Use of gabapentin in management of postoperative pain after crosslinking / Uso da gabapentina no manejo da dor pós-operatória do crosslinking

ABSTRACT Objective: The objective was to evaluate the efficacy of gabapentin in the management of neuropathic pain in patients with keratoconus, who were treated with fast (10 minutes) epi-off corneal crosslinking (CXL). Methods: This was a prospective, double-blind, randomized study. The sample comprised patients with bilateral progressive keratoconus, aged 12 years or older, who underwent a bilateral epi-off corneal CXL (fast - 10 minutes) procedure. One group was given placebo orally, and the other group received gabapentin 600 mg orally, both preoperatively. The visual analogue scale (VAS) was applied to record postoperative pain up to 48 hours after procedure. The study was conducted at the Belotto Stock Centro Oftalmológico, in the city of Joaçaba, Santa Catarina, Brazil, from June 2018 to September 2019. Results: At no point in the study significant differences were observed between groups, in terms of pain intensity measured by means of the VAS questionnaire, or of opioid use (Paco®), though opioid consumption was 21% lower in the group receiving gabapentin. Conclusion: We concluded gabapentin has no efficacy in postoperative pain control after epi-off corneal CXL (fast - 10 minutes). Although there was no statistically significant difference, the group that received gabapentin suffered less pain, resulting in lower opioid consumption. UTN number: U1111-1256-0330.

RESUMO Objetivo: Avaliar a eficácia do uso da gabapentina no manejo da dor neuropática em pacientes portadores de ceratocone submetidos ao tratamento de crosslinking corneano epi-off fast de 10 minutos. Métodos: Tratou-se de pesquisa prospectiva, duplo-cega, randomizada. A amostra foi composta de pacientes com ceratocone progressivo bilateral, a partir dos 12 anos de idade, submetidos ao procedimento de crosslinking corneano acelerado epi-off fast de 10 minutos bilateral. Um grupo recebeu placebo via oral e o outro, gabapentina 600mg, via oral, ambos no pré-operatório. A Escala Visual Analógica foi aplicada para registrar a dor pós-operatória até 48 horas após o procedimento. A pesquisa foi realizada no período de junho de 2018 a setembro de 2019 em um centro oftalmológico. Resultados: Não foram observadas diferenças estatísticas significativas para ambos os grupos, tanto na intensidade da dor medida pela Escala Visual Analógica, como na redução do uso do opioide (Paco®), em qualquer horário analisado durante um período de 48 horas. No entanto, houve redução de 21% no consumo de opioides pelo grupo que fez uso da gabapentina. Conclusão: A gabapentina não demonstrou eficácia no controle da dor no pós-operatório do crosslinking corneano epi-off fast de 10 minutos. No entanto, observou-se que, mesmo não havendo diferença estatisticamente significativa, houve diminuição da dor no grupo em que foi usada a gabapentina, resultando na redução do consumo de opioides. Número UTN: U1111-1256-0330.

Methylene Blue for the Treatment of Health Conditions: a Scoping Review

HIGHLIGHTS This scoping review summarizes the findings of clinical trials using methylene blue (MB) for the treatment of various health conditions. This research method allowed mapping main findings, clarifying research topics, and identifying gaps in the literature.

Abstract studies evaluating effective drugs for health conditions are of crucial importance for public health. Methylene blue (MB) is an accessible synthetic drug that presents low toxicity and has been used in several health areas due to its effectiveness. Objective: this scoping review aims to provide a comprehensive overview of relevant research regarding the use of MB for the treatment of health conditions. Methods: a five-stage framework Arksey and O'maley scoping review was conducted. The literature was searched in Cochrane Library database using Mesh term "methylene blue". Data were collected by two independent reviewers and submitted to descriptive synthesis. Results: The search resulted in 429 records, from which 16 were included after exclusion criteria were applied. The therapeutic use of MB was identified for acute conditions (malaria and septic shock), chronic conditions (discogenic back pain, bipolar disorder, refractory neuropathic pain, and post-traumatic stress disorder), and postoperative care (vasoplegic syndrome, and pain after haemorrhoidectomy, lumbar discectomy, and traumatic thoracolumbar fixation). Conclusion: there is much evidence emerging from clinical trials about the therapeutic use of MB for acute, chronic, and postoperative conditions; however, many gaps were identified, which open further avenues for future research.

Pre-emptive low-dose ketamine with local anesthesia reduces postoperative morbidity after third molar surgery: a systematic review and meta-analysis / Ketamina en dosis bajas con anestesia local reduce la morbilidad postoperatoria de la cirugía del tercer molar: revisión sistemática y metanálisis

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.

Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142, p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control.

Artroplastía total de rodilla con asistencia de brazo-robótico: resultados clínicos postoperatorios tempranos / Robotic arm-assisted total knee arthroplasty: early postoperative results

