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1.
Anesth Analg ; 130(5): 1304-1319, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32102013

RESUMO

BACKGROUND: Interscalene block (ISB) is the acute pain management technique of choice for shoulder surgery, but its undesirable respiratory side effects have prompted seeking alternatives. Supraclavicular block (SCB) is proposed as an ISB alternative, but evidence of comparative analgesic and respiratory-sparing effects is inconsistent. We compared the analgesic and respiratory effects of SCB and ISB for shoulder surgery. METHODS: Trials comparing ISB to SCB for shoulder surgery were sought. We decided a priori that SCB would be an acceptable alternative if it were noninferior for (1) postoperative 24-hour cumulative oral morphine equivalent consumption (primary outcome, noninferiority margin Δ = -25 mg) and (2) postoperative pain (secondary outcome, noninferiority margin Δ = 4.0 cm·hour); and superior for (3) postblock respiratory dysfunction (primary outcome). Opioid-related side effects and block-related complications were also evaluated. RESULTS: Fifteen studies (1065 patients) were analyzed. In single-injection blocks, SCB was noninferior to ISB for 24-hour morphine consumption (mean difference for SCB-ISB, MD [95% confidence interval {CI}] = -3.11 mg [-9.42 to 3.19], Δ = -25 mg); it was also noninferior for 24-hour pain scores (MD = 0.78 cm·hour [0.07-1.49], Δ = 4.0 cm·hour); and decreased the odds of respiratory dysfunction (odds ratio [OR] [95% CI] = 0.08 [0.01-0.68]). Similarly, in continuous blocks, SCB was noninferior to ISB for 24-hour morphine consumption (MD = 0.46 mg [-6.08 to 5.15], Δ = -25 mg), and decreased the odds of respiratory dysfunction (OR = 0.22 [0.08-0.57]). SCB also decreased odds of minor block-related complications (OR = 0.36 [0.20-0.68] and OR = 0.25 [0.15-0.41] for single-injection and continuous blocks, respectively). Consequently, the null joint-hypothesis was rejected, and SCB can be considered an acceptable alternative to ISB. CONCLUSIONS: For acute pain control following shoulder surgery, high-quality evidence indicates that SCB can be used as an effective ISB alternative. SCB is noninferior for postoperative opioid consumption and acute pain, and it reduces the odds of postblock respiratory dysfunction.


Assuntos
Dor Aguda/prevenção & controle , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ombro/cirurgia , Dor Aguda/diagnóstico , Anestésicos Locais/administração & dosagem , Humanos , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico
2.
Nursing (Säo Paulo) ; 23(260): 3543-3553, jan.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1095563

RESUMO

Objetivo: avaliar o uso da oxicodona em pacientes com dor aguda no período pós-operatório em comparação aos outros opioides. Método: Trata-se de uma revisão sistemática de ensaios clínicos randomizados (ECR's). Foram consultadas as bases de dados PubMed, EMBASE, Cochrane e LILACS até setembro de 2018. Revisores rastrearam ECR's elegíveis; extraíram os dados e avaliaram o risco de viés. Houve análise de conteúdo descritiva dos achados. Resultados: Em 8 ERC's incluídos a ação da oxicodona comparada morfina foi considerada superior em três estudos e igual em dois estudos. A oxicodona comparada ao fentanil foi considerada melhor em dois estudos. Na comparação com o placebo, a oxicodona também se sobressaiu positivamente. Entretanto não foram encontradas evidências robustas e convergentes que indiquem a superioridade da oxicodona. Conclusão: A oxicodona é um analgésico eficaz na dor pós-operatória aguda, entretanto, mais estudos devem ser realizados bem como a realização de avaliações econômicas.(AU)


Objective: Evaluate the use of oxycodone in patients with acute postoperative pain compared to other opioids. Method: This is a systematic review of randomized controlled trials (RCTs). The PubMed, EMBASE, Cochrane, and LILACS databases were consulted until September 2018. Reviewers screened eligible RCTs; extracted data and assessed the risk of bias. There was descriptive content analysis of the findings. Results: In 8 RCTs included the action of oxycodone compared morphine was considered superior in three studies and equal in two studies. Oxycodone compared to fentanyl was considered better in two studies. Compared to placebo, oxycodone also stood out positively. However, no robust and converging evidence was found to indicate the superiority of oxycodone. Conclusion: Oxycodone is an effective analgesic for acute postoperative pain; however, further studies should be performed as well as economic evaluations.(AU)


Objetivo: Evaluar el uso de oxicodona en pacientes con dolor postoperatorio agudo en comparación con otros opioides. Método: esta es una revisión sistemática de ensayos controlados aleatorios (ECA). Las bases de datos PubMed, EMBASE, Cochrane y LILACS fueron consultadas hasta septiembre de 2018. Los revisores seleccionaron los ECA elegibles; extrajo datos y evaluó el riesgo de sesgo. Hubo un análisis de contenido descriptivo de los hallazgos. Resultados: en 8 ECA incluidos, la acción de la oxicodona en comparación con la morfina se consideró superior en tres estudios e igual en dos estudios. La oxicodona en comparación con el fentanilo se consideró mejor en dos estudios. En comparación con el placebo, la oxicodona también se destacó positivamente. Sin embargo, no se encontró evidencia sólida y convergente que indique la superioridad de la oxicodona. Conclusión: la oxicodona es un analgésico eficaz para el dolor postoperatorio agudo; sin embargo, se deben realizar más estudios, así como evaluaciones económicas.(AU)


Assuntos
Humanos , Oxicodona , Dor Pós-Operatória , Dor Aguda/prevenção & controle , Dor Aguda/tratamento farmacológico , Analgesia , Medição da Dor
3.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31969473

RESUMO

CONTEXT: Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE: To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES: Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION: Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION: Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS: There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS: Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.


Assuntos
Dor Aguda/prevenção & controle , Manejo da Dor/métodos , Dor Processual/prevenção & controle , Jogos de Vídeo , Terapia de Exposição à Realidade Virtual/métodos , Adolescente , Criança , Pré-Escolar , Intervalos de Confiança , Humanos , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sensibilidade e Especificidade , Estresse Psicológico/prevenção & controle , Adulto Jovem
4.
Anesth Analg ; 130(3): 559-573, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31335400

RESUMO

The common treatment for postoperative pain is prescription opioids. Yet, these drugs have limited effect in preventing chronic pain from surgical intervention and have in part contributed to the opioid epidemic. Recently, preemptive analgesia and multimodal analgesia have been proposed with widely gained acceptance in addressing the pain issues. However, both analgesic approaches have been focused on pharmacological means while completely neglecting the psychological aspect. To address this epidemic, we have conducted a systematic review of preoperative educational methods to explore its application as both a preemptive and a preventive psychological approach to decrease postsurgical pain and improve outcome. Preemptive psychoeducation occurs before surgery and would include information about regional or neuraxial analgesia, while preventive psychoeducation occurs throughout the perioperative period. The content and presentation of preemptive psychoeducation can help patients form accurate expectations and address their concerns of surgical outcome, leading to a significant decrease in patients' anxiety levels. By addressing the psychological needs of patients through preoperative education, one can decrease postoperative recovery time and postsurgical acute pain. Reduced postsurgical acute pain results in fewer opioid prescriptions, which theoretically lowers the patient's risk of developing chronic postsurgical pain (CPSP), and potentially offers a novel concept using preemptive pain psychoeducation as a part of multimodal pain management solution to the opioid epidemic.


Assuntos
Dor Aguda/prevenção & controle , Manejo da Dor , Dor Pós-Operatória/prevenção & controle , Educação de Pacientes como Assunto , Assistência Perioperatória , Dor Aguda/epidemiologia , Dor Aguda/fisiopatologia , Dor Aguda/psicologia , Analgésicos Opioides/efeitos adversos , Terapia Combinada , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/efeitos adversos , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Assistência Perioperatória/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
6.
Support Care Cancer ; 28(1): 221-227, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31016422

RESUMO

PURPOSE: Paclitaxel-associated acute pain syndrome (P-APS) affects 80% of patients undergoing therapy. Although it has been shown that prednisone administration for 5 days relieves P-APS, detailed results have not been reported thus far. Therefore, in this study, we evaluated the preventive effect of dexamethasone (DEX) administration against P-APS. METHODS: A total of 60 patients who received carboplatin (area under the curve; AUC = 5-6) plus paclitaxel (200 mg/m2) (plus bevacizumab 15 mg/kg, if non-squamous carcinoma of lung) were enrolled. Eight milligrams of DEX was orally administered on days 2 and 3 to the DEX group patients, and the frequency, severity, duration of P-APS, and other adverse effects in the first cycle were retrospectively evaluated and compared to those observed in control group patients, who were not administered DEX on days 2 and 3. RESULTS: No difference in terms of patient characteristics, except for type of cancer, was observed between groups. The results showed that the frequency of all grade P-APS was approximately 70% and there was no difference between groups. Frequency of ≥ G2 P-APS was 40% in the control group and 14% in the DEX group, demonstrating a significant reduction. Duration of P-APS was 5.8 days in the control group and 4.3 days in the DEX group, which tended to become shorter following additional DEX administration, although this was not significant. Adverse effects other than P-APS induced by chemotherapy were similar between the two groups. CONCLUSION: Additional DEX administration is safe and useful for the attenuation of the severity of P-APS.


Assuntos
Dor Aguda/induzido quimicamente , Dor Aguda/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Dexametasona/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Paclitaxel/efeitos adversos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/administração & dosagem , Bevacizumab/efeitos adversos , Carboplatina/administração & dosagem , Carboplatina/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimioprevenção/métodos , Dexametasona/efeitos adversos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
7.
Anesth Analg ; 129(6): 1468-1473, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743165

