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1.
J Appl Oral Sci ; 28: e20190025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778442

RESUMO

INTRODUCTION: Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. OBJECTIVE: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. METHODOLOGY: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. RESULTS: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. CONCLUSION: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Raspagem Dentária/efeitos adversos , Géis/administração & dosagem , Dor/prevenção & controle , Aplainamento Radicular/efeitos adversos , Adulto , Idoso , Periodontite Crônica/complicações , Periodontite Crônica/terapia , Método Duplo-Cego , Feminino , Humanos , Lidocaína/administração & dosagem , Combinação Lidocaína e Prilocaína , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Bolsa Periodontal , Placebos , Prilocaína/administração & dosagem , Adulto Jovem
2.
Anaesthesia ; 75(3): 395-405, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31612480

RESUMO

There are numerous possible techniques for delivering local anaesthetic through peripheral nerve catheters. These include continuous infusions, patient-controlled boluses and programmed intermittent boluses. The optimal delivery regimen of local anaesthetic is yet to be conclusively established. In this review, we identified prospective trials of delivery regimens through peripheral nerve catheters. Our primary outcome was visual analogue scale scores for pain at 48 h. Secondary outcomes were: visual analogue scores at 24 h; patient satisfaction scores; rescue opioid use; local anaesthetic consumption; and nausea and vomiting. Network meta-analysis was used to compare these outcomes. Predefined sub-group analyses were performed. Thirty-three studies enrolling 1934 participants were included. In comparison with continuous infusion, programmed intermittent boluses improved visual analogue pain scores at both 48 and 24 h, the weighted mean difference (95%CI) being -0.63 (-1.12 to -0.14), p = 0.012 and -0.48 (-0.92 to -0.03), p = 0.034, respectively. Programmed intermittent boluses also improved satisfaction scores, the weighted mean difference (95%CI) being 0.70 (0.10-1.31), p = 0.023, and reduced rescue opioid use, the weighted mean difference (95%CI) in oral morphine equivalent at 24 h being -23.84 mg (-43.90 mg to -3.77 mg), p = 0.020. Sub-group analysis revealed that these findings were mostly confined to lower limb and truncal catheter studies; there were few studies of programmed intermittent boluses for upper limb catheters. Programmed intermittent boluses may provide optimal delivery of a local anaesthetic through peripheral nerve catheters. Further research is warranted, particularly to delineate the differences between upper and lower limb catheter locations, which will help clarify the clinical relevance of these findings.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Cateterismo/métodos , Nervos Periféricos , Analgesia Controlada pelo Paciente , Cateterismo/efeitos adversos , Cateteres , Humanos , Dor/prevenção & controle
3.
Int J Paediatr Dent ; 30(2): 118-135, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31593320

RESUMO

This systematic review and meta-analysis analysed whether pain and disruptive behaviour can be decreased by the use of computerized local dental anaesthesia (CDLA) in children. The literature was screened to select randomized clinical trials that compared computerized and conventional anaesthesia. The primary outcome was pain perception during anaesthesia; the secondary, disruptive behaviour. The risk of bias of individual papers and the quality of the evidence were evaluated. After search, 8389 records were found and 20 studies remained for the qualitative and quantitative syntheses. High heterogeneity was detected for both outcomes. For the pain perception, the overall analysis showed a standard mean difference of -0.78 (-1.31, -0.25) favouring CDLA; however, when only studies at low risk of bias were analysed (subgroup analysis), there was no difference between the two techniques [-0.12(-0.46, 0.22)]. For disruptive behaviour, no differences were detected for continuous [-0.26 (-0.68, 0.16)] or dichotomous data [0.81 (0.62, 1.06)]. The quality of evidence was judged as low for pain perception and very low for disruptive behaviour. It is concluded that there is no difference in the pain perception and disruptive behaviour in children subjected to computerized or conventional dental local anaesthesia. Notwithstanding, the quality of the available evidence is low.


Assuntos
Anestesia Dentária , Anestesia Local , Assistência Odontológica , Dor , Criança , Humanos , Dor/prevenção & controle , Odontopediatria
5.
Br J Sports Med ; 54(2): 87-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31171514

RESUMO

OBJECTIVE: To determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal intervention (MI) or other invasive intervention, or in addition to decline eccentric squat. METHODS: Searches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT (any intervention not involving invasive procedures or medication) in individuals with PT were included. Two reviewers screened studies, extracted data and assessed risk of bias of all included studies. Where suitable, meta-analyses were conducted; we assessed certainty of the evidence using GRADE methodology. RESULTS: When compared with MI, CT did not improve pain (weighted mean difference (WMD) -2.6, 95% CI -6.5 to 1.2) or function (WMD 1.8, 95% CI -2.4 to 6.1) in the short-term (up to 3 months) follow-up. When compared with invasive intervention, CT did not improve pain (WMD 0.7, 95% CI -0.1 to 1.4) or function (WMD -6.6, 95% CI -13.3 to 0.2) in the short-term follow-up. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (WMD -0.5, 95% CI -1.4 to 0.4) or function (WMD -2.3, 95 % -9.1 to 4.6) at short-term follow-up. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d = 2.42) or dry needling at medium/long-term follow-up (d = 1.17) and function with exercise intervention at medium/long-term follow-up (over 3 months) (d = 0.83). SUMMARY/CONCLUSION: Our estimates of treatment effect have only low to very low certainty evidence to support them. This field of sports medicine/sports physiotherapy urgently needs larger, high-quality studies with pain and function among the potential primary outcomes.


Assuntos
Traumatismos em Atletas/complicações , Traumatismos em Atletas/terapia , Tratamento Conservador , Dor/prevenção & controle , Tendinopatia/complicações , Tendinopatia/terapia , Terapia por Exercício , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Iontoforese , Dor/etiologia
6.
Br J Sports Med ; 54(5): 263-271, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30728126

RESUMO

OBJECTIVES: To determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise. RESULTS: Eight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference -1.06, 95% CI -2.01 to -0.12), but not for outcomes of pain (-0.09, 95% CI -0.96 to 0.79), patient-reported function (-0.74, 95% CI -1.56 to 0.08) or stair function (-0.7, 95% CI -1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI -0.31 to 0.56), patient-reported function (-0.15, 95% CI -0.58 to 0.29) or stair function (0.13, 95% CI -0.3 to 0.57). CONCLUSION: Walking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.


Assuntos
Terapia por Exercício/métodos , Força Muscular/fisiologia , Osteoartrite do Joelho/terapia , Dor/prevenção & controle , Músculo Quadríceps/fisiologia , Qualidade de Vida , Humanos , Osteoartrite do Joelho/fisiopatologia , Dor/etiologia , Medidas de Resultados Relatados pelo Paciente , Treinamento de Resistência
7.
Br J Sports Med ; 54(5): 292-297, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30745314

RESUMO

BACKGROUND: Exercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown. OBJECTIVE: To investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA). METHOD: Assessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0-10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study. RESULTS: 97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: -0.6 [-0.8 to -0.3], p<0.001 and BASDAI: -1.2 [-1.8 to -0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health. CONCLUSION: High intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients' function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA. TRIAL REGISTRATION NUMBER: NCT02356874.


Assuntos
Terapia por Exercício/métodos , Treinamento Intervalado de Alta Intensidade , Treinamento de Resistência , Espondilartrite/reabilitação , Adulto , Aptidão Cardiorrespiratória/fisiologia , Progressão da Doença , Terapia por Exercício/efeitos adversos , Fadiga/prevenção & controle , Treinamento Intervalado de Alta Intensidade/efeitos adversos , Humanos , Pessoa de Meia-Idade , Mialgia/prevenção & controle , Dor/prevenção & controle , Treinamento de Resistência/efeitos adversos , Espondilartrite/fisiopatologia , Fatores de Tempo , Adulto Jovem
8.
Sports Health ; 12(2): 200-206, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850826

RESUMO

CONTEXT: Dosing parameters are needed to ensure the best practice guidelines for knee osteoarthritis. OBJECTIVE: To determine whether resistance training affects pain and physical function in individuals with knee osteoarthritis, and whether a dose-response relationship exists. Second, we will investigate whether the effects are influenced by Kellgren-Lawrence grade or location of osteoarthritis. DATA SOURCES: A search for randomized controlled trials was conducted in MEDLINE, Embase, and CINAHL, from their inception dates, between November 1, 2018, and January 15, 2019. Keywords included knee osteoarthritis, knee joint, resistance training, strength training, and weight lifting. STUDY SELECTION: Inclusion criteria were randomized controlled trials reporting changes in pain and physical function on humans with knee osteoarthritis comparing resistance training interventions with no intervention. Two reviewers screened 471 abstracts; 12 of the 13 studies assessed were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Mean baseline and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and standard deviations were extracted to calculate the standard mean difference. Articles were assessed for methodological quality using the CONSORT (Consolidated Standards of Reporting Trials) 2010 scale and Cochrane Collaboration tool for assessing risk of bias. RESULTS: The 12 included studies had high methodological quality. Of these, 11 studies revealed that resistance training improved pain and/or physical function. The most common regimen was a 30- to 60-minute session of 2 to 3 sets of 8 to 12 repetitions with an initial resistance of 50% to 60% of maximum resistance that progressed over 3 sessions per week for 24 weeks. Seven studies reported Kellgren-Lawrence grade, and 4 studies included osteoarthritis location. CONCLUSION: Resistance training improves pain and physical function in knee osteoarthritis. Large effect sizes were associated with 24 total sessions and 8- to 12-week duration. No optimal number of repetitions, maximum strength, or frequency of sets or repetitions was found. No trends were identified between outcomes and location or Kellgren-Lawrence grade of osteoarthritis.


Assuntos
Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/reabilitação , Dor/prevenção & controle , Treinamento de Resistência/métodos , Atividades Cotidianas , Humanos , Qualidade de Vida , Levantamento de Peso
9.
Br J Anaesth ; 124(3): 292-298, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862159

RESUMO

BACKGROUND: Clinicians traditionally warn patients of pain before peripheral i.v. cannulation (PIVC). However, using words related to pain or undesirable experiences can result in greater pain and anxiety. The use of positive words can improve pain perception and subjective patient experience. We aimed to compare the effects of three types of communication, including hypnotic communication, on pain, comfort, and anxiety in patients during PIVC. METHODS: The Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE) trial is a randomised, parallel, single-blind, multicentre study of patients undergoing PIVC on the dorsal face of the hand before surgery. Patients from three hospitals were randomly allocated to one of three groups: PIVC performed with a hypnosis technique (hypnosis group), negative connotation (nocebo group), and neutral connotation (neutral group). The primary outcome measure was the occurrence of pain measured with a 0-10 numerical rating scale just after PIVC. RESULTS: Of the 272 subjects analysed (hypnosis, n=89; nocebo, n=92; neutral, n=91), pain after PIVC was lower in the hypnosis group (mean [standard deviation]; range) (1.5 [1.9]; 0-5) compared with the neutral (3.5 [2.3]; 0-9; P<0.0001) and nocebo groups (3.8 [2.5]; 0-10; P<0.0001). Whilst anxiety was higher and comfort lower before PIVC in the hypnosis group, anxiety decreased and comfort perception increased after PIVC when hypnosis was used. CONCLUSIONS: This is one of the first well-designed RCTs showing a significant benefit of a hypnosis technique during a routine procedure, such as PIVC. The results could facilitate implementation of hypnosis in daily clinical care. CLINICAL TRIAL REGISTRATION: NCT02662322.


Assuntos
Ansiedade/prevenção & controle , Cateterismo Periférico/efeitos adversos , Comunicação , Hipnose/métodos , Dor/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/psicologia , Cateterismo Periférico/métodos , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/psicologia , Medição da Dor/métodos , Percepção da Dor , Método Simples-Cego , Adulto Jovem
10.
J Dairy Sci ; 103(1): 898-901, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704019

RESUMO

Hoof lesions in dairy cows are usually treated by trimming the hoof. However, trimming by itself can cause severe pain or exacerbate already existing pain. Hoof trimming is usually not carried out by trained veterinarians, and pain management is not provided. Pain control during trimming is not only an ethical obligation but also allows for better manipulation and more meticulous treatment. Tri-Solfen (Bayer Animal Health, Pymble, Australia) is a spray gel containing lidocaine, bupivacaine, and cetrimide that is easily applied topically and has demonstrated pain-mitigation effects during and after hoof trimming. In the European Union, these local anesthetics are not approved for use in food-producing animals because of a lack of residue data and concerns about genotoxic effects in cattle and humans. The aim of this study was to assess lidocaine, bupivacaine, and 2,6-xylidine residues in milk after Tri-Solfen application in dairy cows. Five dairy cattle in the dry-off period were enrolled in the study based on clinical evidence of lameness (score ≥3 on a 5-point scale). After cleaning and superficial trimming, we applied 3 to 14 mL of Tri-Solfen to the lesions before continuing treatment. Two milk samples were collected per animal in the following 4 milkings and analyzed in a reference laboratory. Residues of lidocaine above the limits of quantification (0.2 µg/L) were found in milk samples in the first milking 6 h after treatment in only 2 cows. This study shows that excretion of local anesthetics and their metabolites in milk after topical application of Tri-Solfen is negligible and even undetectable after the first milking 6 h post-treatment.


Assuntos
Anestésicos Locais/química , Doenças dos Bovinos/terapia , Resíduos de Drogas/química , Doenças do Pé/veterinária , Casco e Garras/patologia , Leite/química , Anestésicos Locais/farmacocinética , Animais , Bovinos , Doenças dos Bovinos/metabolismo , Resíduos de Drogas/farmacocinética , Feminino , Doenças do Pé/terapia , Casco e Garras/cirurgia , Leite/metabolismo , Dor/tratamento farmacológico , Dor/prevenção & controle , Dor/veterinária
11.
J Surg Res ; 245: 295-301, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421376

RESUMO

BACKGROUND: One-per-mil tumescent technique could provide local anesthesia in surgical procedures despite using low lidocaine concentration. Tumescence environment within the tissue may play a role in supporting local anesthesia effect. This study aims to delineate whether the tumescence environment, created by one-per-mil solution without a local anesthetic agent, had a local anesthesia effect. METHODS: Four different compositions and volumes of tumescent solutions containing 1:1,000,000 epinephrine were injected into 50 Swiss Webster mice. The animals were divided into five groups: group A, a tumescent solution with 0.2% lidocaine; group B, a tumescent solution with 0.04% lidocaine; group C, a tumescent solution without lidocaine; group D, a doubled volume of tumescent solution without lidocaine; and group E, controls. Local anesthesia effects were tested by using the formalin test (n = 25) and tail immersion test (n = 25). Pain response behavior in the form of paw licking duration and tail withdrawal latency was observed. The analysis of variance and Kruskal-Wallis tests were used to test the statistical difference. Significance was set at P < 0.05. RESULTS: The four interventional groups showed less pain response behavior and significantly longer tail withdrawal latency (P < 0.05) than the control group. However, the groups showed nonsignificantly shorter paw licking duration than the control (P > 0.05). Group A had the fastest onset of the local anesthesia effect. CONCLUSIONS: The tumescence environment was potentially able to provide a local anesthesia effect, although the solution did not contain a local anesthetic agent as proved by the tail immersion test.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Dor/prevenção & controle , Animais , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Injeções Subcutâneas , Lidocaína/administração & dosagem , Masculino , Camundongos , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Procedimentos Cirúrgicos Operatórios/efeitos adversos
12.
Niger J Clin Pract ; 22(12): 1737-1741, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793482

RESUMO

Background: Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. Aim: To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. Methods: A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. Results: There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). Conclusion: EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.


Assuntos
Anestésicos Locais/uso terapêutico , Circuncisão Masculina , Lidocaína/uso terapêutico , Bloqueio Nervoso , Dor/prevenção & controle , Pênis/inervação , Prilocaína/uso terapêutico , Anestesia Local , Humanos , Lactente , Recém-Nascido , Combinação Lidocaína e Prilocaína , Masculino , Dor/etiologia , Manejo da Dor/métodos , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
13.
Nat Hum Behav ; 3(12): 1295-1305, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31636406

RESUMO

Medical treatments typically occur in the context of a social interaction between healthcare providers and patients. Although decades of research have demonstrated that patients' expectations can dramatically affect treatment outcomes, less is known about the influence of providers' expectations. Here we systematically manipulated providers' expectations in a simulated clinical interaction involving administration of thermal pain and found that patients' subjective experiences of pain were directly modulated by providers' expectations of treatment success, as reflected in the patients' subjective ratings, skin conductance responses and facial expression behaviours. The belief manipulation also affected patients' perceptions of providers' empathy during the pain procedure and manifested as subtle changes in providers' facial expression behaviours during the clinical interaction. Importantly, these findings were replicated in two more independent samples. Together, our results provide evidence of a socially transmitted placebo effect, highlighting how healthcare providers' behaviour and cognitive mindsets can affect clinical interactions.


Assuntos
Atitude , Empatia , Relações Interpessoais , Dor/prevenção & controle , Efeito Placebo , Adolescente , Adulto , Expressão Facial , Feminino , Resposta Galvânica da Pele , Humanos , Masculino , Motivação , Estimulação Física , Creme para a Pele , Adulto Jovem
14.
AANA J ; 87(1): 65-70, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31587746

RESUMO

The US Army's 541st Forward Surgical Team (FST) deployed in support of Operation Inherent Resolve- Syria in 2017. Throughout the deployment the 541st FST provided surgical and anesthesia services to US, coalition, and partner forces in numerous austere environments. Following an enemy attack, the FST received multiple casualties and provided a total of 7 critical medication infusions to 3 patients without the aid of electronic-controlled intravenous (IV) infusion pumps or syringes for 10 hours while the wounded soldiers waited for evacuation to a higher level of care. The team administered propofol, norepinephrine, tranexamic acid, and ketamine by individual gravity infusions relying solely on counting drops. An infusion rate monitor (DripAssist, Shift Labs Inc) was used to assist in initial IV rate setup and maintenance. The medics and nurses of the 541st FST found that the infusion rate monitor improved the speed of setting the IV infusion rate, drop counting accuracy, and the team's ability to monitor the continuous delivery of gravity IV infusions.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Conflitos Armados , Infusões Intravenosas/instrumentação , Medicina Militar , Monitorização Fisiológica/instrumentação , Dor/prevenção & controle , Ferimentos e Lesões , Adulto , Feminino , Humanos , Masculino , Síria , Estados Unidos , Adulto Jovem
15.
JAMA Facial Plast Surg ; 21(6): 480-486, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31513234

RESUMO

Importance: Vibration has been shown to decrease injection site pain in patients; however, to date, this effect has not been assessed for patients who catastrophize pain (ie, patients who anticipate a higher pain level). The anticipation of a pain score greater than 4 on the 11-point Numeric Rating Scale (NRS) has been associated with an increase in a patient's perception of procedural pain. Objective: To assess the efficacy of vibration during cutaneous anesthetic injection for dermatologic surgery for patients who catastrophize pain (NRS score >4) and patients who do not (NRS score ≤4). Design, Setting, and Participants: Randomized, parallel-group clinical trial from June 19 to September 4, 2018, at a tertiary dermatologic surgery clinic among 87 adults undergoing cutaneous cancer removal surgery. Patients completed a preprocedural questionnaire detailing their baseline pain, anticipated pain, and drug use. Analysis was performed on an intent-to-treat basis. Interventions: Use of a vibratory anesthetic device (VAD) on the treatment site prior to anesthetic injection in the on (VAD ON) or off (VAD OFF) mode. Main Outcomes and Measures: Pain was reported using the 11-point NRS (where 0 indicates no pain and 11 indicates the worst pain imaginable). A minimum clinically important difference of 22% or more and a substantial clinically important difference of 57% or more were used to assess the efficacy of vibration in patient-reported NRS score during anesthetic injection (iNRS score). Results: A total of 87 patients were included, with 101 unique events reported (among the unique events, 37 were reported in women and 64 were reported in men; mean [SD] age, 66.0 [11.3] years). The mean (confidence level [CL]) iNRS score for patients who catastrophized pain was 2.27 (0.66) compared with 1.44 (0.39) for patients who did not (P = .03). A 38.9% decrease in mean (CL) iNRS score was reported with VAD ON compared with VAD OFF in all participants (1.24 [0.38] vs 2.04 [0.54]). Patients who catastrophized pain reported a 25.5% decrease in mean (CL) iNRS score with VAD ON vs VAD OFF (1.91 [0.99] vs 2.57 [0.98]), and patients who did not reported a 79.4% decrease (1.02 [0.40] vs 1.84 [0.66]). VAD ON was the only statistically significant variable to affect iNRS score (F statistic, 2.741; P = .03). Conclusions and Relevance: This trial demonstrates that those who catastrophize pain prior to a procedure report a higher perceived level of pain. The application of vibration during local anesthetic injection resulted in a minimum clinically important difference in pain level for patients who catastrophize pain and a substantial clinically important difference in pain level for patients who do not. Level of Evidence: 2. Trial Registration: ClinicalTrials.gov identifier: NCT03467685.


Assuntos
Anestésicos Locais/administração & dosagem , Injeções/efeitos adversos , Percepção da Dor , Dor/etiologia , Dor/prevenção & controle , Neoplasias Cutâneas/cirurgia , Vibração , Adulto , Idoso , Idoso de 80 Anos ou mais , Catastrofização , Procedimentos Cirúrgicos Dermatológicos , Humanos , Pessoa de Meia-Idade , Medição da Dor
16.
Georgian Med News ; (292-293): 11-16, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560655

RESUMO

The goal: to study the influence of various methods of analgesia on the state of postoperative anesthesia in patients after thoracotomy; compare the quantity of narcotic analgesics (morphine) used in different types of anesthesia and anesthesia related complications. In 85 patients after thoracotomy, anesthesia was performed by prolonged paravertebral analgesia (PVA) (19 patients), by prolonged epidural analgesia (EDA) (36 patients) with 0.2% solution of rapamycain and by an intravenous patient-controlled analgesia (PCA) with a morphine solution in the control group (30 patients). In all three groups, the nonsteroidal anti-inflammatory drug (NSAIDs) ketorolac tromethamine was used intramuscularly. The evaluation was performed within 3 days after surgery using the visual analog scale (VAS). In the PVA group, the pain level was 29.1 points four hours after surgery to 18.7 points at the end of the third day; in the EDA group - from 24.2 to 20.3 points, respectively; in the control group - from 48.8 to 38.0 points, respectively. The need for morphine administration within the first day after surgery was the highest in the control group and was 42.83±13.23 mg/day. In experimental groups, the need for morphine was 15.0±5.0 mg/day in the EDA group and 16.15±5.38 mg/day in the PVA group. The greatest number of complications was observed in the control group and was associated with the use of morphine. The method of anesthesia associated with the use of PVA was accompanied by the least amount of complications. In terms of the effectiveness of analgesia and the amount of narcotic analgesic used, it was comparable to EDA. Patients of this group least often developed chronic postoperative pain syndrome. PVA may be a priority for postoperative pain management in patients after thoracotomy.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Morfina/administração & dosagem , Morfina/uso terapêutico , Alcaloides Opiáceos/administração & dosagem , Alcaloides Opiáceos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor/prevenção & controle , Toracotomia , Analgesia Epidural , Analgesia Controlada pelo Paciente , Analgésicos Opioides/efeitos adversos , Humanos , Pulmão/cirurgia , Morfina/efeitos adversos , Alcaloides Opiáceos/efeitos adversos , Medição da Dor/efeitos dos fármacos , Complicações Pós-Operatórias
17.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31509943

RESUMO

Insulin-degrading enzyme (IDE) was applied to catalyze hydrolysis of Nociceptin/Orphanin 1-16 (OFQ/N) to show the involvement of the enzyme in degradation of neuropeptides engaged in pain transmission. Moreover, IDE degradative action towards insulin (Ins) was inhibited by the OFQ/N fragments, suggesting a possible regulatory mechanism in the central nervous system. It has been found that OFQ/N and Ins affect each other degradation by IDE, although in a different manner. Indeed, while the digestion of OFQ/N is significantly affected by the presence of Ins, the kinetic profile of the Ins hydrolysis is not affected by the presence of OFQ/N. However, the main hydrolytic fragments of OFQ/N produced by IDE exert inhibitory activity towards the IDE-mediated Ins degradation. Here, we present the results indicating that, besides Ins, IDE cleaves neuropeptides and their released fragments act as inhibitors of IDE activity toward Ins. Having in mind that IDE is present in the brain, which also contains Ins receptors, it cannot be excluded that this enzyme indirectly participates in neural communication of pain signals and that neuropeptides involved in pain transmission may contribute to the regulation of IDE activity. Finally, preliminary results on the metabolism of OFQ/N, carried out in the rat spinal cord homogenate in the presence of various inhibitors specific for different classes of proteases, show that OFQ/N proteolysis in rat spinal cord could be due, besides IDE, also to a cysteine protease not yet identified.


Assuntos
Insulina/metabolismo , Insulisina/metabolismo , Peptídeos Opioides/metabolismo , Medula Espinal/metabolismo , Sequência de Aminoácidos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Cromatografia Líquida/métodos , Insulina/química , Insulisina/antagonistas & inibidores , Espectrometria de Massas/métodos , Neuropeptídeos/química , Neuropeptídeos/metabolismo , Neuropeptídeos/farmacologia , Peptídeos Opioides/química , Dor/prevenção & controle , Medição da Dor/métodos , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/farmacologia , Ratos , Receptor de Insulina/metabolismo , Medula Espinal/efeitos dos fármacos
18.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31510092

RESUMO

There is accumulating evidence supporting electroacupuncture's (EA) therapeutic effects. In mice, local EA reliably attenuates inflammatory pain and increases the transient receptor potential cation channel, subfamily V, member 1 (TRPV1). However, the effect of distal acupoint EA on pain control has rarely been studied. We used a mouse model to investigate the analgesic effect of distal EA by measuring TRPV1 expression in the brain. Complete Freund's adjuvant (CFA) was injected into mice's hind paws to induce inflammatory pain. The EA-treated group received EA at the LI4 acupoint on the bilateral forefeet on the second and the third days, whereas the control group underwent sham manipulation. Mechanical and thermal pain behavior tests showed that the EA-treated group experienced inflammatory pain alleviation immediately after EA, which did not occur in the sham group. Additionally, following CFA injection, the expression of TRPV1-associated molecules such as phosphorylated protein kinase A (pPKA), extracelluar signal-regulated kinase (pERK), and cAMP-response-element-binding protein (pCREB) increased in the prefrontal cortex (PFC) and the hypothalamus but decreased in the periaqueductal gray (PAG) area. These changes were significantly attenuated by EA but not sham EA. Our results show an analgesic effect of distal EA, which is based on the traditional Chinese medicine theory. The mechanism underlying this analgesic effect involves TRPV1 in the PFC, the hypothalamus, and the PAG. These novel findings are relevant for the evaluation and the treatment of clinical inflammatory pain syndrome.


Assuntos
Pontos de Acupuntura , Eletroacupuntura/métodos , Inflamação/terapia , Dor/prevenção & controle , Animais , Encéfalo/metabolismo , Modelos Animais de Doenças , Feminino , Adjuvante de Freund , Inflamação/induzido quimicamente , Camundongos Endogâmicos C57BL , Dor/induzido quimicamente , Manejo da Dor/métodos , Medição da Dor/métodos , Transdução de Sinais , Canais de Cátion TRPV/metabolismo
19.
Shanghai Kou Qiang Yi Xue ; 28(2): 184-186, 2019.
Artigo em Chinês | MEDLINE | ID: mdl-31384906

RESUMO

PURPOSE: This study was to explore the role of Er, Cr:YSGG water laser in relieving endodontic interappointment pain (EIAP) during root canal therapy. METHODS: A total of 272 cases with chronic pulpitis and chronic periapical periodontitis were selected from the Department of Endodontics of our hospital from June 2015 to June 2017, they were randomly divided into 2 groups, 136 cases in each group. After routine root canal preparation, the teeth in group A were sealed with calcium hydroxide paste after Er, Cr : YSGG water laser treatment, while teeth in group B were sealed with calcium hydroxide paste. Caviton (GC company, Japan) was used for temporary fillings in both groups, occurrence and outcomes of postoperative EIAP were recorded and compared. SPSS 17.0 software package was used for statistical analysis. RESULTS: Among the two groups, there was no significant differences in EIAP (P>0.05) immediately and 1 week after surgery, but there was significant difference in the occurrence of EIAP between the first day, the second day and the third day after surgery (P<0.05). Group A had the lowest incidence of EIAP. CONCLUSIONS: Er, Cr: YSGG water laser can effectively reduce pain after root canal therapy, and can effectively shorten pain duration for patients; therefore, it is worthy of wide clinical application.


Assuntos
Lasers de Estado Sólido , Dor , Preparo de Canal Radicular , Água , Humanos , Japão , Dor/prevenção & controle
20.
Clin Rehabil ; 33(12): 1919-1930, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31423822

RESUMO

OBJECTIVE: To establish feasibility of initiating electrical stimulation treatment of wrist extensors and flexors in patients early after stroke to prevent muscle contractures and pain. DESIGN: Feasibility randomized controlled trial with economic evaluation. SETTING: A specialist stroke unit in Nottinghamshire. SUBJECTS: A total of 40 patients recruited within 72 hours post-stroke with arm hemiparesis. INTERVENTIONS: Participants were randomized to receive usual care or usual care and electrical stimulation to wrist flexors and extensors for 30 minutes, twice a day, five days a week for three months. Initial treatment was delivered by an occupational therapist or physiotherapist who trained participants to self-manage subsequent treatments. MEASURES: Measures of feasibility included recruitment and attrition rates, completion of treatment, and successful data collection. Outcome data on wrist range of motion, pain, arm function, independence, quality of life, and resource use were measured at 3-, 6-, and 12-months post-randomization. RESULTS: A total of 40 participants (of 215 potentially eligible) were recruited in 15 months (20 men; mean age: 72 (SD: 13.0)). Half the participants lacked mental capacity and were recruited by consultee consent. Attrition at three-month follow-up was 12.5% (death (n = 2), end-of-life care (n = 2), and unable to contact (n = 1)). Compliance varied (mean: 65 (SD: 53)) and ranged from 10 to 166 treatments per patient (target dosage was 120). Data for a valid economic analysis can be adequately collected. CONCLUSION: Early initiation of electrical stimulation was acceptable and feasible. Data collection methods used were feasible and acceptable to participants. A large definitive study is needed to determine if electrical stimulation is efficacious and cost effective.


Assuntos
Contratura/prevenção & controle , Terapia por Estimulação Elétrica , Dor/prevenção & controle , Paresia/reabilitação , Acidente Vascular Cerebral/complicações , Punho , Adulto , Idoso , Idoso de 80 Anos ou mais , Contratura/etiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Paresia/etiologia , Qualidade de Vida , Amplitude de Movimento Articular , Reabilitação do Acidente Vascular Cerebral
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