OBJETIVO: Describir los resultados clínicos postoperatorios tempranos de la primera serie de pacientes operados de artroplastía total de rodilla (ATR) con asistencia de brazo-robótico en Latinoamérica. MATERIALES Y MÉTODOS: Estudio prospectivo de 52 pacientes (53 rodillas) con gonartoris tricompartimental sintomática operados de ATR primaria con asistencia de brazo-robótico (RIO-MAKO) de manera consecutiva, con seguimiento a 2 meses postoperados. No se excluyeron pacientes. Se utilizó el mismo protocolo anestésico y de rehabilitación. Se realizó revisión de fichas clínicas para recolectar los siguientes resultados: tiempo de isquemia quirúrgica, estadía hospitalaria, tiempo a marcha, dolor postoperatorio diario [Escala visual análoga (EVA)], uso de opioides, rangos de movilidad articular (ROM), pérdida sanguínea, complicaciones y eje mecánico postoperatorio. RESULTADOS: Tiempos de Isquemia: 82 minutos (60­120). Estadía Hospitalaria: 4 días (2­12). Dolor postoperatorio: EVA el mismo día operatorio de 0 (0­10) y previa al alta de 0 (rango 0­4), con 0,3 purgas (0­6,5) de opioides por paciente. Tiempo a marcha (día logrado): 1 día (1­3), cuarenta y cinco pacientes (84,9%) iniciaron la marcha el primer día postoperatorio. ROM (Extensión-Flexión): Aumento progresivo durante el seguimiento. En el control ambulatorio de los dos primeros meses [23 días (13­50)], veintiún pacientes (40%) alcanzaron un ROM mayor o igual a 0­90° y once (20%) presentaron un ROM funcional máximo (0­120°). Pérdida sanguínea: Siete pacientes (13,2%) requirieron transfusión. Complicaciones: un paciente (1,89%) presentó una dehiscencia del cierre de la artrotomía. No hubo otras complicaciones. Eje mecánico postoperatorio: 179,1° (178,2­180). DISCUSIÓN: Los resultados concuerdan con la evidencia descrita en otras regiones, sugiriendo que la asistencia de brazo-robótico permite resultados postquirúrgicos reproducibles. CONCLUSIÓN: Los resultados clínicos postoperatorios tempranos de esta serie de pacientes operados de ATR con asistencia de brazo-robótico, muestran una baja percepción del dolor, con bajo consumo de opioides, una rápida recuperación funcional de la marcha y ROM, y excelentes resultados desde el punto de vista del eje mecánico postoperatorio. NIVEL DE EVIDENCIA: IV.

OBJECTIVE: Describe the early clinical postoperative outcomes, of the first series of patients operated on Robotic Arm-Assisted Total Knee Arthroplasty (TKA) in Latin America. MATERIAL AND METHOD: Retrospective study including 52 patients (53 knees) with advanced symptomatic knee osteoarthritis, consecutively operated on Robotic ArmAssisted TKA (RIO-MAKO) during October 2018 and May 2019 with two months of follow-up. No patients were excluded from the study. The same anesthetic and rehabilitation protocol was followed for all patients. Data were obtained from the clinical files for the following outcomes: Surgical tourniquet time, hospital stay, time to walk, postoperative daily pain [Visual Analog Scale (VAS)], opioid consumption, range of motion (ROM), blood loss, complications, and the attained postoperative mechanical axis. RESULTS: Tourniquet Time: 82 minutes (60­120). Hospital Stay: 4 days (2­12). Postoperative Pain: VAS of 0 (0­10) the same day of surgery, and 0 (0­4) before discharge. The opioid consumption was 0,3 purge (0­6,5) per patient. Time to Walk (Day achieved): 1st day (1­3), forty-five patients (84,9%) walked on their first postoperative day. ROM (Extension-Flexion): progressively increases during the follow up. On the first two-month visits [23 days (13­50)], twenty-one patients (40%) reached a ROM equal or superior to 0­90°, and eleven (20%) presented a maximal functional ROM (0­120°). Blood Loss: Seven patients (13.2%) required a blood transfusion. Complications: one patient (1.89%) presented dehiscence of the arthrotomy closure. No other complications were registered. Postoperative Mechanical Axis: 179.1° (178.2­180). DISCUSSION: The results coincide with the reported evidence from other regions. Robotic-arm assistance may generate reproducible postoperative results. CONCLUSIONS: The early postoperative clinical results of this series of patients operated on Robotic Arm-Assisted TKA show a low pain perception and opioid use, a rapid functional rehabilitation in terms of gait and ROM, and excellent postoperative mechanical alignment. LEVEL OF EVIDENCE: IV.

Macroligadura como tratamiento para hemorroides / Macro-ligation as a hemorrhoid treatment

Introducción: Las hemorroides constituyen una dilatación varicosa de los plexos hemorroidales que involucran la mucosa del recto y ano. Estas constituyen la enfermedad anorrectal más frecuente en el mundo occidental, con una alta prevalencia que suele representar el 50 % de las consultas con el proctólogo. Se pueden describir dos grandes grupos de hemorroides, los internos que son aquellos situados por encima de la línea pectínea y los externos que son los que se encuentran por debajo de esta línea, se tendrán en cuenta los internos. A estos últimos se los clasifica por Goligher en relación con el grado de prolapso de la mucosa rectal y la posibilidad de reducción del prolapso. Para las hemorroides grado II y III se han diseñados diferentes métodos quirúrgicos de tratamiento desde la electrocoagulación, la crioterapia, la terapia fotodinámica y RBL El presente trabajo plantea como objetivo describir nuestros resultados iniciales en el tratamiento de patología hemorroidal por medio de la técnica de macroligadura alta por aspiración RBL. Materiales y Métodos: Se incluyeron 40 pacientes a los que se le realizo RBL, comprendidos desde el mes de octubre de 2016 a marzo de 2018, que presenten patología hemorroidal grado II III y IV, técnica de macroligadura alta por succión. Resultados: Del 63% de femenino y un 37% de masculino, la distribución por grados fue de la siguiente manera, grado 2: 75%, grado 3: 17.5% y grado 4: 7.5%, el dolor posterior al procedimiento en forma inmediata fue de 3.78±2.63, a las 48 hs 2.10±2.31 y a los 7 postquirúrgicos 1.10±1.86. Tuvimos un total de 7 (18%) pacientes con recidivas dentro de los 18 meses de seguimiento, tenesmo se presentó 27.59% en los grados 2, un 57,14% en los grados 3 y un 66,67% en los grados 4. Solo reportamos un 23% de sangrado posquirúrgico. Conclusión: Podemos afirmar que la técnica de macro ligadura alta como variante de la RBL, es una técnica segura, aplicable en forma ambulatoria, con un beneficio importante por sobre el resto de las técnicas resectivas que solo requiere una sedación para el procedimiento, con bajos umbrales de dolor postquirúrgicos, pronta recuperación y reinserción laboral; presenta bajos índices de complicaciones. Además, representa una excelente opción para el tratamiento de las hemorroides grado 2 y 3. (AU)

