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1.
Medicine (Baltimore) ; 98(41): e17542, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593133

RESUMO

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia are 2 common methods of maintaining analgesia after cesarean section. In recent years, transversus abdominis plane block (TAPB) has been gradually applied clinically to reduce opioid analgesics and has achieved good results. Therefore, we performed this study to compare the efficacy and side effects of TAPB and PCIA in analgesia after cesarean section. METHODS: One hundred patients who underwent cesarean section were randomly classified into 2 groups. Following surgery, one group underwent ultrasound-guided TAPB and the other group underwent PCIA. Pain intensity according to the visual analog scale (VAS; 0 for no pain and 10 for severe intolerable pain) was assessed at 2, 4, 6, 8, 12, and 24-hour postsurgery in both groups. The postoperative complication rate and patient satisfaction were also measured. RESULTS: No significant differences were found in the VAS scores between the groups (P > .05). However, the incidence of postoperative complications in the TAPB group was significantly lower than that in the PCIA group (P < .05). Furthermore, patient satisfaction in the TAPB group was significantly higher than that in the PCIA group (P < .05). CONCLUSION: This study demonstrated that ultrasound-guided TAPB can achieve the same analgesic effect as PCIA after cesarean section but with even higher patient satisfaction.


Assuntos
Músculos Abdominais/inervação , Analgesia Controlada pelo Paciente/métodos , Cesárea/efeitos adversos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/efeitos dos fármacos , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Cesárea/métodos , Feminino , Humanos , Incidência , Bloqueio Nervoso/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Qualidade de Vida , Escala Visual Analógica
2.
Anaesthesia ; 74(11): 1381-1388, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402449

RESUMO

Following abdominal surgery, the provision of postoperative analgesia with local anaesthetic infusion through both transmuscular quadratus lumborum block and pre-peritoneal catheter have been described. This study compared these two methods of postoperative analgesia following laparotomy. Eighty-two patients 18-85 years of age scheduled to undergo elective surgery were randomly allocated to receive either transmuscular quadratus lumborum block or pre-peritoneal catheter block. In the transmuscular quadratus lumborum group, an 18-gauge Tuohy needle was passed through the quadratus lumborum muscle under ultrasound guidance to reach its anterior aspect. A 20-ml bolus of ropivacaine 0.375% was administered and catheters placed bilaterally. In the pre-peritoneal catheter group, 20 ml of ropivacaine 0.375% was infiltrated at each of three subcutaneous sub-fascial levels, and pre-peritoneal plane catheters were placed bilaterally. Both groups received an infusion of ropivacaine 0.2% at 5 ml.h-1 , continued up to 48 h along with a multimodal analgesic regime that included regular paracetamol and patient-controlled analgesia with fentanyl. The primary end-point was postoperative pain score on coughing, assessed using a numerical rating score (0-10). Secondary outcomes were pain score at rest, fentanyl usage until 48 h post-operation, satisfaction scores and costs. There was no treatment difference between the two groups for pain score on coughing (p = 0.24). In the transmuscular quadratus lumborum group, there was a reduction in numerical rating score at rest (p = 0.036) and satisfaction scores on days 1 and 30 (p = 0.004, p = 0.006, respectively), but fentanyl usage was similar. In the transmuscular quadratus lumborum group, the highest and lowest blocks observed in the recovery area were T4 and L1, respectively. The transmuscular quadratus lumborum technique cost 574.64 Australian dollars more per patient than the pre-peritoneal catheter technique.


Assuntos
Abdome/cirurgia , Cateteres de Demora , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
3.
Br J Anaesth ; 123(2): e350-e358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31153628

RESUMO

BACKGROUND: Percutaneous nephrolithotomy (PNL) is associated with severe postoperative pain. The current study aimed to investigate the analgesic efficacy of transmuscular quadratus lumborum (TQL) block for patients undergoing PNL surgery. METHODS: Sixty patients were enrolled in this single centre study. The multimodal analgesic regime consisted of oral paracetamol 1 g and i.v. dexamethasone 4 mg before surgery and i.v. sufentanil 0.25 µg kg-1 30 min before emergence. After operation, patients received paracetamol 1 g regularly at 6 h intervals. Subjects were allocated to receive a preoperative TQL block with either ropivacaine 0.75%, 30 ml (intervention) or saline 30 ml (control). Primary outcome was oral morphine equivalent (OME) consumption 0-6 h after surgery. Secondary outcomes were OME consumption up to 24 h, pain scores, time to first opioid, time to first ambulation, and hospital length of stay. Results were reported as mean (standard deviation) or median (inter-quartile range). RESULTS: Morphine consumption was lower in the intervention group at 6 h after surgery (7.2 [8.7] vs 90.6 [69.9] mg OME, P<0.001) and at 24 h (54.0 [36.7] vs 126.2 [85.5] mg OME, P<0.001). Time to first opioid use was prolonged in the intervention group (678 [285-1020] vs 36 [19-55] min, P<0.0001). Both the time to ambulation (302 [238-475] vs 595 [345-925] min, P<0.004) and length of stay (2.0 [0.8] vs 3.0 [1.2] days, P≤0.001) were shorter in the intervention group. CONCLUSIONS: This is the first blinded, RCT that confirms that unilateral TQL block reduces postoperative opioid consumption and hospital length of stay. Further study is required for confirmation and dose optimisation. CLINICAL TRIAL REGISTRATION: NCT02818140.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Analgésicos Opioides/administração & dosagem , Deambulação Precoce/estatística & dados numéricos , Nefrolitotomia Percutânea , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Alta do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
Anaesth Intensive Care ; 47(2): 134-140, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31070463

RESUMO

Clonidine has been used successfully to prolong the duration of action of local anaesthetics in peripheral nerve blocks, but its mechanism of action in this setting remains unclear. Some studies suggest that clonidine exerts a vasoconstrictor effect, limiting the washout of local anaesthetic from its site of deposition. We investigated this potential vasoconstrictor effect, using plasma ropivacaine concentrations as a surrogate measure of vasoconstriction, in patients who received transversus abdominis plane (TAP) blocks with and without clonidine. Eighty women undergoing laparoscopic gynaecological surgery were randomly assigned to receive one of four TAP block solutions: 0.2% ropivacaine (control), ropivacaine with clonidine 2 µg/kg (clonidine), ropivacaine with 1:400,000 adrenaline (adrenaline) or ropivacaine and a subcutaneous injection of clonidine 2 µg/kg (SC clonidine). The primary outcome was total venous plasma ropivacaine concentrations up to 6 h after the block. There were no significant differences in plasma ropivacaine concentrations between the control group and the clonidine group at any timepoint in the study, nor were there differences in either the mean maximum ropivacaine concentration ( Cmax) (1.99 µg/mL versus 2.05 µg/mL, P = 0.712) or the time to maximum concentration ( Tmax) (51.0 min versus 56.0 min, P = 0.537). The SC clonidine group also did not differ significantly from the controls ( Cmax 2.13 µg/mL versus 1.99 µg/mL, P = 0.424; Tmax 43.5 min versus 51.0 min, P = 0.201). Plasma ropivacaine concentrations in the adrenaline group were significantly lower than the controls from 10 to 90 min ( P < 0.003 for each comparison), and the Cmax was less than that of the control group (1.36 µg/mL versus 1.99 µg/mL, P < 0.001) with a longer Tmax (103.5 min versus 51.0 min, P = 0.001). These findings indicate that clonidine at a concentration of 1.35 µg/mL added to ropivacaine for TAP blocks did not produce a reduction in plasma ropivacaine concentrations. This suggests a lack of vasoconstrictor effect during TAP blocks. Further studies should evaluate whether vasoconstriction occurs when clonidine is used at higher concentrations or for other blocks.


Assuntos
Anestésicos Locais , Clonidina , Bloqueio Nervoso , Ropivacaina , Músculos Abdominais/efeitos dos fármacos , Amidas , Anestésicos Locais/uso terapêutico , Clonidina/uso terapêutico , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Ropivacaina/farmacocinética , Ropivacaina/uso terapêutico , Vasoconstritores
5.
Curr Top Med Chem ; 19(11): 927-930, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31072292

RESUMO

BACKGROUND: Quillaja saponaria Mol. bark contains a high concentration of triterpene saponins that have been used for centuries as a cleansing, antiinflammatory and analgesic agent in Chilean folk medicine. In earlier studies, in mice, both the anti-inflammatory as well as the antinociceptive effect of the major sapogenin, quillaic acid have been demonstrated (QA). OBJECTIVE: To determine the antihyperalgesic effect of QA one and seven days after itpl administration of complete Freund's adjuvant (CFA) in male mice using the hot plate test in the presence of complete Freund's adjuvant (HP/CFA) as an acute and chronic skeletal muscle pain model. METHODS: The present study evaluated the antihyperalgesic activity of QA against acute and chronic skeletal muscle pain models in mice using the hot plate test in the presence of complete Freund's adjuvant (HP/CFA), at 24 h (acute assay) and 7 days (chronic assay) , with dexketoprofen (DEX) as the reference drug. RESULTS: In acute and chronic skeletal muscle pain assays, QA at 30 mg/kg ip elicited its maximal antihyperalgesic effects (65.0% and 53.4%) at 24 h and 7 days, respectively. The maximal effect of DEX (99.0 and 94.1 at 24 h and 7 days, respectively) was induced at 100 mg/kg. CONCLUSION: QA and DEX elicit dose-dependent antihyperalgesic effects against acute and chronic skeletal muscle pain, but QA is more potent than DEX in the early and late periods of inflammatory pain induced by CFA.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Ácido Oleanólico/análogos & derivados , Dor/tratamento farmacológico , Quillaja/química , Animais , Hipoglicemiantes/química , Hipoglicemiantes/isolamento & purificação , Masculino , Camundongos , Camundongos Endogâmicos , Conformação Molecular , Ácido Oleanólico/química , Ácido Oleanólico/isolamento & purificação , Ácido Oleanólico/farmacologia
6.
Med Sci Monit ; 25: 1053-1060, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30730866

RESUMO

BACKGROUND This study aimed to investigate the effectiveness of perioperative parecoxib sodium combined with transversus abdominis plane (TAP) block on postoperative pain management following hepatectomy in patients with hepatocellular carcinoma (HCC). MATERIAL AND METHODS One hundred patients with HCC who underwent hepatectomy were randomized into a study group (n=51) and a control group (n=49). The study group received 40 mg of parecoxib sodium 30 minutes before anesthetic induction, and 150 mg of 0.375% ropivacaine with 5 mg dexamethasone as TAP inhibitors, before closing the abdominal incision. The control group received 40 mg of placebo 30 minutes before anesthetic induction, without TAP block. Postoperatively, all patients received patient-controlled intravenous analgesia (PCIA) and evaluation with subjective visual analog scale (VAS) pain scores. Data on adverse events, postoperative ambulation (>6 hours/day), time of flatus and defecation, and hospitalization duration were recorded. RESULTS Pain scores of the study group were significantly lower compared with the control group on the first three postoperative days. No significant differences were found between the two groups in terms of adverse events. In the study group, the number of cases of postoperative ambulation was significantly more than the control group. The onset of flatus and defecation and duration of hospital stay in the study group were significantly shorter in the study group compared with the control group. CONCLUSIONS Parecoxib sodium combined with TAP block effectively reduced postoperative pain, improved ambulation, improved gastrointestinal function, and shortened hospitalization time following hepatectomy in patients with HCC without adverse effects.


Assuntos
Isoxazóis/farmacologia , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/efeitos dos fármacos , Adulto , Idoso , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/cirurgia , China , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Ropivacaina/farmacologia
7.
Medicine (Baltimore) ; 98(1): e13994, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608444

RESUMO

BACKGROUND: We aimed to assess whether an ultrasound (US)-guided oblique subcostal transversus abdominis plane (OSTAP) block would improve the postoperative pain scores and decrease the tramadol consumption after a laparoscopic hysterectomy. METHODS: Sixty-six female patients with American Society of Anesthesiologists I, II, or III, aged 18 to 65 years who were scheduled for laparoscopic hysterectomy for benign gynecologic pathologies were recruited in this randomized, controlled, observer-blinded trial. Sixty patients completed the study. Patients were randomized into 2 groups. In the OSTAP group, the patients received a bilateral OSTAP block with 40 mL of 0.375% bupivacaine and in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. All patients received tramadol patient-controlled analgesia for the first 24th hour. Patients in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. The primary outcome was the 24th hour tramadol consumption. The secondary outcomes included visual analog scale (VAS) scores during movement, the tramadol consumption at the 1st, 4th, and 12th postoperative hours, and nausea scores at the 24th hour postoperatively. RESULTS: At all time points, tramadol consumption of the OSTAP group remained significantly lower when compared with Sham group. The OSTAP group showed a statistically significant reduction at the postoperative 24th hour tramadol consumption (mean difference 22 mg, 95% confidence interval -38.4 to -5.6 mL; P = .009). Compared with the Sham group, OSTAP block reduced the VAS scores at all time points during movement. Nausea scores at the 24th postoperative hour were significantly lower in the OSTAP group compared with the Sham group CONCLUSION:: We concluded that bilateral US-guided OSTAP blocks reduced 24th hour tramadol requirements and VAS scores after laparoscopic hysterectomy. The OSTAP block is a promising technique for producing effective and prolonged postoperative analgesia in patients undergoing laparoscopic hysterectomy surgeries.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Analgésicos/uso terapêutico , Histerectomia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ultrassonografia de Intervenção/instrumentação , Músculos Abdominais/inervação , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Variações Dependentes do Observador , Avaliação de Resultados (Cuidados de Saúde) , Dor Pós-Operatória/prevenção & controle , Tramadol/administração & dosagem , Tramadol/provisão & distribução , Tramadol/uso terapêutico , Ultrassonografia de Intervenção/métodos , Escala Visual Analógica , Adulto Jovem
9.
Dis Colon Rectum ; 61(10): 1196-1204, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30192328

