Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.554
Filtrar
1.
Medicine (Baltimore) ; 99(5): e18939, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000411

RESUMO

RATIONALE: Diagnosing and treating refractory cancer pain have become standardized and effective procedures with guidance from the Expert Consensus on Refractory Cancer Pain released in 2017 by the Committee of Rehabilitation and Palliative Care of China. Doxorubicin has been used for perineural injection in the treatment of chronic non-cancer pain owing to its retrograde sensory ganglion resection effect. Our study reports a new fourth-ladder treatment for cancer pain: CT-guided paravertebral doxorubicin injection for patients with refractory cancer pain caused by paraspinal metastasis. PATIENT CONCERNS: A 48-year-old female and a 47-year-old male patients suffered from refractory cancer pain over the past months. They had both undergone surgical tumor resection, chemotherapy, and precision radiotherapy but result in limited analgesic effect. The daily oral morphine dosage was around 60 to 100 mg and rescue analgesic methods had been used at the time. DIAGNOSES: Refractory cancer pain in 2 patients with renal cancer and hepatobiliary adenocarcinoma. INTERVENTIONS: The patients both received computed tomography (CT)-guided 1 mL of 0.5% doxorubicin paravertebral injection at each affected nerve root segments. OUTCOMES: The Visual Analog Scale and Douleur Neuropathique four Questions were used for 6-month follow-up, and the analgesic requirement was also recorded. The patients enjoyed satisfactory analgesia for up to 6 months without adverse reaction. In addition, the oral opioid analgesic doses were significantly reduced after the neurolytic block. LESSONS: The CT-guided paravertebral doxorubicin injection was an effective fourth-step analgesic interventional technology that allowed our 2 patients with refractory cancer pain to maintain satisfactory analgesia. This analgesia method taken at an appropriate stage, according to the latest analgesic concept, results in good analgesia and opioid use reduction. Also, with the imaging guidance, only a small amount of neurolytic agent is needed to achieve analgesia in a precise and safe way.


Assuntos
Analgésicos/administração & dosagem , Dor do Câncer/tratamento farmacológico , Doxorrubicina/administração & dosagem , Dor Intratável/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Tomografia Computadorizada por Raios X , Dor do Câncer/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Intratável/diagnóstico por imagem , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico
2.
JAMA ; 323(3): 237-247, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31961419

RESUMO

Importance: For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. Objective: To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. Design, Setting, and Participants: The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for ≤2 months or weak opioids for ≤6 months) were included. The 18-month follow-up period ended in March 2018. Interventions: There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. Main Outcomes and Measures: The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach. Conclusions and Relevance: Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings. Trial Registration: ISRCTN Identifier: ISRCTN45877994.


Assuntos
Cálculos/terapia , Drenagem , Endoscopia , Litotripsia , Manejo da Dor/métodos , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/terapia , Adulto , Analgésicos Opioides/uso terapêutico , Área Sob a Curva , Cálculos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Pancreatite Crônica/complicações , Pancreatite Crônica/cirurgia
3.
Plast Reconstr Surg ; 145(2): 316e-323e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985627

RESUMO

BACKGROUND: Perioperative use of opioids is common in surgical practice and frequently results in troublesome opioid-related side effects that often lead to suboptimal postsurgical outcomes. As such, multiple studies have sought to identify alternatives that may reduce reliance on opioid-based perioperative pain management. Recently, it has been shown that patient education and patient involvement in care positively impact surgical outcomes. This study evaluates how patient education regarding the role of endogenous beta-endorphins in reducing pain and the opposing effect of opioid analgesics impacts opioid consumption and mood after surgery. METHODS: Patients scheduled for breast augmentation were divided into two groups, A and B. Both groups received identical multimodal anesthesia regimens; however, only patients in group B were educated on the role of endogenous beta-endorphins in pain control and mood enhancement, and how opioids block their action. RESULTS: Patients in the group receiving preoperative education on the analgesic and mood-enhancing role of endogenous beta-endorphins and how opioids block their action consumed significantly less opioids and had better postsurgical outcomes as determined by self-reported measures of pain level and mood/sense of well-being. CONCLUSIONS: The findings of this study suggest that opioid use was significantly reduced and patients' mood/sense of well-being was significantly enhanced when patients received preoperative education on the oppositional relationship between beta-endorphins and opioids. Such patient education may be linked to a significant reduction in opioid use and improved patient mood/sense of well-being, especially when combined with opioid-free multimodal anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Afeto/efeitos dos fármacos , Analgésicos Opioides/efeitos adversos , Mamoplastia , Manejo da Dor/métodos , Educação de Pacientes como Assunto/métodos , Adulto , Feminino , Humanos , Estudos Prospectivos , Adulto Jovem
4.
Medicine (Baltimore) ; 99(1): e18538, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895790

RESUMO

BACKGROUND: To evaluate the safety and efficacy of dexmedetomidine in patients undergoing total knee and hip arthroplasty for postoperative pain control. METHODS: An updated systematic review and meta-analysis of randomized controlled trials (RCTs) identified in systematic searches of MEDLINE, EMBASE, Google Scholar, the Cochrane Database and the Chinese SinoMed Database. RESULTS: Fourteen RCTs with a total of 1220 patients were included. Overall, dexmedetomidine therapy was associated with significantly decreased pain scores 24 hours after surgery (WMD, -0.36; 95% CI, -0.49 to -0.22; I = 90.0%, P < .001) compared with scores in the control group after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Furthermore, the rate of postoperative delirium was also markedly decreased with dexmedetomidine therapy (RR, 0.38; 95% CI, 0.24 to 0.59; I = 0.0%, P < .001). Moreover, compared with the control group, dexmedetomidine treatment was associated with a decreased risk of postoperative nausea and vomiting in patients undergoing TKA (RR, 0.34; 95% CI, 0.15 to 0.79; I = 0.0%, P = .012), and there was a similar risk of hypotension (RR, 1.03; 95% CI, 0.72 to 1.49; I = 24.4%, P = .87) regardless of whether patients underwent TKA or THA. However, the rate of bradycardia was significantly increased with dexmedetomidine treatment in those undergoing TKA (RR, 6.11; 95% CI, 2.35 to 15.91; I = 0.0%, P < .001). CONCLUSIONS: Dexmedetomidine therapy seems to be an effective treatment for pain control and postoperative delirium in patients undergoing TKA/THA. However, the incidence of bradycardia is markedly increased in patients undergoing TKA. Hence, much larger prospective clinical studies are warranted to confirm these findings.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Dexmedetomidina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Resultado do Tratamento
6.
Anaesthesia ; 75 Suppl 1: e101-e110, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903582

RESUMO

Regional anaesthesia has undergone several exciting advances in the past few decades. Ultrasound-guided techniques of peripheral nerve blockade have become the gold standard thanks to the associated improvements in efficacy, ease of performance and safety. This has increased the accessibility and utilisation of regional anaesthesia in the anaesthesia community at large and is timely given the mounting evidence for its potential benefits on various patient-centred outcomes, including major morbidity, cancer recurrence and persistent postoperative pain. Ultrasound guidance has also paved the way for refinement of the technical performance of existing blocks concerning simplicity and safety, as well as the development of new regional anaesthesia techniques. In particular, the emergence of fascial plane blocks has further broadened the application of regional anaesthesia in the management of painful conditions of the thorax and abdomen. The preliminary results of investigations into these fascial plane blocks are promising but require further research to establish their true value and role in clinical care. One of the challenges that remains is how best to prolong regional anaesthesia to maximise its benefits while avoiding undue harm. There is ongoing research into optimising continuous catheter techniques and their management, intravenous and perineural pharmacological adjuncts, and sustained-release local anaesthetic molecules. Finally, there is a growing appreciation for the critical role that regional anaesthesia can play in an overall multimodal anaesthetic strategy. This is especially pertinent given the current focus on eliminating unnecessary peri-operative opioid administration.


Assuntos
Dor Aguda/tratamento farmacológico , Anestesia por Condução/métodos , Manejo da Dor/métodos , Humanos
7.
J Photochem Photobiol B ; 202: 111674, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31778953

RESUMO

The present work showed the preparation of gold (Au NPs) and silver nanoparticles (Ag NPs) using aqueous leaf extract of Clinacanthus nutans Lindau (C. Lindau). The prepared NPs were studied using various microscopic and spectroscopic techniques, which confirmed the formation of crystalline Ag NPs, Au NPs that are stabilized with C. Lindau extract polyphenols. The prepared Au NPs and Ag NPs are studied to assess their comparative analgesic and muscle relaxant activities conducted on BALB/c mice. The muscle relaxant studies displayed that Ag NPs were comparatively higher efficient than Au NPs and methanolic C. Lindau extract in traction examination. Additionally, the analgesic studies exhibited that Ag NPs, Au NPs showed maximum percentage reduction in acetic acid induced writhing at the concentrations of 50, 100 and 150 mg/kg body weight. Further, these results conclude that as prepared Au NPs and Ag NPs prepared from C. Lindau leaf extract demonstrated very good analgesic and muscle relaxant activities for the use of pain management in nursing care.