Introduction: Hemorrhoids are a varicose dilatation of the hemorrhoidal plexuses that involve the mucosa of the rectum and anus. These constitute the most frequent anorectal disease in the western world, with a high prevalence that usually represents 50% of consultations with the proctologist. Two large groups of hemorrhoids can be described; the internal ones that are those located above the pectineal line and the external ones that are those below this line, the internal ones will be taken into account. The latter are classified by Goligher in relation to the degree of prolapse of the rectal mucosa and the possibility of prolapse reduction. For the grade II and III hemorrhoids, different surgical methods of treatment have been designed from electrocoagulation, cryotherapy, photodynamic therapy and RBL. The present work aims to describe our initial results in the treatment of hemorrhoidal pathology by means of the macro-adherence technique. High by RBL aspiration. Materials and Methods: Forty patients were included, who underwent RBL, from October 2016 to March 2018, who presented grade II III and IV hemorrhoidal pathology, high suction macroligation technique. Results: Of 63% of female and 37% of male, the distribution by grades was as follows, grade 2: 75%, grade 3: 17.5% and grade 4: 7.5%, pain after the procedure immediately it was 3.78 ± 2.63, at 48 hours 2.10 ± 2.31 and at 7 postsurgical 1.10 ± 1.86. We had 7 (18%) patients with recurrences within 18 months of follow-up; tenesmo presented 27.59% in grades 2, 57.14% in grades 3 and 66.67% in grades 4. We only reported 23% of postoperative bleeding. Conclusion: We can affirm that the high macro ligature technique as a variant of the RBL is a safe technique, applicable in ambulatory form, with an important benefit over the rest of the resection techniques that only requires a sedation for the procedure, with low postoperative pain thresholds, early recovery and re-employment; It presents low rates of complications. In addition, it represents an excellent option for the treatment of grade 2 and 3 hemorrhoids. (AU)

Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients

Abstract Purpose: To investigate efficacy of combined use of parecoxib and dexmedetomidine on postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Methods: The present prospective randomized controlled study included a total of 80 patients who underwent laparoscopic cholecystectomy surgery during January 2016 to November 2017 in our hospital. All patients were randomly divided into 4 groups, the parecoxib group, the dexmedetomidine group, the parecoxib and dexmedetomidine combined group, and the control group. Demographic data and clinical data were collected. Indexes of heart rate (HR), mean arterial pressure (MAP), levels of jugular venous oxygen saturation (SjvO2) and jugular venous oxygen pressure (PjvO2) were recorded at different time points before and during the surgery. The mini-mental state examination (MMSE) score, Ramsay score and Visual Analogue Score (VAS) were measured. Results: Levels of both SjvO2 and PjvO2 were significantly higher in parecoxib group, dexmedetomidine group and the combined group than the control group. Meanwhile, levels of both SjvO2 and PjvO2 in the combined group were the highest. VAS scores were significantly lower in the combined group than all other groups, and total patient controlled intravenous analgesia (PCIA) pressing times within 48 h after surgery were the lowest in the combined group. Both Ramsay and MMSE scores were the highest in the combined group compared with other groups, while were the lowest in the control group. Conclusion: The combined use of parecoxib and dexmedetomidine could reduce the postoperative pain and improve the postoperative sedation and cognitive conditions of patients after laparoscopic cholecystectomy.

Efficiency of bupivacaine and association with dexmedetomidine in transversus abdominis plane block ultrasound guided in postoperative pain of abdominal surgery / Eficácia de bupivacaína e associação com dexmedetomidina em bloqueio do plano transverso abdominal guiado por ultrassom na dor após cirurgia abdominal

Abstract Background and objectives We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Methods Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21 mL 0.9% saline in Group C (n = 31), 20 mL 0.5% bupivacaine + 1 mL saline in Group B (n = 31), and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) in Group BD (n = 31). Results Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p < 0.05); it was lower in group BD than in group B at 10-24 h. In Group B, it was lower than Group C at 2-8 h (p < 0.05). Total morphine consumption was lower in Group BD compared to other groups and lower in group B than in the controls (p < 0.001). Patient satisfaction was higher in Group BD than in other groups and was higher in both study groups than in the controls (p < 0.001). Nausea-vomiting scores, antiemetic requirement, or additional analgesic administration were not significant among groups (p > 0.05). Conclusions The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement.

Resumo Justificativa e objetivos O objetivo do estudo foi avaliar o efeito de bupivacaína e dexmedetomidina adicionada à bupivacaína para bloqueio do plano transverso abdominal (TAP) no controle da dor e satisfação do paciente após cirurgia abdominal inferior. Métodos Pacientes submetidos à cirurgia abdominal inferior foram incluídos no estudo. Após a indução da anestesia, o bloqueio TAP guiado por ultrassom foi feito com 21 mL de solução salina a 0,9% no Grupo C (n = 31), 20 mL de bupivacaína a 0,5% + 1 mL de solução salina no Grupo B (n = 31) e 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 µg) no grupo BD (n = 31). Resultados Os escores da escala visual analógica foram menores no Grupo BD comparado com o Grupo C em todos os tempos mensurados (p < 0,05); foi menor no Grupo BD do que no Grupo B em 10-24 horas. No Grupo B, os escores VAS foram menores do que no Grupo C em 2-8 horas (p < 0,05). O consumo total de morfina foi menor no Grupo BD em comparação com outros grupos e menor no Grupo B do que nos controles (p < 0,001). A satisfação do paciente foi maior no Grupo BD do que nos outros grupos e maior em ambos os grupos de estudo do que nos controles (p < 0,001). Os escores de náusea e vômito, necessidade de antiemético ou de analgésicos adicionais não foram significativos entre os grupos (p > 0,05). Conclusões A adição de dexmedetomidina à bupivacaína em bloqueio TAP reduziu os escores de dor e o consumo de morfina no pós-operatório, além de aumentar a satisfação em pacientes submetidos à cirurgia abdominal inferior. Dexmedetomidina não apresentou efeito sobre os escores de náusea e vômito e a necessidade de antiemético.

Opioids and immunosupression in oncological postoperative patients / Opioides e imunossupressão em pacientes oncológicos pós-cirúrgicos

Summary Introduction: Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anesthesia Care Unit (PACU)-acquired infection after a schedule of sedoanalgesia of at least 6 days. Method: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Bivariate analysis was performed to determine risk factors for infection acquired in the unit. A comparative study between periods of 6 days before and after the cessation of remifentanil was performed. Paired samples test and McNemar test was used for quantitative and categorical variables, respectively. Results: There were 1,789 patients admitted to the PACU during the study and the population eligible was constituted for 102 patients. The incidence rate of PACU-acquired infection was 38 per 1,000 PACU days. Ventilator-associated pneumonia was the most frequently diagnosed PACU-acquired infection. Pseudomona aeruginosa was the most frequently isolated microorganism. Hospital mortality was 36.27%. No statistically significant differences were seen in the incidence of HAI in cancer patients in relation to discontinuation of remifentanil (p=0.068). Conclusion: The baseline state of immunosuppression of cancer patients does not imply a higher incidence of HAI in relation to the interruption of remifentanil. It would be of interest to carry out a multicenter PACU study that included immunological patterns.

Resumo Introdução: Recentes pesquisas utilizando animais demonstraram efeitos imunossupressores depois da suspensão de opiáceos, associados a um maior risco de infecção nosocomial. O objetivo desta investigação foi determinar o impacto da interrupção do opioide remifentanilo em uma Unidade de Reanimação Pós-cirúrgica (URP) nas infecções associadas aos cuidados da saúde depois de uma pauta de sedoanalgesia de ao menos 6 dias. Método: Foram relacionados de forma consecutiva todos os pacientes maiores de 18 anos com internação na unidade superior a 4 dias. A população investigada foi aquela afetada por patologia cirúrgica de qualquer origem, na qual a sedação esteve baseada em qualquer hipnótico e como analgésico, foi utilizado o opioide remifentanilo durante pelo menos 96 horas em perfusão contínua. Foram excluídos os pacientes que faleceram durante a internação na unidade e aqueles com analgesia combinada (bloqueios periféricos ou neuroaxiais). Foi realizada uma análise bivariante para determinar fatores de risco para a infecção adquirida na unidade. Foi realizada uma investigação comparativa entre períodos dos 6 dias anteriores e posteriores à interrupção de remifentanilo. Utilizamos o teste de amostras pareadas e a prova de McNemar para as variáveis quantitativas e categóricas, respectivamente. Resultados: O número de pacientes internados na URP durante o período de investigação foi de 1.789. Depois de aplicar os critérios de inclusão e exclusão, a população elegível ficou constituída por 102 pacientes. A densidade de incidência de infecção de forma global foi de 38 por cada 1.000 dias de internamento. A pneumonia associada à ventilação mecânica foi a infecção adquirida mais frequente e Pseudomona aeruginosa, o micro-organismo mais frequentemente isolado. A mortalidade hospitalar foi de 36,27%. Não foram observadas diferenças estatisticamente significativas na incidência de IACS em pacientes oncológicos em relação à descontinuação de remifentanilo (p=0,068). Conclusão: O estado basal de imunossupressão dos pacientes oncológicos não implica uma maior incidência de IACS em relação à interrupção do remifentanilo. Seria interessante a realização de uma investigação multicêntrica de URP que incluísse padrões imunológicos.

Controle da dor no pós-operatório de lipoaspiração / Postoperative control of liposuction pain

Introdução: O controle da dor é essencial em qualquer evento cirúrgico. A lipoaspiração cursa, em geral, com queixas de dor pós-operatória, o que levanta a discussão acerca da melhor maneira de preveni-la e tratá-la. Dessa forma, estudos indicam que a analgesia deveria começar antes que qualquer estímulo doloroso seja deflagrado a fim de reduzir ou prevenir a dor preemptivamente. A abordagem nas diversas vias álgicas, com combinação de diferentes classes de fármacos ou associação dos bloqueios raquimedular ou epidural com anestesia geral, também pode contribuir para o manejo da dor. Métodos: Estudo descritivo, prospectivo, intervencionista, tipo Coorte, com pacientes submetidas à cirurgia plástica envolvendo lipoaspiração. O procedimento anestésico padrão consistiu na associação de anestesia geral e subaracnóidea. O escalonamento da dor, realizado 6 e 18 horas após o término da cirurgia, utilizou escalas unidimensionais. A ausência de dor ou a presença de dor leve foram consideradas como resultado satisfatório. Resultados: Foram avaliadas 50 pacientes do sexo feminino, com média de 35 anos de idade. Não foi encontrada dor severa em qualquer momento do estudo. Os resultados satisfatórios representaram 94% e 92% das pacientes na avaliação das 6 e 18 horas do pós-operatório, respectivamente (p < 0,001). Conclusões: A anestesia geral venosa combinada com raquianestesia, em cirurgia de contorno corporal, foi capaz de controlar satisfatoriamente a dor no pós-operatório imediato na maioria dos casos (>90%). A lipoaspiração mostrou ser cirurgia de dor controlável nesta casuística.

Introduction: Pain control is essential in any surgical event. Liposuction is, in general, accompanied by complaints of postoperative pain, which raises the discussion about the best way to prevent and treat it. Accordingly, studies indicate that the analgesia should begin before any painful stimulus is triggered in order to reduce or prevent the pain preemptively. The approach of the various pain pathways, with a combination of different classes of drugs or utilization of spinal block or epidural/general anesthesia can also contribute to pain management. Methods: A descriptive, prospective, interventional cohort type study was conducted with patients undergoing plastic surgery involving liposuction. The standard anesthetic procedure consisted of an association between general and spinal anesthesia. The assessment of pain, carried out 6 and 18 hours after the end of the surgery, used unidimensional scales. The absence of pain or the presence of mild pain was considered a satisfactory result. Results: Fifty female patients were evaluated, with an average of 35 years of age. No intense pain was found at any time during the study. Satisfactory results accounted for 94% and 92% of the patients in the assessment at 6 and 18 hours post-surgery, respectively (p < 0.001). Conclusions: Intravenous anesthesia combined with spinal anesthesia, in body contouring surgery, was able to satisfactorily control pain in the immediate postoperative period in most cases (>90%). In this study, liposuction was revealed to be a type of surgery with manageable pain.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Dolor postoperatorio, analgesia y presencia de factores de riesgo para dolor crónico en pacientes hospitalizados de un hospital público de Santiago de Chile / Postoperative pain, analgesia and presence of risk factors for chronic postoperative pain in hospitalized patients of a public hospital of Santiago de Chile

INTRODUCCIÓN: el dolor postoperatorio es un importante problema de salud pública, con una elevada incidencia según publicaciones internacionales. el dolor crónico postoperatorio (DCPO) se desarrolla posterior a una cirugía y persiste por más de dos meses, excluyendo otras causas y problemas preexistentes. se han descrito factores de riesgo demográficos, psicosociales y médicos para el desarrollo de dolor crónico postoperatorio (DCPO), siendo el más importante el dolor postoperatorio agudo elevado. actualmente, en Chile se carece de datos locales sobre dolor postoperatorio agudo y crónico. OBJETIVO: evaluar la intensidad del dolor agudo en pacientes post-operados y las medidas analgésicas utilizadas, esto en el contexto de la identificación de los factores de riesgo para el desarrollo de DCPO en pacientes hospitalizados en el servicio de cirugía de un hospital de alta complejidad. MATERRIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de corte transversal retrospectivo. La muestra incluyó a 100 pacientes post-operados seleccionados en forma aleatoria del área de cirugía del Hospital del Salvador entre los meses de septiembre y octubre de 2017. Se realizó una revisión de protocolos operatorios, evoluciones e indicaciones médicas y se registraron edad, sexo, dolor postoperatorio según la escala numérica del dolor (EN) y factores de riesgo de DCPO (cirugía con riesgo de daño nervioso, revisional, abierta, malla, complicaciones postoperatorias, dolor postoperatorio sobre 5, según EN), además del tiempo operatorio. Se realizó un registro electrónico en planilla de excel (Microsoft® Excel® 2011) pre-codificada y diseñada para este fin, resguardando la identidad de los participantes. Los datos obtenidos se expresaron como promedios (con desviación estándar) y medianas. RESULTADOS: se encontró una incidencia de 44% de dolor postoperatorio, con intensidad promedio de 4,4 ± 1,64 puntos entre los pacientes que presentaron dolor en algún grado. el 93% de los pacientes con dolor presentó dolor moderado a severo. en el 98% del total de pacientes se indicó terapia analgésica; de éstos, el 47,95% solo tuvo indicación de antiinflamatorios no esteroidales (AINEs), 39,79% AINEs y paracetamol, 7,14% solo paracetamol y 5,10% otras combinaciones. el 95% de los pacientes presentó uno o más factores de riesgo para DCPO, y el 11%, cuatro o más. DISCUSIÓN: el conocimiento de la incidencia e intensidad local de dolor postoperatorio es un primer paso para optimizar su manejo. la identificación de la población en riesgo de desarrollar DCPO podría permitir implementar a futuro medidas preventivas, que mejoren la calidad de vida de los pacientes postoperados

INTRODUCTION: postoperative pain is an important public health issue, with a high incidence reported in international literature. chronic postoperative pain (CPOP) is developed posterior to a surgical intervention and persists over two months, excluding other causes and preexisting problems. several risk factors for CPOP have been mentioned, including demographic, psicosocial and medical ones; the most relevant being high acute postoperative pain. nowadays, Chile lacks local data of acute and chronic postoperative pain. OBJECTIVES: assess the intensity of acute postoperative pain and the analgesia used, in the context of the identification of risk factors for CPOP in a surgery department of a high complexity hospital. MATERIALS AND METHODS: an observational descriptive tranversal restrospective study was used. the sample was constituted by 100 postsurgical patients selected randomly from the surgical department of the Hospital del Salvador between september and october 2017. a revision of surgical protocols and medical charts was made; age, sex, postsurgical pain according to numeric pain scale (NPS) and risk factors for CPOP (surgery with risk of nervous damage, second look, open, use of mesh, postsurgical complications, postsurgical pain above 5 according to NPS) were registered, besides surgical time. the record was made on an precoded excel sheet (Microsoft® Excel® 2011), designed for this purpose. the identity of the patients was kept anonymous. the data obtained was expressed as mean (with standard deviation) and median. RESULTS: an incidence of 44% of postsurgical pain was found, with mean intensity of 4.4 ± 1.64points between patients that presented any degree of pain.93% from the patients with pain presented moderate to severe pain. 98% from the total of patients had analgesia, from them 47.95% only had non-steroidal antiinflamatory drugs (NSAIDs), 39.79% NSAIDs and acetaminophen, 7.14% only acetaminophen and 5.10% other combinations. 95% of patients had one or more risk factors for CPOP, and 11% four or more of them. DISCUSSION: the knowledge of the incidence and intensity of postsurgical pain is the first step in order to optimize its manage. the identification of the population at risk to develop CPOP could allow the implementation of preventive measures that may improve the quality of life of postsurgical patients.

Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery / Bloqueio paravertebral no controle da dor aguda pós-operatória e dor neuropática do nervo intercostobraquial em cirurgia mamária de grande porte

Abstract Background: Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. Objectives: The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24 h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. Methods: The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine + adrenaline 3 µg mL−1 with a volume of 0.3 mL kg−1 preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24 h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0 h, 1 h, 6 h and 24 h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. Results: The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24 h of study 0 h 1.90 (±2.59) versus 0.88 (±1.5) 1 h 2.23 (±2.2) versus 1.53 (±1.8) 6 h 1.15 (±1.3) versus 0.35 (±0.8); 24 h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0 h and 6 h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0 h 2.95 (±3.1) versus 1.55 (±2.1); 1 h 3.90 (±2.7) versus 2.43 (±1.9) 6 h 2.75 (±2.2) versus 1.68 (±1.5); 24 h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38 ± 0.81 µg kg−1 versus 3.51 ± 0.81 µg kg−1) and morphine (3.5 mg ± 3.4 versus 7 mg ± 6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. Conclusions: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.

Resumo Justificativa: Estão descritas várias técnicas locorregionais para a abordagem da dor aguda e dor crônica após cirurgia de mama. O ideal seria uma técnica fácil de fazer, reprodutível, com pouco desconforto para as doentes, com poucas complicações e que permitirá um bom controle da dor aguda e uma diminuição da incidência de dor crônica, notadamente dor neuropática do intercostobraquial, por ser a entidade mais frequente. Objetivos: Estudar a aplicação de bloqueio paravertebral com picada única no pré-operatório de cirurgia mamária de grande porte. Avaliar numa primeira fase o controle de dor aguda e náuseas-vômitos no pós-operatório (NVPO) nas primeiras 24 horas e numa segunda fase a incidência de dor neuropática na região do nervo intercostobraquial seis meses após a cirurgia. Métodos: Foram incluídas 80 doentes do sexo feminino, ASA I-II, entre 18 e 70 anos, submetidas a cirurgia mamária de grande porte sob anestesia geral, estratificadas em dois grupos: anestesia geral (anestesia geral inalatória com opioides segundo resposta hemodinâmica) e paravertebral (bloqueio paravertebral com picada única em T4 com ropivacaína 0,5% + adrenalina 3 µg/mL com um volume de 0,3 mL/kg pré-operatoriamente e posterior indução e manutenção com anestesia geral inalatória). No pós-operatório imediato foi colocada PCA (Patient-controlled analgesia) de morfina programada com bolus a demanda durante 24 horas. Foram registados fentanil intraoperatório, consumo de morfina pós-operatória, complicações relacionadas com as técnicas, dor em repouso e ao movimento a 0, 1 h, 6 h e 24 h, assim como os episódios de NVPO. Foram analisadas todas as variáveis identificadas como fatores de cronificação da dor idade, tipo de cirurgia, ansiedade segundo escala de HADS (Hospital Anxiety and Depression scale), dor pré-operatória; acompanhamento no domicílio; índice de massa corporal (IMC), tratamentos adjuvantes de quimioterapia/radioterapia e foi verificada a homogeneidade das amostras. Aos seis meses da cirurgia foi avaliada, segundo escala DN4, a incidência de dor neuropática na área do nervo intercostobraquial. Resultados: O grupo paravertebral teve valores de VAS (Escala Visual Analógica) em repouso mais baixos ao longo das 24 horas de estudo 0 h 1,90 (± 2,59) versus 0,88 (± 1,5); 1 h 2,23 (± 2,2) versus 1,53 (± 1,8); 6 h 1,15 (± 1,3) versus 0,35 (± 0,8); 24 h 0,55 (± 0,9) versus 0,25 (± 0,8) com significado estatístico às 0 e às 6 horas. Em relação ao movimento o grupo paravertebral teve valores de VAS mais baixos e com significância estatística nos quatro momentos de avaliação: 0 h 2,95 (± 3,1) versus 1,55 (± 2,1); 1 h 3,90 (± 2,7) versus 2,43 (± 1,9) 6 h 2,75 (± 2,2) versus 1,68 (± 1,5); 24 h 2,43 (± 2,4) versus 1,00 (± 1,4). O grupo paravertebral consumiu menos fentanil (2,38 ± 0,81 µg/Kg versus 3,51 ± 0,81 µg/Kg) e menos morfina no pós-operatório (3,5 mg ± 3,4 versus 7 mg ± 6,4), com diferença estatisticamente significativa. Na avaliação de dor crônica aos seis meses no grupo paravertebral houve menos casos de dor neuropática na região do nervo intercostobraquial (três versus sete) embora sem significância estatística. Conclusões: O bloqueio paravertebral com picada única permite um adequado controle da dor aguda com menor consumo de opioides intraopreatórios e pós-operatórios, mas aparentemente não consegue evitar a cronificação da dor. Mais estudos são necessários para esclarecer o papel do bloqueio paravertebral na cronificação da dor em cirurgia mamária de grande porte.

Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial / Alívio da dor pós-toracotomia com analgesia subpleural ou analgesia epidural torácica: ensaio clínico randomizado

ABSTRACT CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. CONCLUSION: Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.

RESUMO CONTEXTO E OBJETIVO: Dor pós-toracotomia é severa e intensa, causada por trauma de nervos periféricos, músculos e costelas. O objetivo foi comparar analgesia subpleural (SPA) com analgesia epidural torácica (TEA) em pacientes submetidos à toracotomia. TIPO DE ESTUDO E LOCAL: Estudo randomizado no Hospital Educação e Pesquisa de Numune, em Ancara, Turquia. MÉTODOS: Trinta pacientes com o estado físico I-III da Sociedade Americana de Anestesiologistas foram agendados para toracotomia diagnóstica eletiva e escolhidos aleatoriamente para receber, num período de 24 horas, SPA ou TEA, ambas controladas pelo próprio paciente, para controle da dor pós-toracotomia. Os dois grupos receberam mistura de 3 ug/ml de fentanil com solução de 0,05% de bupivacaína por meio de bomba de analgesia controlada pelo paciente. Foi administrada analgesia de resgate por via intravenosa, com 100 mg de tramadol, nos dois grupos. No pós-operatório, a escala visual analógica foi utilizada para medir presença de dor durante a tosse ou em repouso, ao longo de 24 horas. RESULTADOS: No grupo SPA, todos os pacientes necessitaram de analgesia de resgate. Cinco pacientes (33%) necessitaram de analgesia de resgate no grupo TEA (P < 0,05). Os pacientes com SPA exibiram pontuações superiores na escala visual analógica, em repouso e ao tossir, em comparação aos que receberam TEA. Nenhum dos pacientes teve quaisquer efeitos secundários no pós-operatório, como hipotensão ou depressão respiratória. CONCLUSÃO: A analgesia peridural torácica é superior à analgesia subpleural no alívio da dor pós-toracotomia. Consideramos que estudos sobre a dosagem de drogas eficazes para proporcionar analgesia subpleural são necessários.

The efficacy of peritubal analgesic infiltration in postoperative pain following percutaneous nephrolithotomy – A prospective randomized controlled study

ABSTRACT Objective: To study the efficacy of peritubal infiltration in postoperative pain following percutaneous nephrolithotomy in general PCNL patients and PCNL patients with supracostal renal access. Patients and Methods: A total of 105 PCNL patients were randomized into two groups, 53 patients receiving peritubal analgesic infiltration (study group) and 52 patients as the control group. Of these patients, supracostal access was performed in 22 patients of study group and 23 patients of control group. The study group received peritubal injection with 10mL of bupivacain. Postoperative pain as the primary outcome was assessed by using visual analogue scale at 1, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes were the total postoperative morphine usage in 24 hours and time of the first analgesic demand. Results: The average VAS pain at 1 and 4 hours after the operation in the study group were significant lower in the control group (P≤0.001 and 0.026). Doses of morphine usage for controlling postoperative pain and the first analgesic demand were significantly lower and longer in study group. Among patients submitted to supracostal access, the average VAS pain at 1 hour after operation in the study group was lower (P=0.018). Doses of morphine usage for controlling postoperative pain also was lower in the study group (P=0.012). Conclusion: The peritubal local anesthetic infiltration is effective in alleviating immediate postoperative pain after percutaneous nephrolithotomy even with supracostal access.

O papel dos anti-inflamatórios não hormonais no tratamento da dor musculoesquelética / The role of non-steroid anti-inflammatory in the treatment of musculoskeletal pain

Os anti-inflamatórios não esteroides (AINEs) estão entre os medicamentos mais comumente prescritos em todo o mundo e são responsáveis por cerca de um quarto de todas as notificações de reações adversas. Têm sido amplamente indicados em pacientes com doença reumática e outras doenças musculoesqueléticas - população de maior risco de graves complicações gastrintestinais (GI). Os AINEs tópicos são administrados para o tratamento de diversas condições: lesões musculoesqueléticas, dor pós-operatória, neuralgia pós-herpética, periodontite, úlceras aftosas e ceratoses actínicas. Dados mostram que metade dos AINEs é indicada para osteoartrite (OA). Sua administração tópica oferece como benefício menor incidência de efeitos adversos sistêmicos, como úlcera péptica e hemorragia GI, na metabolização do medicamento nos tecidos afetados...

Nonsteroidal anti-inflammatory are among the drugs more usually prescribed in all over the world which is responsible for about a fourth of all notifications of adverse reactions. It has been widely indicated in patients with rheumatic disease and others musculoskeletal disease - high risk population of severe gastrointestinal complications (GI). The topic AINEs are managed for the treatment of many conditions: musculoskeletal injury, postoperative pain, postherpetic neuralgy, periodontic, mouth ulcer and actinic keratosis. Data show that half of AINEs are indicated for osteoarthritis (OA). Its topic administration provides benefits like less incidence of systemic adverse effects like peptic ulcer and GI bleeding in drug-metabolizing in affected tissues...

Preventing and treating chronic disabling pain after surgery

Chronic postoperative pain (CPP) is an important health problem. This is a narrative review of etiologies, mechanisms, risk factors, means of reducing the risk, and treatment of chronic postoperative pain. Methods: This is a topical review based on a focused literature review and personal clinical experience and research efforts on chronic pain after surgical interventions. Results: CPP is defined as new pain in the area of surgery that lasts more than 3-6 months after the operation, is clearly related to tissue and nerve injuries during the operation and cannot be explained by other etiologies. The overall prevalence is that 20-40 percent have some pain and discomfort for a few weeks, 10 percent have moderate pain that cannot be neglected for a few months, about 1 percent develop debilitating CPP. CPP is caused by nerve and tissue injury and abnormal reactions to such injury. Only those who have pre and peri-operative risk factors determined in part by genetic makeup, reinforced by abnormal pain modulating mechanisms, having chronic pain in other part(s) of the body, having psychological stress factors andc atastrophizing thoughts and anxiety, having severe acute pain during and immediately after surgery, chemotherapy or radiation after cancer surgery, and being younger rather than elderly. Risks of CPP can be estimated by a simple scoring system with approximate risk prediction determined by the number and degree of preoperative risk factors. A number of procedures and drugs can ameliorate these risk factors: Regional and local anesthetic techniques when appropriate, anti-hyperalgesic drugs with nitrous Introduction Long-lasting new pain after an operation is a common, sometimes a debilitating consequence of surgery. We know some factors that increase the risk of developing chronic postoperative pain (CPP). The patients' GP, surgeon, and anesthesiologist must focus on these risks and prioritize efforts to reduce their effects...

High-frequency electroacupuncture versus carprofen in an incisional pain model in rats

The objective of the present study was to compare the effect of electroacupuncture (EA) and carprofen (CP) on postoperative incisional pain using the plantar incision (PI) model in rats. A 1-cm longitudinal incision was made through skin, fascia and muscles of a hind paw of male Wistar rats and the development of mechanical and thermal hypersensitivity was determined over 4 days using the von Frey and Hargreaves methods, respectively. Based on the experimental treatments received on the third postoperative day, the animals were divided into the following groups: PI+CP (CP, 2 mg/kg, po); PI+EAST36 (100-Hz EA applied bilaterally at the Zusanli point (ST36)); PI+EANP (EA applied to a non-acupoint region); PI+IMMO (immobilization only); PI (vehicle). In the von Frey test, the PI+EAST36 group had higher withdrawal force thresholds in response to mechanical stimuli than the PI, PI+IMMO and PI+EANP groups at several times studied. Furthermore, the PI+EAST36 group showed paw withdrawal thresholds in response to mechanical stimuli that were similar to those of the PI+CP group. In the Hargreaves test, all groups had latencies higher than those observed with PI. The PI+EAST36 group was similar to the PI+IMMO, PI+EANP and PI+CP groups. We conclude that 100-Hz EA at the ST36 point, but not at non-acupoints, can reduce mechanical nociception in the rat model of incisional pain, and its effectiveness is comparable to that of carprofen.

Aspectos da personalidade e sua influência na percepção da dor aguda em pacientes submetidos à cirurgia cardíaca / Aspects of personality and its influence on acute pain perception in patients submitted to cardiac surgery

OBJETIVO: Verificar o papel e a influência da personalidade na percepção dolorosa aguda de pacientes submetidos à cirurgia cardíaca. MÉTODO: Trata-se de uma pesquisa transversal, analítica, prospectiva de caráter correlacional, realizada em Natal, Rio Grande do Norte, Brasil. A amostra foi composta por 25 pacientes, sendo 64 por cento do sexo feminino, com menos de 60 anos (52 por cento). RESULTADOS: A intensidade dolorosa foi avaliada pela escala numérica de dor do primeiro ao quinto dia de pós-operatório e os estilos de personalidade, pelo Inventário Millon de Estilos de Personalidade. A percepção dolorosa foi experienciada com magnitudes variando de leve a moderada do primeiro ao quinto dia do pós-operatório e relacionada às características de personalidade. Nos pacientes com menos intensidade de dor, foi observada maior elevação significativa da pontuação obtida nos fatores preservação, individualismo, introversão e, nos pacientes com maior intensidade de dor, houve uma elevação significativa nos fatores de proteção, extroversão, retraimento, discrepância, afetividade, acomodação, retraimento, comunicabilidade e firmeza. CONCLUSÃO: A ocorrência do fenômeno doloroso em pacientes submetidos à cirurgia cardíaca mostra-se associada com manifestações comportamentais e com magnitudes variáveis quanto ao tempo do ato cirúrgico, tipo e posição de drenos, além do período pós-operatório imediato. Pode-se caracterizar que aspectos psicológicos enquanto características de personalidade podem influenciar padrões de comportamento como os observados.

OBJECTIVE: To determine the role and influence of personality in acute pain perception of post cardiac surgery patients. METHOD: This is a cross-sectional, analytical, prospective with correlational nature, developed in Natal, Rio Grande do Norte, Brazil. The sample consisted of 25 patients, 64 percent female, less than 60 years (52 percent). RESULTS: Pain intensity was measured by numeric pain scale of 1 to 5 days postoperatory and personality styles was by Millon Inventory of Personality Styles. Pain perception was experienced with magnitudes ranging from mild to moderate from 1st to 5th day after surgery and related to personality characteristics. In patients with less pain intensity was observed a significant elevation of the highest score factors in the preservation, individualism, introversion and in the patients with greater intensity of pain were: protection, extraversion, shyness, discrepancy, affection, accommodation, withdrawal, communication and firmness. CONCLUSION: The occurrence of the painful phenomenon in patients post-cardiac surgery appears to be associated with behavioral manifestations and varying magnitudes as the time of surgery, type and position of drains, besides the immediate postoperative period. To characterize psychological aspects as personality characteristics may influence patterns of behavior as these observed.