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1.
Clin Oral Investig ; 25(1): 23-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33222053

RESUMO

OBJECTIVES: To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment. MATERIALS AND METHODS: A systematic review (SR) was conducted in seven databases. Articles that were published up to 04 February 2020 were included and randomized clinical trials that used a cold saline solution for final irrigation to manage postoperative endodontic pain were compared with those that used a saline solution at room temperature. Metaanalysis was performed to assess postoperative pain after 6, 24, 48, and 72 h using a random effects model, a confidence interval of 95%, and heterogeneity tested by the I2 index. The certainty of evidence was rated using GRADE. RESULTS: Qualitative and quantitative analysis included eight and six studies, respectively. Individuals treated with cryotherapy presented lower means of postendodontic pain than the controls, 6 and 24 h after endodontic treatment (MD - 1.30 [- 2.32, - 0.28] p = 0.01 and SMD - 0.68 [ - 1.21, - 0.16] p = 0.01, respectively, with very low certainty of evidence). After 48 and 72 h, both groups demonstrated similar means of postendodontic pain (MD - 0.06 [- 0.18, 0.07] p = 0.38 and SMD - 0.54 [- 1.18, - 0.11] p = 0.10, with high and low certainty of evidence, respectively). CONCLUSIONS: Based on the limited quality evidence, intracanal cryotherapy application reduced postoperative endodontic pain after 6 and 24 h. New clinical trials are needed to support the result of this review. CLINICAL SIGNIFICANCE: This SR provides information about the use of intracanal cryotherapy in clinical practice, guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies.


Assuntos
Crioterapia , Endodontia , Dor Pós-Operatória , Humanos , Dor Pós-Operatória/terapia
2.
Cochrane Database Syst Rev ; 11: CD001159, 2020 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-33238043

RESUMO

BACKGROUND: This review was published originally in 1999 and was updated in 2001, 2002, 2009, 2017, and 2020. Updating was deemed necessary due to the high incidence of hip fractures, the large number of official societies providing recommendations on this condition, the possibility that perioperative peripheral nerve blocks (PNBs) may improve patient outcomes, and the major role that PNBs may play in reducing preoperative and postoperative opioid use for analgesia. OBJECTIVES: To compare PNBs used as preoperative analgesia, as postoperative analgesia, or as a supplement to general anaesthesia versus no nerve block (or sham block) for adults with hip fracture. Outcomes were pain on movement at 30 minutes after block placement, acute confusional state, myocardial infarction, chest infection, death, time to first mobilization, and costs of an analgesic regimen for single-injection blocks. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. SEARCH METHODS: For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2019); Embase (Ovid SP, 1974 to November 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to November 2019), as well as trial registers and reference lists of relevant articles. SELECTION CRITERIA: We included randomized controlled trials (RCTs) assessing use of PNBs compared with no nerve block (or sham block) as part of the care provided for adults 16 years of age and older with hip fracture.  DATA COLLECTION AND ANALYSIS: Two review authors independently screened new trials for inclusion, assessed trial quality using the Cochrane Risk of Bias-2 tool, and extracted data. When appropriate, we pooled results of outcome measures. We rated the certainty of evidence using the GRADE approach. MAIN RESULTS: We included 49 trials (3061 participants; 1553 randomized to PNBs and 1508 to no nerve block (or sham block)). For this update, we added 18 new trials. Trials were published from 1981 to 2020. Trialists followed participants for periods ranging from 5 minutes to 12 months. The average age of participants ranged from 59 to 89 years. People with dementia were often excluded from the included trials. Additional analgesia was available for all participants. Results of 11 trials with 503 participants show that PNBs reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.05, 95% confidence interval (CI) -1.25 to -0.86; equivalent to -2.5 on a scale from 0 to 10; high-certainty evidence). Effect size was proportionate to the concentration of local anaesthetic used (P = 0.0003). Based on 13 trials with 1072 participants, PNBs reduce the risk of acute confusional state (risk ratio (RR) 0.67, 95% CI 0.50 to 0.90; number needed to treat for an additional beneficial outcome (NNTB) 12, 95% CI 7 to 47; high-certainty evidence). For myocardial infarction, there were no events in one trial with 31 participants (RR not estimable; low-certainty evidence). From three trials with 131 participants, PNBs probably reduce the risk for chest infection (RR 0.41, 95% CI 0.19 to 0.89; NNTB 7, 95% CI 5 to 72; moderate-certainty evidence). Based on 11 trials with 617 participants, the effects of PNBs on mortality within six months are uncertain due to very serious imprecision (RR 0.87, 95% CI 0.47 to 1.60; low-certainty evidence). From three trials with 208 participants, PNBs likely reduce time to first mobilization (mean difference (MD) -10.80 hours, 95% CI -12.83 to -8.77 hours; moderate-certainty evidence). One trial with 75 participants indicated there may be a small reduction in the cost of analgesic drugs with a single-injection PNB (MD -4.40 euros, 95% CI -4.84 to -3.96 euros; low-certainty evidence). We identified 29 ongoing trials, of which 15 were first posted or at least were last updated after 1 January 2018.  AUTHORS' CONCLUSIONS: PNBs reduce pain on movement within 30 minutes after block placement, risk of acute confusional state, and probably also reduce the risk of chest infection and time to first mobilization. There may be a small reduction in the cost of analgesic drugs for single-injection PNB. We did not find a difference for myocardial infarction and mortality, but the numbers of participants included for these two outcomes were insufficient. Although randomized clinical trials may not be the best way to establish risks associated with an intervention, our review confirms low risks of permanent injury associated with PNBs, as found by others. Some trials are ongoing, but it is unclear whether any further RCTs should be registered, given the benefits found. Good-quality non-randomized trials with appropriate sample size may help to clarify the potential effects of PNBs on myocardial infarction and mortality.


Assuntos
Fraturas do Quadril/cirurgia , Bloqueio Nervoso/métodos , Manejo da Dor , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Confusão/epidemiologia , Confusão/prevenção & controle , Deambulação Precoce , Feminino , Fraturas do Quadril/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Infarto do Miocárdio/epidemiologia , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/terapia , Nervos Periféricos , Pneumonia/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/prevenção & controle , Fatores de Tempo
3.
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
4.
Cochrane Database Syst Rev ; 9: CD011216, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871021

RESUMO

BACKGROUND: Pain after caesarean sections (CS) can affect the well-being of the mother and her ability with her newborn. Conventional pain-relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post-CS pain. OBJECTIVES: To assess the effects of CAM for post-caesarean pain. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs), including quasi-RCTs and cluster-RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post-CS pain. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE. MAIN RESULTS: We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women). AUTHORS' CONCLUSIONS: Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.


Assuntos
Cesárea/efeitos adversos , Terapias Complementares/métodos , Dor Pós-Operatória/terapia , Acupressão , Analgesia por Acupuntura , Adolescente , Adulto , Analgesia Obstétrica/métodos , Analgésicos/administração & dosagem , Aromaterapia , Viés , Terapia Combinada/métodos , Feminino , Humanos , Massagem , Musicoterapia , Placebos/uso terapêutico , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia de Relaxamento , Toque Terapêutico , Estimulação Elétrica Nervosa Transcutânea , Adulto Jovem
5.
Obstet Gynecol ; 136(4): 685-691, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925620

RESUMO

OBJECTIVE: To examine the results of a quality-improvement study that implemented an enhanced recovery after surgery (ERAS) program for cesarean delivery. METHODS: A pre-post design was used to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implementation of an evidence-based ERAS pathway for the preoperative, intraoperative, and postoperative management of patients beginning December 2018. RESULTS: A total of 3,679 cesarean deliveries (scheduled and emergent) were included from January 1, 2018, through August 31, 2019, of which 2,171 occurred before implementation on December 17, 2018, and 1,508 occurred postimplementation. Eighty-four percent of patients received opioids as inpatients after cesarean delivery during the preimplementation period, as compared with 24% in the postimplementation period (odds ratio [OR] 16.8, 95% CI 14.3-19.9). Among patients who required any opioids, the total morphine milligram equivalents also significantly decreased (median 56.5 vs 15.0, mean relative change 0.32, 95% CI 0.28-0.35). Compared with the preimplementation period, those in the postimplementation period had a shorter postcesarean length of stay (3.2 vs 2.7 days, mean relative change 0.82, 95% CI 0.80-0.83, median 3 days in both periods), lower median direct costs by $349 (mean relative change 0.93, 95% CI 0.91-0.95), and no change in the 30-day readmission rate (1.4% vs 1.7%, OR 0.83, 95% CI 0.49-1.41). CONCLUSION: An ERAS approach for the cesarean delivery population is associated with improved outcomes including decreases in opioid use, length of stay, and costs.


Assuntos
Analgésicos Opioides/uso terapêutico , Cesárea , Recuperação Pós-Cirúrgica Melhorada , Dor Pós-Operatória/terapia , Cuidados Pós-Operatórios , Adulto , Analgésicos/uso terapêutico , Cesárea/efeitos adversos , Cesárea/métodos , Custos e Análise de Custo , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Gravidez , Melhoria de Qualidade
6.
J Acupunct Meridian Stud ; 13(5): 157-162, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32980559

RESUMO

BACKGROUND: Postcesarean section shoulder pain caused by constrained upper extremity movement limits the maternal activities of breastfeeding and neonatal care. OBJECTIVES: This study aims at investigating the effects of auriculotherapy on shoulder pain after a cesarean section. METHODS: In this randomized controlled trial, 90 candidates for a cesarean section were selected according to the inclusion and exclusion criteria and randomly allocated into control and intervention groups by the minimization method. In the intervention group, ear seeds were placed on shoulder and muscle relaxation points from two hours prior to surgery until 24 hours after it. In the control group, ear seeds were placed on placebo points. Shoulder pain was assessed on a numerical pain scale in 1, 6, and 24 hours after surgery. RESULTS: There was no significant difference between the two groups 1 and 6 hours after surgery. However, there was a significant difference between the two groups 24 hours after surgery and the mean pain score was lower in the intervention group (independent t-test, p < 0.001). CONCLUSION: The use of auriculotherapy is recommended for the prevention and alleviation of shoulder pain after a cesarean section.


Assuntos
Auriculoterapia , Cesárea/efeitos adversos , Dor Pós-Operatória/terapia , Dor de Ombro/terapia , Adulto , Auriculoterapia/métodos , Método Duplo-Cego , Feminino , Humanos , Dor Pós-Operatória/etiologia , Gravidez , Dor de Ombro/etiologia
8.
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
10.
J Craniofac Surg ; 31(7): 1981-1985, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32604311

RESUMO

The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD -1.75, CI 95% -2.69 to -0.81; Swelling: MD -21.16 mL, CI 95% -38.91 to -3.41) and in the final evaluation (Pain: MD -0.31, CI 95% -0.44 to -0.18; MD -4.45 mL, CI 95% -7.87 to -1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.


Assuntos
Traumatismos Faciais/cirurgia , Procedimentos Ortopédicos , Dor Pós-Operatória/terapia , Temperatura Baixa , Crioterapia , Edema/terapia , Equipamentos e Provisões , Humanos , Período Pós-Operatório , Resultado do Tratamento , Água
11.
S D Med ; 73(5): 198-201, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32579798

RESUMO

INTRODUCTION: Medical use and overuse of opioids have become an increasing problem over the past several decades. Postoperative pain control is the strongest indication for the use of opioid analgesics. Previous studies have demonstrated benefit from complementary and alternative therapy (CAT) for postoperative pain relief. A prior study conducted by Riswold et al. found that a unit staff training session on CAT improved patient experiences postoperatively following total joint replacement. The study was limited in that it did not examine if there were any changes in opioid usage following this intervention. METHODS: This study is a continuation of the Riswold et al. study on CAT training intervention. In July 2017, a four-hour staff training session on alternative comfort measures and pain medication administration took place. Opioid administration data was extracted from the PYXIS software for all patients who had received more than three opioid administrations across their hospital stay in the three months prior to CAT training and the three months post-training. Opioid administrations were converted to total oral morphine equivalents. The pre- and post-intervention groups were compared using independent sample t-tests using SPSS software. RESULTS: Statistically significant reduction of total oral morphine equivalents occurred following CAT training intervention (p=.034, CI 2.76, 69.81). Average oral morphine equivalents per day (p=0.023, CI 1.26, 16.57) and per administration (p=0.00048, CI 0.64, 2.25) also were significantly reduced following the CAT training intervention. CONCLUSION: This study strengthens the findings of prior studies, showing that CAT can improve patient satisfaction while also reducing overall opioid burden for post-surgical patients.


Assuntos
Analgésicos Opioides , Terapias Complementares , Transtornos Relacionados ao Uso de Opioides , Manejo da Dor , Humanos , Morfina , Dor Pós-Operatória/terapia
13.
Ann Otol Rhinol Laryngol ; 129(11): 1071-1077, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32483986

RESUMO

OBJECTIVES: (1) To identify clinical factors and perioperative practices that correlate with longer length of stay (LOS) in the post-anesthesia care unit (PACU) after adenotonsillectomy (T&A) in pediatric populations.(2) To understand the relationship between family presence and PACU LOS for pediatric patients after T&A. METHODS: Pediatric patients (ages 3-17) who underwent T&A between February 2016 and December 2016 were retrospectively reviewed. Factors assessed for impact on PACU LOS included BMI, preoperative medications, intraoperative medications/narcotics, postoperative medications/narcotics, method of postoperative medication administration, and family presence in the PACU. Kruskal-Wallis and Spearman tests were used to assess correlations. Statistical significance was set a priori at P < .05. RESULTS: Our cohort included 500 patients. Patients were in the PACU for an average of 135.4 minutes (±65.8). Subset analyses of the type of medications administered intra-operatively and in the PACU show that the intraoperative administration of sedatives is associated with increased LOS (P = .014). Postoperative administration of any medications (P < .001), and specifically, postoperative administration of narcotics (P < .001), analgesics (P = .043), antihistamines (P < .001), and dopamine antagonists (P = .011), are associated with increased LOS. Administration of PACU medications by IV was also correlated with shorter LOS compared to oral administration of PACU medications (P = .016). A comparison of patients who received PACU medications to those who did not demonstrated that intraoperative administration of acetaminophen was associated with a reduced need for PACU medication administration (P = .012). Shorter waiting times for family arrival in the PACU was also associated with shorter LOS (P < .001). CONCLUSION: Our results suggest that postoperative medication administration and time until family arrival in the PACU are associated with significant differences in LOS. We also find that intraoperative administration of acetaminophen is correlated with reduced need for postoperative medication administration. Standardizing postoperative practices to minimize PACU LOS could result in a more efficient recovery for pediatric patients undergoing T&A.


Assuntos
Adenoidectomia/métodos , Período de Recuperação da Anestesia , Tempo de Internação/tendências , Dor Pós-Operatória/terapia , Cuidados Pós-Operatórios/métodos , Tonsilectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/diagnóstico , Prognóstico
14.
Ann Thorac Cardiovasc Surg ; 26(4): 196-201, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32493872

RESUMO

OBJECTIVE: To evaluate the effect of music therapy on the chronic pain and midterm quality of life of patients after mechanical valve replacement. METHODS: Patients were divided into two groups according to whether or not they received music therapy. The patients in the music group received 30 minutes of music therapy every day for 6 months after the operation. The patients in the control group received standard treatment and had 30 minutes of quiet rest time every day in the same period. The short-form of McGill Pain Questionnaire (SF-MPQ) was used to evaluate the degree of postoperative chronic pain, and the SF-36 was used to evaluate the midterm quality of life of patients. RESULTS: In terms of the degree of postoperative chronic pain, the score of the pain rating index (PRI) emotional item in the music group was significantly lower than that in the control group. In the evaluation of the postoperative midterm quality of life using the SF-36, the emotional function score in the music group was significantly higher than that in the control group. CONCLUSION: This study preliminarily showed that music therapy can effectively reduce chronic pain and improve midterm quality of life after surgery.


Assuntos
Valva Aórtica/cirurgia , Dor Crônica/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Musicoterapia , Dor Pós-Operatória/terapia , Qualidade de Vida , China , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Percepção da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Fatores de Tempo , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(21): e20286, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481308

RESUMO

BACKGROUND: The serratus anterior plane (SAP) block is a newer method that can be used in patients undergoing thoracic surgeries. The postoperative analgesia efficacy of SAP blocks for thoracic surgery remains controversial. We conduct a meta-analysis to evaluate the analgesia of SAP blocks after thoracic surgery. METHODS: We searched PubMed, Embase, EBSCO, the Cochrane Library, Web of Science, and CNKI for randomized controlled trials (RCTs) regarding the postoperative pain control of a SAP block on thoracic surgery. All of the dates were screened and evaluated by two researchers and meta-analysis was performed using RevMan5.3 software. RESULTS: A total of 8 RCTs involving 542 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 h (standardized mean difference [Std.MD] = -1.26; 95% confidence interval [CI] = -1.66 to -0.86; P < .0001); 6 h (SMD = -0.50; 95%CI = -0.88 to -0.11; P = .01); 12 h (SMD = -0.63; 95%CI = -1.10 to -0.16; P = .009); 24 h (SMD = -0.99; 95%CI = -1.44 to -0.51; P < .0001); postoperative opioid consumption at 24 h (SMD = -0.83; 95%CI = -1.10 to -0.56; P < .00001); and postoperative nausea and vomiting (PONV) rates (RR = 0.39; 95% CI = 0.21-0.73; P = .003). CONCLUSION: The SAP block can play an important role in the management of pain after thoracic surgery by reducing both pain scores and 24-h postoperative opioids consumption. In addition, there is fewer incidence of PONV in the SAP block group.


Assuntos
Analgesia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Humanos
16.
Eur Rev Med Pharmacol Sci ; 24(9): 5162-5166, 2020 05.
Artigo em Inglês | MEDLINE | ID: covidwho-339621

RESUMO

OBJECTIVE: Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency. PATIENTS AND METHODS: In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. RESULTS: None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed. CONCLUSIONS: Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity.


Assuntos
Anestesia Local/métodos , Infecções por Coronavirus , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparotomia , Pandemias , Pneumonia Viral , Vigília , Idoso de 80 Anos ou mais , Anestesia Epidural/métodos , Raquianestesia/métodos , Betacoronavirus , Feminino , Humanos , Masculino , Duração da Cirurgia , Dor Pós-Operatória/terapia , Dor Processual/terapia
17.
Eur Rev Med Pharmacol Sci ; 24(9): 5162-5166, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32432781

RESUMO

OBJECTIVE: Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency. PATIENTS AND METHODS: In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. RESULTS: None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed. CONCLUSIONS: Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity.


Assuntos
Anestesia Local/métodos , Infecções por Coronavirus , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparotomia , Pandemias , Pneumonia Viral , Vigília , Idoso de 80 Anos ou mais , Anestesia Epidural/métodos , Raquianestesia/métodos , Betacoronavirus , Feminino , Humanos , Masculino , Duração da Cirurgia , Dor Pós-Operatória/terapia , Dor Processual/terapia
18.
J Wound Care ; 29(5): 289-294, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32421480

RESUMO

OBJECTIVE: Studies have shown that ozone in an aqueous state on a scar, because of its antibacterial effect, aids wound-healing. This study aimed to compare the pain control effect, based on the time to wound healing, of using a sitz bath with ozonised water with that of using a sitz bath with ordinary tap water in patients who have had a haemorrhoidectomy. METHOD: Patients were divided into two equal-sized groups: Group O used a sitz bath with ozonised water after haemorrhoidectomy and patients in Group T used a sitz bath with ordinary tap water. Different concentrations (1ppm, 2ppm and 4ppm) of ozonized water were tested to determine their bactericidal activities. Pain levels were measured using the Visual Analogue Scale (ranging from 0-10 where 0 is 'no pain' and 10 is 'unbearable pain'), on days two, three and seven. Cohort analysis was retrospectively performed on the prospectively randomised collected data for this study. RESULTS: A total of 80 patients participated in the study. No case showed any signs of bacterial growth. On postoperative day seven, patients in Group O showed a significantly lower pain level than those in Group T (1.35±0.48 versus 2.40±0.9; p<0.001). The time needed for anus scars to be completely healed was significantly shorter for Group O than that for Group T (2.75±0.63 weeks versus 3.85±0.80 weeks; p<0.001). CONCLUSION: The results of this study showed that using a sitz bath with ozonised water reduced pain and accelerated healing in patients who have had a haemorrhoidectomy.


Assuntos
Banhos , Hemorroidectomia , Dor Pós-Operatória/terapia , Ferida Cirúrgica , Cicatrização , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ozônio , Fatores de Tempo , Resultado do Tratamento
19.
Anesth Analg ; 130(6): 1638-1652, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384350

RESUMO

One of the most prevalent symptoms after major surgery is pain. When postoperative pain treatment is unsatisfactory, it can lead to poor surgical recovery, decreased quality of life, and increased health care costs. Current analgesics, single or in combination, have limited efficacy due to low potency, limited duration of action, toxicities, and risk of addiction. The lack of nonaddictive strong analgesics along with the over prescription of opioids has led to an opioid epidemic in the United States. Therefore, there is an urgent need for the development of newer analgesics. Microribonucleic acids (miRNAs) are small noncoding RNA molecules that modulate protein synthesis in neurons and supporting cells (glia, leukocytes, and Schwann cells). The literature indicates that miRNA regulation is important in nociception. Here, we summarize the current evidence on the role of miRNAs on mechanisms involved in incisional, inflammatory, neuropathic, and cancer pain. We also discuss the role of modulating miRNA functions as potential therapeutic targets for analgesic use and opioid tolerance. Finally, we propose how the delivery of analog miRNAs (mimic-miRNAs or antago-miRNAs) could be introduced into clinical practice to provide analgesia in the perioperative period.


Assuntos
MicroRNAs/metabolismo , Dor Pós-Operatória/genética , Dor Pós-Operatória/metabolismo , Dor Aguda/genética , Dor Aguda/metabolismo , Dor Aguda/terapia , Analgesia , Analgésicos/administração & dosagem , Analgésicos Opioides/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor do Câncer/terapia , Tolerância a Medicamentos , Epigênese Genética , Custos de Cuidados de Saúde , Humanos , Inflamação , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/terapia , Período Perioperatório , Qualidade de Vida , Medula Espinal/metabolismo
20.
J Oral Maxillofac Surg ; 78(9): 1628.e1-1628.e5, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32360236

RESUMO

PURPOSE: Edema and ecchymosis are among the most important morbidities after rhinoplasty. The aim of the present study was to investigate the effects of hilotherapy application compared with traditional ice applications after rhinoplasty in terms of periorbital edema, ecchymosis, and pain. PATIENTS AND METHODS: A total of 60 patients (35 women and 25 men) had undergone primary rhinoplasty with the same surgeon. In the postoperative period, 30 patients in the study group received continuous cooling at 15°C using Hilotherm (Hilotherm GmbH, Argenbühl-Eisenharz, Germany), and 30 patients in the control group were treated with conventional cryotherapy with ice packs. Both treatments started within 45 minutes after the end of the surgery and were maintained for 24 hours. For the following 1 week, the patients were examined for edema, ecchymosis, and pain. RESULTS: When the postoperative periorbital region was evaluated for mean edema and mean ecchymosis for 7 days, less edema and less ecchymosis were detected in the Hilotherm group compared with that observed in the ice pack group (P < .001). When the mean pain scores were compared both morning and evening for 7 days, less pain had been recorded with Hilotherm application compared with ice application (P < .001). CONCLUSIONS: Hilotherapy is a useful method to prevent postoperative edema, ecchymosis, and pain compared with traditional ice application.


Assuntos
Equimose , Rinoplastia , Equimose/etiologia , Edema/etiologia , Edema/prevenção & controle , Feminino , Alemanha , Humanos , Masculino , Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Complicações Pós-Operatórias/terapia
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