Assuntos
Acanthaceae/química , Analgésicos/síntese química , Ouro/química , Nanopartículas Metálicas/química , Prata/química , Acanthaceae/metabolismo , Ácido Acético/toxicidade , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Animais , Química Verde , Nanopartículas Metálicas/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Relaxamento Muscular/efeitos dos fármacos , Cuidados de Enfermagem , Dor/induzido quimicamente , Dor/tratamento farmacológico , Manejo da Dor/métodos , Extratos Vegetais/química , Folhas de Planta/química , Folhas de Planta/metabolismo
9.
Ann Otol Rhinol Laryngol ; 129(2): 175-180, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31625416

RESUMO

OBJECTIVES: The topic of prescription opioid overuse remains a growing concern in the United States. Our objective is to provide insight into pain perception and opioid use based on a patient cohort undergoing common otologic and neurotologic surgeries. STUDY DESIGN: Prospective observational study with patient questionnaire. SETTING: Single academic medical center. SUBJECTS AND METHODS: Adult patients undergoing otologic and neurotologic procedures by two fellowship trained neurotologists between June and November of 2018 were included in this study. During first postoperative follow-up, participants completed a questionnaire assessing perceived postoperative pain and its impact on quality of life, pain management techniques, and extent of prescription opioid use. RESULTS: A total of 47 patients met inclusion and exclusion criteria. The median pain score was 3 out of 10 (Interquartile Range [IQR] = 2-6) with no significant gender differences (P = .92). Patients were prescribed a median of 15.0 (IQR = 10.0-15.0) tablets of opioid pain medication postoperatively, but only used a median of 4.0 (IQR = 1.0-11.5) tablets at the time of first follow-up. Measured quality of life areas included sleep, physical activity, work, and mood. Sleep was most commonly affected, with 69.4% of patients noting disturbances. CONCLUSIONS: This study suggests that practitioners may over-estimate the need for opioid pain medication following otologic and neurotologic surgery. It also demonstrates the need for ongoing patient education regarding opioid risks, alternatives, and measures to prevent diversion.


Assuntos
Analgésicos Opioides , Uso de Medicamentos/estatística & dados numéricos , Procedimentos Cirúrgicos Otológicos , Manejo da Dor/métodos , Percepção da Dor , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Procedimentos Cirúrgicos Otológicos/métodos , Medição da Dor , Estudos Prospectivos
10.
World Neurosurg ; 133: e658-e665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574335

RESUMO

BACKGROUND: Recurrent and chronic low back pain, caused by degenerative lumbar spondylosis, commonly affects elderly patients, even those with no previous low back surgery. These patients, like those affected by failed back surgery syndrome (FBSS), may become unresponsive to medical conservative treatment and their quality of life could be easily compromised. Moreover, general comorbidities, obesity, and other typical conditions of the elderly may make surgery under general anesthesia riskier than the natural history of the disease. These patients could be considered affected by surgical back risk syndrome (SBRS). METHODS: In this article, we report our preliminary observational prospective study on the role of spinal cord stimulation (SCS) in 3 groups of patients: the FBSS group, the SBRS group, and the "other" group. Selection criteria, treatment modality, and outcomes for each patient group are described and discussed. Moreover, a potentially useful diagnostic and therapeutic flowchart on the management options for lumbar back diseases is discussed. RESULTS: The FBSS group included 25 patients, the SBRS group included 10 patients, and the other group included 3 patients. In 22/25 patients with FBSS (88% of the total), the implantation of a definitive neurostimulator was successful. In almost all patients in both the SBRS and the other groups, the implantation of a definitive neurostimulator was successful. CONCLUSIONS: In our opinion, SCS could be considered as a valid alternative treatment not only in selected patients affected by FBSS but also in selected patients affected by SBRS, in whom back surgery under general anesthesia may be challenging and overcome the potential benefit of the surgery itself. SBRS could be considered a new disease entity to be managed through SCS.