RESUMO

BACKGROUND: Pain after cardiac surgery is largely treated with opioids, but their poor safety profile makes nonopioid medications attractive as part of multimodal pathways. Anti-inflammatory drugs reduce acute postoperative pain, but the role of steroids in reducing acute poststernotomy pain is unclear. We evaluated the association between the intraoperative administration of methylprednisolone and postoperative analgesia, defined as a composite of pain scores and opioid consumption, during the initial 24 hours after cardiac surgery. METHODS: We conducted a post hoc retrospective analysis of a large clinical trial in which adults having cardiac surgery were randomized 1:1 to receive 2 intraoperative doses of 250 mg IV methylprednisolone or placebo. Pain scores and opioid consumption were collected during the initial 24 hours after surgery. Methylprednisolone was considered to be associated with better pain control than placebo if proven noninferior (not worse) on both pain scores (defined a priori with delta of 1 point) and opioid consumption (delta of 20%) and superior to placebo in at least 1 of the 2 outcomes. This test was repeated in the opposite direction (testing whether placebo is better than methylprednisolone on postoperative pain management). RESULTS: Of 251 eligible patients, 127 received methylprednisolone and 124 received placebo. Methylprednisolone was noninferior to placebo on pain with difference in mean (CI) pain scores of -0.25 (-0.71 to 0.21); P < .001. However, methylprednisolone was not noninferior to placebo on opioid consumption (ratio of geometric means [CI]: 1.11 [0.64-1.91]; P = .37). Because methylprednisolone was not noninferior to placebo on both outcomes, we did not proceed to superiority testing based on the a priori stopping rules. Similar results were found when testing the opposite direction. CONCLUSIONS: In this post hoc analysis, we could not identify a beneficial analgesic effect after cardiac surgery associated with methylprednisolone administration. There are currently no data to suggest that methylprednisolone has significant analgesic benefit in adults having cardiac surgery.


Assuntos
Dor Aguda/prevenção & controle , Analgésicos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Analgésicos/efeitos adversos , Analgésicos Opioides/uso terapêutico , Glucocorticoides/efeitos adversos , Humanos , Metilprednisolona/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
Anesth Analg ; 129(6): 1512-1518, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743170

RESUMO

BACKGROUND: In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol. METHODS: Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 µg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0.1-0.5 µg·kg·hour, or a propofol group (n = 24), which received a continuous infusion of propofol via a target-controlled infusion to maintain the effect-site concentration within a range of 0.5-2.0 µg/mL. The drug infusion rate was determined according to the sedation level, targeting a modified observer's assessment of alertness/sedation score of 3 or 4. The cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia were recorded at 24 and 48 hours postoperatively (primary outcome). The postoperative numerical rating scale for pain was assessed at 6, 12, 24, and 48 hours (secondary outcome). The postoperative use of additional rescue analgesic (ketoprofen) and antiemetic drugs was also compared between the 2 groups at 24 and 48 hours. RESULTS: Dexmedetomidine significantly reduced postoperative fentanyl consumption (median [interquartile range]) during 0-24 hours (45 [30-71] vs 150 [49-248] µg, P = .004; median difference = -105 µg [99.98% CI, 210-7.5]), 24-48 hours (90 [45-143] vs 188 [75-266] µg, P = .005; median difference = -98 µg [99.98% CI, 195-45]), and 0-48 hours (135 [68-195] vs 360 [146-480] µg, P = .003; median difference = -225 µg [99.98% CI, 405-7.5]). The numerical rating scale (median [interquartile range]) was lower at 6 hours (1 [0-2] vs 2 [1-3], P = .003), 12 hours (1 [1-2] vs 3 [2-3], P < .001), 24 hours (1 [1-2] vs 3 [2-3], P < .001), and 48 hours (2 [2-3] vs 3 [3-4], P < .001) after surgery in the dexmedetomidine group compared to the propofol group. No significant intergroup differences were observed in the amount of rescue analgesics and antiemetics at 24 hours (P = .155 and P = .482) and 48 hours (P = .082 and P = .153) after surgery. CONCLUSIONS: Intraoperative dexmedetomidine sedation was associated with a small but clinically important reduction in postoperative opioid use after total knee arthroplasty.


Assuntos
Dor Aguda/prevenção & controle , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Raquianestesia , Anestésicos Intravenosos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Propofol/administração & dosagem , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos Opioides/administração & dosagem , Raquianestesia/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Dexmedetomidina/efeitos adversos , Feminino , Fentanila/administração & dosagem , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Propofol/efeitos adversos , República da Coreia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Anesth Analg ; 129(6): 1723-1732, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743194

