Collaboration's tool. The primary outcome measures were visual analog scale pain scores and opioid consumption 24 and 48 hours after shoulder surgery. Subgroup analysis was performed for the method of LB administration (interscalene nerve block vs. local infiltration). RESULTS: A total of 7 studies (535 patients) were included in the final meta-analysis comparing LB (n = 260) with NLAs (n = 275). No significant difference was found between the LB and NLA groups in terms of visual analog scale pain scores at 24 hours (95% confidence interval, -1.02 to 0.84; P = .86) and 48 hours (95% confidence interval, -0.53 to 0.71; P = .78). Both groups had comparable opioid consumption at both 24 hours (P = .43) and 48 hours (P = .78) postoperatively and with respect to length of stay (P = .87) and adverse events (P = .97). Subgroup analysis demonstrated comparable efficacy irrespective of the method of administration of LB. CONCLUSION: LB is comparable to NLAs with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after arthroscopic rotator cuff repair and total shoulder arthroplasty.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial , Humanos , Tempo de Internação , Lipossomos , Medição da Dor , Dor Pós-Operatória/etiologia , Lesões do Manguito Rotador/cirurgia
12.
Vet Surg ; 48(7): 1330-1337, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31328291

RESUMO

OBJECTIVE: To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid-based analgesia (OBA) vs those receiving bupivacaine epidural-based analgesia (EPID) during cystotomy. STUDY DESIGN: Retrospective cross-sectional study. ANIMALS: Fifty-six client-owned dogs undergoing cystotomy. METHODS: Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank-sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox-proportional hazard models. RESULTS: Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments. CONCLUSION: Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. CLINICAL SIGNIFICANCE: The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.


Assuntos
Analgesia Epidural/veterinária , Bupivacaína/uso terapêutico , Cistotomia/veterinária , Doenças do Cão/cirurgia , Morfina/uso terapêutico , Dor Pós-Operatória/veterinária , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Epidural , Anestésicos Locais/administração & dosagem , Animais , Bupivacaína/administração & dosagem , Estudos Transversais , Cistotomia/efeitos adversos , Cães , Feminino , Hospitalização , Humanos , Masculino , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos
13.
Br J Anaesth ; 123(2): e434-e441, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331592

RESUMO

BACKGROUND: Several randomised controlled trials show that maintenance of labour epidural analgesia with programmed intermittent epidural bolus reduces the maternal motor block compared with maintenance with a continuous infusion. However, these trials were usually restricted to healthy nulliparous parturients. To assess the generalisability of these randomised controlled trials to 'real-world' conditions, we compared maternal motor function (modified Bromage score) over time between healthy nulliparous and parous women using routinely collected quality-control data. METHODS: After ethical approval, all parturients receiving programmed intermittent epidural bolus labour analgesia between June 2013 and October 2014 were included in this prospective cohort study. Bupivacaine 0.1% with fentanyl 2 µg ml-1 was used allowing for patient-controlled bolus every 20 min. The maternal motor function (primary outcome) was regularly assessed from insertion of the epidural catheter until delivery. RESULTS: Of the 839 parturients included, 553 (66%) were nulliparous and 286 (34%) were parous. The parous women had a shorter median duration of epidural analgesia (3 h 59 min vs 5 h 45 min) and a higher incidence of spontaneous delivery (66% vs 37%). The probability of being in a certain Bromage category at birth was similar in nulliparous and parous women in a general additive model adjusting for duration of epidural analgesia, number of rescue top-ups, and number of catheter manipulations (cumulative odds ratio: 1.18; 95% confidence interval: 0.98-1.41). Parous women required a higher time-weighted number and volume of rescue top-ups. CONCLUSIONS: The results of the randomised controlled trials on a reduced motor block with programmed intermittent epidural bolus seem generalisable to parturients typically not included in these trials.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Trabalho de Parto , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Estudos de Coortes , Feminino , Fentanila/administração & dosagem , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto Jovem
14.
J Opioid Manag ; 15(2): 169-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343718

RESUMO

OBJECTIVE: Efforts to achieve balance between effective pain management and opioid-related adverse events (ORAEs) have led to multimodal analgesia regimens. This study compared opioids delivered via patient-controlled analgesia (PCA) plus liposomal bupivacaine, a long-acting local anesthetic with potential to be an effective component of such regimens, to opioids delivered through PCA alone or PCA plus subcutaneous bupivacaine infusion (ONQ), following laparotomy. DESIGN: Prospective, randomized controlled trial. SETTING: Single, tertiary-care institution. PATIENTS: One hundred patients undergoing nonemergent laparotomy. INTERVENTIONS: Patients were randomly assigned to one of three study treatments: PCA only (PCAO), PCA with ONQ, or PCA with injectable liposomal bupivacaine suspension (EXP). MAIN OUTCOME MEASURES: Cumulative opioid use, daily mean patient-reported pain scores, and ORAEs through 72 hours postoperatively. RESULTS: On average, the EXP (n = 31) group exhibited less than 50 percent of the total opioid consumption of the PCAO (n = 36) group, and less than 60 percent of that for the ONQ (n = 33) group. Postoperative days 1 and 3 pain scores were significantly lower for the EXP group as compared to the ONQ and PCAO groups (p ≤ 0.005). Fewer patients in the EXP group (19.4 percent) experienced ORAEs compared to the PCAO (41.1 percent) and ONQ (45.5 percent) groups (p = 0.002). CONCLUSIONS: Laparotomy patients treated with liposomal bupivacaine as part of a multimodal regimen consumed less opioids, had lower pain scores, and had fewer ORAEs. The role of liposomal bupivacaine in the postoperative care of laparotomy patients merits further study.


Assuntos
Analgesia Controlada pelo Paciente , Bupivacaína , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Anestésicos Locais , Bupivacaína/administração & dosagem , Humanos , Injeções/métodos , Laparotomia , Lipossomos , Medição da Dor , Estudos Prospectivos
15.
Pain Physician ; 22(4): E295-E302, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337171

RESUMO

BACKGROUND: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. OBJECTIVES: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. STUDY DESIGN: A prospective randomized, controlled clinical trial. SETTING: An interventional pain unit in a tertiary center at a university hospital in Egypt. METHODS: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed >/= 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. RESULTS: There was significant reduction in the percentage of patients who showed ≥50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). LIMITATIONS: The study follow-up period was limited to only 3 months. CONCLUSIONS: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. KEY WORDS: Rheumatoid arthritis, atlantoaxial joint injection.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Articulação Atlantoaxial/efeitos dos fármacos , Glucocorticoides/administração & dosagem , Manejo da Dor/métodos , Triancinolona/administração & dosagem , Adulto , Bupivacaína/administração & dosagem , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Estudos Prospectivos , Amplitude de Movimento Articular/efeitos dos fármacos , Resultado do Tratamento
16.
A A Pract ; 13(8): 292-294, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31265441

RESUMO

We present the case of a 51-year-old man with a history of recurrent lung cancer after left upper lobectomy who presented for an elective completion pneumonectomy via a bilateral anterior thoracotomy incision. At the completion of surgery, bilateral multilevel intercostal infiltration was performed with liposomal bupivacaine. Due to poorly controlled postoperative pain after extubation, a thoracic epidural was placed in the intensive care unit. An opioid-only infusion was started and transitioned to a local anesthetic-based infusion on postoperative day 2. This case report represents a novel stepwise approach of thoracic epidural management after surgical infiltration of liposomal bupivacaine.


Assuntos
Analgesia Epidural , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Analgesia Controlada pelo Paciente , Fentanila/administração & dosagem , Humanos , Hidromorfona/administração & dosagem , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas
18.
BMJ Case Rep ; 12(6)2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31227568

RESUMO

Pain is the most common reason for emergency department visits. Traditionally, pain management has been provided by narcotics, non-steroidal anti-inflammatory drugs and non-narcotics. Erector spinae plane block is a new interfascial plane block that has been successfully used for acute pain control in different surgeries. Two female patients with severe back pain related to breast cancer metastasis applied to emergency department. The pain scores of the patients were between 8 and 10. We performed bilateral erector spinae plane block at the levels of T3 and T6. The pain scores decreased under 2 within 30 min and none of the patients required additional analgesic agent for 24 hours. Previously erector spinae plane block was used for rib and spine fractures in emergency department. Different from previous cases, we performed bi-level blocks to cover a larger area and the block abruptly and effectively reduced pain scores of the patients with breast cancer.


Assuntos
Dor nas Costas/tratamento farmacológico , Neoplasias Ósseas/secundário , Bloqueio Nervoso/métodos , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Dor nas Costas/etiologia , Neoplasias da Mama/patologia , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Medição da Dor , Índice de Gravidade de Doença , Coluna Vertebral/patologia , Resultado do Tratamento
19.
Plast Reconstr Surg ; 144(1): 35-44, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246796

RESUMO

BACKGROUND: Postoperative pain control after abdominally based autologous microvascular breast reconstruction is critical to functional recovery, patient satisfaction, and early discharge. The transversus abdominis plane block using 0.25% bupivacaine hydrochloride has been shown to be effective, but it is limited by a short duration of effect. Liposomal bupivacaine is a recently U.S. Food and Drug Administration-approved preparation of bupivacaine that can provide up to 72 hours of pain relief. The purpose of this randomized, controlled trial was to compare the analgesic efficacy of liposomal bupivacaine and conventional bupivacaine. METHODS: This study was a prospective, single-blind, randomized, controlled trial of 44 patients undergoing abdominally based autologous breast reconstruction between June of 2016 and February of 2018 performed by a single surgeon. Each patient was randomized to receive either 266 mg of liposomal bupivacaine or 75 mg of conventional bupivacaine to the transversus abdominis plane at the conclusion of the reconstruction procedure. All patients were managed postoperatively according to an enhanced recovery protocol. RESULTS: In our study of 44 patients, 22 patients received a transversus abdominis plane block with conventional bupivacaine and 22 patients received liposomal bupivacaine. There were no significant differences with regard to any outcome measure. No differences were found in total opioid consumption (p = 0.98), Quality of Recovery-15 scores (p = 0.72), pain scores (p = 0.39), or length of stay (p = 0.20). CONCLUSION: In the setting of a robust enhanced recovery after surgery protocol, liposomal bupivacaine does not confer advantages over conventional bupivacaine when used as single injections in transversus abdominis plane blocks after abdominally based microvascular breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Mamoplastia/métodos , Bloqueio Nervoso/métodos , Músculos Abdominais/inervação , Analgésicos Opioides/uso terapêutico , Esquema de Medicação , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Tempo de Internação/estatística & dados numéricos , Lipossomos , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
20.
A A Pract ; 13(7): 260-263, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31206386

RESUMO

Chronic chest pain is a debilitating condition that is poorly treated, resulting in opioid dependence and significantly decreased quality of life. In this case report, we describe the successful use of 266 mg of liposomal bupivacaine for 4 rounds of left-sided multilevel intercostal nerve blocks performed to treat chronic chest pain of a 21-year-old woman (150 kg, 163 cm). The sensory blockade duration was up to 7 days, analgesia lasted 2 months, and was described superior to that with ropivacaine intercostal blockade. The treatment improved satisfaction with pain control and quality of life.


Assuntos
Bupivacaína/administração & dosagem , Dor no Peito/tratamento farmacológico , Dor Crônica/tratamento farmacológico , Bloqueio Nervoso/métodos , Bupivacaína/uso terapêutico , Feminino , Humanos , Injeções , Nervos Intercostais , Lipossomos , Qualidade de Vida , Resultado do Tratamento , Adulto Jovem
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