RESUMO

BACKGROUND: Multimodal pain management is an integral part of enhanced recovery pathways. The most effective pain management strategies have not been determined. OBJECTIVE: The purpose of this study was to compare liposomal bupivacaine transversus abdominis plane block with epidural analgesia in patients undergoing colorectal surgery. DESIGN: This is a single-institution, open-label randomized (1:1) trial. SETTING: This study compared liposomal bupivacaine transversus abdominis plane block with epidural analgesia in patients undergoing elective open and minimally invasive colorectal surgery in an enhanced recovery pathway. PATIENTS: Two hundred were enrolled. Following randomization, allocation, and follow-up, there were 92 patients with transversus abdominis plane block and 87 patients with epidural analgesia available for analysis. INTERVENTIONS: The interventions comprised liposomal bupivacaine transversus abdominis plane block versus epidural analgesia. MAIN OUTCOME MEASURES: The primary outcomes measured were numeric pain scores and the overall benefit of analgesia scores. RESULTS: There were no significant differences in the Numeric Pain Scale and Overall Benefit of Analgesia Score between groups. Time trend analysis revealed that patients with transversus abdominis plane block had higher numeric pain scores on the day of surgery, but that the relationship was reversed later in the postoperative period. Opioid use was significantly less in the transversus abdominis plane block group (206.84 mg vs 98.29 mg, p < 0.001). There were no significant differences in time to GI recovery, hospital length of stay, and postoperative complications. Cost was considerably more for the epidural analgesia group. LIMITATIONS: This study was conducted at a single institution. CONCLUSIONS: This randomized trial shows that perioperative pain management with liposomal bupivacaine transversus abdominis plane block is as effective as epidural analgesia and is associated with less opioid use and less cost. These data and the more favorable risk profile suggest that liposomal bupivacaine transversus abdominis plane block is a viable multimodal perioperative pain management option for this patient population in an established enhanced recovery pathway. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov (NCT02591407). See Video Abstract at http://links.lww.com/DCR/A737.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Analgesia Epidural/métodos , Bupivacaína/farmacologia , Colo/cirurgia , Cirurgia Colorretal/normas , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Músculos Abdominais/fisiopatologia , Adulto , Analgesia Epidural/economia , Analgesia Epidural/estatística & dados numéricos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Bupivacaína/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Assistência Perioperatória/normas , Período Pós-Operatório
10.
Pain Res Manag ; 2018: 2368930, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29991972

RESUMO

Background: A quadratus lumborum (QL) block is an abdominal truncal block technique that primarily provides analgesia and anaesthesia to the abdominal wall. This cadaveric study was undertaken to compare the dye spread between different needle approaches for ultrasound-guided QL blocks in soft-embalmed cadavers. Methods: After randomization, an experienced anesthesiologist performed two lateral, three posterior, and five alternative QL blocks on the left or right sides of five cadavers. The target injection point for the alternative approach was the lumbar interfascial triangle, same as that of conventional posterior QL block, with a different needle trajectory. For each block, 20 ml of dye solution was injected. The lumbar region and abdominal flank were dissected. Results: Ten blocks were successfully performed. Regardless of the approach used, the middle thoracolumbar fascia was deeply stained in all blocks, but the anterior layer was less stained. The alternative approach was more associated with spread of injectate to the transversus abdominis and transversalis fascia plane. Despite accurate needle placement, all lateral QL blocks were associated with a certain amount of intramuscular or subcutaneous infiltration. Two posterior QL blocks showed a deeply stained posterior thoracolumbar fascia, and one of them was associated with obvious subcutaneous staining. The subcostal, iliohypogastric, and ilioinguinal nerves were mostly involved, but the thoracic paravertebral space and lumbar plexus were not affected in all blocks. Conclusions: The alternative approach for QL blocks was able to achieve a comparable extent when compared to the conventional approach.


Assuntos
Parede Abdominal/cirurgia , Região Lombossacral/cirurgia , Bloqueio Nervoso/métodos , Músculos Abdominais/efeitos dos fármacos , Parede Abdominal/diagnóstico por imagem , Idoso , Cadáver , Corantes/farmacocinética , Feminino , Humanos , Região Lombossacral/diagnóstico por imagem , Masculino , Distribuição Aleatória , Ultrassonografia
11.
Crit Care ; 22(1): 111, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29716625

RESUMO

BACKGROUND: Increased vascular permeability is a pathophysiological hallmark of sepsis and results in increased transcapillary leakage of plasma fluid, hypovolemia, and interstitial edema formation. 6% hydroxyethyl starch (HES 130/0.4) is commonly used to treat hypovolemia to maintain adequate organ perfusion and oxygen delivery. The present study was designed to investigate the effects of 6% HES 130/0.4 on glycocalyx integrity and vascular permeability in lipopolysaccharide (LPS)-induced pulmonary inflammation and systemic inflammation in mice. METHODS: 6% HES 130/0.4 or a balanced electrolyte solution (20 ml/kg) was administered intravenously 1 h after cecal ligation and puncture (CLP) or LPS inhalation. Sham-treated animals receiving 6% HES 130/0.4 or the electrolyte solution served as controls. The thickness of the endovascular glycocalyx was visualized by intravital microscopy in lung (LPS inhalation model) or cremaster muscle (CLP model). Syndecan-1, hyaluronic acid, and heparanase levels were measured in blood samples. Vascular permeability in the lungs, liver, kidney, and brain was measured by Evans blue extravasation. RESULTS: Both CLP induction and LPS inhalation resulted in increased vascular permeability in the lung, liver, kidney, and brain. 6% HES 130/0.4 infusion led to significantly reduced plasma levels of syndecan-1, heparanase, and hyaluronic acid, which was accompanied by a preservation of the glycocalyx thickness in postcapillary venules of the cremaster (0.78 ± 0.09 µm vs. 1.39 ± 0.10 µm) and lung capillaries (0.81 ± 0.09 µm vs. 1.49 ± 0.12 µm). CONCLUSIONS: These data suggest that 6% HES 130/0.4 exerts protective effects on glycocalyx integrity and attenuates the increase of vascular permeability during systemic inflammation.


Assuntos
Permeabilidade Capilar/efeitos dos fármacos , Glicocálix/metabolismo , Derivados de Hidroxietil Amido/farmacocinética , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/metabolismo , Animais , Permeabilidade Capilar/fisiologia , Modelos Animais de Doenças , Método Duplo-Cego , Azul Evans , Glucuronidase/análise , Glucuronidase/sangue , Glicocálix/efeitos dos fármacos , Ácido Hialurônico/análise , Ácido Hialurônico/sangue , Hialuronoglucosaminidase/análise , Hialuronoglucosaminidase/sangue , Derivados de Hidroxietil Amido/uso terapêutico , Hipovolemia/tratamento farmacológico , Pulmão/efeitos dos fármacos , Pulmão/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Pneumonia/complicações , Pneumonia/prevenção & controle , Estatísticas não Paramétricas , Sindecana-1/análise , Sindecana-1/sangue
12.
Vet Anaesth Analg ; 45(3): 374-383, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29627201

RESUMO

OBJECTIVE: To evaluate the perioperative analgesic effects of a transversus abdominis plane (TAP) block with a mixture of lidocaine and bupivacaine administered to cats undergoing ovariectomy. STUDY DESIGN: Controlled, randomized, prospective, blinded clinical study. ANIMALS: A group of 20 healthy cats. METHODS: Robenacoxib (2 mg kg-1) was administered subcutaneously 0.5 hour before intramuscular (IM) administration of ketamine (5 mg kg-1), methadone (0.1 mg kg-1) and dexmedetomidine (0.01 mg kg-1). General anesthesia was induced with intravenous (IV) propofol and maintained with isoflurane. An ultrasound-guided TAP block was performed by injecting 0.5% bupivacaine (0.2 mL kg-1) diluted in a total volume of 1.5 mL 2% lidocaine bilaterally (TAP group, n = 10) or the same volume of saline solution bilaterally in controls (CTR group, n = 10). During surgery, a 20% increase in heart rate and respiratory frequency was treated with IV fentanyl (0.001 mg kg-1). Before premedication and at 1, 2, 3, 4, 6, 8, 12, 16, 20 and 24 hours after extubation, pain was assessed with a simple descriptive pain scale, that ranged from 0 (no pain) to 4 (intense pain). For pain scores ≥3, IM methadone (0.1 mg kg-1) was administered. Data were analyzed with the Friedman or the analysis of variance (anova) test, and p < 0.05 was considered statistically significant. RESULTS: Only two cats in the CTR group were administered one dose of fentanyl during surgery. At 2, 6, 8, 12, 16, 20 and 24 hours after surgery, the pain score was higher in the CTR group. A mean dose of 0.5 ± 0.2 mg kg-1 methadone was administered to all cats in the CTR groups within 24 hours. Methadone was not administered to the TAP group (pain score < 3). CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided TAP block can be a reliable adjunctive technique, providing analgesia for up to 24 hours in cats undergoing ovariectomy.


Assuntos
Analgesia/veterinária , Anestésicos Combinados/administração & dosagem , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Gatos/cirurgia , Lidocaína/administração & dosagem , Bloqueio Nervoso/veterinária , Ovariectomia/veterinária , Ultrassonografia de Intervenção/veterinária , Músculos Abdominais/efeitos dos fármacos , Analgesia/métodos , Animais , Feminino , Bloqueio Nervoso/métodos , Período Perioperatório/veterinária
13.
Vet Anaesth Analg ; 45(3): 392-396, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29559203

RESUMO

OBJECTIVE: To describe a single-site transversus abdominis plane (TAP) block technique in horses. STUDY DESIGN: Prospective, descriptive, experimental anatomical study. ANIMALS: Four adult pony cadavers. METHODS: Freshly euthanized ponies were positioned in dorsal recumbency. A 6-13 MHz linear ultrasonic probe was used to scan the abdominal wall bilaterally midway between the last rib and iliac crest in search of the TAP location. By modifying the technique to accommodate the equine anatomy, the TAP was successfully visualized with the transducer positioned in a transverse plane with its side indicator over the intercept of two lines, one connecting the most cranial aspect of the iliac crest and the most caudal extent of the last rib and another originating just caudal to the umbilicus and extending laterally. Each hemiabdomen was injected with 0.5 mL kg-1 of a 1:1 solution of 1% methylene blue and 0.5% bupivacaine via a 21 gauge 10 cm stimulating needle inserted ventral-dorsally and in plane with the ultrasound beam. Approximately 3 hours after injection, the abdomen was dissected and nerves stained over 1 cm in length were identified. RESULTS: Staining was evident from the fourteenth thoracic (T14) to the third lumbar (L3) nerves. The ventral branches of the fifteenth to the eighteenth thoracic nerves (T15-T18) and first and second lumbar nerves (L1 and L2) were stained in three, six, eight, eight, eight and seven of eight injections, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Nerves T16-L2 had over 75% success rate in staining, suggesting that this technique would block transmission from T16 to L2, assuming that staining indicates potential nerve block. Dorsal spread occurred in three of eight hemiabdomens. Further studies developing techniques for the cranial abdomen and adjusting volume and concentration of injectate are warranted.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Cavalos/anatomia & histologia , Bloqueio Nervoso/veterinária , Anestesia Local/métodos , Anestesia Local/veterinária , Animais , Injeções Intramusculares/métodos , Injeções Intramusculares/veterinária , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/veterinária
14.
Med Princ Pract ; 27(2): 158-165, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29402875

RESUMO

OBJECTIVES: To assess the analgesic efficacy of transversus abdominis plane (TAP) block in patients undergoing colorectal surgery (CRS). MATERIALS AND METHODS: The databases of PubMed, ISI Web of Science, and Embase were searched, and randomized controlled studies (RCTs) that compared TAP block to control for relief of postoperative pain in patients who underwent CRS were included. Outcomes, including postoperative pain at rest and with movement, morphine use, postoperative nausea and vomiting, and the length of hospital stay, were analyzed using STATA software. The weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) or relative risk with 95% CI were used to present the strength of associations. RESULTS: A total of 7 RCTs with 511 patients were included. The results of this study suggested that TAP block significantly relieved postoperative pain during postanesthetic recovery after CRS at rest and during movement (WMDs were -0.98 [95% CI -1.57 to -0.38] and -0.68 [-1.07 to -0.30], respectively), and also decreased pain intensity during movement 24 h after CRS (WMD: -0.57 [95% CI -1.06 to -0.08]). TAP block significantly reduced opioid consumption within 24 h when compared to controls, with a WMD of 15.66 (95% CI -23.93 to -7.39). However, TAP block did not shorten the length of hospital stay. CONCLUSIONS: TAP block was an effective approach for relief of postoperative pain and reduced postoperative consumption of morphine. More RCTs with large sample sizes are required to confirm these findings.


Assuntos
Analgesia/métodos , Analgésicos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/efeitos dos fármacos , Cirurgia Colorretal , Humanos , Tempo de Internação , Medição da Dor , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Clin Neuropharmacol ; 41(2): 73-74, 2018 Mar/Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29474193

RESUMO

Belly dancer syndrome, also called belly dance syndrome or belly dancer dyskinesia, is a kind of abdominal dyskinesia with painful sensation. Its etiology is still unclear and there are few studies reporting its association with antipsychotics. Quetiapine is an atypical antipsychotic that causes lower risk of extrapyramidal symptoms than typical antipsychotics. Here, we presented the first case of belly dancer syndrome in a 71-year-old woman with major depressive disorder after short-term use of quetiapine.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Antipsicóticos/efeitos adversos , Discinesia Induzida por Medicamentos/etiologia , Fumarato de Quetiapina/efeitos adversos , Idoso , Antipsicóticos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Humanos , Fumarato de Quetiapina/uso terapêutico
16.
Pesqui. vet. bras ; 38(2): 315-319, fev. 2018. ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-895564

RESUMO

This paper pretends to demonstrate the effect of the combination of transversus abdominis plane block (TAP block) and Serratus plane block (SP block) techniques in analgesia of 4 dogs undergoing total unilateral mastectomy. Dogs were premedicated with methadone (0.5mg.kg-1) intramuscularly. Anesthesia was induced with propofol (6mg.kg-1) and midazolam (0.3mg.kg-1) and maintained with isoflurane. SP and TAP block were performed unilaterally using ultrasound by the injection of bupivacaine 0.25% (0.3mL kg-1) diluted with NaCl solution 1:1. Heart rate (HR), respiratory rate (f), non-invasive arterial pressure, esophageal temperature (T), oxygen saturation (SpO2) and electrocardiogram were monitored continuously. Animals were monitored for two and four hours after extubation for pain by using the Canine Acute Pain Scale from Colorado State University. Two hours after extubation, tramadol (4mg.kg-1) and dipyrone (25mg.kg-1) was administered to all dogs. It was not observed any alteration on cardiac rhythm. HR, f, T and mean arterial pressure remained below the preincisional values for all dogs. No dog required intraoperative rescue analgesia. Recovery from anesthesia was without any complication. All animals scored 0 (0/5) at pain scale, two and four hours after extubation and none of them expressed concern over the surgical wound. Dogs were able to walk before two hours after extubation. The combination of both techniques is effective in anesthetic blocking the thoracic and abdominal walls and it is suggested both may be included in the multimodal analgesia protocols for this type of surgery.(AU)


Este trabalho pretende demonstrar o efeito analgésico da combinação das técnicas de bloqueio do plano transverso abdominal (TAP block) e bloqueio do plano serrátil (SP block) em 4 cadelas submetidas à mastectomia unilateral total. Os animais foram pré-medicados com metadona (0,5mg.kg-1) por via intramuscular. A anestesia foi induzida com propofol (6mg.kg-1) e midazolam (0,3mg.kg-1) e mantida com isoflurano. Os bloqueios SP e TAP foram realizados unilateralmente, utilizando ultrassonografia, pela injeção de bupivacaína a 0,25% (0,3mL.kg-1), diluída com solução de NaCl a 1:1. A frequência cardíaca (FC), frequência respiratória (f), pressão arterial não invasiva, temperatura esofágica (T), saturação de oxigênio (SpO2) e eletrocardiograma foram monitorados continuamente. Os animais foram monitorizados durante duras e quatro horas após a extubação para a dor usando a Escala de Dor Aguda Canina da Universidade Estadual do Colorado. Duas horas após a extubação, tramadol (4mg.kg-1) e dipirona (25mg.kg-1) foram administrados a todos os cães. Não foi observada qualquer alteração no ritmo cardíaco. HR, f, T e pressão arterial média permaneceram abaixo dos valores basais para todos os cães. Nenhum cão requereu resgate analgésico intra-operatório. Não houve complicações na recuperação anestésica. Todos os animais apresentaram escore 0 (0/5) na escala de dor, duras e 4 quatro horas após a extubação e nenhum expressou desconforto com a ferida cirúrgica. Todos os cães foram capazes de caminhar antes de duas horas após extubação. A combinação de ambas as técnicas é eficaz no bloqueio anestésico das paredes torácica e abdominal e sugere-se que ambos podem ser incluídos nos protocolos de analgesia multimodal para este tipo de cirurgia.(AU)


Assuntos
Animais , Feminino , Cães , Músculos Abdominais/efeitos dos fármacos , Anestesia por Condução/veterinária , Anestésicos Locais/análise , Isoflurano/uso terapêutico , Mastectomia/veterinária , Midazolam/uso terapêutico , Propofol/uso terapêutico
18.
Biomed Res Int ; 2017: 8284363, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29226150

RESUMO

Purpose of Review: Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. This review highlights the nomenclature system and recent advances in TAP block techniques and proposes directions for future research. Recent Findings: Ultrasound guidance is now considered the gold standard in TAP blocks. It is easy to acquire ultrasound images; it can be used in many surgeries involving the anterolateral abdominal wall. However, the efficacy of ultrasound-guided TAP blocks is not consistent, which might be due to the use of different approaches. The choice of technique influences the involved area and block duration. To investigate the actual analgesic effects of TAP blocks, we unified the nomenclature system and clarified the definition of each technique. Although a single-shot TAP block is limited in duration, it is still the candidate of the analgesic standard for abdominal wall surgery because the use of the catheter technique and liposomal bupivacaine may overcome this limitation. Summary: Ultrasound-guided TAP blocks are commonly used. With the unified nomenclature and the development of catheter technique and/or liposomal local anesthetics, TAP blocks can be applied more appropriately to achieve better pain control.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Bloqueio Nervoso/métodos , Parede Abdominal , Analgesia/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/química , Bupivacaína/administração & dosagem , Bupivacaína/química , Humanos , Lipossomos/administração & dosagem , Lipossomos/química , Manejo da Dor/métodos , Ultrassonografia de Intervenção/métodos
19.
Toxins (Basel) ; 9(8)2017 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-28767072

RESUMO

Hemorrhage is the most prominent effect of snake venom metalloproteinases (SVMPs) in human envenomation. The capillary injury is a multifactorial effect caused by hydrolysis of the components of the basement membrane (BM). The PI and PIII classes of SVMPs are abundant in viperid venoms and hydrolyze BM components. However, hemorrhage is associated mostly with PIII-class SVMPs that contain non-catalytic domains responsible for the binding of SVMPs to BM proteins, facilitating enzyme accumulation in the tissue and enhancing its catalytic efficiency. Here we report on Atroxlysin-Ia, a PI-class SVMP that induces hemorrhagic lesions in levels comparable to those induced by Batroxrhagin (PIII-class), and a unique SVMP effect characterized by the rapid onset of dermonecrotic lesions. Atroxlysin-Ia was purified from B. atrox venom, and sequence analyses indicated that it is devoid of non-catalytic domains and unable to bind to BM proteins as collagen IV and laminin in vitro or in vivo. The presence of Atroxlysin-Ia was diffuse in mice skin, and localized mainly in the epidermis with no co-localization with BM components. Nevertheless, the skin lesions induced by Atroxlysin-Ia were comparable to those induced by Batroxrhagin, with induction of leukocyte infiltrates and hemorrhagic areas soon after toxin injection. Detachment of the epidermis was more intense in skin injected with Atroxlysin-Ia. Comparing the catalytic activity of both toxins, Batroxrhagin was more active in the hydrolysis of a peptide substrate while Atroxlysin-Ia hydrolyzed more efficiently fibrin, laminin, collagen IV and nidogen. Thus, the results suggest that Atroxlysin-Ia bypasses the binding step to BM proteins, essential for hemorrhagic lesions induced by PII- and P-III class SVMPs, causing a significantly fast onset of hemorrhage and dermonecrosis, due to its higher proteolytic capacity on BM components.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Bothrops , Hemorragia/induzido quimicamente , Metaloproteases/toxicidade , Pele/efeitos dos fármacos , Venenos de Serpentes/enzimologia , Músculos Abdominais/patologia , Animais , Membrana Basal/efeitos dos fármacos , Membrana Basal/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Feminino , Hemorragia/patologia , Hidrólise , Masculino , Camundongos , Necrose/induzido quimicamente , Necrose/patologia , Pele/patologia
20.
Respir Physiol Neurobiol ; 246: 59-66, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28778649

RESUMO

The modulation of cough by microinjections of codeine in 3 medullary regions, the solitary tract nucleus rostral to the obex (rNTS), caudal to the obex (cNTS) and the lateral tegmental field (FTL) was studied. Experiments were performed on 27 anesthetized spontaneously breathing cats. Electromyograms (EMG) were recorded from the sternal diaphragm and expiratory muscles (transversus abdominis and/or obliquus externus; ABD). Repetitive coughing was elicited by mechanical stimulation of the intrathoracic airways. Bilateral microinjections of codeine (3.3 or 33mM, 54±16nl per injection) in the cNTS had no effect on cough, while those in the rNTS and in the FTL reduced coughing. Bilateral microinjections into the rNTS (3.3mM codeine, 34±1 nl per injection) reduced the number of cough responses by 24% (P<0.05), amplitudes of diaphragm EMG by 19% (P<0.01), of ABD EMG by 49% (P<0.001) and of expiratory esophageal pressure by 56% (P<0.001). Bilateral microinjections into the FTL (33mM codeine, 33±3 nl per injection) induced reductions in cough expiratory as well as inspiratory EMG amplitudes (ABD by 60% and diaphragm by 34%; P<0.01) and esophageal pressure amplitudes (expiratory by 55% and inspiratory by 26%; P<0.001 and 0.01, respectively). Microinjections of vehicle did not significantly alter coughing. Breathing was not affected by microinjections of codeine. These results suggest that: 1) codeine acts within the rNTS and the FTL to reduce cough in the cat, 2) the neuronal circuits in these target areas have unequal sensitivity to codeine and/or they have differential effects on spatiotemporal control of cough, 3) the cNTS has a limited role in the cough suppression induced by codeine in cats.


Assuntos
Antitussígenos/uso terapêutico , Codeína/uso terapêutico , Tosse/tratamento farmacológico , Bulbo/fisiologia , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/fisiopatologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Gatos , Diafragma/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Eletromiografia , Feminino , Masculino , Bulbo/efeitos dos fármacos , Microinjeções , Músculos Respiratórios/efeitos dos fármacos , Músculos Respiratórios/fisiopatologia
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