Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.501
Filtrar
1.
Anaesthesia ; 76(2): 238-250, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33141959

RESUMO

Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.


Assuntos
Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Lidocaína/administração & dosagem , Lidocaína/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Administração Intravenosa , Anestésicos Locais/efeitos adversos , Comorbidade , Consenso , Humanos , Infusões Intravenosas , Lidocaína/efeitos adversos , Bloqueio Nervoso , Segurança do Paciente , Recuperação de Função Fisiológica , Medição de Risco , Resultado do Tratamento
2.
Anaesthesia ; 76(2): 189-198, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32564365

RESUMO

Peri-operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single-centre, prospective, randomised double-blind placebo-controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg-1 , then a continuous infusion of 2 mg.kg-1 .h-1 until the end of the surgery, then 1 mg.kg-1 .h-1 for 1 h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0-6.0 [0.0-14.5]) and 5.0 mg (3.3-7.0 [3.3-20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6-3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml-1 and 1.77 (0.51) µg.ml-1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non-relevant difference in postoperative oxycodone consumption.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cirurgia Bariátrica , Lidocaína/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Laparoscopia , Tempo de Internação , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Recuperação de Função Fisiológica
3.
Medicine (Baltimore) ; 99(49): e23408, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285730

RESUMO

Even though chronic abdominal pain is 1 of the most common reasons for hospital visits, diagnostic testing is often time-consuming and treatment is inadequate. Abdominal myofascial pain syndrome (AMPS) is usually not included as a differential diagnosis, but it should be considered in cases of chronic abdominal pain. The purpose of this study was to investigate the clinical characteristics of AMPS and to assess the effect of sonography-guided trigger point injections (TPI).A total of 100 patients with AMPS from 2012 to 2018 were retrospectively evaluated for clinical characteristics and TPI effects. AMPS was diagnosed using Srinivasan and Greenbaum's criteria, and the TPIs were performed at intervals of 2 to 4 weeks. The Visual Analog Scale (VAS) ratio was calculated by subtracting the final VAS from the initial VAS score and dividing it by the initial VAS score after injections, and the patients were divided into 4 groups: non-responders, mild, moderate, and good responders.The median duration of pain was 12 months, and the median number of hospital visits before TPI was 2. Of the 100 patients, 66 (66%) were categorized as good responders, 11 (11%) as moderate responders, 7 (6.9%) as mild responders, and 16 (15.7%) as non-responders. When the initial and final VAS scores were compared, the sonography-guided injections were found to be effective in alleviating pain (P < .001). Moreover, patients who received the injections 2 or more times tended to have more significant pain reduction than those who received a single injection (P < .001).Patients with AMPS suffer from long-term pain and undergo many hospital visits and diagnostic tests. TPI with lidocaine can be an effective and safe treatment for patients with chronic AMPS.


Assuntos
Dor Abdominal/tratamento farmacológico , Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Síndromes da Dor Miofascial/tratamento farmacológico , Pontos-Gatilho , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Doença Crônica , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia de Intervenção , Adulto Jovem
4.
J Am Acad Orthop Surg Glob Res Rev ; 4(12): e20.00100, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33332853

RESUMO

INTRODUCTION: Wide-awake local anesthesia no tourniquet (WALANT) presents a nonstandard anesthetic approach initially described for use in hand surgery that has gained interest and utilization across a variety of orthopaedic procedures. In response to operating room resource constraints imposed by the COVID-19 pandemic, our orthopaedic service rapidly adopted and expanded its use of WALANT. METHODS: A retrospective review of 16 consecutive cases performed by 7 surgeons was conducted. Patient demographics, surgical details, and perioperative outcomes were assessed. The primary end point was WALANT failure, defined as intraoperative conversion to general anesthesia. RESULTS: No instances of WALANT failure requiring conversion to general anesthesia occurred. In recovery, one patient (6%) required narcotics for pain control, and the average postoperative pain numeric rating scale was 0.6. The maximum pain score experienced was 4 in the patient requiring postoperative narcotics. The average time in recovery was 42 minutes and ranged from 8 to 118 minutes. CONCLUSION: The WALANT technique was safely and effectively used in 16 cases across multiple orthopaedic subspecialties, including three procedures not previously described in the literature. WALANT techniques hold promise for use in future disaster scenarios and should be evaluated for potential incorporation into routine orthopaedic surgical care.


Assuntos
Anestesia Local/métodos , Salas Cirúrgicas/organização & administração , Procedimentos Ortopédicos , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Hemostáticos/administração & dosagem , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Entorpecentes/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Pandemias , Estudos Retrospectivos , Vasoconstritores/administração & dosagem , Adulto Jovem
5.
BMJ ; 370: m3027, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-33315586

RESUMO

OBJECTIVE: To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy. DESIGN: Patient and assessor blinded, placebo controlled randomised clinical trial. SETTING: Sports medicine department of a large district general hospital, the Netherlands. PARTICIPANTS: 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo. INTERVENTIONS: Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline. MAIN OUTCOME MEASURES: Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks. RESULTS: Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval -17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) v 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) v 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups. CONCLUSIONS: A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group. TRIAL REGISTRATION: ClinicalTrials.gov NCT02996409.


Assuntos
Tendão do Calcâneo , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Solução Salina/administração & dosagem , Tendinopatia/tratamento farmacológico , Adolescente , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Doença Crônica , Terapia Combinada , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Terapia por Exercício , Feminino , Seguimentos , Humanos , Injeções , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Solução Salina/uso terapêutico , Tendinopatia/diagnóstico , Tendinopatia/terapia , Resultado do Tratamento , Adulto Jovem
6.
Proc Natl Acad Sci U S A ; 117(46): 28667-28677, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33139557

RESUMO

The treatment of diabetic ulcer (DU) remains a major clinical challenge due to the complex wound-healing milieu that features chronic wounds, impaired angiogenesis, persistent pain, bacterial infection, and exacerbated inflammation. A strategy that effectively targets all these issues has proven elusive. Herein, we use a smart black phosphorus (BP)-based gel with the characteristics of rapid formation and near-infrared light (NIR) responsiveness to address these problems. The in situ sprayed BP-based gel could act as 1) a temporary, biomimetic "skin" to temporarily shield the tissue from the external environment and accelerate chronic wound healing by promoting the proliferation of endothelial cells, vascularization, and angiogenesis and 2) a drug "reservoir" to store therapeutic BP and pain-relieving lidocaine hydrochloride (Lid). Within several minutes of NIR laser irradiation, the BP-based gel generates local heat to accelerate microcirculatory blood flow, mediate the release of loaded Lid for "on-demand" pain relief, eliminate bacteria, and reduce inflammation. Therefore, our study not only introduces a concept of in situ sprayed, NIR-responsive pain relief gel targeting the challenging wound-healing milieu in diabetes but also provides a proof-of-concept application of BP-based materials in DU treatment.


Assuntos
Pé Diabético/terapia , Fósforo/administração & dosagem , Materiais Inteligentes/administração & dosagem , Cicatrização/efeitos dos fármacos , Anestésicos Locais/administração & dosagem , Animais , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Diabetes Mellitus Experimental , Avaliação Pré-Clínica de Medicamentos , Células Endoteliais/efeitos dos fármacos , Fibrinogênio/administração & dosagem , Géis , Células Endoteliais da Veia Umbilical Humana , Humanos , Lidocaína/administração & dosagem , Masculino , Camundongos Endogâmicos BALB C , Neovascularização Fisiológica/efeitos dos fármacos , Trombina/administração & dosagem
7.
Pan Afr Med J ; 36: 356, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33224422

RESUMO

The object of this study is to determine which local wound analgesic option is superior, local anaesthetic infiltration or intercostal nerve block, by combined local anaesthetic agents (0.5% bupivacaine + 2% lidocaine) and to detect which option can best alleviate the post-operative pain management and significantly prolong the time to the first rescue analgesic requirement and the total consumption of opioids in the first post-operative 72 hrs. The medical records of 1458 patients who underwent flank incision procedures by two different surgeons in our institute were retrospectively reviewed. Each surgeon used a different type of local incisional pain management; the first one used infiltration of flank incision routinely, the second surgeon used an intercostal block with all his patients. These elective procedures were carried out in our Urology Centre between June 2007 and June 2019. The duration of follow-up was from the recovery transfer until the end of the third post-operative day. Patients were divided into two groups: group 1 (729 patients-infiltration of flank incision) and group 2 (729 patients-intercostal nerve block). Patients were aged between 19-78 years. No significant differences were seen regarding the demographic data between both groups, P > 0.05. On the other hand, there were significant differences between group 1 and group 2 according to the mean visual analogue scale score (lower in group 1, P < 0.05), the total mean analgesic requirements during the first post-operative 72 hrs (lower in group 1, P < 0.05) and the time to the first analgesic demand (higher in group 1, P < 0.05). There were no statistically significant differences in post-operative complications between both groups, P > 0.05. The infiltration of flank incision with combined local anaesthetic agents (0.5% Bupivacaine + 2% lidocaine) is more effective in alleviating post-operative pain, decreasing total analgesic consumption during the first post-operative 72 hrs and prolonging the time required for the first rescue opioid.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Nervos Intercostais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
8.
Medicine (Baltimore) ; 99(48): e23332, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235097

RESUMO

BACKGROUND: Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. METHODS: We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. RESULT: Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD -0.50, 95%CI, -0.76 to -0.25, P < .001), at 24 hours after surgery (WMD -0.50, 95%CI, -0.70 to -0.29, P < .001) and at 48 hours after surgery (WMD -0.57, 95%CI, -0.96 to -0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD -15.36, 95%CI, -21.40 to -9.33 mg intravenous morphine equivalents, P < .001). CONCLUSION: This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.


Assuntos
Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Coluna Vertebral/cirurgia , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Humanos , Tempo de Internação , Lidocaína/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Pan Afr Med J ; 37: 12, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33062115

RESUMO

Introduction: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures. Methods: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications. Results: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery. Conclusion: combined lumbar plexus-sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia.


Assuntos
Anestésicos Locais/administração & dosagem , Fraturas do Fêmur/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Bupivacaína/administração & dosagem , Estudos Transversais , Feminino , Humanos , Lidocaína/administração & dosagem , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Nervo Isquiático
10.
Medicine (Baltimore) ; 99(42): e22751, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080740

RESUMO

BACKGROUND: The use of hysteroscopy for the diagnosis and treatment of uterine and endometrial abnormalities is often associated with postoperative pain. This randomized controlled trial aimed to assess the efficacy of preoperative intravenous (IV) lidocaine in reducing pain after hysteroscopy. METHODS: In total, 138 patients undergoing elective hysteroscopy at the CHA Bundang Medical Center, Seongnam, Korea were randomly assigned to a control group (n = 69) or a lidocaine group (n = 69), which received normal saline or IV lidocaine at 1.5 mg/kg, respectively. The primary outcome was the incidence of postoperative pain. RESULTS: The incidence of pain was significantly lower in the IV lidocaine group than in the control group at the post-anesthesia care unit (27.3% vs 68.2%, P < .001). The visual analog scale (0-10) score (median [interquartile range]) was lower in the IV lidocaine group than in the control group (0 [0-2]) vs 2 [0-4]), P < .001). The use of rescue analgesics and postoperative nausea and vomiting were similar between the 2 groups. This study demonstrated that administering 1.5 mg/kg of preoperative IV lidocaine can be a simple method to reduce incidence of pain after hysteroscopy. CONCLUSION: Preoperative bolus administration of 1.5 mg/kg of IV lidocaine may be used to decrease incidence of pain after hysteroscopy under general anesthesia.


Assuntos
Anestésicos Locais/administração & dosagem , Histeroscopia , Lidocaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Adulto , Feminino , Humanos , Injeções Intravenosas , Cuidados Pré-Operatórios , Escala Visual Analógica
11.
Medicine (Baltimore) ; 99(43): e22739, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120774

RESUMO

OBJECTIVES: It was recently proposed that a costoclavicular (CC) approach can be used in ultrasound (US)-guided infraclavicular brachial plexus block (BPB). In this study, we hypothesized that triple injections in each of the 3 cords in the CC space would result in a greater spread in the 4 major terminal nerves of the brachial plexus than a single injection in the CC space without increasing the local anesthetic (LA) volume. METHODS: Sixty-eight patients who underwent upper extremity surgery randomly received either a single injection (SI group, n = 34) or a triple injection (TI group, n = 34) using the CC approach. Ten milliliters of 2% lidocaine, 10 mL of 0.75% ropivacaine, and 5 mL of normal saline were used for BPB in each group (total 25 mL). Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5 minutes intervals for 30 minutes immediately after LA administration. RESULTS: Thirty minutes after the block, the blockage rate of all 4 nerves was significantly higher in the TI group than in the SI group (52.9% in the SI group vs 85.3% in the TI group, P = .004). But there was no significant difference in the anesthesia grade between the 2 groups (P = .262). The performance time was similar in the 2 groups (3.0 ±â€Š0.9 minutes in the SI group vs 3.2 ±â€Š1.2 minutes in the TI group, respectively; P = .54). DISCUSSION: The TI of CC approach increased the consistency of US-guided infraclavicular BPB in terms of the rate of blocking all 4 nerves without increasing the procedure time despite administering the same volume of the LA.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/métodos , Antebraço/cirurgia , Mãos/cirurgia , Lidocaína/administração & dosagem , Ropivacaina/administração & dosagem , Adulto , Clavícula , Feminino , Humanos , Injeções/métodos , Injeções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
13.
AAPS PharmSciTech ; 21(7): 278, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33033939

RESUMO

People with weakened immune systems are at risk of developing candidiasis which is a fungal infection caused by several species of Candida genus. In this work, polymeric nanoparticles containing miconazole nitrate and the anesthetic lidocaine clorhydrate were developed. Miconazole was chosen as a typical drug to treat buccopharyngeal candidiasis whereas lidocaine may be useful in the management of the pain burning, and pruritus caused by the infection. Nanoparticles were synthesized using chitosan and gelatin at different ratios ranging from 10:90 to 90:10. The nano-systems presented nanometric size (between 80 and 300 nm in water; with polydispersion index ranging from 0.120 to 0.596), and positive Z potential (between 20.11 and 37.12 mV). The determined encapsulation efficiency ranges from 65 to 99% or 34 to 91% for miconazole nitrate and lidocaine clorhydrate, respectively. X-ray diffraction and DSC analysis suggested that both drugs were in amorphous state in the nanoparticles. Finally, the systems fitted best the Korsmeyer-Peppas model showing that the release from the nanoparticles was through diffusion allowing a sustained release of both drugs and prolonged the activity of miconazole nitrate over time against Candida albicans for at least 24 h.


Assuntos
Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Lidocaína/administração & dosagem , Miconazol/administração & dosagem , Nanopartículas/química , Polímeros/química , Antifúngicos/administração & dosagem , Antifúngicos/química , Varredura Diferencial de Calorimetria , Quitosana , Humanos , Lidocaína/química , Miconazol/química , Nanopartículas/administração & dosagem , Difração de Raios X
14.
AAPS PharmSciTech ; 21(7): 257, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32895787

RESUMO

The skin is the largest human organ and an important topical route. Even with some challenges, it is an important ally in medication administration, mainly because it is painless and easy-to-apply. Semisolid formulations are the most used dosage forms for drug administration via this delivery route and can be optimized when transformed into a film, favoring on-site maintenance, and promoting drug permeation. However, in situ film-forming systems are difficult to assess and characterize using Franz-type diffusion cells once this apparatus is ideal to formulations without transition phases. The present study proposed a different method to characterize these formulations and provide complementary data on drug and penetration enhancer behaviors, as close as possible to real application conditions. This characterization method allowed us to analyze drug concentration on three necessary occasions: remaining in the polymer film, stratum corneum using adhesive tape, and skin to check where drugs will have a desirable effect. As a proof-of-concept, the proposed ex vivo permeation method was used to evaluate a film-forming system containing lidocaine and prilocaine. We could also evaluate transition phases of drug compositions and quantify drugs at key times after application. Hence, the developed method may be used to provide complementary data to the Franz diffusion cell method, in terms of drug and penetration enhancer behaviors incorporated into film-forming delivery systems.


Assuntos
Administração Tópica , Absorção Cutânea , Adesivos/metabolismo , Administração Cutânea , Animais , Composição de Medicamentos , Sistemas de Liberação de Medicamentos/métodos , Humanos , Lidocaína/administração & dosagem , Permeabilidade/efeitos dos fármacos , Polímeros/metabolismo , Pele/metabolismo
15.
PLoS One ; 15(9): e0239896, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986770

RESUMO

INTRODUCTION: Pain management is the pillar of caring for patients with traumatic rib fractures. Intravenous lidocaine (IVL) is a well-established non-opioid analgesic for post-operative pain, yet its efficacy has yet to be investigated in trauma patients. We hypothesized that IVL is associated with decreased inpatient opioid requirements among patients with rib fractures. METHODS: We retrospectively evaluated adult patients presenting to our Level 1 trauma center with isolated chest wall injuries. After 1:1 propensity score matching patients who received vs did not receive IVL, we compared the two groups' average daily opioid use, opioid use in the last 24 hours of admission, and pain scores during admissions hours 24-48. We performed multivariable linear regression for these outcomes (with sensitivity analysis for the opioid use outcomes), adjusting for age as a moderating factor and controlling for hospital length of stay and injury severity. RESULTS: We identified 534 patients, among whom 226 received IVL. Those who received IVL were older and had more serious injury. Compared to propensity-score matched patients who did not receive IVL, patients who received IVL had similar average daily opioid use and pain scores, but 40% lower opioid use during the last 24 hours of admission (p = 0.002). Multivariable regression-with and without sensitivity analysis-did not show an effect of IVL on any outcomes. CONCLUSION: IVL was crudely associated with decreased opioid requirements in the last 24 hours of admission, the time period associated with opioid use at 90 days post-discharge. However, we did not observe beneficial effects of IVL on multivariable adjusted analyses; we are conducting a randomized control trial to further evaluate IVL's opioid-sparing effects for patients with rib fractures.


Assuntos
Administração Intravenosa , Assistência ao Convalescente/métodos , Analgésicos não Entorpecentes/uso terapêutico , Lidocaína/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Fraturas das Costelas/cirurgia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Escala de Gravidade do Ferimento , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
16.
Sci Rep ; 10(1): 15458, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32963266

RESUMO

The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.


Assuntos
Anestésicos Locais/administração & dosagem , Dor Facial/tratamento farmacológico , Hiperalgesia/tratamento farmacológico , Lidocaína/administração & dosagem , Músculo Masseter/efeitos dos fármacos , Fator de Crescimento Neural/efeitos adversos , Adulto , Estudos de Casos e Controles , Método Duplo-Cego , Dor Facial/etiologia , Dor Facial/patologia , Feminino , Humanos , Hiperalgesia/etiologia , Hiperalgesia/patologia , Injeções Intramusculares , Masculino , Músculo Masseter/fisiopatologia , Limiar da Dor
17.
Niger J Clin Pract ; 23(9): 1183-1187, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913154

RESUMO

Aims: This study compared the analgesic effect of apical peri-prostatic block with that of intra-rectal xylocaine gel for trans-rectal ultrasound guided prostate biopsy (TRUS-PBx) in Nigeria. Methods: This is a prospective randomized comparative study carried out over one year in University of Benin Teaching Hospital, Edo State, Nigeria. The participants were randomized into two groups; Group A had 10 mls of intra-rectal xylocaine gel instillation while Group B had apical infiltration of 10 mls of 1% xylocaine all before TRUS-PBx. Result: There was a statistically significant difference in the mean pain score during and one hour after TRUS-PBx between Group A and Group B of the study population respectively (p < 0.0001). Those that had intra-rectal xylocaine gel (Group A) had more pain during and after biopsy. There was no difference in the mean pain score during probe insertion between the two groups (p = 0.952). Conclusion: This study demonstrated the superiority of apical peri-prostatic nerve block over intra rectal xylocaine gel instillation during TRUS-PBx with respect to its anesthetic efficacy. Therefore, centers providing TRUS-PBx in Nigeria should consider apical peri-prostatic nerve block as their mode of anesthesia for the procedure due to its efficacy and high safety profile.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor/prevenção & controle , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Administração Retal , Idoso , Anestésicos Locais/administração & dosagem , Biópsia por Agulha/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/inervação , Reto/patologia , Ultrassonografia de Intervenção
18.
Bone Joint J ; 102-B(10): 1354-1358, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993329

RESUMO

AIMS: In the UK, fasciectomy for Dupuytren's contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. METHODS: Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks. RESULTS: The mean preoperative contractures were 35.3° (0° to 90°) at the metacarpophalangeal joint (MCPJ), 32.5° (0° to 90°) at proximal interphalangeal joint (PIPJ) (a combined deformity of 67.8°). The mean correction was 33.6° (0° to 90°) for the MCPJ and 18.2° (0° to 70°) for the PIPJ leading to a combined correction of 51.8°. There was a complete deformity correction in 21 fingers (59.5%) and partial correction in 14 digits (37.8%) with no correction in one finger. The mean residual deformities for the partial/uncorrected group were MCP 4.2° (0° to 30°), and PIP 26.1° (0° to 85°). For those achieving a full correction the mean preoperative contracture was less particularly at the PIP joint (15.45° (0° to 60°) vs 55.33° (0° to 90°)). Mean preoperative URAM scores were higher in the fully corrected group (17.4 (4 to 31) vs 14.0 (0 to 28)), but lower at three months post-surgery (0.5 (0 to 3) vs 4.40 (0 to 18)), with both groups showing improvements. Infections occurred in two patients (three digits) and both were successfully treated with oral antibiotics. No other complications were noted. The estimated cost of a fasciectomy under local anaesthetic in the community was £184.82 per patient. The estimated hospital theatre costs for a fasciectomy was £1,146.62 under general anaesthetic (GA), and £1,085.30 under an axillary block. CONCLUSION: This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. Local anaesthetic fasciectomy in a community setting achieves a saving of £961.80 for a GA and £900.48 for an axillary block per case. Cite this article: Bone Joint J 2020;102-B(10):1354-1358.


Assuntos
Anestesia Local/economia , Anestesia Local/métodos , Contratura de Dupuytren/cirurgia , Fasciotomia/economia , Fasciotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Custos e Análise de Custo , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reino Unido
19.
Pain Physician ; 23(4S): S239-S270, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942786

RESUMO

BACKGROUND: Multiple randomized controlled trials (RCTs) and systematic reviews have been conducted to summarize the evidence for administration of local anesthetic (lidocaine) alone or with steroids, with discordant opinions, more in favor of equal effect with local anesthetic alone or with steroids. OBJECTIVE: To evaluate the comparative effectiveness of lidocaine alone and lidocaine with steroids in managing spinal pain to assess superiority or equivalency. STUDY DESIGN: A systematic review of RCTs assessing the effectiveness of lidocaine alone compared with addition of steroids to lidocaine in managing spinal pain secondary to multiple causes (disc herniation, radiculitis, discogenic pain, spinal stenosis, and post-surgery syndrome). METHODS: This systematic review was performed utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) for literature search, Cochrane review criteria, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) to assess the methodologic quality assessment and qualitative analysis utilizing best evidence synthesis principles, and quantitative analysis utilizing conventional and single-arm meta-analysis. PubMed, Cochrane Library, US National Guideline Clearinghouse, Google Scholar, and prior systematic reviews and reference lists were utilized in the literature search from 1966 through December 2019. The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. OUTCOME MEASURES: A hard endpoint for the primary outcome was defined as the proportion of patients with 50% pain relief and improvement in function. Secondary outcome measures, or soft endpoints, were pain relief and/or improvement in function. Effectiveness was determined as short-term if it was less than 6 months. Improvement that lasted longer than 6 months, was defined as long-term. RESULTS: Based on search criteria, 15 manuscripts were identified and considered for inclusion for qualitative analysis, quantitative analysis with conventional meta-analysis, and single-arm meta-analysis. The results showed Level II, moderate evidence, for short-term and long-term improvement in pain and function with the application of epidural injections with local anesthetic with or without steroid in managing spinal pain of multiple origins. LIMITATIONS: Despite 15 RCTs, evidence may still be considered as less than optimal and further studies are recommended. CONCLUSION: Overall, the present meta-analysis shows moderate (Level II) evidence for epidural injections with lidocaine with or without steroids in managing spinal pain secondary to disc herniation, spinal stenosis, discogenic pain, and post-surgery syndrome based on relevant, high-quality RCTs. Results were similar for lidocaine, with or without steroids.


Assuntos
Corticosteroides/administração & dosagem , Lidocaína/administração & dosagem , Dor Lombar/tratamento farmacológico , Manejo da Dor/métodos , Corticosteroides/efeitos adversos , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Humanos , Injeções Epidurais , Reprodutibilidade dos Testes
20.
Lima; IETSI; 24 ago. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1119647

RESUMO

INTRODUCCIÓN: Uno de los mayores intereses en el campo de la salud y en torno a la pandemia de COVID-19 es el desarrollo de estrategias para reducir la transmisión de la infección por SARS-CoV-2, incluyendo la protección de los trabajadores de salud, grupo de riesgo frente a la infección por este virus (Ng et al. 2020). La extubación es un procedimiento generador de aerosoles debido a la respuesta refleja del sistema respiratorio durante esta actividad, manifestada como la presencia de tos en algunos pacientes a los que se les realiza destete del ventilador mecánico (Brewster et al. 2020). Realizar la extubación requiere la proximidad de los trabajadores de salud con los pacientes, los cuales, incluyendo los casos de pacientes con COVID-19, suelen seguir siendo infecciosos al momento de la extubación (Brewster et al. 2020, Zhou et al. 2020, Ng et al. 2020), por lo que realizar esta actividad incrementaría la probabilidad de transmisión de esta infección viral. Ante ello, diversos grupos relacionados a la anestesiología señalan como útil el empleo de medicación que reduzca la generación de tos durante la extubación, que, junto a otras medidas de protección, disminuiría la probabilidad de transmisión de la infección por SARS-CoV-2 (Brown et al. 2020, Cook et al. 2020, D'Silva et al. 2020, Tan Li et al 2020). En EsSalud, se dispone de lidocaína y fentanilo, medicamentos descritos en la literatura científica como útiles para reducir la tos en pacientes a los que se les realizará el destete de la ventilación mecánica. Sin embargo, algunos especialistas argumentan que estos agentes sedantes podrían causar depresión respiratoria, retraso en el despertar e incrementar el riesgo de delirio si son administrados por periodos largos. Adicionalmente, los especialistas argumentan que dexmedetomidina es una alternativa que ofrecería la ventaja un despertar más rápido y una menor incidencia de delirio, además de reducir la incidencia de tos durante la extubación, estos efectos facilitarían la extubación del paciente y disminuiría la transmisión del SARS-CoV-2 al equipo médico tratante en la UCI. En ese sentido, el presente documento tuvo como objetivo evaluar la eficacia y seguridad de dexmedetomidina comparado con lidocaína y fentanilo para destete de ventilación mecánica invasiva en pacientes con COVID-19. TECNOLOGÍA DE INTERÉS: Dexmedetomidina es un agonista selectivo de los receptores alfa-2 con efectos ansiolíticos, sedantes (mediados por la inhibición del locus coeruleus, el núcleo noradrenérgico predominante, situado en el tronco cerebral) y analgésicos, produciendo además un efecto simpaticolítico al disminuir la liberación de noradrenalina en las terminaciones nerviosas simpáticas. METODOLOGÍA: Se buscó la evidencia disponible al 24 de agosto del 2020 en las siguientes bases de datos bibliográficas: PubMed, The Cochrane Library y LILACS. Asimismo, se realizó una búsqueda en sitios web pertenecientes a grupos que realizan evaluaciones de tecnologías sanitarias y guías de práctica clínica, incluyendo: The Canadian Agency for Drugs and Technologies in Health (CADTH), Scottish Medicines Consortium (SMC), The National Institute for Health and Care Excellence (NICE), Institute for Quality and Efficiency in Healthcare (IQWiG), Haute Authorité de Santé (HAS), Institute for Clinical and Economic Review (ICER) y el portal BRISA (Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas). Adicionalmente, se realizó búsqueda de evidencia en sitios web de organizaciones internacionales en anestesiología o de instituciones que estén desarrollando protocolos para el manejo de pacientes con COVID-19. RESULTADOS: En la búsqueda de la evidencia no se identificaron estudios que evalúen la eficacia y seguridad de dexmedetomidina, comparado con lidocaína y fentanilo, para el destete de ventilación mecánica invasiva, en pacientes con COVID-19. Sin embargo, se identificaron: tres GPC o consensos de expertos elaborados por la Safe Airway Society, Alfred ICU y la Difficult Airway Society e instituciones colaboradoras; una RS con metaanálisis en red realizada por Tung et al., así como dos ensayos clínicos controlados, aleatorizados (ECA) que no fueron incluidos en la RS. Se debe precisar que esta RS y estos ECA no fueron realizados en la población de interés del presente reporte breve (pacientes con COVID-19); por lo que fueron incluidos como evidencia indirecta. CONCLUSIONES: En el presente documento, se evaluó la mejor evidencia científica disponible hasta la actualidad sobre eficacia y seguridad de dexmedetomidina comparado con lidocaína y fentanilo para destete de ventilación mecánica en pacientes con COVID-19. Se encontraron: tres GPC o consensos de expertos, una RS y dos ECA. La RS y los ECA incluidos aportan al reporte breve como evidencia indirecta; al no haber sido desarrollados en pacientes con COVID-19. Las guías de la Safe Airway Society (SAS), Alfred ICU y de la Difficult Airway Society (DAS) e instituciones colaboradoras que fueron elaboradas para dar recomendaciones para el proceso de extubación en pacientes con COVID-19, hacen mención a dexmedetomidina (SAS, Alfred ICU), opioides como el fentanilo (SAS y DAS) y la lidocaína (SAS, DAS) para reducir la tos durante el proceso de extubación, aunque precisan la ausencia de evidencia sobre el uso de este medicamentos en pacientes con COVID-19, señalando que se debe evaluar el balance riesgo-beneficio para el uso de los mismos. En general, las recomendaciones descritas en estos documentos proceden de consensos por opinión de expertos, y no establecen una preferencia de un medicamento sobre los otros. En cuanto a los resultados de la RS con MA en red de Tung et al., y los ECA de Kothari et al., y Hu et al., no han podido encontrar evidencia que apoye la hipótesis que el efecto de la dexmedetomidina sea superior al de lidocaína y fentanilo sobre el manejo de la tos (esto es, no se encontraron diferencias entre estos). Estos resultados deben ser interpretados con cautela debido a que la población de estudio de los mismos no son pacientes COVID-19. No obstante, la información que proporcionan puede ayudar a tener una idea del efecto que se podría esperar con el uso de cada uno de los medicamentos mencionados, tanto en eficacia como en seguridad. Al respecto, frente a una ausencia de diferencia entre dexmedetomidina en comparación con lidocaína y fentanilo, se tiene evidencia que la primera tiene un mayor riesgo de bradicardia que los dos últimos. Esto se condice con la literatura previa acerca de dicho medicamento (dexmedetomidina), donde además se describe que los adultos mayores y personas con comorbilidades presentan una mayor proporción de eventos de bradicardia atribuibles al uso de dexmedetomidina lo que, siendo que estos grupos poblacionales son los más afectados por COVID-19, sería esperable una mayor presencia de bradicardia como evento adverso en pacientes con COVID-19 que reciben dexmedetomidina, lo que llama a la precaución cuando se considera el uso de esta tecnología en estos pacientes. De este modo, la mejor evidencia disponible a la fecha (24 de agosto del 2020), procedente de tres GPC o consensos de expertos, una RS con metaanálisis en red y dos ECA, apunta a que el balance de riesgo-beneficio del empleo de dexmedetomidina comparado con el uso de lidocaína o fentanilo, en la reducción de la tos durante el destete de ventilación mecánica en pacientes con COVID-19 es de alta incertidumbre, especialmente por el hecho que la dexmedetomidina está asociada a un mayor riesgo de reacciones adversas frente a los otros dos medicamentos, especialmente en lo referente a bradicardia. Por ello, con este cuerpo de evidencia, el IETSI no ha encontrado sustento técnico que pueda apoyar una recomendación a favor del uso de dexmedetomidina por sobre el de lidocaína o fentanilo en pacientes COVID-19 para reducir la tos al momento de la extubación.


Assuntos
Humanos , Respiração Artificial/métodos , Desmame do Respirador/instrumentação , Fentanila/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Dexmedetomidina/administração & dosagem , Betacoronavirus/efeitos dos fármacos , Lidocaína/administração & dosagem , Avaliação da Tecnologia Biomédica , Avaliação em Saúde
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA