A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Influence of tramadol on functional recovery of acute spinal cord injury in rats

Abstract Purpose: To evaluate the influence tramadol on functional recovery of acute spinal cord injury in rats. Methods: Ten rats were divided into two groups (n = 5). All animals were submitted by a laminectomy and spinal cord injury at eighth thoracic vertebra. In control group, the rats didn't receive any analgesic. In tramadol group, the rats received tramadol 4mg/Kg at 12/12h until 5 days by subcutaneous. Animals were following by fourteen days. Was evaluated the Basso, Beattie, Bresnahan scale (locomotor evaluation) and Rat Grimace Scale (pain evaluation) at four periods. Results: There no difference between the groups in locomotor evaluation in all periods evaluated (p>0.05) and in both groups there was a partial recover of function. The tramadol group show a lower pain levels at the first, third and seventh postoperatively days when comparing to the control group. Conclusion: The tramadol as an analgesic agent don't influence on functional recovery of acute spinal cord injury in rats

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.

Incidência de flebite e flebite pós-infusional em adultos hospitalizados / Incidencia de flebitis y flebitis después de la infusión en adultos hospitalizados / Incidence of phlebitis and post-infusion phlebitis in hospitalised adults

RESUMO Objetivo Avaliar a incidência de flebite durante o uso de cateter intravenoso periférico (CIP) e pós-infusional e analisar a associação com fatores de risco em pacientes hospitalizados. Método Estudo de coorte com 165 pacientes adultos internados em hospital universitário de Porto Alegre que totalizaram 447 acessos no período de dezembro 2014 a fevereiro 2015. A coleta dos dados foi diária, e a análise dos dados ocorreu pela estatística descritiva e analítica. Resultados A incidência de flebite durante o uso do CIP foi de 7,15% e de flebite pós-infusional, 22,9%. A flebite durante o uso do cateter associou-se com a Amoxicilina + Ácido Clavulânico. A flebite pós-infusional apresentou associação do grau de gravidade com a idade e com o uso de Amoxacilina + Ácido Clavulânico, Cloridrato de Tramadol e Anfotericina. Conclusão A incidência de flebite pós-infusional mostrou-se um indicador importante para a análise do cenário da qualidade da assistência em saúde.

RESUMEN Objetivo Evaluar la incidencia de flebitis en el uso de catéter periférico intravenoso (CIP) y posinfusional y analizar la asociación con los factores de riesgo en pacientes hospitalizados. Método Estudio de cohorte con 165 pacientes adultos ingresados en un hospital universitario de Porto Alegre, que ascendió a 447 accesos de diciembre 2014 a febrero de 2015. La recolección de datos fue diaria y el análisis de datos fue mediante estadística descriptiva y analítica. Resultados La incidencia de flebitis durante el uso de catéter periférico intravenoso fue del 7,15% y de la flebitis posinfusional fue del 22,9%. La flebitis durante el uso del catéter se asoció con el uso de Amoxicilina + Ácido clavulánico. La flebitis posinfusional presentó una asociación del grado de gravedad con la edad, y con el uso de Amoxicilina + Ácido clavulánico, Clorhidrato de tramadol y Anfotericina. Conclusión La incidencia de flebitis posinfuncional mostró ser un indicador importante para el análisis del escenario de la calidad de atención en salud.

ABSTRACT Objective to determine the incidence of phlebitis during and after the use of peripheral intravenous catheter (PIC), and analyse the association of this complication with risk factors. Methods cohort study with 165 adult patients admitted to a university hospital in Porto Alegre, totalling 447 accesses, from December 2014 to February 2015. Data were collected on a daily basis and analysed by means of descriptive and analytical statistics. Results The incidence of phlebitis during PIC was 7.15% and the incidence of post-infusion phlebitis was 22.9%. Phlebitis during catheter use was associated with the use of Amoxicillin + Clavulanic Acid. The grade of post-infusion phlebitis was associated with age and use of Amoxicillin + Clavulanic Acid, Tramadol Hydrochloride, and Amphotericin. Conclusion The incidence of post-infusion phlebitis proved to be an important indicator to analyse the quality of the healthcare setting.

Eficacia analgesica e tolerabilidade do tramadol / Analgesic efficaccy and tolerability of tramadol

Em estudo aberto,com 1355 pacientes,foi avaliada a eficacia e seguranca do tramadol,por 225 medicos de varias especialidades.Dos pacientes,524(45,6 pr cento)foram atendidos em unidades de internacao e 831(54,4 por cento) emunidades ambulatoriais.Em 94,6 por cento dos casos as idades variaram entre 13 e 75 anos.Na maioria das vezes 94 por cento a dor era moderada ou intensa.A dor se originou de traumatismos operatorios em 50,2 por cento dos casos,traumatismo acidentais e fraturas em 12,0 por cento anormalidades do aparelho locomotor em 29,3 por cento e neoplasias em 2,7por cento.A medicacao foi prescrita como ampolas,gotas,comprimidos esupositorios;mais de uma apresentacao foi empregada em 6,5por cento das ocasioes.A dose media inicial foi de 81mg e a dose media diaria de 195mg.Tramadol foi utilizado varias vezes em 85,0 por cento dos doentes.A duracao do tratamento foi de uma semana em 73,0 por cento dos casose de ate duas semanas em 13,7 por cento.Ocorreu melhora inicial satisfatoria em 91 por cento dos doentes.A eficacia analgesica se manteve em 87,5 por cento dos casos.Efeitos colaterais,foram observados em 15 por cento dos casos;os mais frequentes foram nauseas,instabilidade da marcha,tonturas e sonolencia.Concluiu-se que o tramadol foi eficaz e seguro para o tratamento da dor aguda e da dor cronica