RESUMO

BACKGROUND: Methadone is a potent opioid exerting an analgesic effect through N-methyl-D-aspartate receptor antagonism and the inhibition of serotonin and noradrenaline reuptake. It has also been used in several procedures to reduce postoperative pain and opioid use. This meta-analysis aimed to determine whether the intraoperative use of methadone lowers postoperative pain scores and opioid consumption in comparison to other opioids. METHODS: Double-blinded, controlled trials without language restrictions were included from MEDLINE, Embase, LILACS, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL via EBSCOhost. The included studies tracked total opioid consumption, postoperative pain scores, opioid-related side effects, and patient satisfaction until 72 hours postoperatively. Mean difference (MD) was used for effect size. RESULTS: In total, 476 articles were identified and 13 were considered eligible for inclusion in the meta-analysis. In 486 patients (7 trials), pain at rest (MD, 1.09; 95% confidence interval (CI), 1.47-0.72; P < .00001) and at movement (MD, 2.48; 95% CI, 3.04-1.92; P = .00001) favored methadone 24 hours after surgery. In 374 patients (6 trials), pain at rest (MD, 1.47; 95% CI, 3.04-1.02; P < .00001) and at movement (MD, 2.03; 95% CI, 3.04-1.02; P < .00001) favored methadone 48 hours after surgery. In 320 patients (4 trials), pain at rest (MD, 1.02; 95% CI, 1.65-0.39; P = .001) and at movement (MD, 1.34; 95% CI, 1.82-0.87; P < .00001) favored methadone 72 hours after surgery. A Trial Sequential Analysis was performed and the Z-cumulative curve for methadone crossed the monitoring boundary at all evaluations, additionally crossing Required Information Size at 24 and 48 hours at rest. Methadone group also showed lower postoperative opioid consumption in morphine equivalent dosage (mg) at 24 hours (MD, 8.42; 95% CI, 12.99-3.84 lower; P < .00001), 24-48 hours (MD, 14.33; 95% CI, 26.96-1.91 lower; P < .00001), 48-72 hours (MD, 3.59; 95% CI, 6.18-1.0 lower; P = .007) postoperatively. CONCLUSIONS: Intraoperative use of methadone reduced postoperative pain scores compared to other opioids, and Trial Sequential Analysis suggested that no more trials are required to confirm pain reduction at rest until 48 hours after surgery. Methadone also reduced postoperative opioid consumption and led to better patient satisfaction scores through 72 hours postoperatively compared to other opioids.


Assuntos
Dor Aguda/prevenção & controle , Analgésicos Opioides/administração & dosagem , Cuidados Intraoperatórios/métodos , Metadona/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Ensaios Clínicos como Assunto/métodos , Humanos , Dor Pós-Operatória/diagnóstico
10.
Cochrane Database Syst Rev ; 2019(11)2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31747720

RESUMO

BACKGROUND: Pain following brain surgery can compromise recovery. Several pharmacological interventions have been used to prevent pain after craniotomy; however, there is currently a lack of evidence regarding which interventions are most effective. OBJECTIVES: The objectives are to assess the effectiveness of pharmacological interventions for prevention of acute postoperative pain in adults undergoing brain surgery; compare them in terms of additional analgesic requirements, incidence of chronic headache, sedative effects, length of hospital stay and adverse events; and determine whether these characteristics are different for certain subgroups. SEARCH METHODS: We searched MEDLINE, Embase, CINAHL, CENTRAL, Web of Science and two trial registries together with reference checking and citation searching on 28th of November 2018. SELECTION CRITERIA: We included blinded and non-blinded, randomized controlled trials evaluating pharmacological interventions for the prevention of acute postoperative pain in adults undergoing neurosurgery, which had at least one validated pain score outcome measure. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. We calculated mean differences for the primary outcome of pain intensity; any pain scores reported on a 0 to 100 scale were converted to a 0 to 10 scale. MAIN RESULTS: We included 42 completed studies (3548 participants) and identified one ongoing study. Nonsteroidal anti-inflammatories (NSAIDs) Nonsteroidal anti-inflammatories (NSAIDs) reduce pain up to 24 hours (0 to 6 hours, MD -1.16, 95% CI -1.57 to -0.76; 12 hours, MD -0.62, 95% CI -1.11 to -0.14; 24 hours, MD -0.66, 95% CI -1.18 to -0.13; 6 studies, 742 participants; all high-quality evidence). Results for other outcomes were imprecise (additional analgesic requirements: MD 1.29 mg, 95% CI -5.0 to 2.46, 4 studies, 265 participants; nausea and vomiting RR 1.34, 95% CI 0.30 to 5.94, 2 studies, 345 participants; both low-quality evidence). Dexmedetomidine reduces pain up to 12 hours (0 to 6 hours, MD -0.89, 95% CI -1.27 to -0.51, moderate-quality evidence; 12 hours, MD -0.81, 95% CI -1.21 to -0.42, low-quality evidence). It did not show efficacy at 24 hours (MD -0.08, 95% CI -0.32 to 0.16; 2 studies, 128 participants; low-quality evidence). Dexmedetomidine may decrease additional analgesic requirements (MD -21.36 mg, 95% CI -34.63 to -8.1 mg, 2 studies, 128 participants, low-quality evidence). Results for other outcomes were imprecise (nausea and vomiting RR -0.43, 95% CI 0.06 to 3.08, 3 studies, 261 participants; hypotension RR 0.5, 95% CI 0.05 to 5.28, 3 studies, 184 participants; both low-quality evidence). Scalp blocks may reduce pain up to 48 hours (0 to 6 hours, MD -0.98, 95% CI -1.66 to -0.3, 10 studies, 414 participants; 12 hours, MD -0.95, 95% CI -1.53 to -0.37, 8 studies, 294 participants; 24 hours, MD -0.78, 95% CI -1.52 to -0.05, 9 studies, 433 participants, all low-quality evidence; 48 hours, MD -1.34, 95% CI -2.57 to -0.11, 4 studies, 135 participants, very low-quality evidence. When studies with high risk of bias were excluded, significance remained at 12 hours only. Scalp blocks may decrease additional analgesia requirements (SMD -1.11, 95% CI -1.97 to -0.25, 7 studies, 314 participants). Results for other outcomes were imprecise (nausea and vomiting RR 0.66, 95% CI 0.33 to 1.32, 4 studies, 165 participants, very low-quality evidence). Scalp Infiltration may reduce pain postoperatively but efficacy was inconsistent, with a significant effect at 12 and 48 hours only (12 hours, MD -0.71, 95% CI -1.34 to -0.08, 7 studies, 309 participants, low-quality evidence; 48 hours, MD - 1.09, 95% CI -2.13 to - 0.06, 3 studies, 128 participants, moderate-quality evidence). No benefit was observed at other times (0 to 6 hours, MD -0.64, 95% CI -1.28 to -0.00, 9 studies, 475 participants, moderate-quality evidence; 24 hours, MD -0.39, 95% CI -1.06 to 0.27,6 studies, 260 participants, low-quality evidence. Scalp infiltration may reduce additional analgesia requirements MD -9.56 mg, 95% CI -15.64 to -3.49, 6 studies, 345 participants, very low-quality evidence). When studies with high risk of bias were excluded, scalp infiltration lost the pain benefit at 12 hours and effects on additional analgesia requirements, but retained the pain-reducing benefit at 48 hours (MD -0.56, 95% CI -1.20 to -0.32, 2 studies, 100 participants, very low-quality evidence). Results for other outcomes were imprecise (nausea and vomiting, RR 0.74, 95% CI 0.48 to 1.41, 4 studies, 318 participants, low-quality evidence). Pregabalin or gabapentin may reduce pain up to 6 hours (2 studies, 202 participants), MD -1.15,95% CI -1.66 to -0.6, 2 studies, 202 participants, low-quality evidence). One study examined analgesic efficacy at 12 hours showing significant benefit. No analgesia efficacy was shown at later times (24 hours, MD -0.29, 95% CI -0.78 to -0.19; 48 hours, MD - 0.06, 95% CI -0.86 to 0.77, 2 studies, 202 participants, low-quality evidence). Additional analgesia requirements were not significantly less (MD -0.37 (95% CI -1.10 to 0.35, 3 studies, 234 participants, low-quality evidence). Risk of nausea and vomiting was significantly reduced (RR 0.51, 95% CI 0.29 to 0.89, 3 studies, 273 participants, low-quality evidence). Results for other outcomes were imprecise (additional analgesia requirements: MD -0.37, 95% CI -1.10 to 0.35, 3 studies, 234 participants, low-quality evidence). Acetaminophen did not show analgesic benefit (0 to 6 hours, MD -0.35, 95% CI -1.00 to 0.30; 12 hours, MD -0.51, 95% CI -1.04 to 0.03, 3 studies, 332 participants, moderate-quality evidence; 24 hours, MD -0.34, 95% CI -1.20 to 0.52, 4 studies, 439 participants, high-quality evidence). Results for other outcomes remained imprecise (additional analgesia requirements, MD 0.07, 95% CI -0.86 to 0.99, 4 studies, 459 participants, high-quality evidence; length of hospitalizations, MD -3.71, 95% CI -14.12 to 6.7, 2 studies, 335 participants, moderate-quality evidence). AUTHORS' CONCLUSIONS: There is high-quality evidence that NSAIDs reduce pain up to 24 hours postoperatively. The evidence for reductions in pain with dexmedetomidine, pregabalin or gabapentin, scalp blocks, and scalp infiltration is less certain and of very low to moderate quality. There is low-quality evidence that scalp blocks and dexmedetomidine may reduce additional analgesics requirements. There is low-quality evidence that gabapentin or pregabalin may decrease nausea and vomiting, with the caveat that the total number of events for this comparison was low.


Assuntos
Dor Aguda/prevenção & controle , Analgesia/métodos , Analgésicos/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Dor Aguda/tratamento farmacológico , Encéfalo/cirurgia , Humanos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1353-1359, out.-dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022039

RESUMO

Objective: The study's main purpose has been to analyze scientific articles on the world scenario about nursing interventions in the process of preparation and administration of intravenous drugs, risks inherent in professional practice and actions integrated with medical prescription. Methods: It is a research of literary nature that was carried out through the main databases of online indexed studies. For the development of this research, books related to the practice of intravenous therapy and current legislation were consulted. Results: This investigation describes the main urgent and emerging pathologies in the hospital service, nursing actions aimed at intravenous therapy and pain relief. Conclusion: Finally, it is needed to improve the instruments used to measure acute pain, because they have limitations in its implementation, either for evaluating the size of a single aspect or to be extensive in its application in the level of hospital care


Objetivo: Objetivo do estudo consiste em analisar artigos científicos no cenário mundial acerca das intervenções de enfermagem no processo de preparo e administração de medicamentos por via venosa, riscos inerentes a pratica profissional e ações integradas à prescrição médica. Método: pesquisa de natureza literária, realizada através dos principais bancos de dados online de pesquisas indexadas. Para desenvolvimento do estudo foram consultados livros relacionados à prática da terapia intravenosa e legislações vigentes. Resultados: descrição das principais patologias urgentes e emergentes no serviço hospitalar, ações de enfermagem voltadas para terapia intravenosa e alivio da dor. Conclusão: necessidade de aprimoramento dos instrumentos utilizados para mensurar a dor aguda, pois possuem limitações em sua implementação, seja por avaliar a dimensão de um único aspecto ou serem extenso em sua aplicação em nível de atendimento hospitalar


Objetivo: El objetivo del estudio consiste en analizar artículos científicos en el escenario mundial acerca de las intervenciones de enfermería en el proceso de preparación y administración de medicamentos por vía venosa, riesgos inherentes a la práctica profesional y acciones integradas a la prescripción médica. Método: investigación de naturaleza literaria, realizada a través de las principales bases de datos en línea de investigaciones indexadas. Para el desarrollo del estudio se consultó libros relacionados con la práctica de la terapia intravenosa y las legislaciones vigentes. Resultados: descripción de las principales patologías urgentes y emergentes en el servicio hospitalario, acciones de enfermería dirigidas a terapia intravenosa y alivio del dolor. Conclusión: necesidad de perfeccionamiento de los instrumentos utilizados para medir el dolor agudo, pues poseen limitaciones en su implementación, sea por evaluar la dimensión de un solo aspecto o ser extenso en su aplicación a nivel de atención hospitalaria


Assuntos
Humanos , Dor Aguda/enfermagem , Dor Aguda/prevenção & controle , Segurança do Paciente , Risco , Redução do Dano , Administração Intravenosa/enfermagem
12.
Ann Emerg Med ; 74(4): 530-537, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31383385

RESUMO

STUDY OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are used extensively for the management of acute pain, with ibuprofen being one of the most frequently used oral analgesics in the emergency department (ED). We compare the analgesic efficacy of oral ibuprofen at 3 different doses for adult ED patients with acute pain. METHODS: This was a randomized, double-blind trial comparing analgesic efficacy of 3 doses of oral ibuprofen (400, 600, and 800 mg) in adult ED patients with acute painful conditions. Primary outcome included difference in pain scores between the 3 groups at 60 minutes. RESULTS: We enrolled 225 subjects (75 per group). The difference in mean pain scores at 60 minutes between the 400- and 600-mg groups was -0.14 (95% confidence interval [CI] -0.67 to 0.39); between the 400- and 800-mg groups, 0.14 (95% CI -0.65 to 0.37); and between the 600- and 800-mg groups, 0.00 (95% CI -0.47 to 0.47). Reductions in pain scores from baseline to 60 minutes were similar for all subjects in each of the 3 groups. No adverse events occurred in any group. CONCLUSION: Oral ibuprofen administered at doses of 400, 600, and 800 mg has similar analgesic efficacy for short-term pain relief in adult patients presenting to the ED with acute pain.


Assuntos
Dor Aguda/prevenção & controle , Analgésicos não Entorpecentes/administração & dosagem , Ibuprofeno/administração & dosagem , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
13.
Rev Bras Anestesiol ; 69(4): 396-402, 2019.
Artigo em Português | MEDLINE | ID: mdl-31399197

RESUMO

BACKGROUND AND OBJECTIVES: Patient self-rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values. METHODS: A total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated-based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients' pain was rated on a 0-10 point Numerical Rating Scale. The patients' heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined. RESULTS: The study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤ 3, compared with Numerical Rating Scale> 3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p <0.001). A significant negative linear relationship (r2=-0.312, p=0.001) was observed between analgesia nociception index and Numerical Rating Scale. CONCLUSION: Analgesia nociception index measurements at postoperative period after volatile agent and opioid-based anesthesia correlate well with subjective Numerical Rating Scale scores.


Assuntos
Dor Aguda/diagnóstico , Analgesia/métodos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Aguda/prevenção & controle , Adulto , Analgésicos Opioides/administração & dosagem , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Nociceptividade/efeitos dos fármacos , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Remifentanil/administração & dosagem , Adulto Jovem
14.
J Headache Pain ; 20(1): 81, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307383