Assuntos
Dor Lombar/terapia , Estimulação da Medula Espinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome Pós-Laminectomia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos
11.
J Urol ; 203(1): 151-158, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31464563

RESUMO

PURPOSE: Opioids are frequently overprescribed after surgery. The 2018 AUA position statement on opioid use suggests using the lowest dose and potency to achieve pain control but the lack of procedure specific prescribing guidelines contributes to wide variation in prescribing patterns. To address this gap we aimed to develop opioid prescribing recommendations through an expert panel consensus. MATERIALS AND METHODS: The 15-member multidisciplinary expert panel included representatives from 5 stakeholder groups. A 3-step modified Delphi method was used to develop recommendations for postoperative opioid prescribing. Recommendations were made for opioid naïve patients without chronic pain conditions. The panel used oxycodone 5 mg equivalents to define the number of prescribed tablets. RESULTS: Procedure specific recommendations were developed for 16 endourological and minimally invasive urological procedures. The panel agreed that not all patients desire or require opioids and, thus, the minimum recommended number of opioid tablets for all procedures was 0. Consensus ranges were identified to allow prescribed quantities to be aligned with expected needs. The maximum recommended quantity varied by procedure from 0 tablets (3 procedures) to 15 tablets (6 procedures) with a median of 10 tablets. Attending urologists typically voted for higher opioid quantities than nonattending panel members. The panel identified 8 overarching strategies for opioid stewardship, including contextualizing postoperative pain management with patient goals and preferences, and maximizing nonopioid therapies. CONCLUSIONS: Procedure specific guidelines for postoperative opioid prescribing may help align individual urologist prescribing habits with consensus recommendations. These guidelines can aid quality improvement efforts to reduce overprescribing in urology.


Assuntos
Analgésicos Opioides/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Urológicos , Técnica Delfos , Humanos , Estados Unidos
12.
Emerg Med Clin North Am ; 38(1): 223-241, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757252

RESUMO

Pain management in acute orthopedic injury needs to be tailored to the presentation and patient. Subjective and objective assessment, in conjunction with pathophysiology, should be used to provide symptom control. Ideally, treatment should be administered in an escalating fashion, attempting to manage pain with the lowest dose of the safest medication available. There are also adjunctive therapies, including those that are nonpharmacologic, that can provide additional relief.


Assuntos
Analgesia/métodos , Manejo da Dor/métodos , Medição da Dor/métodos , Dor/etiologia , Ferimentos e Lesões/complicações , Humanos , Dor/diagnóstico , Ferimentos e Lesões/diagnóstico
13.
Int J Gynaecol Obstet ; 148(1): 113-117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31593299

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of flushing the cervical canal and the uterine cavity with local anesthetic in order to reduce the pain felt by patients during office hysteroscopy. METHODS: A double-blind randomized controlled trial was conducted between May 1, 2018, and February 28, 2019, involving 260 women undergoing office hysteroscopy at Kasr Al Ainy Hospital, Cairo, Egypt. Women were randomized using a computerized random number generator to intrauterine and intracervical instillation 5 minutes before the procedure of either 5 mL lidocaine 2% diluted in 15 mL normal saline, or 20 mL normal saline alone. The primary outcome measure was the visual analog scale (VAS) pain score reported by women during the procedure. Secondary outcomes included VAS score at 10 and 30 minutes after the procedure, the need for analgesia, and occurrence of vasovagal attacks. RESULTS: Women in the lidocaine flushing group reported a significantly lower VAS score during the procedure (1.8 ± 1.1 vs 5.2 ± 1.8) and 10 and 30 minutes after it (1.3 ± 1.15 and 0.8 ± 0.9 vs 4.3 ± 2.1 and 2.98 ± 1.96) when compared with control women (P<0.001). More women without lidocaine flushing experienced vasovagal attacks (25/130 vs 9/130, P<0.001) and needed analgesia (84/130 vs 13/130, P<0.001) when compared with women with lidocaine flushing. CONCLUSION: Flushing of the cervical canal and uterine cavity with local anesthetic significantly decreased pain sensation in women undergoing office hysteroscopy. CLINICALTRIALS.GOV: NCT03530488.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Histeroscopia/métodos , Lidocaína/administração & dosagem , Adulto , Método Duplo-Cego , Egito , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor/métodos , Gravidez , Cuidados Pré-Operatórios/métodos
15.
Ideggyogy Sz ; 72(11-12): 413-418, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31834685

RESUMO

Background and purpose: Background - The research of alexithymia - the inability to express or understand emotions - has recently become of great importance in clinical practice, mainly in the field of doctor-patient and psychologist patient communication. Many studies have proven the correlation between alexithymia and the development of functional somatic symptoms, i.e. somatization. Purpose - The aim of this clinical study was to examine the emotion-recognition and emotion communication patterns of patients suffering from chronic pain (e.g., headache, low back pain, arthralgia, neuropathy). Moreover, the participants received access to the Hungarian adaptation of a new international online educational site (www.retrainpain.org) dealing with pain management. Methods: Data were collected from the Headache and Chronic Pain Outpatient Clinic, Department of Neurology, Faculty of Medicine, University of Szeged, Hungary (tertiary care - Group 1) and from a general practice in district 2, Budapest, Hungary (primary care - Group 2) from March, 2017 to April, 2018. Patients received a test package containing a pain-specific questionnaire, then the Difficulties in Emotion Regulation Scale (DERS), the Toronto Alexithymia Scale (TAS-20), and the shortened Hungarian version of the WHO-Well-being (WBI-5) had to be completed. After filling out the questionnaires, all patients got access to the Hungarian adaptation of the www.retrainpain.org website. Results: Altogether 92 patients participated in the study (Group 1 n=50; Group 2 n=42). Based on the TAS-20 re-sults, 35 patients reached a pathological score (≥60 points), which indicates the diagnosis of alexithymia. The mean TAS-score was lower in Group 2 (primary care) than in Group 1 (tertiary care) (p=0.003). The DERS disclosed pathological results in 19 cases (p=0.009). As regards the www.retrainpain.org chapters, we received feedback only from 25 out of 92 patients (27%) (Group 1 n=20; Group 2 n=5). Conclusion: Although the examined patients have been suffering from different chronic pain syndromes for years and 50% of them confirmed that symptoms placed at least moderate or heavy burden on their everyday life, the available educational programme was studied only by a smaller proportion of patients than expected. Additionally, those who surveyed the Hungarian adaptation of the www.retrainpain.org website were mainly patients from primary care (Group 2), in spite of the fact that patients from specialized medical care (Group 1) had worse subjective conditions. Our future objective is to extend our database with follow-up results and to improve patients' response willingness.


Assuntos
Dor Crônica , Internet , Manejo da Dor/métodos , Educação de Pacientes como Assunto , Sintomas Afetivos , Comunicação , Emoções , Cefaleia , Humanos , Hungria , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 98(49): e17808, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804304

RESUMO

BACKGROUND: The efficacy of celecoxib for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to assess if celecoxib before the surgery decreases postoperative pain intensity of arthroscopy. METHODS: We search PubMed, Embase, Web of science, EBSCO, and Cochrane library databases for randomized controlled trials (RCTs) assessing the effect of celecoxib versus placebo on pain control of arthroscopy. RESULTS: Five RCTs are included in the meta-analysis. Celecoxib is administered at 200 mg or 400 mg dosage before the surgery. Overall, compared with control group for arthroscopy, preemptive celecoxib has remarkably positive impact on pain scores at 2 to 6 hours (standard mean difference (SMD) = -0.66; 95% confidence interval (CI) = -0.95 to -0.36; P < .0001) and 24 hours after the surgery (SMD = -1.26; 95% CI = -1.83 to -0.70; P < 0.0001), analgesic consumption (SMD  = -2.73; 95% CI = -5.17 to -0.28; P = .03), as well as the decrease in adverse events (risk ratio (RR) = 0.56; 95% CI = 0.39 to 0.79; P = .001), but shows no obvious effect on first time for analgesic requirement (SMD  = 0.02; 95% CI = -0.22 to 0.26; P = .87), nausea, or vomiting (RR = 0.70; 95% CI = 0.42 to 1.17; P = .18). CONCLUSION: Celecoxib administered at 200 mg or 400 mg dosage before the surgery decreases postoperative pain intensity of arthroscopy.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia/métodos , Celecoxib/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Celecoxib/administração & dosagem , Celecoxib/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
17.
Medicine (Baltimore) ; 98(51): e17820, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860946

RESUMO

INTRODUCTION: With the development of economy and the acceleration of population aging, Prostate cancer (PCa) has presented a situation of high morbidity and mortality worldwide. The recent studies have shown that Chinese patent medicine combined with endocrine therapy in the treatment of prostate cancer not only plays a synergistic role in enhancing the efficacy. This review hopes to adopt meta-analysis to evaluate the efficacy and safety of Chinese patent medicine in the treatment of pain caused by prostate cancer and provides evidence for its application in clinical practice. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to June 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of pain caused by prostate cancer. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of Chinese patent medicine for pain caused by prostate cancer. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019131544.


Assuntos
Dor do Câncer/terapia , Medicina Tradicional Chinesa/métodos , Manejo da Dor/métodos , Neoplasias da Próstata/complicações , Idoso , Dor do Câncer/diagnóstico , China , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/fisiopatologia , Medição da Dor , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/mortalidade , Medição de Risco , Análise de Sobrevida
18.
Medicine (Baltimore) ; 98(52): e18448, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876726

RESUMO

BACKGROUND: This study aimed to compare the quadratus lumborum block (QLB) method with transversus abdominis plane block (TAPB) for postoperative pain management in patients undergoing laparoscopic colorectal surgery. METHODS: Seventy-four patients scheduled for laparoscopic colorectal surgery were randomly assigned into 2 groups. After surgery, patients received bilateral ultrasound-guided single-dose of QLB or TAPB. Each side was administered with 20 ml of 0.375% ropivacaine. All patients received sufentanil as patient-controlled intravenous analgesia (PCIA). Resting and moving numeric rating scale (NRS) were assessed at 2, 4, 6, 24, 48 hours postoperatively. The primary outcome measure was sufentanil consumption at predetermined time intervals after surgery. RESULTS: Patients in the QLB group used significantly less sufentanil than TAPB group at 24 and 48 hours (P < .05), but not at 6 hours (P = .33) after laparoscopic colorectal surgery. No significant differences in NRS results were found between the two groups at rest or during movement (P > .05). Incidence of dizziness in the QLB group was lower than in TAPB group (P < .05). CONCLUSIONS: The QLB is a more effective postoperative analgesia as it reduces sufentanil consumption compared to TAPB in patients undergoing laparoscopic colorectal surgery.


Assuntos
Músculos Abdominais/inervação , Músculos Abdominais Oblíquos/inervação , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Anestésicos Locais/administração & dosagem , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem , Ultrassonografia de Intervenção
19.
Medicine (Baltimore) ; 98(50): e18233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852086

RESUMO

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN betweenThe success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.


Assuntos
Anestesia Epidural/instrumentação , Cateteres , Dor Lombar/terapia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Injeções Epidurais/métodos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Medicine (Baltimore) ; 98(50): e18356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852139

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is accompanied by moderate to severe postoperative pain. Multimodal analgesia, such as femoral nerve block, periarticular infiltration analgesia (PIA), and patient-controlled intravenous analgesia, have been used for postoperative analgesia. Recently, randomized controlled trials have compared the efficacy of the adductor canal block (ACB) and the PIA in patients undergoing TKA. However, there is no definite answer as to the efficacy and safety of the ACB compared with the PIA. METHOD: Randomized controlled trials about relevant studies were searched from PubMed (1996 to May 2019), Embase (1980 to May 2019), and Cochrane Library (CENTRAL, May 2019). Five studies which compared the ACB with the PIA methods were included in our meta-analysis. RESULTS: Five studies containing 413 patients met the inclusion criteria. There were no significant differences between the ACB and the PIA group in visual analog scale (VAS) score at rest (P = .14) and movement (P = .18), quadriceps muscle strength (P = .95), complications (P = .78), length of stay (LOS) (P = .54), and time up and go (TUG) test (P = .09), While patients in the ACB group had less equivalent morphine consumption (P < .05) compared with the PIA group. CONCLUSIONS: Our pooled data indicated the ACB group reduced the equivalent morphine consumption compared with the PIA group, with no statistically significant differences in the VAS score, quadriceps muscle strength, TUG test, complications, and LOS.


Assuntos
Analgesia/métodos , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Anestesia por Condução/métodos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Força Muscular/efeitos dos fármacos , Dor Pós-Operatória/etiologia , Músculo Quadríceps/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Coxa da Perna , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA