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1.
Klin Monbl Augenheilkd ; 237(10): 1194-1201, 2020 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33059380

RESUMO

INTRODUCTION: The course of the recovery phase after general anaesthesia, during which consciousness and pain gradually return, is essentially determined by the choice of anaesthetic drug, and its total dose or duration of application. This phase is often complicated by more or less severe agitation, especially in children. In the present study we investigated whether the application of a topical anaesthetic to the conjunctiva at the end of a strabismus operation had a positive effect on the recovery behaviour of the child. PATIENTS/METHODS: This prospective, randomised, blinded study was conducted with 50 healthy, ASA class I or II children, aged 3 to 8 years undergoing their first strabismus operation. Following the surgeon's randomisation two drops of a 0,5% tetracaine-HCl ophthalmic solution were applied to the operated conjunctiva three times at 30-s intervals immediately following wound closure. The postoperative evaluation encompassed heart rate, as well as COMFORT and CHEOPS scores. The first assessment was directly postoperatively with repetitions at 15, 30, 45, 60, 75, 90 and 120 min, as well as on the day after surgery. RESULTS: The CHEOPS scores did not differ significantly between children with or without topical anaesthesia at any time during the observation period. The COMFORT scores revealed a slight, but non-significant analgesic effect at 15 and 30 min. The 60 min score showed the opposite effect, possibly indicating a slight disadvantage of the topical anaesthesia. There were no significant differences with regard to time to first request for additional systemic analgesia, to the total dose of systemic pain medication, or to when the patient was eligible for discharge to the ward. CONCLUSION: The application of topical tetracaine-HCl immediately after wound closure had no positive effects on the course of the postoperative recovery period after strabismus surgery in children. There was no evidence of an effect on pain or emergence agitation.


Assuntos
Dor Pós-Operatória , Estrabismo , Anestesia Local , Criança , Pré-Escolar , Humanos , Músculos Oculomotores/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Estrabismo/cirurgia
2.
Compend Contin Educ Dent ; 41(9): 466-473; quiz 474, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001657

RESUMO

It is well-known that there is an opioid crisis in the United States. Prescription opioid analgesics contribute to this crisis; in 2012, dentists ranked second to family care physicians as the top prescribers. The medical and dental literature demonstrates that dental prescribing practices have been excessive, resulting in leftover medication that could then be diverted, misused, or abused. A multimodal analgesic approach is highly valuable in targeting pain along various points on the peripheral and central pain pathways and includes the use of long-acting local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, the last of which are generally reserved for the most severe pain only. The Dental Impaction Pain Model demonstrates that NSAIDs are the frontline drugs for postoperative dental pain. Opioids have their role in postoperative analgesia but should be reserved for severe breakthrough pain or in situations where NSAIDs may be contraindicated.


Assuntos
Analgésicos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Estados Unidos
3.
J Cardiothorac Surg ; 15(1): 296, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008451

RESUMO

BACKGROUND: The Surgical Pleth Index (SPI) is a monitoring method that reflects painful stimuli during general anesthesia, and dexmedetomidine is an analgesic adjuvant with an opioid-sparing effect. But up to now, it is still unclear whether dexmedetomidine has any influence on SPI. To investigate whether dexmedetomidine has an effect on SPI during video-assisted thoracoscopic surgery. METHODS: We enrolled 94 patients who underwent video-assisted thoracoscopic lung lobectomy. Patients were randomly assigned to a dexmedetomidine group (dexmedetomidine: 0.8 µg/kg administered for 10 min before anesthesia) or normal saline group (equal volume of normal saline). SPI and vital signs were recorded. The number rating scale (NRS) pain score was also evaluated. RESULTS: SPI values were significantly lower in the dexmedetomidine group than in the normal saline group at intubation and at discharge from the postanesthesia care unit. Compared with the normal saline group, mean arterial pressure and heart rate were both significantly lower in the dexmedetomidine group at intubation. Heart rate was lower at skin incision in the dexmedetomidine group. The NRS score in the normal saline group was noticeably higher vs. the dexmedetomidine group at discharge from the postanesthesia care unit. CONCLUSIONS: Dexmedetomidine decreased intraoperative SPI and NRS scores. Our results showed that dexmedetomidine attenuated noxious stimuli. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR): ChiCTR-OOC-16009450 , Registered 16 October, 2016.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Dexmedetomidina/uso terapêutico , Pneumopatias/cirurgia , Adolescente , Adulto , Idoso , Anestesia Geral , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória , Pneumonectomia , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida , Adulto Jovem
4.
Medicine (Baltimore) ; 99(40): e22477, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019439

RESUMO

INTRODUCTION: Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods of managing intra-operative and post-operative pain for these patients. The erector spinae plane block with catheter (ESPC) is a newer interfascial regional anesthetic technique that can be used to manage peri-operative pain in these patients. CLINICAL FINDINGS: Three patients complained of significant flank pain were scheduled for percutaneous nephrolithotomy under general anesthesia in the prone position. DIAGNOSES: Patients were diagnosed with large renal calculi. THERAPEUTIC INTERVENTIONS: Patients received ESPC in the pre-operative holding area at the level of the T7 transverse process. The ESPCS were bolused with a solution of 30 mL 0.25% bupivacaine with 4 mg dexamethasone prior to surgery. Patients also received oral tramadol 50 mg and acetaminophen 1 g as part of the multimodal pain protocol prior to surgery. After the procedure, the patients were bolused with 0.25% bupivacaine or started on an infusion of 0.25% bupivacaine to manage their pain. OUTCOMES: No opioid or other pain medications, other than the local anesthetic solution given in the ESPCs, were used during the intra-operative or post-operative period for management of pain in these patients. Visual analogue scale (VAS) scores were below 4 for all patients in the post-operative period, and patients did not report any issues with post-operative nausea or vomiting. CONCLUSION: These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Músculos Paraespinais
5.
Zhonghua Yi Xue Za Zhi ; 100(38): 3010-3013, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33086453

RESUMO

Objective: To observe the analgesic effect, complication and patient satisfaction of Acute Pain Service (APS) after thoracic surgery. Methods: The clinical data were collected from 264 patients who underwent different thoracic surgery from January 2017 until December 2019 retrospectively. They were divided into thoracotomy group (group O) and thoracoscopy surgery group (group T). There were 90 cases in group O and 174 cases in group T. According to the use of APS, the group O is divided into the no-APS group (group O1) and the APS group (group O2), the group T is divided into the no-APS group (group T1) and the APS group (group T2). The effect of postoperative analgesia, the incidence of nausea and vomiting and the satisfaction of patients were compared between group O1 and group O2, group T1 and group T2, respectively. Results: In the resting state, the Numeric Rating Scales (NRS) scores of the group O2 at 0 h (0.92±0.50 vs 1.59±0.62), 4 h (0.92±0.50 vs 2.06±1.03), 8 h (0.92±0.50 vs 2.18±1.13), 12 h (0.92±0.50 vs 2.47±1.42), 24 h (1.00±0.71 vs 2.53±1.42), and 48 h (1.00±0.71 vs 2.35±1.80) after leaving the Anesthesia Recovery Room (PACU) were significantly lower than those of the group O1 (all P<0.05), and in the active state, the NRS scores of the group O2 at 0 h (P=0.023), 4 h (P=0.001), 8 h (P=0.000), 12 h (P=0.001), 24 h (P=0.000), 48 h (P=0.000), and 72 h (P=0.019) after leaving the PACU were significantly lower than those of the group O1 (all P<0.05). In the resting state, the NRS scores of the group T2 at 4 h (P=0.029), 8 h (P=0.008), 12 h (P=0.006), and 24 h (P=0.013) after leaving the PACU were significantly lower than those of the group T1 (all P<0.05). In the active state, the NRS scores of the group T2 at 4 h (P=0.019), 8 h (P=0.000), 12 h (P=0.001), 24 h (P=0.002), and 48 h (P=0.002) after leaving the PACU were significantly lower than those of the group T1 (all P<0.05). Conclusion: APS can significantly reduce the NRS scores after thoracotomy and thoracoscopic surgery compared to ordinary analgesia model.


Assuntos
Clínicas de Dor , Cirurgia Torácica , Analgésicos/uso terapêutico , Humanos , Medição da Dor , Dor Pós-Operatória , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(41): e22251, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031265

RESUMO

BACKGROUND: The randomized controlled study aimed to examine the efficacy of preoperative ultrasound-guided erector spinae plane (ESP) block combined with ropivacaine in patients undergoing hepatectomy. METHODS: A total of 60 patients were randomized to ESP block group receiving ropivacaine (Group A) and control group (Group B), n = 30 per group. Visual analog scale (VAS) was recorded in both the groups during rest and movement at the various time intervals. Both the groups were also compared for time to initial anal exhaust, analgesic usage, early postoperative complications and side-effects, walk distance after the operation, time to out-of-bed activity, and duration of hospital stay. RESULTS: No significant differences were observed in the demographic characteristics. For group A, when compared to group B, VAS scores during rest and movement within post-operative 24 hours were decreased, the time of first anus exhaust and ambulation were earlier, analgesic consumption and the incidence of postoperative nausea, vomiting and headache was reduced, the duration of hospital stay were shorter with longer walk distance. CONCLUSION: ESP block combined with ropivacaine treatment effectively reduced early postoperative pain and improved recovery after hepatectomy.


Assuntos
Anestésicos Locais/uso terapêutico , Hepatectomia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais , Ropivacaina/uso terapêutico , Ultrassonografia de Intervenção , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor
7.
Zhonghua Yi Xue Za Zhi ; 100(33): 2596-2600, 2020 Sep 08.
Artigo em Chinês | MEDLINE | ID: mdl-32892605

RESUMO

Objective: To investigate the effects of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy. Methods: From December 2019 to April 2020, 60 patients receiving single-port video-assisted pulmonary lobectomy at Ningbo Medical Center Lihuili Hospital were selected. The patients were randomly and equally divided into control group and paravertebral block group using a random number table. Patients of paravertebral block group were injected into the thoracic 4-5 intercostal, paravertebral 1 cm using 0.375% ropivacaine (20 ml) with thoracoscopy-guided at the end of surgery, while patients of control group were given patient controlled intravenous analgesia (PCIA). Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of postoperative adverse reactions, additional dose and times of pethidine, the time to resume eating, the rate of postoperative active cough, the first time to get out of bed after surgery and postoperative hospital stay of two groups' patients were recorded. t test and chisquare test were used for statistical analysis. Results: The VAS score of paravertebral block group were lower than those of control group at all time points (all P<0.05). The Ramsay sedation scale of paravertebral block group were higher than those of control group at all time points (all P<0.05). The additional dose and times of pethidine of paravertebral block group were (8.2±2.3) mg and (0.2±0.1) time, which were lower than (87.8±15.3) mg and (1.8±0.3) time of control group, the differences were statistically significant (t=28.91, 34.37, all P<0.05). Incidence of nausea, vomiting and pruritus of paravertebral block group were 10.0%, 6.7% and 0, which were lower than 40.0%, 30.0% and 13.3% of control group, the differences were statistically significant (χ(2)=7.20, 5.45, 4.29, all P<0.05). The rate of postoperative active cough of paravertebral block group was 33.3%, which was higher than 10.0% of control group, the difference was statistically significant (χ(2)=4.81, P<0.05). The time to resume eating, the first time to get out of bed after surgery and postoperative hospital stay were (6.5±0.4) h, (20.9±3.1) h and (4.6±1.0) d, which were lower than (8.5±0.7) h, (28.6±4.8) h and (6.1±1.3) d of control group, the differences were statistically significant (t=13.47, 7.39, 4.19, all P<0.05). Conclusion: Thoracic paravertebral block under thoracoscopy-guided can effectively reduce the postoperative pain of single-port thoracoscopic lobectomy, with fewer adverse reactions, and is beneficial to postoperative recovery.


Assuntos
Bloqueio Nervoso , Analgesia Controlada pelo Paciente , Humanos , Manejo da Dor , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Toracoscopia
8.
Braz Dent J ; 31(4): 353-359, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32901709

RESUMO

The aim of this prospective, randomized, clinical study was to analyze the influence of occlusal adjustment on the prevalence of postoperative pain after endodontic treatment. Seventy-eight patients, diagnosed with symptomatic irreversible pulpitis with indication for endodontic treatment, were selected to participate in the study. The participants were randomized and divided into two groups: in the occlusal adjustment group (OAG), endodontic treatment was performed with subsequent occlusal adjustment. In the control group (CG), endodontic treatment was performed without occlusal adjustment. Treatments were performed by the same operator. Pain occurrence and intensity were recorded on two scales: the verbal rating scale (VRS) and numerical rating scale (NRS). Pain assessment was carried out by a second examiner, blinded to the experiment, 6, 24 and 72 h after endodontic treatment. Data were analyzed using Mann-Whitney, chi-squared, and Fisher's exact tests. In the occlusal adjustment group, 71.1% reported postoperative pain and 67.5% reported pain in the control group. At the 6-hour assessment, 21 individuals reported pain in the occlusal adjustment group and 24 in the control group (p=0.672). At the 24-hour assessment, 18 and 19 individuals reported pain (p=0.991) and at the 72-hour assessment, 8 and 4 reported pain (p=0.219), respectively. Occlusal adjustment did not influence the prevalence of postoperative pain of endodontically treated teeth with symptomatic irreversible pulpitis.


Assuntos
Cavidade Pulpar , Tratamento do Canal Radicular , Humanos , Ajuste Oclusal , Dor Pós-Operatória , Estudos Prospectivos
9.
Medicine (Baltimore) ; 99(35): e21449, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871867

RESUMO

BACKGROUND: Pulsed electromagnetic fields shows some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis is conducted to investigate the analgesic efficacy of pulsed electromagnetic fields for pain control after mammaplasty. METHODS: The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials regarding the impact of pulsed electromagnetic fields on pain intensity after mammaplasty. RESULTS: This meta-analysis has included 4 randomized controlled trials. Compared with control group after mammaplasty, pulsed electromagnetic fields results in remarkably reduced pain scores on 1 day (MD = -1.34; 95% confidence interval [CI] = -2.23 to -0.45; P = .003) and 3 days (MD = -1.86; 95% CI = -3.23 to -0.49; P = .008), as well as analgesic consumption (Std. MD = -5.64; 95% CI = -7.26 to -4.02; P < .00001). CONCLUSIONS: Pulsed electromagnetic fields is associated with substantially reduced pain intensity after mammaplasty.


Assuntos
Mama/cirurgia , Campos Eletromagnéticos/efeitos adversos , Mamoplastia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Idoso , Analgésicos/farmacologia , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
10.
Medicine (Baltimore) ; 99(35): e21881, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871917

RESUMO

BACKGROUND: Pain control after total knee arthroplasty has shown many advances; however, the optimal method remains controversial. The purpose of this present study is to assess the efficacy and safety of the addition of local infiltration analgesia to adductor canal block for pain control after primary total knee arthroplasty. METHODS: This prospective randomized controlled research was conducted from January 2018 to June 2019. All the patients and their family members signed the informed consent forms, and this work was authorized via the ethics committee of Jinxiang Hospital Affiliated to Jining Medical College (JXHP0024578). Inclusion criteria were 55 years old or older, who possess the physical status I-III of American Society of Anesthesiologists, and the body mass index in the range of 18 to 30 kg/m. Exclusion criteria were regional and/or neuroaxial anesthesia contraindications, the history of drug allergy involved in the research, neuropathic pain, as well as the chronic pain requiring opioid therapy. Seventy-two patients were divided into 2 groups randomly. Study group (n = 36) received both adductor canal block and local infiltration analgesia. Control group (n = 36) received adductor canal block alone. Primary outcome included postoperative pain score (visual analog scale 0 to 10 cm, in which 0 represents no pain and 10 represents the most severe imaginable pain). The measures of secondary outcome included the knee range of motion, opioid consumption, the hospital stay length as well as the postoperative complications (for instance, pulmonary embolism, deep vein thrombosis, and the wound infection). All the analyses were conducted through utilizing the SPSS for Windows Version 20.0. RESULTS: The results will be shown in .(Table is included in full-text article.) CONCLUSION:: The study will provide more evidence on the combination use of adductor canal block and local infiltration analgesia in the treatment of pain after the total knee arthroplasty. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5832).


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Bupivacaína/administração & dosagem , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Ropivacaina/administração & dosagem , Escala Visual Analógica
11.
Arthroscopy ; 36(9): 2486-2487, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891249

RESUMO

Identification of risk factors for prolonged opioid use is imperative as opioid misuse continues to plague society. Recent data suggest that many modifiable and nonmodifiable patient factors may be associated with prolonged opioid use after arthroscopic meniscal surgery. Surgeons and patients share the burden of the opioid epidemic and must collaborate to decrease the overall opioid burden on society. As the number of tools to treat pain and the knowledge of at-risk patients grow, standardized postoperative narcotic regimens to treat a diverse population of patients are no longer acceptable; narcotic regimens must be customized to each patient. To limit opioid use and enhance patient outcomes, it is apparent that the next frontier of postoperative pain control is upon us: the personalization of pain control.


Assuntos
Analgesia , Osteoartrite do Joelho , Analgésicos Opioides , Artroscopia , Humanos , Masculino , Meniscectomia , Dor Pós-Operatória
12.
Bone Joint J ; 102-B(9): 1122-1127, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862693

RESUMO

Evidence suggests that the alleviation of pain is enhancedby a strong patient-clinician relationship and attending to a patient's social and mental health. There is a limited role for medication, opioids in particular. Orthopaedic surgeons can use comprehensive biopsychosocial strategies to help people recover and can work with colleagues who have the appropriate expertise in order to maximize pain alleviation with optimal opioid stewardship. Preparing patients for elective surgery and caring for them after unplanned injury or surgery can benefit from planned and practiced strategies based in communication science. Cite this article: Bone Joint J 2020;102-B(9):1122-1127.


Assuntos
Manejo da Dor , Dor Pós-Operatória/terapia , Humanos , Procedimentos Ortopédicos , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(35): e21672, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871881

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is known to be a painful orthopedic procedure and moderate to severe pain is common, especially immediately postoperatively and during active motion. The aim of the present study was to compare epidural analgesia (EA) and adductor canal block (ACB) techniques with regard to early period pain levels, need for additional opioids, and ambulation and functional scores in patients who had undergone primary TKA. METHODS: Approval for the study was granted by the Changji Branch of the First Affiliated Hospital of Xinjiang Medical University. Written informed consent will be obtained from all of the participants. Inclusion criteria included the following: planned unilateral TKA; spinal anesthesia; American Society of Anesthesiologists physical status classification score of I to III. Prospective assessment will be done for 100 patients who are scheduled for unilateral primary TKA surgery in our academic hospital by a single senior surgeon between August 2020 and December 2021. Patients were randomized to ACB treatment or EA treatment by a computer random number generator. The primary outcome was visual analog scale pain scores in the immediate postoperative period. Secondary outcomes included postoperative opioid use, length of hospital stay, activity level during physical therapy, and knee range of motion. Results were evaluated in a confidence interval of 95% and at a significance level of P < .05. CONCLUSIONS: We hypothesized that standard ACB would be as effective as EA for postoperative pain management following TKA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5775).


Assuntos
Analgesia Epidural , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Humanos , Articulação do Joelho/fisiopatologia , Medição da Dor , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular
14.
Medicine (Baltimore) ; 99(35): e21683, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871883

RESUMO

Several studies have reported short-term results for post-cholecystectomy symptoms and quality of life (QoL). However, reports on long-term results are still limited. This study aimed to identify risk factors affecting short- and long-term patient-reported outcome (PRO) following laparoscopic cholecystectomy.From 2016 to 2017, a total of 476 patients from 5 institutions were enrolled. PRO was examined using the Numeric Rating Scale (NRS) pain score and the Gastrointestinal (GI) QoL Index questionnaire at postoperative 1 month and 1 year.Most of patients recovered well at postoperative 1 year compared to postoperative 1 month for the NRS pain score, QoL score, and GI symptoms. A high operative difficulty score (HR 1.740, P = .031) and pathology of acute or complicated cholecystitis (HR 1.524, P = .048) were identified as independent risk factors for high NRS pain scores at postoperative 1 month. Similarly, female sex (HR 1.571, P = .003) at postoperative 1 month and postoperative complications (HR 5.567, P = .001) at postoperative 1 year were independent risk factors for a low QoL. Also, age above 50 (HR 1.842, P = .001), female sex (HR 1.531, P = .006), and preoperative gallbladder drainage (HR 3.086, P = .001) were identified as independent risk factors for GI symptoms at postoperative 1 month.Most patients showed improved long-term PRO measurement in terms of pain, QoL, and GI symptoms. There were no independent risk factors for long-term postoperative pain and GI symptoms. However, postoperative complications were identified to affect QoL adversely at postoperative 1 year. Careful and long-term follow up is thus necessary for patients who experienced postoperative complications.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar/cirurgia , Gastroenteropatias/etiologia , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Fatores Etários , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/complicações , Colecistite/cirurgia , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Fatores de Tempo
15.
Medicine (Baltimore) ; 99(33): e21748, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872065

RESUMO

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a benign proliferative disease of synovial joint, synovial sac and tendon sheath. PVNS is usually treated by surgery, but postoperative joint dysfunction and pain will be accompanied, which seriously affects the quality of life. The purpose of this review is to evaluate the effectiveness and safety of this intervention in patients with pain and dysfunction caused by postoperative symptoms of PVNS. METHODS: We will search the EMBASE, the Cochrane Library, Ovid MEDLINE, PubMed, Web of Science, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chongqing VIP (VIP), the US National Institute of Health, the NIH clinical registry Clinical Trials, the ICTRP, and the Australian New Zealand Clinical Trials Registry and the Chinese clinical registry, from their inception to 1st July 2020. Randomized controlled trials that include patients with postoperative symptoms of pigmented villonodular synovitis receiving acupuncture therapy versus a control group will be included. The selection of studies, data extraction and risk of bias assessment will be conducted by 2 independent researchers. A third review author resolved disagreements. The dichotomous data will be presented as risk ratios with 95% confidence intervals (CIs) and the continuous data will be presented as weighted mean differences or standardized mean differences with 95% CIs. Evidence quality will be evaluated using the GRADE system. RESULTS: The results will be disseminated through a peer-reviewed journal publication. CONCLUSIONS: This systematic review will provide updated evidence of various types of acupuncture specifically focuses on its effectiveness and safety for patients' pain and dysfunction caused by post-operation of pigmented villonodular synovitis. ETHICS AND DISSEMINATION: Ethical approval is not necessary as this review will not require data from individual patients. The results of this will be published through peer-reviewed journal articles or conference presentations. REGISTRATION: Open Science Framework (OSF). 2020, July 7. 10.17605/OSF.IO/CZW9P.


Assuntos
Terapia por Acupuntura , Dor Pós-Operatória/terapia , Sinovite Pigmentada Vilonodular/reabilitação , Humanos , Metanálise como Assunto , Sinovite Pigmentada Vilonodular/cirurgia , Revisões Sistemáticas como Assunto
16.
Bone Joint J ; 102-B(10): 1297-1302, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993338

RESUMO

AIMS: Although periarticular injection plays an important role in multimodal pain management following total hip arthroplasty (THA), there is no consensus on the optimal composition of the injection. In particular, it is not clear whether the addition of a corticosteroid improves the pain relief achieved nor whether it is associated with more complications than are observed without corticosteroid. The aim of this study was to quantify the safety and effectiveness of cortocosteroid use in periarticular injection during THA. METHODS: We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. A total of 187 patients were randomly assigned to receive periarticular injection containing either a corticosteroid (CS group) or without corticosteroid (no-CS group). Other perioperative interventions were identical for all patients. The primary outcome was postoperative pain at rest during the initial 24 hours after surgery. Pain score was recorded every three hours until 24 hours using a 100 mm visual analogue scale (VAS). The primary outcome was assessed based on the area under the curve (AUC). RESULTS: The CS group had a significantly lower AUC postoperatively at 0 to 24 hours compared to the no-CS group (AUC of VAS score at rest 550 ± 362 vs 392 ± 320, respectively; mean difference 158 mm; 95% confidence interval (CI) 58 to 257; p = 0.0021). In point-by-point evaluation, the CS group had significantly lower VAS scores at 12, 15, 18, 21, 24, and 48 hours. There were no significant differences in complication rates, including surgical site infection, between the two groups. CONCLUSION: The addition of corticosteroid to periarticular injections reduces postoperative pain without increasing complication rate following THA. Cite this article: Bone Joint J 2020;102-B(10):1297-1302.


Assuntos
Corticosteroides/uso terapêutico , Artroplastia de Quadril , Dor Pós-Operatória/prevenção & controle , Idoso , Anestesia Geral , Método Duplo-Cego , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos
17.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 406-410, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879065

RESUMO

OBJECTIVES: To evaluate the efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty (TKA). METHODS: A total of 50 patients with knee osteoarthritis treated by TKA from July to September 2018 were randomly divided into two groups (n=25). The Group 1 underwent anterior intra-articular injection before prosthesis implanted while the Group 2 underwent posterior intra-articular injection before prosthesis implanted. Visual Analogue Scale (VAS) of all patients for pain during activity and at rest, maximal flexion degree of the knee at the 48th h and the 72th h after surgery, the time of raise leg, usage rate of patient-controlled analgesia (PCA), and complications were evaluated and analyzed. RESULTS: VAS for pain at rest of patients in the Group 1 was significantly less than that in the Group 2 at the 6th, 12th, and 24th h after surgery (all P<0.05). Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the Group 1 was better than that in the Group 2 (both P<0.05). The Group 1 costed less time than the Group 2 on the ability to perform an active straight leg raise (P=0.027). CONCLUSIONS: The anterior intra-articular cocktail analgesic mixture injection can strongly relieve the pain early after TKA, which can improve knee function and achieve painless rehabilitation in most patients, with safety.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho/cirurgia , Analgésicos , Humanos , Injeções Intra-Articulares , Medição da Dor , Dor Pós-Operatória/prevenção & controle
18.
Ther Umsch ; 77(6): 252-257, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32930078

RESUMO

Chronic postoperative pain and psychological factors Abstract. Chronic postsurgical pain is highly prevalent, also or particularly in hand surgical patients. Considerable progress has been made in identifying risk and protective factors for chronic postsurgical pain. Psychological - that is cognitive, affective and behavioral - aspects including depression, anxiety, pain catastrophizing and patient trust in physician also play a key role in determining the probability of developing chronic pain after surgery. These factors are measurable and serve as important targets for specific psychological interventions by the surgeon or an interdisciplinary team. Empirical evaluation of these treatments demonstrates that psychological as well as interdisciplinary multimodal interventions are accepted by surgical patients and able to reduce postsurgical pain and disability.


Assuntos
Dor Crônica/terapia , Ansiedade , Catastrofização , Depressão , Humanos , Dor Pós-Operatória
19.
Medicine (Baltimore) ; 99(38): e22162, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957340

RESUMO

BACKGROUND: Patients with spinal fusion often have opioid tolerance and chronic pain, which makes it difficult to control postoperative pain. In this double-blind, randomized, prospective study, we assessed the safety and efficacy of intravenous low-dose ketamine for the treatment of pain in patients undergoing the lumbar spinal fusion. METHODS: This randomized, prospective, double-blind and placebo-controlled study was approved via the hospital institutional review committee. Patients were registered with signed written consent. All the floor nurses, recovery room and surgeons, patients, statisticians as well as research assistants were unaware of the grouping. The patients were randomly divided into ketamine group and control group by random number table. Nausea, vomiting or vomiting, the intensity of pain, adverse events, cumulative morphine consumption, as well as the amount of extra antiemetics or analgesics were evaluated at 6 hours, 12 hours, 24 hours, 36 hours, and 48 hours after the operation. P < .05 was considered to be the statistically significant. The Statistical Package for the software of Social Sciences 20.0 was utilized for statistical analysis. CONCLUSIONS: For the present trial, we assumed that intravenous ketamine could improve the satisfaction of patient by reducing the total consumption of morphine equivalent and the pain scores. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5896).


Assuntos
Analgésicos/uso terapêutico , Ketamina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Fusão Vertebral , Método Duplo-Cego , Humanos , Medição da Dor , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Zhonghua Yi Xue Za Zhi ; 100(37): 2947-2951, 2020 Oct 13.
Artigo em Chinês | MEDLINE | ID: mdl-32993256

RESUMO

Objective: To investigate the effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy. Methods: One hundred patients undergoing radical laparoscopic nephrectomy in Affiliated Cancer Hospital of Zhengzhou University from September 2018 to February 2020 were divided into two groups (n=50) using a random number table: butorphanol patient-controlled intravenous analgesia group (group A) and sufentanil patient-controlled intravenous analgesia group (group B). Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery. The formulation of group A was butorphanol (0.15 mg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. The formulation of group B was sufentanil (1.5 µg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. At the time points of 4, 8, 24, 48 h after operation (T(1), T(2), T(3), T(4)), VAS scores at rest and cough were recorded. The incidence of remedial analgesia, the number of pressings during 48 h after the operation, the postoperative anal exhaust recovery time of the patients were recorded. Quality of recovery-40(QoR-40) scores were recorded at T(3) and T(4). Adverse reactions were recorded. Results: There was no significant difference in VAS scores at rest and cough at T(1), T(2), T(3) and T(4) between two groups (all P>0.05). There was no significant difference in the incidence of remedial analgesia and the number of pressings during 48 h after the operation between two groups (all P>0.05). The postoperative anal exhaust recovery time of the patients in group A was (32±6) h, which was lower than that in group B with statistically significant difference [(40±5) h, t=7.937, P<0.01]. The QoR-40 total scores in group A were higher than those in group B at T(3) and T(4), which were (185.8±2.5) vs (170.7±2.7), (194.8±1.9) vs (183.6±2.6), and the differences were statistically significant (t=28.878, 25.025, all P<0.01). The incidence of nausea, retching/vomiting, respiratory depression and itch during 48 h after the operation in group A were 10%, 6%, 2%, 2%, which were lower than that in group B (32%, 20%, 14%, 18%), with statistically significant difference (χ(2)=7.294, 4.322, 4.891, 5.983, all P<0.05). Conclusion: PCIA with butorphanol or sufentanil can provide satisfactory analgesia for patients undergoing radical laparoscopic nephrectomy, but butorphanol can promote postoperative rehabilitation with fewer adverse reactions.


Assuntos
Laparoscopia , Sufentanil , Butorfanol , Humanos , Nefrectomia , Dor Pós-Operatória
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