RESUMO

BACKGROUND: OnabotulinumtoxinA (BOTOX®, Allergan plc, Dublin, Ireland) is approved for the preventive treatment of headaches in adult patients with chronic migraine (CM) in Australia by the country's reimbursement mechanism for medicines, the Pharmaceutical Benefits Scheme (PBS). To our knowledge, this study represents the first focused report evaluating real-world evidence of onabotulinumtoxinA treatment via the PBS in Australian clinics. METHODS: This study reviewed the medical records of adults with inadequately controlled CM from 7 private neurology practices in Australia who, beginning in March 2014, received PBS-subsidized onabotulinumtoxinA per product labelling for the first time. The primary effectiveness measure was the percentage of patients achieving a response defined by 50% or greater reduction in headache days from baseline after 2 treatment cycles. Additional data were recorded in the case report form when available and included demographics, clinical characteristics, headache severity and frequency, Headache Impact Test (HIT-6) score, medication use, and days missed of work or study at baseline, after 2 treatment cycles, and at last follow-up. Differences in mean changes from baseline were evaluated with a 1-tailed t-test or Pearson's chi-squared test (p < 0.05). RESULTS: The study population included 211 patients with a mean (SD) of 25.2 (5.3) monthly headache days at baseline. In the primary outcome analysis, 74% of patients achieved a response, with a mean (SD) of 10.6 (7.9) headache days after 2 treatment cycles (p < 0.001). Secondary effectiveness outcomes included mean (SD) reductions in HIT-6 score of - 11.7 (9.8) and - 11.8 (12.2) after 2 treatment cycles (p < 0.001) and final follow-up (p < 0.001), respectively, and mean (SD) decreases in days per month of acute pain medication use of - 11.5 (7.6) after 2 treatment cycles (p < 0.001) and - 12.7 (8.1) at final follow-up (p < 0.001). CONCLUSION: This study provides additional clinical evidence for the consistent effectiveness of onabotulinumtoxinA for the treatment of CM in Australia. This effectiveness was made evident by reductions in migraine days, severe headache days, and HIT-6 scores from baseline.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Cefaleia/tratamento farmacológico , Cefaleia/prevenção & controle , Transtornos de Enxaqueca/prevenção & controle , Dor Aguda/tratamento farmacológico , Dor Aguda/prevenção & controle , Adulto , Austrália/epidemiologia , Doença Crônica , Feminino , Cefaleia/epidemiologia , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
15.
Schmerz ; 33(4): 287-294, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31342162

RESUMO

BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.


Assuntos
Agranulocitose , Dipirona , Dor Aguda/tratamento farmacológico , Dor Aguda/prevenção & controle , Agranulocitose/induzido quimicamente , Agranulocitose/prevenção & controle , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anestesiologia/normas , Associação , Cuidados Críticos , Dipirona/administração & dosagem , Dipirona/efeitos adversos , Humanos , Período Perioperatório
16.
Pain Manag ; 9(4): 347-354, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31099305

RESUMO

Peripheral nerve stimulation or peripheral neuromodulation is a modality utilized for decades to manage chronic pain. There have been recent studies published describing its use in managing acute surgical pain for orthopedic surgery. The postoperative acute pain associated with several types of surgeries often outlasts the analgesia duration provided by single and continuous peripheral nerve blocks. Ultrasound-guided percutaneous peripheral nerve stimulation has the potential to provide much longer analgesia for acute pain while avoiding some limitations associated with local anesthetic-based peripheral nerve blocks. We summarize the current devices used in published studies to demonstrate feasibility with a focus on acute pain control.


Assuntos
Dor Aguda/prevenção & controle , Analgesia/instrumentação , Manejo da Dor/instrumentação , Dor Pós-Operatória/prevenção & controle , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Analgesia/métodos , Humanos , Manejo da Dor/métodos , Nervos Periféricos/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção
17.
Adv Emerg Nurs J ; 41(2): 135-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033661

RESUMO

Proximal femur fractures (PFF) are one of the many common injuries that present to the emergency department (ED). The current practice for pain management utilizes systemic opioid analgesics. The use of opioids is an excellent analgesic choice, but they carry a significant burden for potential adverse effects. It is vital that providers have a variety of approaches to acute pain control. The use of femoral nerve blocks (FNBs) and fascia iliaca compartment blocks (FICB) are an alternative method of pain control in the ED. They have advantages over systemic opiates in that they do not require hemodynamic monitoring, have less adverse effects, and more importantly they induce rapid pain control with longer duration than systemic analgesics (). This manuscript examines a review of literature and identifies the efficacy, patient safety, indications, contraindications, patient satisfaction, and ultrasound-guided FNB and FICB techniques.


Assuntos
Dor Aguda/prevenção & controle , Serviço Hospitalar de Emergência , Fraturas do Fêmur , Nervo Femoral , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Humanos
18.
Ann Rheum Dis ; 78(6): 837-843, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30975645

RESUMO

OBJECTIVE: Steroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL. METHODS: This was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0-100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up. RESULTS: The estimated mean difference in the first week's maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups. CONCLUSION: Non-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption. TRIAL REGISTRATION NUMBER: NTC02403856.


Assuntos
Calcinose/terapia , Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Punções/métodos , Tendinopatia/terapia , Dor Aguda/etiologia , Dor Aguda/prevenção & controle , Adulto , Calcinose/diagnóstico por imagem , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Seguimentos , Glucocorticoides/efeitos adversos , Humanos , Injeções Intra-Articulares , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Punções/efeitos adversos , Manguito Rotador , Solução Salina , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/terapia , Tendinopatia/diagnóstico por imagem , Irrigação Terapêutica/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção
19.
JAMA Netw Open ; 2(3): e190168, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30821824

RESUMO

Importance: Acute postoperative pain is associated with the development of persistent postsurgical pain, but it is unclear which aspect is most estimable. Objective: To identify patient clusters based on acute pain trajectories, preoperative psychosocial characteristics associated with the high-risk cluster, and the best acute pain predictor of remote outcomes. Design, Setting, and Participants: A secondary analysis of the Stanford Accelerated Recovery Trial randomized, double-blind clinical trial was conducted at a single-center, tertiary, referral teaching hospital. A total of 422 participants scheduled for thoracotomy, video-assisted thoracoscopic surgery, total hip replacement, total knee replacement, mastectomy, breast lumpectomy, hand surgery, carpal tunnel surgery, knee arthroscopy, shoulder arthroplasty, or shoulder arthroscopy were enrolled between May 25, 2010, and July 25, 2014. Data analysis was performed from January 1 to August 1, 2018. Interventions: Patients were randomized to receive gabapentin (1200 mg, preoperatively, and 600 mg, 3 times a day postoperatively) or active placebo (lorazepam, 0.5 mg preoperatively, inactive placebo postoperatively) for 72 hours. Main Outcomes and Measures: A modified Brief Pain Inventory prospectively captured 3 surgical site pain outcomes: average pain and worst pain intensity over the past 24 hours, and current pain intensity. Within each category, acute pain trajectories (first 10 postoperative pain scores) were compared using a k-means clustering algorithm. Fifteen descriptors of acute pain were compared as predictors of remote postoperative pain resolution, opioid cessation, and full recovery. Results: Of the 422 patients enrolled, 371 patients (≤10% missing pain scores) were included in the analysis. Of these, 146 (39.4%) were men; mean (SD) age was 56.67 (11.70) years. Two clusters were identified within each trajectory category. The high pain cluster of the average pain trajectory significantly predicted prolonged pain (hazard ratio [HR], 0.63; 95% CI, 0.50-0.80; P < .001) and delayed opioid cessation (HR, 0.52; 95% CI, 0.41-0.67; P < .001) but was not a predictor of time to recovery in Cox proportional hazards regression (HR, 0.89; 95% CI, 0.69-1.14; P = .89). Preoperative risk factors for categorization to the high average pain cluster included female sex (adjusted relative risk [ARR], 1.36; 95% CI, 1.08-1.70; P = .008), elevated preoperative pain (ARR, 1.11; 95% CI, 1.07-1.15; P < .001), a history of alcohol or drug abuse treatment (ARR, 1.90; 95% CI, 1.42-2.53; P < .001), and receiving active placebo (ARR, 1.27; 95% CI, 1.03-1.56; P = .03). Worst pain reported on postoperative day 10 was the best predictor of time to pain resolution (HR, 0.83; 95% CI, 0.78-0.87; P < .001), opioid cessation (HR, 0.84; 95% CI, 0.80-0.89; P < .001), and complete surgical recovery (HR, 0.91; 95% CI, 0.86-0.96; P < .001). Conclusions and Relevance: This study has shown a possible uniform predictor of remote postoperative pain, opioid use, and recovery that can be easily assessed. Future work is needed to replicate these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT01067144.


Assuntos
Dor Aguda , Gabapentina/administração & dosagem , Medição da Dor/métodos , Dor Pós-Operatória , Cuidados Pré-Operatórios/métodos , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Dor Aguda/prevenção & controle , Idoso , Analgésicos/administração & dosagem , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/psicologia , Prognóstico , Psicologia , Medição de Risco/métodos , Fatores de Risco , Resultado do Tratamento , Suspensão de Tratamento
20.
Int J Surg ; 63: 63-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30769214

RESUMO

BACKGROUND: This prospective double-blind randomized study aimed at evaluating the short- and long-term postoperative analgesic efficacy of the ultrasound-guided tranversus abdominis plane (TAP) block in inguinal hernia repair under general anesthesia. METHODS: Sixty patients undergoing inguinal hernia repair were allocated to TAP block with either ropivacaine 0.75% 20 mL or placebo 20 mL. Postoperatively, they had access to a patient-controlled analgesia (PCA) device administering 1 mg doses of morphine as rescue analgesia. Pain was assessed at rest and during movement with the numeric rating scale (NRS) score 3,6 and 24 hs postoperatively. Other variables recorded were intraoperative dose of remifentanil required to maintain systolic arterial pressure within 20% of baseline, mg of morphine used in the Post Anesthesia Care Unit (PACU) and total dose of morphine administered via the PCA device. Six months after surgery, the occurrence of chronic pain was assessed with the NRS score at rest and during movement. Patients were also asked to fill in the DN4 questionnaire to estimate the development of neuropathic pain. RESULTS: Patients who were administered ropivacaine demonstrated significantly less pain at rest and on movement, as expressed by NRS scores in comparison to patients in the placebo group. The former group also required less remifentanil intraoperatively, less morphine during the PACU stay and had lower morphine consumption through the PCA device. Six months after surgery, pain scores at rest and during movement were comparable between the two groups. At the same time DN4 scores were low and comparable between the two groups. CONCLUSION: Ultrasound-guided TAP block provided better pain control than placebo in the acute setting after inguinal hernia repair. However, the incidence of chronic pain was low and not significantly affected by the performance of the block.


Assuntos
Dor Aguda/prevenção & controle , Dor Crônica/prevenção & controle , Hérnia Inguinal/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Abdominais/inervação , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Estudos Prospectivos , Ropivacaina/administração & dosagem
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