Ocular surface evaluation in patients treated with a fixed combination of prostaglandin analogues with 0.5% timolol maleate topical monotherapy: a randomized clinical trial

OBJECTIVES: To compare ocular surface changes induced via glaucoma treatment in patients using fixed combinations of prostaglandin analogues (travoprost, latanoprost and bimatoprost) with 0.5% timolol maleate METHODS: A prospective, multicenter, randomized, parallel group, single-blind clinical trial was performed in 33 patients with ocular hypertension or open angle glaucoma who had not been previously treated. The ocular surface was evaluated prior to and three months after treatment, with a daily drop instillation of one of the three medications. The main outcome measurements included the tear film break-up time, Schirmer's test, Lissamine green staining, the Ocular Surface Disease Index questionnaire, impression cytology using HE and PAS and immunocytochemistry for interleukin-6 and HLA-DR. Ensaiosclinicos.gov.br: UTN - U1111-1129-2872 RESULTS: All of the drugs induced a significant reduction in intraocular pressure. Decreases in the Schirmer's test results were observed with all of the drugs. Decreases in tear-film break-up time were noted with travoprost/timolol and latanoprost/timolol. An increase in the Lissamine green score was noted with travoprost/timolol and bimatoprost/timolol. The Ocular Surface Disease Index score increased after treatment in the travoprost/timolol group. Impression cytology revealed a significant difference in cell-to-cell contact in the same group, an increase in cellularity in all of the groups and an increase in the number of goblet cells in all of the groups. The fixed combinations induced an increase in IL-6 expression in the travoprost/timolol group, in which there was also an increase in HLA-DR expression. CONCLUSIONS: All of the fixed combinations induced a significant reduction in intraocular pressure, and the travoprost/timolol group showed increased expression of the inflammatory markers HLA-DR and interleukin-6. All three tested medications resulted in some degree of deterioration in ...

Epidural anesthesia using a 0,75 percent ropivacaine and subarachnoid anesthesia with a 0,5 percent bupivacaine associated or not with clonidine in hemorroidectomies / Anestesia peridural com ropivacaína a 0,75 por cento e anestesia subaracnóidea com bupivacaína a 0,5 por cento associadas ou não à clonidina em hemorroidectomias

PURPOSE: To study the safety and efficiency of two anesthetic blockages in hemorroidectomy and the effect of clonidine on analgesia. METHODS: 80 patients were studied, randomly divided into four groups: l (n=19)- peridural with a 0,75 percent ropivacaine; 2 (n=21)-peridural with a 0,75 percent ropivacaine and 150 µg of clonidine; 3 (n=19)- subarachnoid with a 0,5 percent bupivacaine; 4 (n=21)- subarachnoid with a 0,5 percent bupivacaine and 50 µg of clonidine. The intensity of pain was evaluated by the visual analogical scale 8, 12 and 24 hours after surgery. The use of vasoconstrictors on the transoperatory and the amount of analgesics within the 24 hours were registered. RESULTS: The intensity of pain, 8 hours after surgery, was lesser on group 4, and much lesser on group 4 comparing with groups 1 and 2, 12 hours (p=0,022; p=0,001) and 24 hours (p=0,03; p=0,003). The frequency of vasoconstrictors usage on the transoperatory and the analgesics on the post-operatory showed no difference among the groups. There were no anesthetic complications. CONCLUSIONS: The subarachnoid anesthesia with a 0,5 percent bupivacaine with clonidine, showed better analgesia comparing with the peridural anesthesia with a 0,75 percent ropivacaine with or without clonidine, however all were safe and efficient. The clonidine aided on the decreasing of pain when subarachnoid anesthesia was used.

OBJETIVO: Verificar a segurança e a eficácia de dois bloqueios anestésicos na hemorroidectomia e o efeito da clonidina na analgesia. MÉTODOS: Foram estudados oitenta pacientes, distribuídos aleatoriamente em quatro grupos: 1 (n=19)- peridural com ropivacaína a 0,75 por cento; 2 (n=21)-peridural com ropivacaína a 0,75 por cento e 150 µg de clonidina; 3 (n=19)-subaranóidea com bupivacaína a 0,5 por cento; 4 (n=21)- subaracnóidea com bupivacaína a 0,5 por cento e 50 µg de clonidina. A intensidade da dor foi avaliada pela escala analógica visual 8, 12 e 24 horas após a cirurgia. O uso de vasoconstritores no transoperatório, o consumo de analgésicos em 24 horas foram anotados. RESULTADOS: A intensidade da dor, 8 horas após a cirurgia, foi menor no grupo 4, e significantemente menor no grupo 4 em relação aos grupos 1 e 2, 12 horas (p=0,022; p=0,001) e 24 horas (p=0,03; p=0,003). A freqüência do uso de vasoconstritores no transoperatório e de analgésicos no pós-operatório não diferiu entre os grupos. Não houve complicações anestésicas. CONCLUSÕES: A anestesia subaracnóidea com bupivacaína a 0,5 por cento, com clonidina, apresentou melhor analgesia que a anestesia peridural com ropivacaína a 0,75 por cento com ou sem clonidina, porém todas foram seguras e eficazes. A clonidina contribuiu para diminuir a dor na anestesia subracnóidea.

Ropivacaína subtenoniana como tratamiento del dolor luego de la cirugía de estrabismo en los niños / Subtetonian ropivacaine to diminish pain in children undergoing strabismus surgery

Objetivo: Evaluar el efecto de la ropivacaina subtenoniana para disminuir el dolor en el postoperatorio de estrabismo en niños. Material y Método: 44 pacientes que recibieron cirugía primaria o secundaria de los músculos extraoculares fueron randomizados. 22 recibieron 0.5 ml de ropivacaína al 2 por ciento en espacio subtenoniano antes del cierre conjuntival del último músculo operado a cada ojo. El dolor fue evaluado con la escala CE-POS por los padres a 1,4 y a las 24 horas por el cirujano. Resultados: El grupo que no recibió anestésico (22) incluyó 10 niños y 12 niñas. El que la recibió se integró con 13 varones y 9 mujeres. El promedio de edad fue de 7,4 y 7,8 respectivamente. El score de dolor no mostró diferencias significativas entre los grupos en la cirugías primarias, en las de dos o más músculos y en la recesiones en los tres momentos evaluados. Se encontró diferencia entre los grupos a la primera y cuarta horas en las reintervenciones, las cirigías monomusculares y las miectomías (p: 0.0053), (p: 0.00322) and (p: 0.00446) respectivamente. Conclusión: en nuestros pacientes la ropivacaína subtenoniana se mostró efectiva en la reducción del dolor en el postoperatorio de las miectomías, las reoperaciones y las cirugías de un solo músculo.

Purpose: To evaluate the effect of subtenonian ropivacaine to diminish pain in children undergoing strabismus surgery. Material and Method: Forty four children undergoing primary or secondary strabismus surgery were randomized, receiving either 0.5 ml of subtenonian ropivacaine 2 percent inmediatly before closing conjunctiva over the last extraocular muscle operated on, or not having extra dose of anesthetic at all. Level of pain was evaluated using the CE-POS scale by parents at hours 1 and 4, and at 24 hours by the surgeon. Results: The group that did not receive the anesthetic included 10 male and 12 female. Group receiving ropivacaine included 13 males and 9 females, averaging 7.4 and 7.8 years respectively. The pain score was similar in the primary intervention group, with two or more muscle, and the recessions, at the three time points of evaluation. We found significative differences in cases of reinterventions, monomuscular surgeries, and miectomies, with p values of 0.00322, 0.00446, respectively. Conclusion: Intraoperative subtenon injection of ropivacaine is effective for reducing pain in the early postoperative period in reinterventions, one muscle surgery and miectomies.